Epinephrine in Dental Application; Dentistry is a medical field that entails the treatment of diseases and conditions affecting teeth and gums. Among the services provided in the dentistry include extraction of teeth, repair, and the insertion of artificial teeth. The American Dental Association exercise oversight on the practice of dentistry in the United States. This paper aims to provide an in-depth understanding of how Epinephrine is used in dental applications. More
Chemical name and proprietary name
Epinephrine is both a hormone and medication and is generated in the medulla oblongata (Grabenhenrich et al., 2018). Both the adrenaline glands and neurons produce it. Epinephrine acts as a neurotransmitter in regulating functions such as respiration. Epinephrine’s proprietary name is adrenaline and is based on the incorrect assumption that it is similar to Takamine’s adrenaline (Grabenhenrich et al., 2018).
Chemical structure
Epinephrine is a catecholamine that is derived from two amino acids phenylalanine and tyrosine. In most species, the hormone is secreted from the adrenal medulla. The chemical structure of Epinephrine is as shown below in figure 1.
Figure 1 (Ala’a et al., 2019)
Functional groups present in Epinephrine
Epinephrine has four main functional groups. They include a N-CH3 group, a β-OH group, and two catechol OHs (Tashkhourian, Nami-Ana, & Shamsipur, 2018).
Boiling point and melting point
Epinephrine is a white or nearly white powder, and its solution is slightly alkaline. Interestingly, the boiling point of Epinephrine is 413.1 °C (Aydın & Tugcu, 2018). The standard melting point of the drug is 211.5 °C (Aydın & Tugcu, 2018). Other properties of Epinephrine include a molar mass of 183.204 g/mol, a PubChem CID of 5816, and a density of 1.283±0.06 g/cm3 @ 20 °C, 760 Torr (Aydın & Tugcu, 2018). Epinephrine in Dental Application;
The symptoms Epinephrine is used for
Epinephrine is commonly used to treat allergic reactions that stem from insect stings, foods, and drugs (Grabenhenrich et al., 2018). Additionally, the drug is used to treat symptoms such as low blood pressure, swelling, skin itching, wheezing, and breathing problems (Grabenhenrich et al., 2018). It is important to mention that the medication was earlier used as an additive in local anesthetics and to reduce excess bleeding in dentistry.
History of Epinephrine
A Polish physiologist identified Epinephrine by the name Napoleon Cybulski in the year 1895. The drug was again discovered by a Japanese chemist, Jokichi Takamine, in 1900 (Ishida, 2018). Interestingly, Takamine managed to isolate and purify Epinephrine from cow glands. Friedrich Stolz is said to have been the first person to artificially synthesized Epinephrine in 1904 (Ishida, 2018). The medicine, therefore, came into medical use in 1905.
What was used before Epinephrine was available?
Before Epinephrine became available in around 1905, ether was used as an anesthetic in dentistry. William Morton discovered ether in October 1846 in his search for a way of relieving the pain of patients undergoing dental procedures (Yang & Alston, 2018). However, the use of ether as anesthesia began to decline in the mid-70s. Ether was administered through inhaling its vapor and was an effective pain reliever. It is said that a doctor can saw off an injured soldier’s leg without pain whatsoever after using ether.
Figure 2
Chemical structure of an ether (Alyanova et al., 2019)
Who developed the epinephrine drug first?
Jokichi Takamine was the first time to develop the epinephrine drug back in the year 1901. Epinephrine came into medical use in 1905 (Ishida, 2018). Epinephrine drug has an effect of tightening blood vessels and relaxing muscles in the airways.
When did Epinephrine become available?
The epinephrine drug was obtained by Jokichi Takamine in the year 1901 and then launched for medical use four years later (Ishida, 2018). The Epinephrine is said to be effective and retains over 90 percent of its concentration many years after expiry. It is an expensive brand and costs between $150 to $350 for a two-pack (Ishida, 2018). A supply shortage alert issued by the Food and Drug Administration (FDA) after surveying pharmacies in 45 states shows that it is difficult to purchase epinephrine. Epinephrine in Dental Application;
Why is the drug the choice for use for the symptom?
Epinephrine drug is the choice for people undergoing deontology procedures. This is because it improves the depth and duration of anesthesia. This means that Epinephrine can stay longer than all other drugs used to induce patients (Grabenhenrich et al., 2018). Normal dental processes take an average of 30 minutes to one hour. Depending on different types, Epinephrine as anesthesia can take up to 4 hours in the body of a patient (Grabenhenrich et al., 2018). This gives health care providers an ample time to provide services. It is also preferred because it is a perfect pain reliever. Epinephrine in Dental Application;
Any previous drug it has replaced and why?
Epinephrine drugs came to replace drugs such as ether. This is because ether was found to cause dizziness in both patients and healthcare workers, choked patients, and caused vomiting and was highly flammable (Yang & Alston, 2018).
Mechanism of action
The action of epinephrine drugs varies between tissues and how they express adrenergic receptors. Epinephrine at extremely high levels, for instance, causes muscles around the airways to relax while at the same time causing contraction of the muscles lining the arterioles (Dalal & Grujic, 2020). Epinephrine also causes increased vascular smooth muscle contraction, intestinal sphincter muscle, and pupillary dilator muscle. Epinephrine acts by binding adrenergic receptors, which trigger metabolic changes in the body (Dalal & Grujic, 2020). The changes include secretion of adrenocorticotropic hormone (ACTH) and secretion in the pancreas. The changes made increase coronary and cerebral perforation pressure, which increases the circulation of blood at the cellular level (Dalal & Grujic, 2020).
How is the drug sold?
There are three different types of Epinephrine, including Jext, EpiPen, and auto-injector. This means that the drug is available in solid, liquid, and gaseous states (Dalal & Grujic, 2020). In the United States, one requires a prescription from a doctor to buy Epinephrine. However, this is different in countries like Canada, where individuals can buy it without a prescription.
What is the constituent of the formulation?
In a 1 ml solution, tartrate contains 1mg epinephrine. Jext contains less than one mmol sodium per dosage. The EpiPen contains 2ml of epinephrine injection and is designed to release precisely 0.3 ml of Epinephrine in a single dose (Aydın & Tugcu, 2018). An auto-injector contains 1.1 ml epinephrine and is designed to release precisely 0.3 ml of Epinephrine in a single dose (Aydın & Tugcu, 2018).
Side effects of Epinephrine
Epinephrine’s common side effects include vomiting, nausea, sweating, pounding heartbeats, breathing problems, a feeling of anxiety, and a throbbing headache (Dalal & Grujic, 2020). The side effects are, however, short-lived as they only last between 10 and 20 minutes. The drug also stays in a patient’s body for at least six hours.
Alternative drugs in the market for the same symptom?
There are several types of drugs available that can be used as an alternative for Epinephrine. They include Phenylephrine, Adrenaclick, Auvi-Q, and Symjepi (Pepper et al., 2017). The alternatives of Epinephrine are more effective, affordable, and have less severe side effects. The alternative medications are shown below in figure 3, 4, 5, and 6. Epinephrine in Dental Application;