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Mark Bornfeld, DDS
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 5650
Experience:  Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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If I am allergic to Lidocaine, Novocaine and Benzocaine, what

Resolved Question:

If I am allergic to Lidocaine, Novocaine and Benzocaine, what alternatives are available, in terms of local anesthetics, when visiting my Dentist?
Submitted: 4 years ago.
Category: Dental
Expert:  Mark Bornfeld, DDS replied 4 years ago.
Dear ,

For patients allergic to the ester anesthetic derivatives (benzocaine and procaine) and lidocaine, most
dentists would use bupivacaine (Marcaine).

Be advised that true allergy to amide-class anesthetics such as lidocaine, prilocaine, or mepivacaine is very rare-- in fact, although it has been reported, I have never encountered allergy to any of these three commonly used anesthetics in 32 years of practice. (Ester-class anesthetics are more potent allergens, and are not used that much in their injectable forms.) Most reactions to parenteral dental local anesthetics are not true allergies, but rather are related to the heart-stimulating effects of a vasopressor ingredient which is a common constituent in anesthetic formulations. Reactions typically take the form of rapid heartbeat and/or panic-type reaction, and an increase in blood pressure. If this is the type of reaction you had, it would be prudent simply to ask your dentist to use an anesthetic without a vasopressor, such as 3% mepivacaine.

True allergy, which might manifest as hives, itching, swelling of the lips, eyes, or face, and difficulty breathing, would certainly require a change to another class of anesthetic.

Hope this helps...
Customer: replied 4 years ago.
Thank you for answering my question. Just need a little clarification. Two weeks ago sitting in the chair at my Dentist office I was given a local of Lidocaine. Within 30 seconds of receiving the injection, my throat closed, my tongue swelled, and I couldn't breathe. An ambulance had to be called and I was rushed to the hospital. While there, I was diagnosed with Anaphylaxis, the severest reaction to the medication (Lidocaine) and now must carry an Epi-pen. I need to return to my dentist next month to finish the work started and I am looking for a safe and proven, alternative local anesthetic. Does something exist?
Expert:  replied 4 years ago.
Dear ,

The reaction you describe suggests a true allergy to lidocaine, which is very rare indeed. (I am assuming that your
dentist used a conventional single-dose cartridge without preservative. This distinction is necessary, because lidocaine is also available in multi-dose cartridges with preservatives that may act as allergens, so you should be sure to inquire of your dentist whether a preservative-free product was used.)

As I mentioned previously, the anesthetic that is recommended in those rare cases of allergy to other amide-class products is bupivacaine, marketed under the brand name Marcaine. However, allergy to amide anesthetics is so rare that reliable data as regards XXXXX XXXXX other anesthetics are sparse. You should consider consulting with an allergist, who can do the necessary allergy testing.

You can read a relevant journal article here; although it deals specifically with allergy to mepivacaine, it contains pertinent information about cross-sensitivity among amide local anesthetics.

Hope this helps...
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 5650
Experience: Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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