Thursday, August 7, 2014

Getting a Cavity Filled

Anesthetic injection to the Trigeminal Nerve
So, I had to get a cavity filled yesterday.  Not too much fun, but I did figure out that I can learn from it.  If I asked you what drug they give you to numb you up, I am sure that you would all know the answer - Novocaine.  Right?  Nope.  Apparently, dentists have not used Novocaine for about 30 years.  The answer that we all seem to know is wrong.  Novocaine is the brand name for procaine a synthetic cocaine from 100 years ago.  Unfortunately, a lot of people had allergic reactions to the drug and dentists search for a new choice.

This post started because I asked the technician what the drug was that I would be injected with.  Of course, I then told her that I was in pharmacy school.  I have learned that whenever a nurse or technician learns that you are in pharmacy school, the very next thing they will say is how much they hated their pharmacology class.  Every time, guaranteed.  Moving on.

Articaine - Dental Amide
The dental assistant said that it wasn't novocaine but instead Sceptocaine.  Unfamiliar with the name, I figured it was just a specific brand of Novocaine (which I later learned is itself a brand name).  Sceptocaine is a combination of 4% articaine and 1:100,000 epinephrine that was approved by the FDA in 2000.  For the nerve block to perform a tooth filling, the dentist injects 0.5 to 3.4 mL under the mucous in the back of your mouth near the trigeminal nerve.  The articaine blocks our pain receptors by altering the action potential threshold for the nerves in the area.  A much greater stimulus is needed for a response, which doesn't come.  The epinephrine constricts the surrounding blood vessels to prevent the absorption of articaine into the blood stream and keeps the tissue concentration high.

There aren't a lot of problems with articaine, but allergies to sulfites can be an issue.  This is only for submucousal injects as accidental intravenous injection could lead to serious problems.  As the dentist tells you, you will lose all sensation in the area for several hours.  It will come back.  It took over four hours before I regained all my senses in the area.  The dentist also tells you not to eat anything while drug is working because you might bite your lip, check or tongue.   So when you go to get that next cavity filled, remember that you are not getting Novocaine anymore.  Dentists now give articaine in the form of Sceptocaine or Orabloc.

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