Local anesthesia should be used with caution with the patient with ADHD. The dental practitioner should seek to achieve profound anesthesia so that endogenous epinephrine is not released, which could react with medications (especially methylphenidate). In addition, an aspirating syringe must be used to avoid intravascular injections and the possibility of a summation of drug effects from the vasoconstrictor, which could increase BP and heart rate.20
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