Enzyme issue...who said that novocaine didn't work for them??

Discussion in 'The Watercooler' started by buddy, Apr 4, 2012.

  1. buddy

    buddy New Member

    Q was to have a cavity filled and it hit me just when I woke that I never told the dentist about his CYP450 2d6 and 2c19 poor metabolizer issues....

    So I called the dentist and he said we had to cancel and he had to do some research because he doesn' want him in pain...it could be nothing or it may mean we need another plan...

    BUT, I have to research this of course, LOL

    and I remember some here wondering if they had CYP enzyme issues because they or their difficult child had weird medication. issues.

    Almost 25% of all drugs on the market today are broken down by a specific
    enzyme within the Cytochrome P450 class of enzymes known as CYP 2D6. This
    is well known by chemical scientists. What is less known, and what big
    pharma has tried to keep under wraps is that not everyone has this enzyme,
    and for those that do - there may be subtle variations or "defects" in their
    genetic makeup so that not everyone produces the same amount of this enzyme.
    This science is so well understood that the population has been divided
    into four main categories, and they are:

    1. Ultra extensive metabolizers
    2. Extensive metabolizers
    3. Intermediate metabolizer
    4. Poor metabolizer

    Now let me provide you with a couple of examples to help you better
    understand why this information is so important.

    Let's say that someone is an ultra extensive metabolizer of Novocaine. This
    means that this person produces an "excess" amount of the enzyme that breaks
    down Novocaine and helps to clear this chemical from the person's body. So,
    when this person goes to the dentist to have some work done, the dentist
    administers the standard dose of Novocaine, and believing that his patient
    is now numb, begins to work. The patient screams out in pain because the
    standard dose of Novocaine had no effect. The patient's enzymes broke down
    the Novocaine quickly, before the drug could produce its intended effect.

    Now, lets say that Prozac is prescribed for a poor metabolizer. This
    patient has a genetic variant which results in very little production of CYP
    2D6. Not only that, but the patient has also been taking another drug which
    needs CYP 2D6 enzyme for break down and clearance. Because the enzyme which
    breaks down Prozac is deficient, levels of the drug soon build to toxic
  2. Hound dog

    Hound dog Nana's are Beautiful

    I have to have MANY shots before they can touch me. Not sure if that's the enzyme thing or not. I have the same issue with topical anesthetic, it doesn't take well to begin with and wears off fast.

    But then again, maybe it's all anesthetics to some degree. I come out of surgery, wake up almost immediately (usually to the major shock of the nurses) and am ready to eat and drink. No nausea, no symptoms from the medications.

    While this can be a blessing (as with major surgery), it can also be a curse (like with dental procedures). When I had the teeth pulled for the dentures the dentist was a great guy.......he watched me closely for any hint of the medications wearing off and he'd give me more at the slightest hint it was.........this after about a half hour 45 mins of shots to get me numb in the first place. I've had gas.......but gas doesn't NOTHING to numb pain for me.

    You might want to search for a dental surgeon who can give Q IV sedation (like with surgery just not quite as deep) to work on his teeth.
  3. buddy

    buddy New Member

    If they find that he wont have good pain control then they will do alternatives. This is a specialty clinic and I love most of the pediatric dentists there.

    There are many things that affect metabolizing of medicines and this is just one of them so you may have some other issue that blanket affects all medications you take??? It is all pretty interesting to me now that I am forced to learn about it. And given how many medications need enzymes to either convert them to the properties that work or that need them to break them down to be used, whatever..... it is amazing that more is not taught to patients and doctors in general about this.

    The dental office at first thought I was saying he was allergic and I had to explain totally. They were trying to tell me that most people are not allergic to topical medications. Now they have called three times and one of the girls said that it is actually fun learning about it, yeah LOADS of fun, LOL.

    My mind has been going over past medication issues with him. When he was just barely 3 he had his first MRI and of course they needed to sedate him. They got to the MAX level of anesthesia and he was wide awake. He had been poked in the feet, arms etc...so at that time I thought they had just worked him up so much that the adrenaline was blocking his sedation. What did I know. I did kick them all out and rocked him and he fell asleep and stayed asleep long enough for the MRI.

    His only other filling, he said that it hurt the whole time and I said, why didn't you tell them and he said he was scared to tell them. At the time I thought maybe it was more sensory??? that he didn't like them in his mouth??? but now I DO wonder if he was really in pain and so I figure it is better to make sure even though this is the best day ever to do it. It will stink having to make an appointment if he starts a new school....he hates missing school for appointments.

    Oh well, just thought I'd share...
  4. TeDo

    TeDo Guest

    Thanks for sharing that. difficult child 1 had to have a baby tooth pulled and he had no problem with the novocaine. difficult child 2 had one pulled and he had to have a second novocaine shot because he felt everything they were doing. I am the same way. I need a double dose. As you know, difficult child 1 had a HUGE problem with Prozac so it's interesting to me that these were the two examples they gave. Hmmmm Interesting....
  5. Hound dog

    Hound dog Nana's are Beautiful

    Travis has some of the same issues. Now his are quirky as all get out. It took us years to figure out his nerves are pretty messed up. For him, it depends on the part of the body. He's had one surgery and seemed to take the anesthetic well.......at least doctor didn't indicate it had been an issue, but he was fully awake and screaming when they expected him to still be really groggy. (screaming because I was NOT there..)

    If it's his right side, he may or may not feel it. Mostly he doesn't feel pain normally on that side......I suspect strongly he does not feel it at all on that side except for his feet. He's had 3rd degree burns on that right hand/wrist and didn't feel it either when he did it (trying to light a candle for me) or when docs treated it. (he should have been in agony when they treated it) He's put a knife through that same hand and did not feel pain. An accident......calmly went to the bathroom to wash the wound and bandage it himself......until I noticed he kept the water running forever and went to check and there was blood everywhere. He didn't require topical anesthetic for them to stitch it and he didn't even flinch.

    Let the boy stub his toe and the world comes to an end. You'd think he was dying, I swear. He's over sensitive in the feet.

    So while Q has an enzyme issue, he might also be having some issues due to the Traumatic Brain Injury (TBI) as well. Or you might see them in the future. Just something to keep in mind.
  6. buddy

    buddy New Member

    I think you are absolutely on to something. It (the enzyme piece) is a piece of the puzzle that can be dangerous (as in the prozac example....or any medication that builds to toxic levels at normal doses becasue it is not being metabolized) but I do think some of his neuro and sensory issues do affect him when it comes to the pain issue. Like your Travis, it seems to depend on side of the body too.... Poor guys, the ones who can tolerate it the least.
  7. Star*

    Star* call 911........call 911


    I can't use novicane because it has epineprine in it. I am allergic to epineprine. HOWEVER I get many, many arguments about that with many, many dentists who think they are anesthesiologists and want to argue the point to the degree of sending me into shock - one TWICE. No, I didn't sue-should have but didn't. I am not allergic to the suspension that is used to prolong the life OF the novicane - I am actually allergic to Epi. Epineprine is a chemical that is naturally occuring in our chemical makeup so this is a mystery and (the arguable point) that I continually explain. I even had EMDR therapy to desensitize myself to bees and the reaction most people have to the buzzing and swatting. I have been told that the buzzing in humans creates an increase in our blood pressure (genetically) and the increase in our blood pressure raises our heart beat, releases sweat and that sweat combined with the swatting motion is usually what draws the bees/wasps and aggitates them. So with the therapy/hypnosis I have a better chance of NOT sweating and worrying or swatting at them - and thus not getting stung - and thus not having to get the "antidote" which would kill me QUICKER than the bee sting - which will also cause an allergic reaction.

    As of today -the bee stings have had one very severe reaction out of seven stings and the epi has sent me to the ER twice - out of three accidental injections. I think they give me carbocane...it lasts shorter, but I get more shots and I'm okay for dental work. I just make sure I brush a LOT and floss MORE, and swish and spit a ton, for the teeth I have left - lol. ANd I don't plant flowers that attract bees like I used to.

    I believe I'm the one you were looking for. (hahaha) that's a first. ROFL.
  8. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I also have horrible reactions to the shots at the dentists. The novacaine makes me react in horrible ways. I get sweaty and start to have heart palpitations and this last time I actually started having tears run down my face. I simply couldnt get control of myself I was shaking so badly. I also take about 4 times the amount of medication as normal folks according to the dentists and it wears off quicker.
  9. buddy

    buddy New Member

    Interesting Janet, I may be remembering wrong but I thought one article on novocaine said that it is in the lidocaine family which also can be used as heart medicine (antiarrythmic...sp???) or something like that. It did say that for those people who are UM (ultra metabolizers) the medication just goes in and out and does no good and can cause all kinds of problems. I wish I remembered where I found that. For you I suppose it could be more important to really find out. That is kind of scary. (not trying to be overly dramatic, just that I have been reading so much about it so I admit I am a little freaked out)
  10. buddy

    buddy New Member

    geeze Star, that is really scary too.... do you wear a medication alert bracelet or something because I bet that is such a common emergency drug you, as you said could be given it before you knew what hit you.

    I knew there were some of you out there who said that you had terrible reactions to that kind of medication.... YIKES
  11. Star*

    Star* call 911........call 911

    DF and I both carry cards in our wallets that say what all I'm allergic to. My ID says see card in wallet.

    That's a very interesting article you found.