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Auxon
12-05-2005, 07:15 PM
My roommate just got a novocaine injection used for a cavity filling for the first time. While I'm not sure where I heard it, I warned him that it is possible for the dentist to accidentally kill you if s/he injects the novocaine directly into a nerve in your jaw. He couldn't believe me so we turned to google, but I can't find any references for or against this. Could this be an urban legend? Thanks,

Kevin

(P.S. This never stopped me from having them use novocaine... drug me up doc! :D )

OslerKnew
12-05-2005, 07:43 PM
Novocaine (generic drug name procaine) can cause major problems if directly injected into the blood stream in large amounts and too rapidly (that is, injected directly into a blood vessel). Direct injection into the blood stream can cause a seizure, which in some circumstances could result in death. Direct injection into a nerve would not be deadly -- the drug only works when it is injected in close proximity to a nerve, thereby inactivating the ability of the nerve to send pain signals. So, unless the dentist mistakenly injected the anesthetic into a vessel, no worries - unless of course the patient has an previously unknown allergy to the drug and has a severe hypersensitivity reaction (but that's a whole different story).

Qadgop the Mercotan
12-05-2005, 07:46 PM
My roommate just got a novocaine injection used for a cavity filling for the first time. While I'm not sure where I heard it, I warned him that it is possible for the dentist to accidentally kill you if s/he injects the novocaine directly into a nerve in your jaw. He couldn't believe me so we turned to google, but I can't find any references for or against this. Could this be an urban legend?
Use of the "caine" anesthetics (lidocaine, cocaine, novocaine, etc) does have some risks, as the medications can cause heart arrhythmias when injected directly into the vein. One may also get (mostly) minor arrhythmias from injecting high concentrations into soft tissues when trying to get them to numb up. But I'm unaware of any direct fatal toxicity mechanism when injected into a nerve. Frankly, that's where the medication is supposed to go, to numb the nerve. It does so by blocking sodium channels in the nerve.

It is actually used to counter arrhythmias in many folks who are having rhythm disturbances, like after heart attacks.

Of course, any drug, given in excess, can be fatal. The LD 50 dose (the dose at which 50% of the test specimens die) is 250 mg/kg when given IV to a rabbit. That's a pretty big dose. I doubt I've given more than 50 mg for any local procedure.

OslerKnew
12-05-2005, 08:00 PM
Two doctors who agree on the same issue - imagine that!!! Hey QtM - we haven't crossed the same thread since andrewdt85...

Qadgop the Mercotan
12-05-2005, 08:02 PM
Two doctors who agree on the same issue - imagine that!!! Hey QtM - we haven't crossed the same thread since andrewdt85...
Should we engage in some "fee splitting"? ;)

OslerKnew
12-05-2005, 08:03 PM
Ah, good thought - hey I didn't know it was possible to bill for services rendered on the SDMB...

Qadgop the Mercotan
12-05-2005, 08:16 PM
Ah, good thought - hey I didn't know it was possible to bill for services rendered on the SDMB...
Sadly, battling ignorance remains poorly remunerative. It's a non-covered benefit for most insurers, ya know! :D

OslerKnew
12-05-2005, 08:29 PM
Well said ;)

Joey P
12-06-2005, 12:00 AM
I warned him that it is possible for the dentist to accidentally kill you if s/he injects the novocaine directly into a nerve in your jaw.

While the good doctors have chimed in with book smarts, I can tell you from first hand experience, that having novocaine injected directly into a nerve, while rather (rather = really really) painful, is hardly deadly....at least not for me.

Doctor Jackson
12-06-2005, 09:20 AM
While preping me for a root canal, the dentist noticed that I jumped a little while he was injecting the novacaine. He asked "Did you just feel an electric shock sensation"? I nodded "yes". He said "Cool! I hit the nerve dead on. That means good news and bad news. The good news is that you won't feel anything at all during the procedure. The bad news is you won't feel anything for a long time after the procedure". He was right. It took more than 24 hours for the effects to wear off completely.

CookingWithGas
12-06-2005, 09:39 AM
He said "Cool! I hit the nerve dead on. . . ."I am now at the age when some of my doctors are younger than me, but it would still give me pause if my dentist, in the middle of a procedure, started a sentence with "cool." Or even worse, "Awesome."

Tevildo
12-06-2005, 10:09 AM
Of course, any drug, given in excess, can be fatal. The LD 50 dose (the dose at which 50% of the test specimens die) is 250 mg/kg when given IV to a rabbit. That's a pretty big dose. I doubt I've given more than 50 mg for any local procedure.
Just to confirm something - even if injected into a vein, the normal dental dose of novocaine wouldn't prove fatal in a normal patient (that is, someone without an allergy or pre-existing heart condition)? The figures quoted seems to suggest that you'd need something like 400 times the normal dose (injected incorrectly) to get to the LD50 - am I interpreting them correctly?

Qadgop the Mercotan
12-06-2005, 12:01 PM
Just to confirm something - even if injected into a vein, the normal dental dose of novocaine wouldn't prove fatal in a normal patient (that is, someone without an allergy or pre-existing heart condition)? The figures quoted seems to suggest that you'd need something like 400 times the normal dose (injected incorrectly) to get to the LD50 - am I interpreting them correctly?

Yes, you are interpreting them correctly.

We would still like to avoid directly injecting into a vein, as it can cause nausea and some rather interesting (if you're watching the patient) heart rhythm disturbances, but it would rarely be fatal.

watyalikRDH
12-06-2005, 07:36 PM
There are techniques for avoiding a deposit of anesthetic into a vein. Aspirating (pulling back on the ring) and checking for blood in the carpule is one of them also a double check by turning the needle and aspirating again. But if for some reason the good hygienist or dentist injects anesthetic into a vein, and the anesthetic contains epinephrine, you will experience an extremely fast heart rate and can be fatal if you have heart problems.
Also, people with liver problems or kidney problems, also others with thyroid conditions and diabetes. All of these conditions deserve special attention by the dentist and hygienist, all play a part in which type of anesthesia is used in comparing amides and ester type anesthetics. All can have fatal results of the precautions and protocol are not followed.

watyalikRDH
12-06-2005, 07:47 PM
Novacaine is also known as procaine which is in the ester family. The ester family is not used anymore for one thing, and one reason being is that too many people had an allergic reaction, of which can be fatal for some. Especially people today with their plethora of allergies and asthmatics. Just a tid-bit of info. Cocaine is an ester also, and is the original anesthetic and was also the original pain medication also before they knew their addictive properties.

Joey P
12-08-2005, 10:29 AM
While preping me for a root canal, the dentist noticed that I jumped a little while he was injecting the novacaine. He asked "Did you just feel an electric shock sensation"? I nodded "yes". He said "Cool! I hit the nerve dead on. That means good news and bad news. The good news is that you won't feel anything at all during the procedure. The bad news is you won't feel anything for a long time after the procedure". He was right. It took more than 24 hours for the effects to wear off completely.

Years ago I was getting a shot waaay back in the crock of my jaw, each time the dentist moved the needle it felt like water was spraying on my face, (and it was rather painful to boot). I asked about it afterwords and she said that means she hit a nerve. It was numb before she was done injecting and stayed numb for a looong time after.

Rysdad
12-08-2005, 10:51 AM
I seem to remember a news story from long ago about a man who basically went nuts, ran out of the dentist office, and committed some sort of crime after the dentist accidentally injected the novocaine into a vessel rather than IM.

Is that a reasonable possibility?

Hm...time to Snopes, I guess.

irishgirl
12-08-2005, 11:00 AM
Interesting things also happen if you use a local anaesthetic containing adrenaline for a ring block.

That's if you count you patient's anaesthetised digit (or, in one memorable malpractice case, penis) falling off as being interesting.

Qadgop the Mercotan
12-08-2005, 01:54 PM
Interesting things also happen if you use a local anaesthetic containing adrenaline for a ring block.

That's if you count you patient's anaesthetised digit (or, in one memorable malpractice case, penis) falling off as being interesting.
Do you have actual cites for that, irishgirl? I'm not asking to be snotty, but I've been told the same thing about adrenaline for over 25 years, and recently heard from a semi-reliable source that it was all based on theoretical risk, there were no documented cases of digits, noses, ear bits or other members being lost due to the vasoconstrictive properties of adrenaline.

I have not started using it in my digital blocks yet, however. :D

Revenant Threshold
12-08-2005, 02:05 PM
......Is it safe?

alterego
12-08-2005, 03:35 PM
A novicane injection once caused my entire lower lip to be completely numb for greater than 24 hours. I was quite scared (but thankfully did not die)

irishgirl
12-09-2005, 03:23 AM
No cites, but the lecture I remember this from was definitely illustrated with slides, and the ischaemic penis one definitely stuck in my memory...not a pretty picture.

Sorry.

Dr_Paprika
12-09-2005, 12:54 PM
Sometimes it is necessary to use anesthetic injections on infants. When you weigh seven pounds, it doesn't take a lot of something to be posionous. For children and adults it would require a lot of novocaine to approach the toxic dose.

It would be hard to kill with novocaine, though, unless the injection is really far from the mark. Injecting into the nerve helps it work. Injecting into the jugular vein less so.