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Considerations in differential diagnosis of adverse reactions to local anesthetic: report of case
Journal article   Peer reviewed

Considerations in differential diagnosis of adverse reactions to local anesthetic: report of case

S M Levy and K A Baker
The Journal of the American Dental Association (1939), Vol.113(2), pp.271-273
08/1986
DOI: 10.14219/jada.archive.1986.0171
PMID: 3462233

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Abstract

A 62-year-old woman with reported allergies to procaine and lidocaine requested dental care. Consultation with the patient, the patient's physicians, and the patient's dentists did not identify the causes of the adverse reactions had occurred only when anesthetic was administered without vasoconstrictor. There were no reactions when vasoconstrictor was used. Skin testing by an allergist disclosed no evidence of true allergic reaction to any of the 'caine drugs. In addition, no evidence of reaction to preservatives was found during patch testing. The adverse reactions were determined to be caused by an idiosyncratic low threshold to toxic side effects of 'caine drugs. The use of vasoconstrictor (epinephrine) apparently promoted the retention of the anesthetic locally and prevented systemic absorption sufficient to cause the toxic reaction. Practitioners must be aware that adverse reactions to dental anesthetic may be a result of true allergy, psychogenic reaction (syncope), normal toxic overdose, or idiosyncratic toxic overdose.
Drug Hypersensitivity - etiology Medical History Taking Diagnosis, Differential Lidocaine - adverse effects Anesthesia, Dental - adverse effects Procaine - adverse effects Humans Middle Aged Anesthesia, Local - adverse effects Drug Hypersensitivity - diagnosis Female Referral and Consultation Syncope - chemically induced

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