There still is conflict among practitioners and researchers concerning the systemic effects of epinephrine retraction systems. However, the concentration of epinephrine in our commercially available retraction systems, as reported by Shaw, is cause for concern. Therefore, before using these systems, the dentist must consider the following variables: medical history of the patient, health of the oral cavity (especially the dentogingival unit), type of procedure to be done, amount and length of retraction, and exposure of the vascular bed. After careful attention to the foregoing variables, the retraction system of choice is the 8% racemic epinephrine-impregnated retraction cord. In addition to these variables, a calm and organized manner in the dental operatory can and will reassure the patient of the best of care with the least side effects.