Dental Work And Dysautonomia - Tips, Issues, Thoughts

[iheartcats]

Hello -

I had to go to an emergency dental visit today (tooth pain from broken cavity) so that's fixed...but I have a crown in my future to avoid a root canal. Fun!

I tried explaining to the dentist what I have. She asked if I was 'sure it wasn't from stress.' Sigh. I said no. It's real and likely my autonomic nervous system is damaged and the meds I'm on manage me and I hope I eventually heal blah blah blah.

It was hot and I was freaked out (hate dental work) so of course I got hives. I calmed myself so then she numbed me, but it still hurt like crap. I like how I'm sensitive to some meds (small doses needed) but yet apparently not numbing stuff for dental work. Anyone else have this issue?

I'm worried about how much I'll need numbed up for the crown now! I wonder why this is?

Since I like back I try to plan to take my Midodrine 3 hours prior and be somewhat hydrated. I can't keep running to the toilet.

How do you guys handle dental work? Any weird issues?

[Brye]

I hate dental work!! During my long hospital stay when I was 1st dx with POTS I sucked on lifesavers all day long and it took me about 5 days before I remembered I had to brush my teeth. I came out of that with 7 cavities. The thing I hate most is the no Epi in the numbing meds so it doesn't last as long and isn't nearly as localized so half my face goes numb. I've always required a lot of numbing medicine to begin with and without the epi I think maybe it wears off sooner so the dentist is always asking if I'm sure it's still numb. I hate dental pain!! Good luck and always remember STAND UP SLOWLY AFTER!!

Brye

[Tachy Phlegming]

When I went for dental work, I had epinephrine with my anesthesia. I had asked only about the anesthetic because I thought I could have a reaction to it. Little did I realize, other tricks were up the dentist's sleeve. I didn't realize the dentist would use epinephrine.

My heart went into racing mode and I was up for the count. I had to get up and walk around while my heart raced.

Thinking that my problem was with the epinephrine, when I went for turbinate reduction, I asked that no epinephrine be used. The doctor put tissues with anesthetic in my nose and when he took them out after 10 minutes, I felt faint. I told him not to inject more as he planned to do. He asked if I still wanted the procedure and I told him I did, that as long as I felt so awful, he should do as much as he could. So he did one pass in one nostril. The second one would have been painful so he didn't. But my nose was the least of my concerns at that point.

My mouth started to get numb and my hands got numb. I wanted to be down for the count.

I didn't get to go there because this doctor was sitting at my side and telling me to breathe more slowly.

Happily, I was so focused on remaining conscious that I had no idea what he was thinking or why he was saying what he was. All I could think was that if I listened to him, I would black out.

His secretary called to cancel my follow-up appointment because he was sick. She said they'd call to reschedule. They haven't yet. I am wondering why.

So to echo the above (but with the weird experience to back it up), if anybody has any idea what I should do or ask for next time I need local anesthesia, do tell.

[iheartcats]

I did know they use Epi in dental work! Do they all? I know she poked me with a needle to numb things...

Plus I'm on Beta Blockers so Epi isn't as useful - I need 'more' of it, technically, if I have a bad allergic reaction the allergist said.

You learn something everyday.

So what do we do? Help!

[iheartcats]

This is why I was tachy the rest of the day, and I had to do errands. Now am exhausted.

"However if the patient is taking a non-cardioselective beta blocker (eg Inderal), both beta-1 and beta-2 receptors are blocked and so if they receive a moderate to high dose of epi, epi can not stimulate either beta receptor. All that happens is the alpha mediated vasoconstriction and this results in a rise in blood pressure (no counteracting beta-2 mediated vasodilation can occur) and to make matters worse, the patient will characteristically have a low pulse due to being on a beta blocker. Low pulse and rising blood pressure is obviously a bad combination."

I take Inderal...and thankfully I'd taken Midodrine 4 hours before my appointment or it would've been worse.

Not sure what to do next time. Didn't even know about this until today!

[carinara]

When i told my dentist about my concernes because of my medication sensivity, POTS and my bad experiences with anesthetics i experienced in the past, he explained to me that there are anesthetics with adrenaline (epinephrine) or anesthetics without adrenaline he could use. I know that adrenaline is a big no go for me so i chose the one without adrenaline and had no problem with it.

[Janey]

One thing that Professor Grahame told me (the European Ehlers Danlos Expert) is that people with Ehlers Danlos Syndrome do not get numb-enough during injections at the dentist. They sometimes need 3 or more injections before their mouth feels properly numb and this is something to do with collagen. This is one of the first questions he asked me as I walked through the door. I couldn't read on the bottom of your page whether you had EDS or not, but it could be that it's a autonomic thing and just an aspect of dysautonomia generally for dental anaesthesia to have a lesser effect.

How annoying that she suggested it was stress! That INFURIATES me!!

Janey

[potsgirl]

I am terrified of the dentist. Since I was young, I've had myriad dental work done, including a lot of fillings, impacted wisdom teeth (I actually had an extra pair up high, so I had 8 instead of 6 - still waiting for the extra wisdom...sigh), 8 teeth pulled for braces, root canals, crowns, and 3 implants. I have 8 of my 22 teeth that are still all mine. One of these teeth needs to be crowned next month. I have to have gas before they can get near me with the shots, and I usually end up with 4-5 shots of novacaine instead of the 2-3 that most people would take. I am so sensitive to my other meds, but for some reason, novacaine doesn't work well for me. I have to get up very slowly from the dental chair, and have someone drive me home. It's like I'm drunk....Grrr.

[maggie]

There is a web site that is for the dental treatment for those with pots, it's: http://jada.ada.org/cgi/content/full/137/4...s=10&RESULT. I print this out for the dentist when I first found this article. It explains what must be done for the patient. I highlight the portion about the dentall for the dentist to see what is important in this article for them. Hope this helps.

Maggie

[potsgirl]

Another great article! Thank you so much for posting this. I will take it in to my dentist when I have my work done next month. It explains why I have frequent cavities and why novacaine doesn't have much effect on me.

Cheers,

Jana

[gertie]

I get anxiety just thinking of going to dentist for a cleaning. I ask for no epinephrine but the last time I had a filling the numbing shot had worn off before dentist got through. I was under such stress & I knew if I mentioned it to the dentist I would get another injection & it would take a lot longer. Somehow I got through the pain. When I was a child I passed out at the dentist everytime they gave me a shot. It was probably the epinephrine in the shot that caused it but that was over 50 years ago & no one knew about dysautonomia.

[samannran]

I find it interesting that others have trouble being numbed for dental work. I've always had that problem and never made the connection. I remember as a teenager telling the dentist that I could feel what she was doing. She said there was no way I was feeling pain and went on to perform a root canal on me!! She said she had given me plenty of shots. I was numb. Needless to say, she's not my dentist now! I learned on my own to stay away from epi after passing out when I was raised up. The dental assistant could barely feel a pulse and my bp was way too low. I asked my cardiologist about it later, and he said to stay away from epi.

I hope your visit for the crown goes much better,

Sam

[potsgirl]

Sam,

I had the same thing happen to me when I was about 10. The dentist insisted there was no way I could feel pain, and continued to pull out my tooth. I refused to ever go back to him!

[iheartcats]

I'll take this article so she can have it on file - maybe it'll help some poor soul in the future who has Dysautonomia/POTS/OI/Etc! Thanks for posting this!

I emailed my Cardio and he said to avoid Epi in short treatments. Sometimes it's harder in longer treatments - so it depends on symptoms/necessity/etc. I wonder if all dentists have BP machines to monitor things?

Interesting about the numbing, though. I never seem to be numb enough and just 'deal' which is no fun. Interesting so many of you guys have this issue too. I agree. There's a point you just want it over with and no more shots!

I know I need an implant in the future but am putting that one off...it's just OK for now and OK will have to be enough.

I'm so glad I had my wisdom teeth out before all of this so I feel for those of you who haven't.

[delphicdragon]

Count me in to the "doesn't ever get numb" category!

I needed the maximal dose of two different numbing agents to get my wisdom teeth out. And 5 epidurals for my knee surgery. Oh the joys of EDS!

Sara

[ajw4790]

Yep, it always takes me a long time and many shots (they often have to go up to a stronger anesthetic) to get numbed up for the dentist and for foot surgery. AND it wears off about 3-4x as quick as they say it should. This has been "normal" for me since I was a kid, so it is not all due to meds etc. They never can believe it! I have just learned to expect it... I have seen before where for some it can be due to hypokalemia (I believe).

I could also see where for me it could be a collagen thing....

[persephone]

how apt I came across this today. I hd an emergency appt with the dentist today because I had a filling fall out.

They never told me there was such a thing as NON adrenalin based anaesthetic. They told me it's impossible to be allergic to adrenalin because we all have it, and that's it, so I have always had to put up with unbearable tachycardia at the dentist.

I also have Ehlers Danlos and I tried to explain to the Dentist today that the shot takes longer to work on me, and then doesn't last long. She said. "Well, I'll just TRY now to work on the tooth as I've given you the shot, and we'll see what happens..."

I lasted FIVE SECONDS with the drill. It was like I had been given no anaesthetic at all.

It took me THIRTY MINUTES to get numb.

I have spent upwards of ?1000 ($2000) on my teeth this past year- and this is on the NHS. I don't know anyone else who has trouble with their teeth like I do, and I really look after them. I despair, I really do!

[bellgirl]

Four or five shots of Carbacaine worked for me when I was getting a crown. They had to inject again during the procedure and wait a long time before it worked. He said move your right hand, and I'll get some more and he did. Also Marcaine has no epi, but he didn't have that one when I asked. There is also lidocaine without epi for locals, too, if you ask, some doctors will have it. I know this thread was 4 years ago, but I thought it might help some that look it up now. They wouldn't let me on the ADA site to view the article above, btw. I think it had something to do with the protection on my computer, though.

[Guest Alex]

here is another link to the same article Kim, this should work.

http://www.cfids-cab.org/rc/Brooks.pdf

Alex

[bellgirl]

Thanks it did

[Guest maia]

NO epi for me.

I couldnt access the link to the article and found this one, not sure if its the same article or not, but wow:

http://www.google.com/search?q=JADA+Continuing+Education%3A+Postural+orthostatic+tachycardia+syndrome%3A+Dental+treatment+considerations+&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a

how wonderful it would be if all medical professionals were that compassionate and understanding!

[yobuck285]

I just left the Endodontist, practically in tears - promised myself I wouldn’t cry.  I had put in the initial paperwork that I had POTS; he didn’t read it.  I had a first appointment and tried to tell him about POTS.  All he said was “oh, okay”, and kind of seemed like he was dismissing me.

I got to the appointment and explained some things that might affect me.  He sort of pretended to listen.  

Yeah… I just had a root canal without enough novocaine.  I told him TWICE that I could feel it, and he gave me this lecture on how vibration can feel like pain.  I was getting angrier and angrier.  It was PAIN!!! He then purposely didn’t touch the tooth and asked “does this hurt”?  The level of arrogance and condescension was alarming.  I wouldn’t answer him.  He asked two more times and I just said, “is this done yet”?  It was horrible.  I couldn’t get out fast enough.

Now I have a tooth that needs a crown, and he already charged me for the crown but I feel traumatized and so angry at the way I was treated that I can’t go back.   
 

POTS patients have trouble getting numb, correct?  Shouldn’t he have known this, or stopped the procedure to numb the area more?

Im so sick of these g*dd*mn arrogant doctors and dentists!

Im so done!!

[Pistol]

9 hours ago, yobuck285 said:

 

POTS patients have trouble getting numb, correct?

@yobuck285- not as far as I know. For me it takes LONGER to feel the numbing, but my dentist avoids the modern numbing agents ( contain epi ) and uses the older version because of my POTS. They take longer to take effect. 

Sorry about this horrible experience!

[Jyoti]

Coincidentally, I had some minor dental work done yesterday and I only though to ask the dentist about the anesthesia after it was injected.  Epinephrine?  No wonder I feel like I do!  I had no idea previously that they did that, but was reeling from it all day. And then happened on this thread.  I am grateful for the advice and thoughts and will take them all into consideration when next I sit in that chair.  

[Sushi]

I always ask for an anesthetic agent without epinephrine and they have always had it at hand and been happy to use it. It just takes a bit larger dose and you may need more frequent injections if it is a long procedure. I even had a pacemaker put in using lidocaine without epinephrine. If a doctor or dentist is unwilling to give you a non-epinephrine injection, become an insistent patient! It is not only POTS patients who don't tolerate epinephrine, many others don't as well. I just tell them from the get-go that I don't tolerate it and to please use a preparation without it. Your experience is shocking!