Question

My dentist has told me about a drug in regular use as a local anaesthetic in dentistry, which is stronger than Citanest, called Mepivacane. I need a lower molar removed and would feel more comfortable with it should the need arise. I occasionally suffer from palpitations so wish to avoid adrenaline if possible. What is your opinion of the relative merits of these anaesthetics for someone with ME/CFS?

Answer

“It is not of course possible for me to give advice to you as an individual as I have no knowledge of your particular dental circumstances or medical history. Your own dentist must choose the most appropriate anaesthetic for any particular procedure – taking into consideration many factors, including the procedure to be carried out, and your own medical history, including your ME/CFS.

“Given your ‘palpitations’ in the past, it would not be unreasonable to avoid adrenaline used to prolong the effect of the anaesthetic and to help control bleeding during surgery. It is a recognised complication of local anaesthetic administration that we sometimes get anaesthetic directly into the bloodstream, despite taking precautions to mitigate against this before injecting.

“If an adrenaline-containing solution was being used, your heart rate might be expected to increase. The adrenaline produced by your own body as a reaction to being in the dental chair might also cause this effect. As far as Citanest (Prilocaine) is concerned, it has not been available in the UK for some time. As an alternative, I use Mepivacaine as a 3% solution without adrenaline, but it is also available with adrenaline.

“It is not entirely accurate to talk about stronger or weaker anaesthetics. The aim is obviously to provide a pain-free treatment for you, and I feel certain that your dentist will make sure you cannot feel anything before embarking on your molar extraction.”

Dr Richard Cantillon, Hon. Dental Adviser, ME Association.

Important note re Citanest: Citanest was not available at the time of preparing this answer. Citanest is now available again for use as a dental anaesthetic.

See also: Dental: Pain, Dental: White or Amalgam Fillings.

More information

• Dental Care – Your Questions Answered
  We help address common questions about maintaining dental hygiene while ill with ME/CFS. We also consider how to best manage mouth ulcers, anaesthetic sensitivity, and the role of antibiotics in dental practice. This leaflet is available to download from the Free Literature.