<s>[INST] Hi doctor, Is there a reason why dentists typically do not use Bupivacaine for nerve block for dental procedures? So far, only one dentist used it for me. While it had a slow onset, I was pain free for almost 8 hours. I did not need to take as many narcotic analgesics afterwards. I have really severe anxiety when it comes to dentistry due to dental trauma and painful procedures. Bupivacaine helped ease my anxiety about post procedure pain. I have asked every dentist I have seen to use Bupivacaine. But, they have always chosen Carbocaine. I also have a vasovagal response to epinephrine and Bupivicaine formulations have a lower ratio of epinephrine as compared to Mepivacaine and Lidocaine. I have always informed them of my response to epinephrine, but they still always chosen Carbocaine (Mepivacaine). Is there a pharmacological justification for not using it? Or is it just provider preference? Is there a way I can advocate for myself as a patient? I work in a pharmacy, so I am familiar with a lot of these medications. Thank you for your thoughts on this. [/INST] Hi. I have gone through your query and understand it. For further information consult a dentist online --> </s>