FAQ for Dental Treatment with Benadryl as a Local Anesthetic

Here you will find detailed information regarding how we treat patients with -caine allergies using Benadryl as a local anesthetic coupled with IV sedation. If you are considering contacting us with questions, please read the entire page, as we’ve answered the most common questions that we receive. Our main page on the use of Benadryl/diphenhydramine is located here.

I experienced a weird reaction at the dentist after an injection. I went to an allergist who did testing and he said I should avoid lidocaine. What should I do?

Excellent question. At this point you have two options:

  1. Ask the allergist to test you with another -caine local anesthetic. You may find that you are NOT allergic to other -caine local anesthetics. If that is the case, then that is the brand of local anesthetic that should be used on you.
  2. Have treatment using Benadryl as a local anesthetic and IV sedation using our technique.
I had a reaction at the allergist. They want me to do additional testing but I am scared. What should I do?

Don’t worry! We’ve had multiple patients who were similarly tired/confused/scared to undergo additional testing. In this scenario, our recommendation would be to have dental treatment performed using Benadryl with IV sedation.

I don’t know if I am allergic to lidocaine. Can Dr. Calcaterra help?

Dr. Nick Calcaterra is a dentist with advanced training in IV sedation. He has also – using existing studies – pioneered a treatment technique to treat -caine allergic patients. He can treat you if needed. But he is not an allergist. While he can listen to your history and share his insight, he is not qualified to diagnose you with an allergy to local anesthetic. Only an allergist is qualified to do that.

If you wish to skip testing by an allergist, you are certainly welcome to do so. Dr. Nick can still treat you using this technique – even without a documented allergy or adverse reaction test result from an allergist.

Are Benadryl and diphenhydramine the same medication?

Yes, they are the same medication. The only difference is the name. It is equivalent to the difference between Motrin and Ibuprofen. Motrin is the brand name and ibuprofen is the generic. For the purposes of this FAQ, we use both terms.

I’m 70 years old and have hypertension and diabetes. Am I too old or sick to be treated?

Every individual has a unique medical and dental history. Some 60 year old patients are not healthy enough to be treated in an outpatient setting. Some 80+ year old patients have been successfully treated under IV sedation in our office.  At your consult appointment, Dr. Nick will review your medical history and current medications and then assess if you can be safely treated in our office.

I want to be treated with Benadryl/diphenhydramine as a local anesthetic but I don’t want the IV sedation. Can you do it?

The short answer is no.

We’ll elaborate. Benadryl combined with epinephrine – even when it is compounded correctly – is only a weak local anesthetic. It is unlikely to get you sufficiently numb for the vast majority of dental procedures. The end result is that you would likely feel significant pain during the procedure. We may have to abort our plans mid-procedure due to your pain – leading to disastrous consequences. In contrast, Benadryl/epinephrine – when combined with Dr. Nick’s premedication protocol and IV sedation – can get you sufficiently numb to complete nearly any dental procedure without any pain. And with the IV sedation, the entire experience will be more pleasant for you.

For these reasons, if you are unwilling to do the IV sedation, then we cannot treat you.

Great! So I just make an appointment, I show up, you do the treatment, and then go home?

Not quite. We require at least one consultation before any treatment can be rendered.

For those patients living a reasonable commuting distance from our office, we do an in person exam/consultation. At that visit, the nature of your allergic/adverse reaction is established, your medical history is reviewed, your dental needs are identified, and a plan is developed. This sometimes takes more than one visit.

For those patients who live far away and wish to do a telemedicine visit first – before committing to visiting Connecticut – we offer that. For the telehealth consult, Dr. Nick will:

  1. Review your medical history.
  2. Review the nature of your allergic/adverse reaction.
  3. Briefly touch upon what dental procedures could be done.

The goal of this virtual visit is to determine whether treatment in our office using this approach is possible. It is not a dental exam. We do not want you to come all the way to Connecticut only to learn that you are not a good candidate. Note that a second telehealth visit and/or in-person dental exam may still be required.

This type of telehealth visit is not covered by insurance. Our fee is $150 and must be paid in advance to reserve the time.

Wait. You say that you can avoid general anesthesia with this approach, but you still do an IV and push drugs?

We establish an IV and push medications. But keep in mind that there is a big difference between general anesthesia and IV sedation. You can read more on this page regarding the types of sedation and anesthesia.

But to summarize, general anesthesia nearly always needs to be performed in a hospital or surgi-center. You are given medications that basically paralyze you – thus preventing you from feeling pain. You typically have a breathing tube down your throat. There is always a risk with this level of anesthesia. In contrast, in IV sedation, you are breathing on your own and your protective reflexes are intact. You will think that you were asleep – because of the amnesia – but in reality – you were able to respond to our commands.

We find that most patients prefer IV sedation over general anesthesia.

How do you make the Benadryl local anesthetic?

Because Dr. Nick administers IV sedation, he is skilled in drawing up medications and mixing them. The vast majority of general dentists have neither the supplies nor the expertise to do so. Dr. Nick combines diphenhydramine with preservative-free epinephrine along with normal saline. He mixes it to a very specific concentration and puts it in a specialized disposable syringe. He does this shortly before you arrive.

I think I am allergic to epinephrine too. Can I still do this?

It is not possible to be allergic to epinephrine. You have billions of molecules of epinephrine circulating in your body as you read this. If you were allergic to epinephrine, you would be having an allergic reaction right now.

It is possible (and quite common) to experience an adverse reaction to the epinephrine. This can include a racing or pounding heart, muscle twitching, sweating, a feeling of heightened anxiety, etc. Some individuals are hypersensitive and/or have underlying medical conditions (such as POTS) that predispose them to adverse reactions. Or you can be allergic to the sulfite preservative used in anesthetics that contain epinephrine. We would need to learn more about your past experiences. Those would be discussed at your consult visit.

Does insurance cover this?

We participate with many dental insurance plans. We will submit both the dentistry and the sedation to your dental insurance plan to obtain an estimate in advance.  This will permit us to provide you with your estimated out-of-pocket costs. That is the only way we’ll know if dental insurance covers the procedures – and what percentage is covered.

Are you able to give me an estimate without doing a consult?

No. We can occasionally give broad general estimates. But, without knowing your treatment needs, and without knowing the details of your dental insurance, it is not possible. And we are unable to send anything to your insurance company for an estimate without first doing a consultation (either in person or via Zoom).

What is the cost of the IV Sedation?

Consistent with hospital anesthesia billing, the cost of the IV sedation is based on the amount of 15 minute increments you are sedated for. In general, these cases almost always last more than an hour. Some cases last longer. Our fee is $250 per 15 minute increment. Please note that this is significantly less than traveling anesthesiologists or hospital based practitioners.

I called my medical insurance and they said they would cover the IV sedation. Is that true?

It’s great that you took the initiative to call your medical insurance. Learning the “ins and outs” of your medical insurance is the first step in getting them to potentially reimburse you!

Keep in mind that every medical insurance and dental insurance company is different. They all have different policies, deductibles, and coverage percentages. We will stress these points:

  • We are in-network with most – but not all – dental insurance plans.
  • As stated above, we can obtain an estimate from your DENTAL insurance company after your consultation.
  • We are NOT in-network with any medical insurance plan.

For those patients wishing to have medical insurance cover the IV sedation, this is how we handle it:

  • You can call your medical insurance company yourself and inquire. If they say they will cover it, then great!
  • Prior to your appointment, we will give you an estimate for the cost of the IV sedation for that visit. The cost is based on the estimated amount of time you will be sedated. You will then pay us directly for the cost of the IV sedation in advance of your appointment.
  • Once complete, we will fill out the bottom portion of the standard medical claim form for you. We will then give the form to you. You will fill out the remainder of the form and then submit it to them. Your medical insurance may reimburse you directly.
I live in California and Connecticut is too far. Can I ask my dentist to do this?

Of course you could ask him/her, but the likelihood that your dentist is able to render treatment successfully is incredibly slim. Not only does the compounding of Benadryl and epinephrine require considerable supplies and expertise, you will also need IV sedation, which is something very few general dentists are licensed to do. Your best bet would be to call a local dental school or hospital with a dental residency program and see if they can make a recommendation.

What do you use for the IV sedation?

See this page on the medications we use for IV sedation. Note that these do not include the medications we have you take starting several days before your appointment to reduce the sensitivity of your pain receptors.

Lidocaine and other local anesthetics don’t seem to work on me. Can you help?

A resistance or lack of effectiveness to local anesthetics would not be considered an allergy. But IV sedation can and will help. Dr. Nick has treated hundreds of “local anesthesia resistant” or “I can’t get numb” patients over the years using IV sedation and a similar technique. So we are able to help.

I am allergic and I need a tooth pulled. Can an oral surgeon do this?

Maybe. Oral surgeons extract teeth and many do general anesthesia. The issue is whether the oral surgeon feels comfortable enough with his/her general anesthesia skills to bring you “deep” enough in order to not need local anesthesia. Alternatively, he/she could do IV sedation and then do a Benadryl local anesthetic (just like we do). It is best to call the oral surgeon and ask.

I have just a couple of quick questions about my case for Dr. Nick. Can he call me?

No. Unfortunately, due to the significant demand for his services, he is not available to talk to non-patients of record. Your best option is to schedule a telehealth visit or in-person consult with him where he can answer your questions.