Tooth extraction and adrenaline

[Arthursullivan]

I am having two wisdom teeth extracted quite soon. My usual dentist gives me local anaesthetic injections without adrenaline because of the possible AF inducing effect. I am normally in AF all the time but I don't have symptoms. I am having the teeth extracted at the hospital as the roots go close to my sinus cavities. The dentist wants to use adrenaline in the injections and says he has never seen problems with using it. However I would guess any problems occur after the patient has gone home and the adrenaline starts to leave the gum. I am particularly worried as I will be having a double dose (two injections one for each tooth, left and right.) Any comments would be welcome as I think the dentist would take notice.

[CDreamer]

Before I knew that local anaesthesia with adrenaline had an affect on some people, not just those with AF, I had a reaction when I went for a filling - it was immediate. If it’s going to affect you at all it, your dentist will recognise the reaction - I went very pale and she could see I was about to go unconscious so she used the chair as a Tilt Table, very slowly. I had just travelled from Devon to Maidenhead and although when I recovered I was OK, I was cautioned not to drive or travel for 3 days which meant I had to get a friend to pick up and stay with.

If you are in persistent AF without other issues will it make any difference to your AF? May increase your HR though.

The difficulty with using adrenaline free local anaesthetic is that it may not kill the pain effectively enough for a wisdom tooth extraction

[CDreamer]

This from a study on the subject

Patients run a low risk of feeling an adrenaline rush or vasovagal reaction when injected with lidocaine and epinephrine. Routinely advising patients that the adrenaline rush can happen, and that this is not an allergic reaction can be helpful to allay fear of the unknown and to prevent false allergy beliefs. Injecting patients lying down may decrease the incidence of vasovagal reactions by increasing cerebral blood flow with the advantage of gravity.

This for the reason to give adrenaline:-

Epinephrine (adrenaline) is usually injected with lidocaine to prolong the local anesthetic effect. The adrenaline vasoconstrictive effect also decreases bleeding, which eliminates the need for the tourniquet and sedation for extremity surgery.

[Bagrat]

I have recently had extraction with adrenaline local. ( I Iusually ask for non adrenaline. It was a dentist who deals with complex extractions. She said she would give it very slowly and watch carefully as it reduces bleeding. I was fine.

I have had extraction with non adrenaline of bigger teeth. Did need a top up but not a problem. Told other ways of controlling bleeding.

I have asked health care professionals and the jury is out. If you have concerns re effects of with or without, you will be producing plenty of natural adrenalin (fight or flee!!) Trust your dentist he won't want to give you extra concerns.

[TracyAdmin Partner]

Please ensure they are aware if you are taking anti-coagulants well in advance, they will decide if the extraction should take place at the Surgery or at the hospital.

[opal11uk]

Maybe contact your dentist and ask for support, perhaps something in writing to support you with the hospital dentist, although he should know that there is risk, quite disappointing really, plus you are the patient, surely your views count!

[PCC62]

I understand your concern. I have had two instances at the dentist where I was given a local anaesthetic with adrenalin. On the first occasion, I was unaware of any likely side effect. As soon as the injection was given, I started to go hot and cold and sweat. The dentist noticed immediately and asked whether I had any medical conditions which at the time I was unaware of. I then passed out and was out for several minutes apparently. I was advised to request adrenalin-free injections going forward. Several years later, with a new dentist, I was having a filling. I advised on the need for an adrenalin-free jab. The dentist queried it and said my asymptomatic AFib shouldn't be affected. Within seconds, exactly the same thing happened and I passed out again. My AFib had gone to 220 and I had to go to A&E. Everyone is different but I definitely think it's important to interrogate this before your wisdom teeth extractions. I'd check in with your cardiologist - I'm sure they'll be able to advise. Good luck.

[Foxey2]

I have been the dentist twice over the last couple of months and had the normal adrenaline anaesthetic with no side effects at all, I did check with my dentist and she said she had never known anyone to have a bad reaction who had AFib so I went ahead with it. I think my fear of the dentist over rode any worry about the reaction.

[Desanthony]

I am in permanent AF and have no problems with the injections - had a lot recently and more to come as having a lot of dental work done. the main thing is to make sure that all the medical professionals know about your AF and what medication you are on. They may or may not advise you to stop taking any anticoagulants for a certain time before the surgery - my dentist has decided I do not need to stop taking them as I still do not bleed too much and stop bleeding quickly - I always have and taking anticogulants has not changed this though I do bruise more easily - and what bruises I have!

[Ducky2003]

My dentist mentioned an anesthetic called Articaine, which has a lower adrenaline content than lidocaine, as the non adrenaline stuff is useless on one of my teeth he worked on. Apparently, they can only use it in certain circumstances but it may be worth an ask.

[Bellaowl]

I always have non adrenaline anaesthetic at the dental hospital. But I’m told to stop the rivaroxaban the night before.

Pain has been well controlled.

No heart issues.