Vasoconstrictors and the heart

The use of vasoconstrictors in local anesthetics, as topical hemostatic agents, and in gingival retraction cord, remains controversial although data exists from which to formulate reasonable guidelines. The value of such vasoconstrictors to increase local anesthetic efficacy and reduce systemic uptake is unquestioned. Elevated blood levels of epinephrine can occur with their use but do not generally appear to be associated with any significant cardiovascular effects in healthy patients or those with mild to moderate heart disease. Reduced dosages or local anesthetics without vasoconstrictors are indicated for patients with more significant disease, and epinephrine-impregnated retraction cord should be used cautiously or avoided in certain situations. Endogenous epinephrine released in dental treatment-associated stress may also reach significant blood levels and make it difficult to determine causation of cardiovascular adverse events. The safety record of dental local anesthetics and their vasoconstrictors has been impressive and will remain so with continued judicious use of these agents.