Big fillings coming up - local without adrenaline/epinephrine

Lovely to put faces to names at Dr Sanjay Gupta's talk in York yesterday. Was encouraged to hear that local without adrenaline/epinephrine does work from people. Being me had to dig a bit. My dentist said cautiously "It's a less intense anaesthetic" which did not fill me with confidence. i am an utter wimp and as I am having two big fillings replaced at the same time ( no escape they are old and crumbling (like me) I would like to hear positive experiences. Also found a bit of research that said as long as it was less than 0.04mg should be OK.

endoexperience.com/filecabi...

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  • I am also a total wimp and have a horror of dental treatment but I've had a filling and a large extraction with adrenaline free anaesthetic and both worked fine. The numbness wasn't as extensive and wore off more quickly but I felt nothing during either event.

    Best wishes with it and I did wish I lived closer to York as I would have really liked to hear Dr Gupta.

  • It was very good. Nothing new to you I wouldn't think, but good analogies for AF with a sprinkling of his personal feelings, advice and experiences. He did say that that risk of cerebral bleeds was 50% less with Rivaroxaban compared with warfarin. I did ask 50% of what? (wasn't sure of the percentage of warfarin takers who have a bleed). he said he had the figures somewhere and see him afterwards but I had to dash off. I've a feeling its one of those statistically significant figures which is quite small ( unless it's me of course)

  • I agree with statistics being meaningless sometimes unless we have the comparative figures. Five times the risk of a stroke with AF sounds awful until it is put into context. Glad the talk was interesting.

  • You were right to challenge him about a percentage risk. Simple numbers give the game away. If the risk is 2 per 10,000 then a 50% risk increase puts it up to 3 per 10,000. If the risk is 2 per 100, the new risk is 3 per 100. My rule of thumb is that risks below 1 per 1000 are difficult to objectively quantify and usually difficult to do much about.

  • I had the same, went fine.

  • I've had a massive awkward tooth extracted and a small lump removed from my tongue with no pain though plenty of 'natural' adrenaline!

  • I've had adrenaline free local for over thirty years since having an adverse reaction at the dentists and having a really weak turn. I've wondered since AF was diagnosed four years ago, if I perhaps had this condition has been present long before it was detected.

    My dental notes have always had a large "no adrenaline" note with no negative effects on my dental treatment.

  • Snap!

  • Really Buffafly ? I was pregnant the first time it happened and was terrified, naturally, as adrenaline in its natural state is produced through fear. Do you think there's a link?

  • Think the fear comes first and the heart reaction after? I had found that a dental anaesthetic caused increasing numbness in my throat and an unpleasant choking feeling, finally when I had the last adrenaline one I came over hot, cold and nauseous then collapsed when I stood up 😰. The dentist lay me down in his chair and when I opened my eyes I caught him showing the nurse my fingers which had gone blue! So I went to the doc wailing that I was allergic to local anaesthetic and he said it was impossible, must be the adrenaline. My youngest daughter had a similar reaction and has now developed palpitations.

  • One enormous filling. No pain at all! Was also told less intense anaesthetic .no pain in still no pain!

  • Don't chance it.

    Adrenaline free worked for me absolutely fine. The difference to them is that it takes an extra 2 or 3 minutes to kick in and doesn't last at long so they may need to top up with a second one.

    From you point of view you'll feel better with it as much less numbness and you'll recover to normal much quicker.

  • Was talking to a young friend who is a dentist and she said in their guidelines the main contraindication for adrenalin containing local anaesthetic is unstable angina. AF definitely not on the list. Am thinking they do not know difference between Paroxysmal AF and persistent or permanent where maybe the advice would be different. Intend to email AFA re this as there must be many many PAF persons ( hate the word sufferers) who are unaware.

  • I have had two dentist visits in the past few weeks for root canal work. First time for me having a non adrenaline anaesthetic. All was fine. I asked my dentist how it differed from an adrenaline one and he said with adrenaline it takes effect quicker and lasts longer. However, on me It seemed to last ~ 5 hours.

    I'm there again tomorrow for some more. Having a silver filling changed for a composite one and possibly need a back tooth out which apparently has a crack in the root so non repairable.

    Pat

  • Thank you. I can't "like" your dental adventures!

  • Hi Pat, I had a back tooth out rather than another root canal, don't miss it at all and the procedure was fine.

    I do wonder at a link between AF and dental work after spending a massive amount at the dentists over my AF period of 5 years. I can only suggest AFers redouble their efforts to keep their teeth cleaning in the 'Premier league' as an insurance policy as Root Canals themselves are the lesser of two evils.

  • I wonder about that too. I had an awful dentist(I didn't know it at the time) about 25 years ago, and he did lots of unnecessary work which I now know I didn't need. He told me all my filling needed replacing(?). He said fillings must be replaced after 8-10 years! Then he replaced every one with overly big fillings leaving those teeth weaker and prone to chipping/breaking. Subsequent root canals and or crowns have followed.

    Anyway, today's 3.30pm visit resulted in just the one silver-white filling swap at my request. My top lip is still numb btw.

    Also, I do need that back tooth out and he was going to do it today but I have controversially asked for antibiotic cover(after reading a report online stating how many fatal heart attack victims had invasive dental procedures in the preceding days or weeks before the dental work) .

    The dentist said government guidelines said not to give them. I knew that but want them. So now I'm having the tooth out next tuesday and having an antibiotic sachet one hour beforehand.

    Pat

  • Just after I was diagnosed with AF (2007) I had a dental appointment and I didn't know about avoiding adrenaline and I hadn't declared AF and my dentist gave me a local, luckily she was watching me very carefully and realised something was wrong immediately, she said my pallor changed very quickly and everything went black for me. She inverted the chair very quickly and luckily I came round a few moments later. I was ill for days after and couldn't travel home to Devon and had to get a friend to come pick me up and had to stay with her for 2 days - and I didn't get my filling!

    I never had the courage to try adrenaline based locals again.

  • My dentist understood completely. It's the pain relief we all used to have. It's not quite as effective but without the adrenaline rush you at least feel in control.

  • Don't know what my dentist used but he knows I am on Warfarin and he took my wisdom tooth out and for the first time in my 70 years I can say honestly that it didn't hurt or frighten me. I can now put it in writing - I am no longer scared of going to the Dentist.

  • I am a dentist whimp as well. I have had painfree dental work with local minus the adrenaline. Has worked for me several times. With me it took a little longer than normal to be effective. My dentist waitd until all was numb.

  • Hi, I have had root canal work etc for many years without adrenaline in the local anaesthetic as I fainted after an ordinary injection. I have had no problems whatsoever. I have had really good dentists who where happy to do this before I had AF. I am not a huge fan of going to the dentist but I really have no worries on the anaesthetic front. I am sure all will go well. Best wishes, Kath

  • I'm so grateful that so many of you have taken the time to reply and reassure. Have emailed AFA re dentists' education!

    Thanks again

    Wendyb

  • After having two ablation, second being the charm. Went nine months no AF and no mess except for xarelto....never knew about ephedrine in the stuff at the dentist. Had to have a tooth pulled , two shots later back into AFib....I was pissed needless to say...back on meds. Although 4 months later with melds back to no ptoblems but still have to get back off mess.... definitely an AF trigger

  • Thank you Terri

  • Here in the US besides having an injection most Dentists offer nitrous oxide. I've had it numerous times and I find it to be calming and sedative. Have never known if it can bring on an episode of AFib. I haven't personally had an issue but wondering if anyone has any information , thank you, Gracey

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