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July 31, 1967

Epinephrine in Dental Anesthesia

JAMA. 1967;201(5):334. doi:10.1001/jama.1967.03130050068037

To the Editor:—  In response to a query, Dr. A. J. Miller (199:953, 1967) responded correctly that, indeed, small amounts of epinephrine in the solution results in a "more prompt, longer acting, and stronger..." anesthetic action. We agree that, especially in patients with coronary disease, the dentist should be careful to prevent pain. To this end, the American Heart Association,1 the American Dental Association,2 the American Dental Society of Anesthesiology,3 and the Public Health Service,4 have all emphasized that the minute amounts of epinephrine commonly employed in local anesthetic preparations (1: 100,000) is negligible compared to the endogenous epinephrine which might be released should pain be felt. It is quite true, therefore, that it is more important that the dental procedure be painless than that harmless amounts of epinephrine be avoided.However, Dr. Miller was not correct in stating that "lidocaine without an added vasoconstrictor