title: Dose-related effects of epinephrine on human gingival blood flow and crevicular fluid production used as a soaking solution for chemo-mechanical tissue retraction.
abstract: BACKGROUND
  Epinephrine is a frequently used agent for impregnation of the retraction cord. Removal of retraction cord from the gingival sulcus has been shown to elicit a hyperemic response that could be prevented by epinephrine. However, the epinephrine may cause local or systemic adverse effects in the circulation.
  
  
  OBJECTIVE
  The aim of this study was to identify the effective concentration of epinephrine that may prevent the hyperemic response and consequently keep the crevicular fluid production low after cord removal without local or systemic side effects.
  
  
  METHODS
  Seventeen healthy human subjects had their crevicular fluid volume and gingival blood flow measured by Periotron and laser Doppler flowmetry, respectively, before and after cord removal at the left maxillary central incisor. The right maxillary incisor served as the control. Retraction cords were presoaked in physiological saline or various concentrations (0.001%, 0.01%, and 0.1% w/v) of epinephrine solution. Double repeated-measures analysis of variance with the Fisher Least Significant Difference post hoc test was used to statistically evaluate the blood flow values (mean +/- SE, alpha=.05), and the Wilcoxon matched pair test was used for crevicular fluid values, given as median (25-75 percentile, alpha=.01).
  
  
  RESULTS
  In the saline group, cord removal resulted in elevated blood flow (140% +/- 11%, P<.001) and crevicular fluid production (300% (130%-470%), P<.05). After cord removal in the 0.01% and 0.1% epinephrine groups, blood flow remained low for the measured period (43%-70%, P<.05). The crevicular fluid production transiently increased in the 0.01% epinephrine group (170% (140%-380%), P<.001), but then returned to baseline level and remained low as for the 0.1% group. No systemic vascular effect was detected in any groups.
  
  
  CONCLUSIONS
  The prolonged increase in crevicular fluid production and hyperemic response after cord removal can be prevented by application of 0.01% epinephrine solution without systematic changes.
authors.affiliation: Department of Conservative Dentistry, Semmelweis University, Mikszáth K. Tér 5, Budapest, Hungary. csillag@fok.usn.hu
authors.forename: Maria
authors.initials: M
authors.lastname: Csillag
authors.forename: Gabriella
authors.initials: G
authors.lastname: Nyiri
authors.forename: Janos
authors.initials: J
authors.lastname: Vag
authors.forename: Arpad
authors.initials: A
authors.lastname: Fazekas
mesh_terms: D000287:Administration, Topical; D000704:Analysis of Variance; D003761:Dental Impression Technique / Q000295:instrumentation*; D004305:Dose-Response Relationship, Drug; D004837:Epinephrine / Q000008:administration & dosage*; D005881:Gingiva / Q000098:blood supply / Q000187:drug effects* / Q000378:metabolism; D005883:Gingival Crevicular Fluid / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D007180:Incisor; D017078:Laser-Doppler Flowmetry; D008437:Maxilla; D012016:Reference Values; D012039:Regional Blood Flow / Q000187:drug effects; D018709:Statistics, Nonparametric; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine