Treating a Novocaine Allergic Patient with Benadryl as Local Anesthetic

[@JourneyMetaspirit]

Fantastic! Stella is very fortunate to have you as her dentist!

[@glendacouch6098]

This is very promising as my daughter is life-threateningly allergic (not vasovagal symptoms but true allergy) to any and all locals that have been attempted on her in the past. She has ceased going to the dentist for this reason but I fear what will happen once something comes up again. Are other offices starting to offer this? We are 10 hours down the coastline from your location, I would be ecstatic to find an office close to us that could offer this protocol.

[@calcaterrafamilydentistry]

This is a very specialized approach to dental treatment. To our knowledge, there is no office publicly promoting this approach, other than hours. If you go to the webpage listed in the video, that page and corresponding FAQ answers a lot of questions and lays out the options of "caine" allergic patients

[@dentalhygiene3300]

Wow! Very rare to be allergic to an Amide!

[@tbecker4645]

Fantastic video from start to finish, packed with gems !!! And Dr Calcaterra seems to epitomize the best of the best dentists, highly skilled/competent and caring at the same time. As someone with a history of acute acquired methemoglobinemia, I was wondering if higher level of IV sedation alone i.e no Benadryl nor any other local anesthetics, would be sufficient for procedures such as root canal or simple extraction ???

[@calcaterrafamilydentistry]

Generally speaking, deeper levels of IV sedation would be insufficient for pain control in the absence of local anesthetics (either benadryl or -caine local anesthetics). To truly circumvent local anesthetics, you would likely need true general anesthesia. Without local anesthetic, even a 15 second extraction would be highly unpleasant for a patient under IV or deep sedation. Hope this helps.

[@tbecker4645]

Thanks@@calcaterrafamilydentistry for your response !

[@silvinagarcia]

I have to do a root canal too. I’m scared about the shot.

[@user-mp2yq4cw5z]

When will there be more videos like these?

[@calcaterrafamilydentistry]

Finding a patient who is willing to be recorded is not easy. Stella was very kind to allow us to film her. We'll see if we can do another one in the future.

[@MiroBG359]

is the benadryl enough of a pain killer? I can't tolerate epi, probably thyroid issue + anxiety, and I noticed when my #3 and #4 were being taken out my heart rate felt like it went down (might not have helped taking 2.5mg propranolol)

[@chrismunoz999]

Good job, doc👍

[@jjaf4055]

What oral sedation medication and IV sedation medications/doses did u use for her? Thanks

[@calcaterrafamilydentistry]

We do a pre-op benzodiazepene. And then an IV benzodiazepene and opioid. There is also another pre-medication routine we do to desensitize the pain receptors.

[@lunan5620]

What is the dentist name plz?

[@calcaterrafamilydentistry]

Dr. Nicholas Calcaterra, Orange, Connecticut, USA.

[@jivebunny3765]

Was there epinephrine in the locals that she was allergic to? Some medical journals haven't discounted patients suffering allergic reactions eg severe vasovagal syncope, from the combined effects of epinephrine and lidocaine. Epi is of course a naturally ocurring substance in the body, so she couldn't have been allergic to that in isolation, so it was either lidocaine in isolation, or the effects of both. My personal view of this is, "For God's sake, just put the poor woman under general anesthetic. Hasn't she been through enough already, and now you want to inject her with antihistamines?

[@calcaterrafamilydentistry]

She experienced the reactions with amide locals both with and without epinephrine. The two allergists also did similar testing (with and without epi) and she had similar reactions. Your last comment suggests you have not fully grasped the logic/rationale behind this technique. Many individuals DO NOT want general anesthesia. Do you want to be injected with a muscle paralyzer that will in effect stop your breathing, leaving only 4 minutes for an anesthetist/anesthesiologist to put a breathing tube into you? That is the level of anesthesia that would be required. Many “-caine allergic patients” opt for the much simpler, easier, and safer technique that is outlined in the video. And geesh, you make it seem like “being injected with antihistamines” is some horrible thing. It’s not. During allergy season, you probably have over 1 million Americans taking oral antihistamines every day.

[@jivebunny3765]

@@calcaterrafamilydentistry Did she expressly not want general anesthetic, or was it not made available to her? What I don't understand is the now almost global refusal to put people under GA for any dental procedures bar removal of impacted wisdoms, and even then you're probably going to have to fight for GA if you want it. It's almost impossible to be put to sleep for dental work in the UK, even if you've got multiple issues with drug allergies, vasovagal syncope etc etc. I thought GA was safer than it's ever been. If dentists were doing much of what they do to patients under local or IV sedation on any other part of the body, the patient would be put out. I have another question while you're here, which neither I or others can get an answer to. What's your protocol for dealing with needle phobic, epi and or amide allergic, vasovagal syncope patients who require IV sedation? If they're in syncope from seeing so much as the needle before the sedation's been injected, do you still sedate? Are there dangers to sedating someone who's BP is already through the floor and who is most of the way to fainting?

[@calcaterrafamilydentistry]

She expressly did not want general anesthesia. Before she ended up with me, she was offered to be seen by an anesthesiologist, but declined. We have heard, somewhat indirectly, from residents in the UK, about "everything being done only with local." I don't know if it has to do with licensure - meaning there are onerous restrictions on who is allowed to provide either IV sedation or GA - or if it is budgetary in nature. The financials woes of the NHS are known here in the States. If you ask us, it likely has more to do with NHS not wanting to pay for it. But then again, we're base in the US. Your second paragraph asks lots of questions. But to summarize, we give needle-phobic patients a pre-op benzodiazepine to take. That reduces the possibility of vasovagal syncope. But then again, one of the best places to have a vasovagal attack is actually in the chair of a dentist who can provide IV sedation. We see syncope episodes at least once a month, and we're ready for it.

[@jivebunny3765]

@@calcaterrafamilydentistry In the early 2000's in the UK, a couple of young kids (about 6 yrs old) died while under GA at the dentist, one of them put to sleep by an unqualified dentist who shouldn't have been using GA. Very sad, but shit happens. In typical kneejerk fashion, instead in ensuring proper training and certification for dentists wanting to offer GA, the UK government banned all GA in dental surgeries, both NHS and private. I had a white filling back in 1994. Got in such a state from my allergies to locals and my syncope issues, that when the dentist finished he told me I needed to find a dentist that would put to me to sleep. Of course, I can't now get put to sleep for anything. My experience of dentistry in the UK is that it's nothing more than medieval butchery.

[@jivebunny3765]

@@calcaterrafamilydentistry A couple of 6 year olds died under GA at UK dentists in the early 2000s, one due to an unlicensed dentist, so in typical UK government fashion, it banned GA in dental surgeries rather than introduce training and certification. I was told by a dentist who gave me a white filling on a broken front tooth back in the mid 90s that I needed putting to sleep, so you can imagine what sort of state I get in from local allergies and syncope. Of course, I can't now get put to sleep for anything, and NHS hospitals rarely put you out for dental work unless you're deemed to be mentally and or physically disabled. I've also had locals for removal of sebaceous cysts on my head at the doctor's surgery, and despite being fine through the procedures, I've fainted as soon as I've got off the bed and stood up.Had to go private for the last lot as the NHS would no longer do it. Told the consultant before the op that I had syncope and local anesthetic issues, and I think he used something different because I didn't faint afterwards, despite the nurses being ready for me to pass out. First time I've never gone in to syncope from a local.

[@grgumgee1]

This is so cool

[@Annabelle751]

I need this for real