Misconceptions Related to the Appropriate Use of Vasoconstrictors for Local Dental Anesthesia

By Mana Saraghi, DMD

Commercial Supporter: DentalVibe

Vasoconstrictors have been used in local dental anesthetic solutions for their beneficial effects. They reduce systemic absorption of local anesthetic, which prolongs the duration of local anesthesia by keeping the local anesthetic at the site of injection. Vasoconstrictors also enhance hemostasis at the site of the injection. While safe in most patients, there are circumstances in which the use of a vasoconstrictor is either contraindicated or a dose reduction is prudent. There are other instances where the use of a vasoconstrictor is riddled with misconceptions. The goal of this article is to present the clinician with a brief and practical overview of the vasoconstrictors used in local dental anesthetic solutions: pharmacology, indications, contraindications, and to review the recommended vasoconstrictor dose reductions and calculations.

LEARNING OBJECTIVES:

• Describe the indications for vasoconstrictor in dental local anesthetic

• Describe the principal hemodynamic effect of vasoconstrictors in dental local anesthetic

• List the conditions and drug interactions which may warrant a dose reduction or avoidance of vasoconstrictor

• Understand the rationale for dispelling the most common misconceptions related to the use of vasoconstrictors in dental local anesthetics

About the Author

Dr. Saraghi is a former attending dentist anesthesiologist in the Department of Periodontics, Division of Pediatric Dentistry, Department of Oral and Maxillofacial Surgery at the University of Pennsylvania School of Dental Medicine in Philadelphia, Pennsylvania. She is a member of the American Society of Dentist Anesthesiologists and the American Dental Societyof Anesthesiology.Dr Saraghi is a dentist anesthesiologist in the Greater New York Area.