Horrible Experience At The Dentist

October 15, 2016 8:10 PM

I sufferred a very severe panic attack along with weakness and trembling in my arms and hands about 45 seconds after being injected with local anesthesia. This is the second time such a thing has happened and I'm looking for advice. A few more details to follow.

I have only had two fillings in my life previous to this past year and a half. I had no problems of any kind with the previous two. About a year and a half ago I had to have a wisdom tooth pulled and today I had to get a broken tooth filled and fixed. On both occasions I felt no anxiety at all prior to the injection of the anesthetic but with in a minute of the injection my hands began to shake and I could feel a full blown panic attack coming on. Last time I was able to breaathe through it and keep calm enough that the kind and extremely gentle dentist could pull my tooth. I thought the anxiety might be because of the proceedure and I didnt connect it to the injection, but today there was no mistaking it. I was totally calm and chill one moment, and a wreck the next, trembling and weak and trying to hold back tears of panic. I told the dentist I was experiencing very severe anxiety but she went ahead and started to try to do the work. I held it together until she put this thing in my mouth that was made to hold my jaw open. At that point it was like the dam holding back the panic burst and I began to fight and cry. I was so embarrassed, but it was utterly out of my control. When she was able to get the holder thing out of my mouth I was able to calm down and use some deep breathing.

I have googled, and anxiety and trembling are definitely reactions to local anesthesia, but web sites vary in how serious they saw these side effects are and what can be done about it.

Have you ever experienced this? What do you do about it? Going forward how can I let my dentist know that this is a real panic thing? Today, when I told the dentist I was experiencing severe anxiety and showed her my trembling hands, she patted my shoulder and said, "its ok, its normal to be nervous." I want to maybe use more clinical terms so the next dentist knows this isnt just me being a little nervous about some pain. To clarify, when the panic hit, my body convulsed up off the table and I accidentally hit the dentist with my arm because I was struggling to escape. I couldn't get my breath for a moment even when the thing was out of my mouth. This was horrible and SO embaressing! Any help or insight much appreciated.

posted by WalkerWestridge to Health & Fitness (18 answers total)

This is most likely from the epinephrine that is mixed in with the local anesthetic. They mix it in to make the local last longer. See if they can use local without epi. It might mean they have to inject more or more frequently, but hopefully it will keep this from happening again.
posted by brevator at 8:15 PM on October 15, 2016 [13 favorites]

They mix the anesthetic with adrenaline - I don't think this used to be standard procedure because it was only during my last round of dental work that I felt my heart racing and started shaking and asked the dentist about it. Apparently you can request anesthesia without adrenaline or with a lower amount.
posted by annathea at 8:16 PM on October 15, 2016 [3 favorites]

I get the same thing. For me the only thing to do is get full sedation. It's a pain the ass cause you have to find a dentist who works with a dental anesthesiologist but it's so worth it. Google "sedation dentistry". In my experience the normal storefront dentists are great for most people but if you need anything even a little bit out of the absolutely ordinary they can't help you.
posted by bleep at 8:17 PM on October 15, 2016 [1 favorite]

This is extremely common*, very disconcerting, and a lot of dentists seem to get kind of exasperated about it like you should just suck it up and deal.

*It's common enough that the general opinion in some quarters is that it happens to everyone, but some people find it less disturbing than others and/or possibly they're getting nitrous along with it and so are not especially bothered.
posted by Lyn Never at 8:22 PM on October 15, 2016 [1 favorite]

Your reaction may be due to the epinephrine that is usually added to local anesthetics to make them last longer. Sometimes they have that effect on me. Hopefully knowing what it is and being prepared will help.

While your dentist can use a local without the epinephrine, they would likely have to administer the anesthetic multiple time because it doesn't last long.

I have had panic disorder for over twenty years. On those occasions when I do have a panic attack (for me, it has been controlled with sertraline/Zoloft), no one else usually knows.

On the other hand, twenty years ago I had such a severe string of panic attacks that I was on disability for 90 days, so I empathize. I cannot have any of the "triptans" for migraines because they make me panic and also feel like the top of my head is going to blow off.
posted by Altomentis at 8:22 PM on October 15, 2016 [1 favorite]

I never knew about the epinephrine being part of the anesthetic, but I've been anxious and trembly in the chair my whole life. I always insist that my dentist use nitrous in addition to whatever they inject. Works for me, but you may have reasons not to go the nitrous route.
posted by BillMcMurdo at 8:32 PM on October 15, 2016 [1 favorite]

Best answer: I developed the same reaction in my 50's (never had any problems before). My dentist identified it immediately as an adverse reaction to epinephrine. The dentist will have to give you more frequent shots of the local anesthesia during the procedure, but you will already be numb, so it won't make much difference, except longer in the chair.

My dentist was matter-of-fact about it, said it's uncommon but not unknown. I can't see any reason to find an actual anesthesiologist unless you want to be knocked out completely. I mentioned it to my medical doctor, and she made sure it was listed on my medical records, and that I knew to mention it when asked if I'm allergic to anything.

It is very disconcerting the first time it happens, though!
posted by kestralwing at 8:42 PM on October 15, 2016 [3 favorites]

Perhaps you can find a doctor that uses nitrous oxide in lieu of giving shots? Not sure how common this is though.
posted by ball00000ns at 8:56 PM on October 15, 2016 [1 favorite]

This happens to me occasionally. You definitely should ask about getting anesthesia without the epi in it. My OB specially had me ask for it when I was pregnant and having some dental work done.
posted by I_love_the_rain at 9:11 PM on October 15, 2016 [1 favorite]

This happened very severely to me once. I thought my heart was going to pound out of my chest, and I literally couldn't stop myself from crying out in a way that sounded like some kind of wounded animal! At first I thought I was having a severe attack of hypoglycemia because the shaking, palpitations, and disorientation were very similar, although this was more intense.

The dentist (a truly wonderful human being) stopped working, went and got me a pillow and blanket, dimmed the lights, and stayed with me until I felt better. He said that he was pretty sure he had accidentally injected the anesthetic directly into a blood vessel. Since that one ingredient acts by constricting blood vessels, getting it directly into my bloodstream made my whole body react.

I've never had a problem since then, though, so I'm inclined to believe that *in my case* it really was an accident with the injection rather than an unavoidable side-effect of that medication.

So sorry you had to go through that; I'm shaking a little just remembering it.
posted by The Underpants Monster at 9:23 PM on October 15, 2016 [1 favorite]

I didn't know about the epinephrine, but it TOTALLY makes sense. I had some work done last week and while I didn't have a panic attack, I was definitely shaky and jittery. I asked them if that was normal, and they said it was, but they didn't mention why.
posted by jhope71 at 9:45 PM on October 15, 2016 [1 favorite]

I get this as well. There's a whole long story about it, but the short version is that I have the same problem as you, plus fainting. The solution for me was a few things together:

1. They don't use the shot that has epinephrine in it. I don't know what they use, but it's something else. This means it doesn't last as long and they need to use more, but that's okay.

2. They tip me upside-down when they give me shot and then leave me alone for 5-10 minutes. If I have a reaction, it will be less severe (since the blood won't all leave my head) and subside within that time.

3. They prescribe me an anti-anxiety drug (it's always been valium) to be taken an hour before we start the procedure.

These 3 things together have gotten me through a lot of dental work, and hopefully will continue to do so.
posted by gloriouslyincandescent at 2:04 AM on October 16, 2016 [2 favorites]

To add: This whole procedure was devised by a rather ritzy dentist in Manhattan who specializes in patients who have phobias or other issues with normal dental work. I'm very grateful to have had the insurance that allowed me to see him, however temporarily, because now even though I don't see him anymore (I don't live there) I can explain to other dentists what the problem was and how it was solved, and it's pretty simple to recreate.
posted by gloriouslyincandescent at 2:05 AM on October 16, 2016

Piling on that I too react to epinephrine, and I now inform all dentists about that upfront and have learned to be aggressively proactive about my needs when evaluating new dentists. (Not that I dentist-hop, but I've moved states a lot.) Any signs that they're not going to take me seriously and come up with alternative options for anesthesia and I seek out a different provider.

I haven't actually needed local anesthesia since the last time when I discovered the epinephrine thing, but my understanding is that the primary purpose it's serving is to dilate the vessels and make the numbing agents reach their targets faster, so it's more for convenience than effectiveness.
posted by deludingmyself at 7:51 AM on October 16, 2016 [1 favorite]

I don't know anything about the scientific side of it, but I just wanted to make sure that you dump that dentist. And make sure your old dentist knows why. I'd even write a calm, matter-of-fact Yelp review.

There are dentists who specialize in people with dental anxiety. Your case is a little different, but someone like that is probably going to have a much more proactive plan and empathetic demeanor.
posted by radioamy at 12:38 PM on October 16, 2016 [1 favorite]

I had a bout of anxiety about 7 years ago and it triggered really bad when i got local anesthesia. Told my dentist and he immediately said it was the epinephrine. The next time he simply gave me a local without the epi. Problem solved.
posted by jasondigitized at 6:55 PM on October 16, 2016 [1 favorite]

They tip me upside-down when they give me shot and then leave me alone for 5-10 minutes. If I have a reaction, it will be less severe (since the blood won't all leave my head) and subside within that time.

My dentist does this, too.
posted by The Underpants Monster at 8:44 PM on October 16, 2016 [1 favorite]

Response by poster: Thanks for your answers everyone. I'm really shocked, looking back on it, that this dentist didnt think to mention the epinephrine thing, but instead left me feeling bewildered and embarrassed until I could get some answers on the internet! A bad review is indeed in their future.
posted by WalkerWestridge at 10:38 AM on October 17, 2016