PANDAS meltdown from novacaine?

[kmom]

DD had first cavity filled today. She was a bit nervous but generally did well until almost 2 hrs after when she went into full blown meltdown mode. She kept saying she had pain where the needle went into her gum but this meltdown was more mental than pain from an injection site. It brought me back to months ago to her first exacerbation when she'd meltdown badly. Tonight was the same where she was crying, holding her head and yelling, "Why is this happening?". It was so sad to watch. In order to calm her, I gave her an epsom salt bath. The whole crying, moaning and yelling lasted about an hour till she seemed calmer. Anyone have this experience or can you shed some light? Is there mercury in the novacaine? Is it just the stress that set her off? The materials used? She had a cleaning last Thurs. and did just fine. Not sure how we'll ever handle another cavity down the road.

[Suzan]

My daughter had the worst OCD episode I've ever seen in her the day after her filling. It was either the novacaine or the laughing gas. Scary times but it got better after a couple of days. Sorry you went through all that!

 

susan

[Buster]

We also had escalations after dental treatment -- we thought it likely that GABHS in throat was getting into blood, but Nitrous Oxide also affect BBB.

 

Buster

[peglem]

We have escalations after dental treatment as well, but also with new teeth coming in, or baby teeth falling out. I don't think my daughter has ever had novocaine, but the fact that it happens in the absence of dental treatment, leads me to think that in our case it may be more related to tissue trauma in the gums.

[NancyD]

All local anesthetics can easily cross the BBB. I have a problem with adrenaline in novacaine (also found in sudafed and other OTC medication) so I always make sure I get novacaine without adrenaline. I will do the same for DD if and when she has to have dental work.

[EAMom]

We also had escalations after dental treatment -- we thought it likely that GABHS in throat was getting into blood, but Nitrous Oxide also affect BBB.

 

Buster

 

Stress also opens the bbb.

[EAMom]

Is she on antibiotics?

 

I suspect a combination of factors is involved: stress (epinephrine etc.), bacteria (strep, maybe others) entering the bloodstream, novacaine (plus more epinephrine if it's in there), nitrous oxide....

Edited September 15, 2010 by EAMom

[Fixit]

ok..i'm getting nervous...

so far, we are still a go for ta on friday....

when ds had surgery to remove a tooth a that was in his palette(sp)..i had to have the nurse hold my baby, while i phyisically restrained a 7 1/2 year old....

of course dh is never around for the fun.....

and at that time ds was not in an episode....

maybe i should have dh do this one...

[NancyD]

I meant epinephrine, not adrenaline.

 

All local anesthetics can easily cross the BBB. I have a problem with adrenaline in novacaine (also found in sudafed and other OTC medication) so I always make sure I get novacaine without adrenaline. I will do the same for DD if and when she has to have dental work.

[kmom]

Followup to my post:

 

Talked to neurologist about the meltdown and he said to ask dentist if she gave her novacaine with epinephrine. He said that we know from other parents that tooth extractions, teeth coming through and epinephrine have caused PANDAS flare-ups before. Our dentist said she didn't do a block and not even a full infiltration but that doesn't mean that epinephrine didn't enter blood stream but "unlikely". But did note in DD's chart that she had an issue and will use non epi novacaine next time. Talked to my cousin, a ped. dentist, and he had his own take on non PANDAS kids in this situation. He says he can't comment on PANDAS kids b/c he doesn't know enough but that when people (adults even) "react" so to say, it's usually b/c the the dentist hit a blood vessel and epinephrine goes to the heart and causes weird temporary symptoms--heart palpitations, major anxiety, sweaty and just an overall bad feeling. So if someone ever says that happens, they note it and give them non epi novacaine from there on. Dentists use epi novacaine b/c it makes patients numb faster, numbing lasts longer and essentially use less novacaine...bottom line...time and $. If the reaction happened sooner after the infection he'd think it was due to dentist hitting a blood vessel accidentally. But since it happened at the point when the novacaine was wearing off (2 hrs. post filling), he believes it was from the weird feeling of meds wearing off and even non PANDAS kids freak out from that. On the other hand, when I told him infection, inflammation and epinephrine (stress) open the BBB and that's an issue for my DD, he said to be on safe side, definitely use non epi novacaine and for that matter, just make the drive to his office in NY and he'd treat her. He has a laser and can do laser fillings with no need for novacaine. It's her godfather and DD trusts him so I'll drive the couple of hours from now on since I may not get her to the dentist any other way.