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Does Articaine/Septocaine cause Parasthesias?
- Thread starter Fullosseousflap
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Thanks for your curteous reply. I will now respond to you if I may.
1. Articaine may be an excellent local anesthetic, but so is lidocaine and is by far the safer choice. ALL studies indicate the incidence of paresthesia from lido is significantly less. I pity the patient who experiences a long term or permanent paresthesia from your mandibular blocks, should that occur (and it will). What will you tell the patient... I'm sorry? Sorry doesn't cut it here... this is life altering and life threatening... and there is no drug, no therapy, and no surgery that can fix the problem. NONE.
2. Please review this article published in Dentistry Today on Malamed's "study", the one he used to get articaine approved by the FDA.
http://www.nodentalpain.com/ArticaineParesthesia.html
Are you saying this is untrue? This is fact. Perhaps you were not aware of the statistical analysis, or the flawed analysis by Malamed? Giving lower mandibular blocks to people using articaine is indeed playing russian roulette with their lives. A 1 in 21% chance of paresthesia is absolutely unacceptable. Who are you kidding?
3. No argument from me there... but even lido is far safer even though it is neuro and hepato toxic.
4. In fact I don't mind having dental work without an anesthetic and am quite capable of withstanding the discomfort. Even before my injury I almost never used it. My latest root canal post injury was done without any until the roots had to be scraped. At that juncture I had my dentist use carbocaine directly into the roots. It worked, and I had no danger of neural injury. Perhaps this technique should be applied more often.
5. I am not overstating anything. The literature is clear, nerve injury is always greater when articaine is used, and is always decreased when lidocaine is used for the same procedure. The incidence of paresthesia jumps up wildly when articaine is used for lower mandibular blocks.
In my opinion articaine should never be used when safer alternatives exist that work just as well (and the literature again proves this, even Malamed says it's so). In EVERY study the incidence of injury jumps when articaine is used, regardless of what type of block is employed. When used for mandibular blocks, lingual injury jumps up wildly. This is inexcusable, and God forbid if one of your patients should suffer this injury you will see first hand the horror of this persons plight. Sorry, if a safer alternative is available, it should be used. If you care to read the package insert for Septocaine you will see the WARNING the company itself gives for mandibular blocks.
Finally you may wish to peruse the following site to read about some the horrific injuries people experience from anesthetic injections. This is a far under reported event, and one that should not go unnoticed. Some folks choose to take their own lives due to the tortuous symptoms they must endure for life. If there is anything you as a dentist can do to minimize the risk you MUST, anything less is neglegent IMO.
http://www.sciential.net/cgi-bin/dcforum/dcboard.cgi
quote=aphistis;7568771]1) Articaine is an excellent local anesthetic and I am glad to have it in my armamentarium. I use it most frequently for local infiltration of mandibular teeth that are refractory to nerve block, but have used it on numerous occasions to place mandibular or inferior alveolar nerve blocks when I did not have lidocaine immediately available. I do not apologize for this.
2) While I sympathize with your condition (and I mean that sincerely), your claim that either 4% or 22% (I can't tell which you mean) of patients receiving articaine experience permanent nerve damage is patently ridiculous, and merits neither consideration nor rebuttal.
3) Procaine is an ester local anesthetic whose metabolites include para-aminobenzoic acid, a highly allergenic compound responsible for allergic reactions in a significant number of patients. Furthermore, its slow, unpredictable onset and short, unpredictable duration make it an extremely suboptimal agent.
4) Your reluctance to undergo local anesthesia after your injury is understandable, but nobody is forcing you to do anything.
5) Nobody is playing Russian roulette with anything, and your insistence on overstating the risks of local anesthesia isn't helping your argument.
As a licensed dentist, I can assure you I know a goodly amount about what I speak. I value patient autonomy very highly and would never impose my wishes on an unwilling patient; nonetheless, if someone refuses to let me anesthetize them for a procedure known to be significantly painful, they will be given a listing of other dentists and be politely shown the door.
Again, I genuinely empathize with your plight and I wouldn't wish your situation on anyone, but local anesthesia is one of the landmark achievements of modern medicine, and articaine is a contributing ingredient to its success. Sequelae such as yours are truly unfortunate; however, they can occur with any drug, they are quite uncommon, and--most importantly--the cumulative benefit a drug like articaine offers our patients far exceeds the remote risks it poses.[/quote]
1. Articaine may be an excellent local anesthetic, but so is lidocaine and is by far the safer choice. ALL studies indicate the incidence of paresthesia from lido is significantly less. I pity the patient who experiences a long term or permanent paresthesia from your mandibular blocks, should that occur (and it will). What will you tell the patient... I'm sorry? Sorry doesn't cut it here... this is life altering and life threatening... and there is no drug, no therapy, and no surgery that can fix the problem. NONE.
2. Please review this article published in Dentistry Today on Malamed's "study", the one he used to get articaine approved by the FDA.
http://www.nodentalpain.com/ArticaineParesthesia.html
Are you saying this is untrue? This is fact. Perhaps you were not aware of the statistical analysis, or the flawed analysis by Malamed? Giving lower mandibular blocks to people using articaine is indeed playing russian roulette with their lives. A 1 in 21% chance of paresthesia is absolutely unacceptable. Who are you kidding?
3. No argument from me there... but even lido is far safer even though it is neuro and hepato toxic.
4. In fact I don't mind having dental work without an anesthetic and am quite capable of withstanding the discomfort. Even before my injury I almost never used it. My latest root canal post injury was done without any until the roots had to be scraped. At that juncture I had my dentist use carbocaine directly into the roots. It worked, and I had no danger of neural injury. Perhaps this technique should be applied more often.
5. I am not overstating anything. The literature is clear, nerve injury is always greater when articaine is used, and is always decreased when lidocaine is used for the same procedure. The incidence of paresthesia jumps up wildly when articaine is used for lower mandibular blocks.
In my opinion articaine should never be used when safer alternatives exist that work just as well (and the literature again proves this, even Malamed says it's so). In EVERY study the incidence of injury jumps when articaine is used, regardless of what type of block is employed. When used for mandibular blocks, lingual injury jumps up wildly. This is inexcusable, and God forbid if one of your patients should suffer this injury you will see first hand the horror of this persons plight. Sorry, if a safer alternative is available, it should be used. If you care to read the package insert for Septocaine you will see the WARNING the company itself gives for mandibular blocks.
Finally you may wish to peruse the following site to read about some the horrific injuries people experience from anesthetic injections. This is a far under reported event, and one that should not go unnoticed. Some folks choose to take their own lives due to the tortuous symptoms they must endure for life. If there is anything you as a dentist can do to minimize the risk you MUST, anything less is neglegent IMO.
http://www.sciential.net/cgi-bin/dcforum/dcboard.cgi
quote=aphistis;7568771]1) Articaine is an excellent local anesthetic and I am glad to have it in my armamentarium. I use it most frequently for local infiltration of mandibular teeth that are refractory to nerve block, but have used it on numerous occasions to place mandibular or inferior alveolar nerve blocks when I did not have lidocaine immediately available. I do not apologize for this.
2) While I sympathize with your condition (and I mean that sincerely), your claim that either 4% or 22% (I can't tell which you mean) of patients receiving articaine experience permanent nerve damage is patently ridiculous, and merits neither consideration nor rebuttal.
3) Procaine is an ester local anesthetic whose metabolites include para-aminobenzoic acid, a highly allergenic compound responsible for allergic reactions in a significant number of patients. Furthermore, its slow, unpredictable onset and short, unpredictable duration make it an extremely suboptimal agent.
4) Your reluctance to undergo local anesthesia after your injury is understandable, but nobody is forcing you to do anything.
5) Nobody is playing Russian roulette with anything, and your insistence on overstating the risks of local anesthesia isn't helping your argument.
As a licensed dentist, I can assure you I know a goodly amount about what I speak. I value patient autonomy very highly and would never impose my wishes on an unwilling patient; nonetheless, if someone refuses to let me anesthetize them for a procedure known to be significantly painful, they will be given a listing of other dentists and be politely shown the door.
Again, I genuinely empathize with your plight and I wouldn't wish your situation on anyone, but local anesthesia is one of the landmark achievements of modern medicine, and articaine is a contributing ingredient to its success. Sequelae such as yours are truly unfortunate; however, they can occur with any drug, they are quite uncommon, and--most importantly--the cumulative benefit a drug like articaine offers our patients far exceeds the remote risks it poses.[/quote]
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Look, I'm trying to tread lightly here to avoid giving the impression that I'm dismissing your terrible situation, but this one of those situations where you just don't know what you don't know.
Based on your individual experience and some product research you've done as a layperson, you seem to believe yourself an expert on local anesthetic pharmacology, pharmacodynamics, and toxicology. I have to tell you that you are not, and most of the arguments you're advancing in your ignorance (which is perfectly excusable, considering you are not a dentist) are so fundamentally and thoroughly flawed that I can't even untangle them to formulate individual responses.
While I personally respect your opinion as sincere, professionally I have to dismiss it as poorly informed and unsupported by any meaningful data. The FDA is satisfied with articaine's profile of safety and effectiveness, and so am I. For anything else, I refer you to my preceding post. Good night.
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I think I've made my point, even to experienced dentists like yourself Dr. Johnson. You should not fall back on "FDA approval" for your defense, as the FDA is nothing but a front for the pharmacutical companies protection. Does the name Vioxx ring a bell? There are dozens of drug recalls due to deaths and injuries from their "approved" drugs. Septocaine is one such dangerous substance. The statistics don't lie, and neither do the published findings in my previous posts. Perhaps the Texas Injury Board is another meaningless link, but if true Septodont has already been found neglegent in not informing the public of articaine's dangers.
http://dallas.injuryboard.com/fda-a...s-dental-drug-septocaine.aspx?googleid=200988
I want to wish all of you the best of luck in your studies and practice. I hope I've made at least some aware of the dangers inherent in your profession. REMEMBER... First Do No Harm.
http://dallas.injuryboard.com/fda-a...s-dental-drug-septocaine.aspx?googleid=200988
I want to wish all of you the best of luck in your studies and practice. I hope I've made at least some aware of the dangers inherent in your profession. REMEMBER... First Do No Harm.
FDA scientists complain to Obama of 'corruption'
By RICARDO ALONSO-ZALDIVAR WASHINGTON (AP) In an unusually blunt letter, a group of federal scientists is complaining to the Obama transition team of widespread managerial misconduct in a division of the Food and Drug Administration.
"The purpose of this letter is to inform you that the scientific review process for medical devices at the FDA has been corrupted and distorted by current FDA managers, thereby placing the American people at risk," said the letter, dated Wednesday and written on the agency's Center for Devices and Radiological Health letterhead.
The center is responsible for medical devices ranging from stents and breast implants to MRIs and other imaging machinery. The concerns of the nine scientists who wrote to the transition team echo some of the complaints from the FDA's drug review division a few years ago during the safety debacle involving the painkiller Vioxx.
The FDA declined to publicly respond to the letter, but said it is working to address the concerns.
In their letter the FDA dissidents alleged that agency managers use intimidation to squelch scientific debate, leading to the approval of medical devices whose effectiveness is questionable and which may not be entirely safe.
"Managers with incompatible, discordant and irrelevant scientific and clinical expertise in devices...have ignored serious safety and effectiveness concerns of FDA experts," the letter said. "Managers have ordered, intimidated and coerced FDA experts to modify scientific evaluations, conclusions and recommendations in violation of the laws, rules and regulations, and to accept clinical and technical data that is not scientifically valid."
A copy of the letter, with the names of the scientists redacted, was provided to The Associated Press by a congressional official.
"Currently, there is an atmosphere at FDA in which the honest employee fears the dishonest employee, and not the other way around," the scientists wrote.
FDA spokeswoman Judy Leon said in response: "We have been working very closely with members of the transition team and any concerns or questions they have on any issue, we will address directly with the team. Separately, the agency is actively engaged in a process to explore the staff members' concerns and take appropriate action."
Senior Democratic and Republican lawmakers are urging Obama to appoint a commissioner who will shake up the FDA and restore the confidence of its working-level scientists and medical experts. But industry officials fear that approval of new drugs and devices could be delayed by endless scientific disputes which is the agency's reputation.
The FDA dissidents have previously taken their concerns to Congress and found support from lawmakers in the House.
In the letter the group singled out mammography computer-aided detection devices as an example of a technology that should not have gone forward. The devices were supposed to improve breast cancer detection, but instead studies showed they were associated with false alarms that led to unnecessary breast biopsies.
Since 2006, FDA experts have recommended five times against approving the devices without better clinical evidence, the letter said. In March of last year, a panel of outside advisers supported some of the concerns of the FDA's in-house scientists. Nonetheless, FDA managers overruled the objections and ordered approval.
Top FDA managers "committed the most outrageous misconduct by ordering, coercing and intimidating FDA physicians and scientists to recommend approval, and then retaliating when the physicians and scientists refused to go along," the letter said.
A spokeswoman said the Obama transition team had no comment.
By RICARDO ALONSO-ZALDIVAR WASHINGTON (AP) In an unusually blunt letter, a group of federal scientists is complaining to the Obama transition team of widespread managerial misconduct in a division of the Food and Drug Administration.
"The purpose of this letter is to inform you that the scientific review process for medical devices at the FDA has been corrupted and distorted by current FDA managers, thereby placing the American people at risk," said the letter, dated Wednesday and written on the agency's Center for Devices and Radiological Health letterhead.
The center is responsible for medical devices ranging from stents and breast implants to MRIs and other imaging machinery. The concerns of the nine scientists who wrote to the transition team echo some of the complaints from the FDA's drug review division a few years ago during the safety debacle involving the painkiller Vioxx.
The FDA declined to publicly respond to the letter, but said it is working to address the concerns.
In their letter the FDA dissidents alleged that agency managers use intimidation to squelch scientific debate, leading to the approval of medical devices whose effectiveness is questionable and which may not be entirely safe.
"Managers with incompatible, discordant and irrelevant scientific and clinical expertise in devices...have ignored serious safety and effectiveness concerns of FDA experts," the letter said. "Managers have ordered, intimidated and coerced FDA experts to modify scientific evaluations, conclusions and recommendations in violation of the laws, rules and regulations, and to accept clinical and technical data that is not scientifically valid."
A copy of the letter, with the names of the scientists redacted, was provided to The Associated Press by a congressional official.
"Currently, there is an atmosphere at FDA in which the honest employee fears the dishonest employee, and not the other way around," the scientists wrote.
FDA spokeswoman Judy Leon said in response: "We have been working very closely with members of the transition team and any concerns or questions they have on any issue, we will address directly with the team. Separately, the agency is actively engaged in a process to explore the staff members' concerns and take appropriate action."
Senior Democratic and Republican lawmakers are urging Obama to appoint a commissioner who will shake up the FDA and restore the confidence of its working-level scientists and medical experts. But industry officials fear that approval of new drugs and devices could be delayed by endless scientific disputes which is the agency's reputation.
The FDA dissidents have previously taken their concerns to Congress and found support from lawmakers in the House.
In the letter the group singled out mammography computer-aided detection devices as an example of a technology that should not have gone forward. The devices were supposed to improve breast cancer detection, but instead studies showed they were associated with false alarms that led to unnecessary breast biopsies.
Since 2006, FDA experts have recommended five times against approving the devices without better clinical evidence, the letter said. In March of last year, a panel of outside advisers supported some of the concerns of the FDA's in-house scientists. Nonetheless, FDA managers overruled the objections and ordered approval.
Top FDA managers "committed the most outrageous misconduct by ordering, coercing and intimidating FDA physicians and scientists to recommend approval, and then retaliating when the physicians and scientists refused to go along," the letter said.
A spokeswoman said the Obama transition team had no comment.
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1) Articaine is a drug, not a medical device.
2) Articaine has been in use for more than 35 years in European countries and more than 25 years in Canada, in addition to its approval nearly a decade ago in America. The regulatory bodies in these nations have *all*, independently and over a span of nearly four decades, determined that articaine is a safe & effective medication.
Perhaps you missed this.
"The concerns of the nine scientists who wrote to the transition team echo some of the complaints from the FDA's drug review division a few years ago during the safety debacle involving the painkiller Vioxx."
"The concerns of the nine scientists who wrote to the transition team echo some of the complaints from the FDA's drug review division a few years ago during the safety debacle involving the painkiller Vioxx."
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I recall of one personal incident with articaine. I did a local infiltation for #3.
In a few days, I heard the lad went to the ER because he felt facial paralysis on the side I worked on.
When he returned for his one-week post-op visit, his sensations were back to normal.
In a few days, I heard the lad went to the ER because he felt facial paralysis on the side I worked on.
When he returned for his one-week post-op visit, his sensations were back to normal.
The malfeasance by FDA over the years is well documented. Simply google FDA Malfeasance for a sample. What happens in other countries with their regulatory bodies matters little here in the USA and has no bearing on the safety or effectiveness of a drug that is to be approved for use. That being said, there are studies showing increased incidences of paresthesias from articaine in Canada after its introduction. The Haas study shows this quite well and graphs it. A point to remember is that most studies compare paresthesias using differing sites for injection, not just mandibular blocks. When mandibular blocks alone are compared, paresthesia rates explode with articaine. Look, I'm not going to change your mind about this drug but at least I've made you more aware of the risks vs. rewards regarding it's use for mandibular blocks. Many dental schools teach to avoid this drug for this procedure... there is a reason. I am living proof of that, and there are thousands of others like me who suffer in silence because there is no outlet for them to register their feelings or complaints. Yes I did report my injury to the FDA. I'm now quite sure the FDA simply took Malamed's conclusions as gospel without even reviewing the statistics. FDA does a lousy job at best protecting the public from harm. They do a much better job at protecting pharma companies from lawsuits. Try this;
http://appliedclinicaltrialsonline....ersight/ArticleStandard/Article/detail/468088
or better yet, this;
http://www.huffingtonpost.com/dr-peter-breggin/the-fda-wants-to-stop-you_b_107162.html
Dr. Johnson I wish you the best, really I do. At least now somewhere in the back of your mind you will have been made more aware of the horrors of articane. I hope you never have to experience them.
http://appliedclinicaltrialsonline....ersight/ArticleStandard/Article/detail/468088
or better yet, this;
http://www.huffingtonpost.com/dr-peter-breggin/the-fda-wants-to-stop-you_b_107162.html
Dr. Johnson I wish you the best, really I do. At least now somewhere in the back of your mind you will have been made more aware of the horrors of articane. I hope you never have to experience them.
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Your claim that articaine should be avoided because dental schools say so is bunk (once again, I've been to dental school). Dental schools teach dental students to be afraid of everything, and do the profession a real disservice by promoting these unnecessary paranoias.
More importantly, your problem now is that your entire argument now rests on the claim that the FDA acted improperly in approving articaine. My own point is that you can't isolate the FDA in the case of articaine because it was the *last* agency to approve the drug, with practically the entire Western world approving the drug earlier. Unless you can convincingly prove that every single regulatory agency that has approved articaine, dating back to 1972, has acted incompetently, your argument is dead in the water. I likewise wish you the best; good day.
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There is not much hope if there is failure with Gow Gates, Akinosi, greater palatine and X-Tip.
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I never agreed to that!
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I beg to differ. Give me a 20-gauge IV needle, some midazolam, some fentanyl, and maybe a little propofol, and I'll give any patient all the hope they need.
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I beg to differ. Give me a 20-gauge IV needle, some midazolam, some fentanyl, and maybe a little propofol, and I'll give any patient all the hope they need.
It was an allusion to alternatives to the usual local anesthesia techniques rather than IV or general and it does beat "gripping the chair". Good of you to point out the obvious.
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so true!
the tooth college i go to wont even allow us to use septocaine as a local infiltration. our grad endo, perio, and oral surgery dept get to use them as they wish but as a DDS student in comp care they'll dare you to even ask for it even if you just want to use it as a local infiltrarion.
there is a lot of things we have been thought not to EVER do and yet GPs do all day all the time. remember being told not to ever give bilateral IANB blocks? i shadowed an oral surgeon for a week last year and he gave bilaterals without any hesitations. (i probably wouldnt but the point is they teach us a lot of things that outsiders wouldnt agree on).
what deeply profound, serious, and debilitating injuries can result from mandibular blocks. I suffer from a permanent paresthesia on only one side of my tongue... I can't imagine suffering a bilateral injury. The pain is horrendous and unrelenting, do you really want to submit your patients to injuries on BOTH sides of their mouth at the same time? The dental school is CORRECT, they KNOW there are problems out there that dentists and their patients experience which are life threatenting. To submit your patients to the risk of a bilateral injury is unconscionable, you simply don't realize how horrific this injury is. As I've said before there is no therapy, no drug, and no surgical procedure that can cure an injectional injury. If you care at all about the welfare of your patients, if you have any compassion for their suffering, you will use the least toxic substance coupled with the least dangerous technique in order to administer anesthesia and hopefully not bilaterally.
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I've taken the liberty of identifying your biggest problem, and the reason nobody here is taking you seriously. You had a freak unlucky injury. Rather than accept that fact, however, you want to eliminate the only thing that makes dental and medical procedures tolerable for a HUGE majority of patients, so that way everyone gets to be miserable instead of just a very small number.
You're arguing to erase one of the benchmark accomplishment of modern medicine based on your own personal anecdote and a handful of poor-quality studies from the back of an advertising junk journal. As long as that's all you've got, you're going to keep getting laughed out of the building every time you post.
Do you work for Septodont? Or Malamed? I am saying no such thing... I am simply saying that you can and should use a safer alternative to articaine.... lidocaine is one such anesthetic that all studies have shown to be as effective and considerably safer. Who in their right mind can argue that? I am aware that paresthesias also occur with lido, but the incidence is miniscule in comparison. You say it is a rare occurance... well not according to Septodont's own study showing that you have a 1 in 21 chance of an injury when articaine is used for lower mandibular blocks. That is hardly rare.... that is off the charts rampant. Have you read the warning on the package insert for Septocaine?
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There is no way this can be true...I have used it a whole lot more than that and not had any problems with it.
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i didnt say bilateral blocks using articaine. sorry i should have been more clear. the OS that i shadowed gave bilateral IANBs using lidocaine all day the whole week to ext 3rds. this is something that our tooth college wont ever allow and i wont do myself.
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The alternative is to extract 3rd molars in 4 appointments with 4 times the experience of post op discomfort, meds and in some cases quadruple experience with IV sedation.
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Agreed. Blocking the entire mouth at one appointment is something I did dozens of times during residency. It's not a big deal. If you give bilateral mandible blocks, you just tell the patient to be careful not to chew on their tongue until they get feeling back. If they bite themselves a couple times, well, their post-op Vicodin will cover that nicely until it heals in a couple days.
I don't know if you've seen this, but here is a breakdown of a few studies, including Septodonts's, regarding the incidence of paresthesias for mandibular blocks using articaine.
http://www.nodentalpain.com/ArticaineParesthesia.html
You say it can't be true, but unfortunately it is. Numbers don't lie, people do. As an aside, my own personal dentist will not allow any anesthesia be given to him for fillings, nor will his hygenist, and yet he uses articaine in his practice (but not for mandibular blocks). The last time I was there he had another patient who also suffered from a paresthesia due to a mandibular block. My previous dentist, educated as USC, had three patients suffer from this injury in the past year. I'm sure there are many who haven't had the bad luck of injuring their patients, but use it enough and over time statistics will catch up with you. Why take the chance when lido will do the job just as well. That's all I'm trying to say.
http://www.nodentalpain.com/ArticaineParesthesia.html
You say it can't be true, but unfortunately it is. Numbers don't lie, people do. As an aside, my own personal dentist will not allow any anesthesia be given to him for fillings, nor will his hygenist, and yet he uses articaine in his practice (but not for mandibular blocks). The last time I was there he had another patient who also suffered from a paresthesia due to a mandibular block. My previous dentist, educated as USC, had three patients suffer from this injury in the past year. I'm sure there are many who haven't had the bad luck of injuring their patients, but use it enough and over time statistics will catch up with you. Why take the chance when lido will do the job just as well. That's all I'm trying to say.
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You have a dysesthesia which is NOT the same as a paresthesia.
http://jada.ada.org:80/cgi/content/full/137/4/437
My numbers show up again. Hmm... maybe just maybe they're true, eh?
My numbers show up again. Hmm... maybe just maybe they're true, eh?
My symptoms are burning pain, feelings of swelling and stiffness on the right side of my tongue, and altered taste sensations. Overall it feels like my tongue has been scraped along the street. I appear to have some of both paresthesia and dysesthesia as the definitions seem to overlap somewhat. My numbness has gone, but I'd trade that for the burning I have any day. I'm now 18 months post injury, so I assume it's permanent, although I never give up hope. Should I find a cure I'll be certain to let the board know.
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Painful (altered) sensation is dysesthesia while simply having altered sensation is paresthesia. I would venture a guess and say that when that article a couple posts above refers to paresthesia they are talking about the condition you do NOT have. I say this because they specifically say, and I quote, "Some of the patients with the paresthesias also have the pain of dysesthesia from the site of the paresthesia."
What does "some" mean? Even if 1 out of 21 patients present with paresthesia, "some" could mean 1 out of 50 of THOSE. Now we're dealing with 1 out of 1000 in the total population. Of course the actual number could be much higher or lower.
What does "some" mean? Even if 1 out of 21 patients present with paresthesia, "some" could mean 1 out of 50 of THOSE. Now we're dealing with 1 out of 1000 in the total population. Of course the actual number could be much higher or lower.
Paresthesia and dysesthesia
http://www.wrongdiagnosis.com/symptoms/nose_tingling/book-causes-10a.htm
I've been diagnosed by two neurologists as having paresthesia. I don't think the disticntion merits much consideration as the definitions are almost identical depending on the author. Burning pain is a common denominator in both.
http://www.wrongdiagnosis.com/symptoms/nose_tingling/book-causes-10a.htm
I've been diagnosed by two neurologists as having paresthesia. I don't think the disticntion merits much consideration as the definitions are almost identical depending on the author. Burning pain is a common denominator in both.
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I'll trust what I've learned in dental school rather than some googled website.
Yes the two have some overlap but the bottom line is that you would not describe someone as having a dysesthesia if they did not experience some form of a painful sensation.
(Aphistis correct me if I'm wrong anywhere here by all means.)
Reading that article, I believe that when they refer to paresthesia they mean anyone with altered sensation, including those with dysesthesia. However, they consider dysesthesia to be a subset of that category. Thus the percentage of people who end up with your specific condition is far less than 1 in 21.
I'm not even arguing the 1 in 21 number here like everyone else has. I'll leave that to them.
Yes the two have some overlap but the bottom line is that you would not describe someone as having a dysesthesia if they did not experience some form of a painful sensation.
(Aphistis correct me if I'm wrong anywhere here by all means.)
Reading that article, I believe that when they refer to paresthesia they mean anyone with altered sensation, including those with dysesthesia. However, they consider dysesthesia to be a subset of that category. Thus the percentage of people who end up with your specific condition is far less than 1 in 21.
I'm not even arguing the 1 in 21 number here like everyone else has. I'll leave that to them.
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why 4?
i think 2 appts would be enough. take out upper right and lower right in 1st appt and then the other side in your 2nd appt.
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Ok. For those who are more adventuresome just double the pleasure.
hi-- first post-- i ran across this thread by accident while researching something else, and after reading through the thread I could not resist commenting. The study with the best hard data is the 2001 JADA article here http://jada.ada.org/cgi/content/full/132/2/177. Comparing the side effects of articaine with lidocaine shows very similar incidence of side effects for both with articaine very slightly higher. I would be careful to conclude much by these differences, however-- due to the nature of the study. The types of procedures ranged from simple restorative to surgery--- including extractions.
In order to generate data which would one would could hold to strict statistical analysis; it would seem to me that the study would have to include a placebo group, and be dental procedure independent (as the procedures themselves may be culpable). This is unlikely to happen.
In the conclusions however-- the author states that in all reported cases the parasthesia ultimately resolved. They also refer to the Hass and Lennon study which shows an incidence of parasthesia for articaine at about 2.27 per million injections.
Enough for the studies. Let's move on to my own experience with this drug. About five years ago i started using it, and found it superior to lidocaine to the extent that i use it almost exclusively now. I have never had a case of parasthesia with this drug. I have been in practice for 28 years-- and have experienced only one patient who i feel had significant (about 4 days) parasthesia. This was about 10 years ago, and was with lidocaine. I live in a small town and do almost all of my own endo, am referred cosmetic work by others, and basically do everything except perio surgery and oral surgery. I do not hesitate to use articaine in any situation that i would have used lidocaine. After having given several thousands of injections with the drug, and having no increased incidences of untoward side effects, I feel very comfortable with it's safety. Believe me -- I am a great believer in not creating problems for myself. After all of these years and having never been sued, i feel very solid in my clinical judgement.
Anyway--just my two cents worth. By the tone of some of the other posters, some will assuredly crucify me for what they consider a cavalier approach to this subject. It only seemed to me that there was a lot of theory being thrown around here, and not much experience.
I choose this as my primary local anesthetic the same way as I choose everything I use in my practice--- whatever works the best, and is the best for my patients. The rest takes care of itself.
In order to generate data which would one would could hold to strict statistical analysis; it would seem to me that the study would have to include a placebo group, and be dental procedure independent (as the procedures themselves may be culpable). This is unlikely to happen.
In the conclusions however-- the author states that in all reported cases the parasthesia ultimately resolved. They also refer to the Hass and Lennon study which shows an incidence of parasthesia for articaine at about 2.27 per million injections.
Enough for the studies. Let's move on to my own experience with this drug. About five years ago i started using it, and found it superior to lidocaine to the extent that i use it almost exclusively now. I have never had a case of parasthesia with this drug. I have been in practice for 28 years-- and have experienced only one patient who i feel had significant (about 4 days) parasthesia. This was about 10 years ago, and was with lidocaine. I live in a small town and do almost all of my own endo, am referred cosmetic work by others, and basically do everything except perio surgery and oral surgery. I do not hesitate to use articaine in any situation that i would have used lidocaine. After having given several thousands of injections with the drug, and having no increased incidences of untoward side effects, I feel very comfortable with it's safety. Believe me -- I am a great believer in not creating problems for myself. After all of these years and having never been sued, i feel very solid in my clinical judgement.
Anyway--just my two cents worth. By the tone of some of the other posters, some will assuredly crucify me for what they consider a cavalier approach to this subject. It only seemed to me that there was a lot of theory being thrown around here, and not much experience.
I choose this as my primary local anesthetic the same way as I choose everything I use in my practice--- whatever works the best, and is the best for my patients. The rest takes care of itself.
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thank you for the input drisin80.
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Great comment! I had an incident of lingual nerve paraesthesia prior to coming to dental school, working as an RDH (SRP-with need of LA). Compared to you though, one incident in the 6 years I had was with Articaine. Lucky me though, the patient was an attorney. However, full function and sensation returned after about 2 weeks and the patient was understanding of the reality that any time you can an injection theres a small risk of permanent nerve injury irregardless of solution strength. There was some research showing 4% solutions (including Prilocaine) having a higher incidence of paraesthesia's due to the concentration of the L.A. (lido being used is usually around 2% and Septocaine/Articaine is 4%, Prilocaine is also 4%). Europe and Canada apparently use more 4% prilocaine and articaine when being compared to the USA in some of these studies. Great comments again though.
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I've been using septocaine at a practice that I'm an associate dentist at for a few years. My boss uses it as the primary anesthetic in the practice. But, just the past 2 months, I've had 2 cases where I injected septocaine for the mandibular block, and the patient experiences numbness in the neck and shoulder; one of the patients even experienced numbness in the throat and eye and claims that she was losing her voice. The first time it happened I didn't think much of it, but the second time it happened it happened to a new patient, and this incidence had cause her to lose confidence in me and the practice. Although in both instances the sensation came back within a few hours, it's one too many case, and it's hard to explain why this happens to the patient, so I've decided that I won't be using septocaine for nerve blocks anymore.
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How do you know this aberrant "numbnesses" are being caused by the type of anesthetic? Did you ask the patients if they've ever experienced this before? Hadthese patients everhad an IA before? Do you use topical anesthetic? Are you using IANB or V3 block type mandibular anesthesia? What's your technique?
My point is, there's 100 other things you have to consider before you can say "AHA, it must be the septocaine!"
My point is, there's 100 other things you have to consider before you can say "AHA, it must be the septocaine!"
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Numbness in the eye? Shoulder? Where exactly are you injecting the Septo?
My technique is the basic technique: injecting a 27 gauge long needle within the triangle formed by the retromandibular raphe, mandibular ramus, and the occlusal plane. I, too, didn't understand why the eye, shoulder, etc. got numb. To make matters worse, the second patient that it happened to didn't have any numbness along the IA innervation. I consulted with an oral surgeon, and he doesn't recommend using septocaine for mandibular blocks, and he seemed a little dumbfounded himself why those said areas got numb, but his explanation is that septocaine is 4% compared to lidocaine being 2%, so any small amount of septocaine that get into certain spaces in the head may cause such numbness.
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Yes, both patients have multiple large fillings in all quads of their mouths. They both reported of being numb for their previous fillings before and that this type of neck, etc. numbness never happened to them before. I did use topical, but I don't think that contributes to anything since it dissipates so quickly. Again, my technique is the basic technique: injecting a 27 gauge long needle within the triangle formed by the retromandibular raphe, mandibular ramus, and the occlusal plane; there were no positive aspiration. I've administered many, many mandibular blocks during my 6 years in practice using lidocaine, septocaine, carbocaine, etc with no complications. Although some studies don't recommend septocaine for blocks, there hasn't been any other substantial reason for me not to use septocaine for mandibular blocks until now -- these 2 similar incidences occurred recently, and occurred when I used septocaine. Personally, I regret not following the studies' recommendation. I've talked to more than a handful of dentists in my area, and almost none of them use septocaine for mandibular blocks.
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Numbness in the eye? Shoulder? Where exactly are you injecting the Septo?
Transient drooping of the eyelid on either the ipsilateral or contralateral side is more commonly seen in injection with the Gow Gates than with the conventional technique. The effect on the oculomotor, trochlear and abducens has more to do with the technique than with the pharmacological agent used.
http://jada.ada.org/cgi/content/full/132/10/1420
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Hello Dr.'s,
I'm here to report on some progress relating to my paresthesia/dysesthesia resulting from an articaine injection for a lower mandibular block. My original injury occurred in July 07 and I have been suffering ever since. I have had some improvement in my symptoms recently and feel I should make you all aware of how I achieved this, in case you have a patient or two experience the same thing. I started rubbing very hot capsicum (capsiacin) on my tongue, right side where the burnng pain has been. The protocol I'm using was outlined in the following study; http://www.medscape.com/viewarticle/462066_10. In addition, I started taking some proteolytic enzymes (serrapeptase, papain, bromelain, and a few others) in the hopes of digesting the scar tissue that no doubt surrounds my lingual nerve, or what's left of it. In just a few days time I've experienced more relief than I've had in almost three years and although I still have my symptoms they are far more tolerable. I said I'd return if I ever found anything to help this horrific injury so I've kept my word. I plan on continuing with this protocol for a while and will let the board know if I continue with the improvement or if it's just transient.
Cheers.
I'm here to report on some progress relating to my paresthesia/dysesthesia resulting from an articaine injection for a lower mandibular block. My original injury occurred in July 07 and I have been suffering ever since. I have had some improvement in my symptoms recently and feel I should make you all aware of how I achieved this, in case you have a patient or two experience the same thing. I started rubbing very hot capsicum (capsiacin) on my tongue, right side where the burnng pain has been. The protocol I'm using was outlined in the following study; http://www.medscape.com/viewarticle/462066_10. In addition, I started taking some proteolytic enzymes (serrapeptase, papain, bromelain, and a few others) in the hopes of digesting the scar tissue that no doubt surrounds my lingual nerve, or what's left of it. In just a few days time I've experienced more relief than I've had in almost three years and although I still have my symptoms they are far more tolerable. I said I'd return if I ever found anything to help this horrific injury so I've kept my word. I plan on continuing with this protocol for a while and will let the board know if I continue with the improvement or if it's just transient.
Cheers.
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Hello Dr.'s,
I'm here to report on some progress relating to my paresthesia/dysesthesia resulting from an articaine injection for a lower mandibular block. My original injury occurred in July 07 and I have been suffering ever since. I have had some improvement in my symptoms recently and feel I should make you all aware of how I achieved this, in case you have a patient or two experience the same thing. I started rubbing very hot capsicum (capsiacin) on my tongue, right side where the burnng pain has been. The protocol I'm using was outlined in the following study; http://www.medscape.com/viewarticle/462066_10. In addition, I started taking some proteolytic enzymes (serrapeptase, papain, bromelain, and a few others) in the hopes of digesting the scar tissue that no doubt surrounds my lingual nerve, or what's left of it. In just a few days time I've experienced more relief than I've had in almost three years and although I still have my symptoms they are far more tolerable. I said I'd return if I ever found anything to help this horrific injury so I've kept my word. I plan on continuing with this protocol for a while and will let the board know if I continue with the improvement or if it's just transient.
Cheers.
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some of this has been mentioned but here is a great response to the studies regarding articaine induced paresthesia. I chose not to copy and paste portions of it because the entire pdf is worth reading =) Let me know what you think
http://www.endoexperience.com/filec...s/Anesthesia/Atricaine Paresthesia issues.pdf
http://www.endoexperience.com/filec...s/Anesthesia/Atricaine Paresthesia issues.pdf
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I was pumped reading this article until I got to the end and realized it was written by a manufacturer of a 4% solution...
Seems like no one has good evidence and both sides are equally not interested in evidence based medicine. I would like to grab malamed's articles tomorrow at school though to see how those studies were done.
