Lidocaine and Prilocaine (Gingival)

During dental procedures, lidocaine and prilocaine are used to numb the nerve endings in the gum to prevent the patient from feeling excessive pain.

Overview

Lidocaine and prilocaine are two kinds of local anesthetic gel that are combined together for use during dental procedures. It is usually applied only by the dentist and not available to the patient; the dentist administers the gel to the periodontal pockets of the mouth in two stages, for about a minute prior to treatment, so that the gel will have enough time to numb the nerve endings in the selected gum area.

Because of the lack of feeling in the mouth, patients are advised to refrain from overly hot or cold foods, and from biting and chewing, until they have regained feeling, as they may otherwise injure themselves severely. They may wish to consult with their dentists as to how long it may take for the numbness to wear off.

Lidocaine and prilocaine may be prone to interacting with certain medical conditions. Patients with heart disease, liver disease, G6PD defiency or methemoglobinemia especially should let their dentists know prior to usage of the gel, or there may be a possibilty of leading to adverse interactions. If the patient has any allergies or is using any other medication at the moment, they should also let their dentist know in case of any unwanted drug interaction.

Breastfeeding patients may wish to check with their doctor about the possibilities of lidocaine and prilocaine entering breast milk, and if it is safe to use.

Conditions Treated

  • Numbs gums during dental procedures

Type Of Medicine

  • Local anesthetic gel

Side Effects

While using lidocaine and prilocaine, the medicine may cause some unwanted side effects, although not all patients will experience these effects. If the patient notices any of the following symptoms, they should let their doctor or dentist know as quickly as possible. Some of these effects may happen a period of time after using lidocaine and prilocaine and vary in being more common to extremely rare.

  • Persistent gum numbness

Some of these side effects are milder and should go away after a short while. However, patients should notify their doctor or dentist right away if they notice these symptoms persisting or getting worse:

  • Bitter or unpleasant taste from the gel

While rare, patients may experience a serious allergic reaction to lidocaine and prilocaine. If they notice the following symptoms, they should alert their doctor or dentist right away:

  • Trouble with breathing

Dosage

This medicine is applied to the gums of the patient via a dispenser and is only given by a dentist in a clinic or hospital setting. The amount of lidocaine and prilocaine required is determined by the dentist.

The gel is often applied with a blunt-tipped applicator, to the gum area. After the initial 30 seconds, the periodontal pockets are filled with the lidocaine and prilocaine until it reaches the gingival margin, and the anesthetic is given another 30 seconds before the dentist proceeds with the treatment required. Up to 5 cartridges per session may be used.

An overdose is unlikely as it is administered by a trained medical professional. However, signs of overdose can include:

  • Slowed or irregular breathing

Interactions

Certain drugs, herbal products and supplements may interact with lidocaine and prilocaine to produce unwanted effects, or lead to a change in the effectiveness of the dental gel. Prior to treatment, patients should let their doctor or dentist know of any medicines, supplements or herbal products they are consuming or have consumed, in order to prevent such interactions from happening. On occasion, however, the doctor or dentist may choose to continue using both medicines together if they feel that it is necessary.

The following is a list of common medications that may interact with lidocaine and prilocaine. It is not a complete list of everything that can interact with this dental gel.

  • Acecainide

Certain illnesses may also affect the use of lidocaine and prilocaine. Patients who have or have had the following conditions should take care to let their doctor or dentist know of their medical history prior to using this dental gel.

  • Cardiovascular problems such as heart disease or heart rhythm problems

Some foods and drinks have higher chances of interacting with medications. Alcohol and tobacco are especially likely to cause unwanted interactions. Patients should check with their doctor or dentist the use of these products before the use of lidocaine and prilocaine.

Warnings

Prior to using this medication, patients should let their doctor or dentist know of any allergies they have, particularly if they are allergic to lidocaine, prilocaine or similar anesthetics such as dibucaine or mepivacaine. Other allergies are also important to mention as the gel may contain inactive ingredients that the patient is allergic to.

Aside from allergies, patients should also inform their healthcare givers of medical conditions they may have, as these problems may interact with and affect the use of lidocaine and prilocaine.

The dentist should check the patient carefully during use of lidocaine and prilocaine in order to ensure that it is working as intended and that no unwanted effects are developing.

The use of lidocaine and prilocaine may cause a serious but rare blood disorder called methemoglobinemia. Patients who already have this condition should refrain from using this anesthetic. If the patient discovers the following symptoms while using lidocaine and prilocaine, or within a short time period of treatment, they should seek immediate medical help:

  • Lips, fingernails and skin turning blue or bluish-purple

While the gum is still numb from the medicine, patients should be careful to avoid injury until the numbness wears off, as any injury can become serious. They should not chew food or gum until they regain feeling in their mouth, as they may bite their tongue or the inside of their cheeks by accident. It is also recommended to avoid foods or drinks that are too hot or too cold until the anesthetic has worn off.

Pregnant or breastfeeding patients should inform their doctor before treatment. While it is unlikely that lidocaine and prilocaine will harm unborn babies, it may pass into breastmilk and is therefore not advised for use with breastfeeding patients.

Lidocaine and prilocaine are not expected to work differently with elderly patients, although if they have age-related kidney or liver problems, the body may take longer to process the removal of the medication.

Summary

Lidocaine and prilocaine are topical numbing gels combined to form a better effect when used during dental procedures. This medication is available only through a doctor's prescription and is often applied only by the dentist. It is not usually accessible to patients.

The gel is applied to the gums via a blunt-tipped applicator, and during dental procedures, up to 5 cartridges may be used.

Before using this gel, patients should alert their doctors to any health problems they have, particularly if they have or have had heart disease, liver problems, G6PD deficiencies or methemoglobinemia, as these may leave to adverse interactions with lidocaine and prilocaine. The medicine may also lead to a development in methemoglobinemia under rare circumstances. Patients should also let their doctors know if they are allergic to lidocaine, prilocaine or similar anesthetics.

As lidocaine and prilocaine may take a while to wear off, patients are recommended not to chew food or gum until they regain feeling in their mouth as they may accidentally bite their tongue or the inside of their cheeks and cause severe injury to themselves. They are also recommended not to consume anything too hot or cold.