The patient returned 24 hours later with a large 10-cm-long, 7-cm-wide raised wheal on the right forearm. It was red and itchy (Figures 4 and 5). The location of the reaction corresponded to the test dose of 2% lidocaine with 1:100,000 epinephrine. The anterior vestibule and soft tissue of the chin had mild/moderate edema as well. The other sites, ie, those of saline, mepivacaine, and lidocaine without epinephrine, showed no reaction. Read the rest of this entry »

This patient had 3 injections of lidocaine with epinephrine solution within 5 days by 3 different dentists. The incision and drainage was performed with the presumptive diagnosis of an abscess. The elevated white blood cell count was minimal and would be considerably more elevated (ie, greater than 20,000) if an abscess were the etiology. The only exception would be an infection in an immunocompromised patient such as someone who has AIDS or is taking steroids.

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A 22-year-old female with a questionable lidocaine allergy presented to her general dentist for a routine four-surface amalgam restoration on tooth 3. She had previously had other restorative work performed by this dentist. The lidocaine reaction first presented in her 6 months prior at a primary physician’s office in which she was having several moles removed. The physician told her she was allergic to lidocaine because she apparently had significant swelling all around the surgical site.

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Frequently, patients present to the dental office labeled as “caine” allergic. While allergic reactions to local anesthetics are rarely reported, less than 1% of the adverse reactions to local anesthetics are true immunologic reactions. If, after a thorough medical history, the possibility of an allergic reaction is likely, then skin testing should be performed. A dental cartridge with vasoconstrictor contains metabisulfite as an antioxidant, while a multidose vial of local anesthetic with vasoconstrictor contains both metabisulfite and methyl-paraben as a preservative. A multidose vial of local anesthetic without vasoconstrictor contains only methyl-paraben as a preservative. Therefore, the intradermal testing should include methylparaben, metabisulfite, and local anesthetic solutions. Read the rest of this entry »