IMPORTANCE OF MEDICALHISTORY Taking a comprehensive history both oral and systemic is essential. A thorough medical history should always be obtained on the first visit to dental office and updated periodically . This crucial information should be as accurate as possible since it can have an impact on dental treatment. Forgetting to include relevant medical information could lead to serious consequences.
DENTAL ALLERGIES Types of dental materials associated with allergic or other adverse reactions1. “Base metal” alloys containing Nickelused to make crowns and bridges. Anexample would be a “non-precious” metalalloy used to make a Porcelain Fused toMetal (PFM) crown or bridge.2. Gold alloys used for crowns and bridgesthat may contain base metals.
3. Dental amalgam: Veryrare allergic reactions to themetals in amalgams – theallergic individual may havea family history of metalallergies.4. Acrylics or denturereline materials: A verysmall percentage of patientsmay have allergic or irritantreactions to the chemicals inthese materials.
Medications used in Dentistry associated withallergic or other adverse reactions 1. Antibiotics such as Penicillin, Sulfa drugs, Tetracycline Allergy to Penicillin is the most common drug allergy. Allergic reactions can range from a rash, to hives, and can even result in a life-threatening anaphylactic response that can cause difficulty breathing, requiring emergency action and treatment. Erythromycin is usually prescribed for patients allergic to Penicillin, and allergy to Erythromycin is rare.
. ALLERGY TO TOPICAL AND LOCAL ANESTHETICSSome individuals are allergic to benzocaine. In thiscase dentist will make sure tonot use topical anesthetics containing benzocaine and avoid using any localanesthetics related to benzocaine.•Prescription whitening/bleaching agents – misuse and overuse ofthese products can cause adverse, rash-like irritant reactions to gum andoral tissues and can also damage the teeth by demineralizing the enamel
Epinephrine (“adrenalin”) in localanesthetics Many patients believe they may have had an allergic reaction to the epinephrine, when what has actually occurred is an adverse reaction to the amount of epinephrine the patient received in the local anesthetic. Local anesthetic injections can sometimes inadvertently deliver some epinephrine into the bloodstream and this can cause the patient’s heart to beat faster, or feel like the heart is “racing” – this causes significant concern and anxiety in most patients. Some individuals are more sensitive to epinephrine, and local anesthetics do contain different concentrations of epinephrine. Certain dental procedures require more local anesthetic and this increases the overall amount of epinephrine the patient receive.
Consumer Dental Products associated withallergic or other adverse reactions 1. Toothpastes and mouth rinses containing Sodium Laurel Sulfate (SLS): In a very small percentage (less than 2%) of patients, SLS can irritate the soft tissue lining of the mouth and in some cases can cause localized areas of surface epithelium (skin) of the oral tissue to slough, similar to how skin can peel off after sunburn. For example, some patients report a “slimy feeling” in their mouth when waking up in the morning, and this may indicate a reaction to SLS. Many dentists, periodontists and oral pathology/oral medicine specialists are familiar with this condition and can help patients identify SLS as the causative agent. Treatment consists of discontinuing use of any toothpastes or mouthrinses containing SLS and monitoring the patient for resolution of the problem.
2. Tartar control toothpastes: In some individuals, the tartar control ingredient has been reported to cause sensitivity reactions that irritate oral tissues. 3. Toothpastes, mouth rinses and floss containing natural oil flavoring agents such as cinnamon: These can produce a rash-like reaction (mucositis) on the oral tissues that may feel like it is burning the tissue. 4. Topical pain relieving gels (topical anesthetics) that contain benzocaine 5. Whitening/bleaching agents – Overuse of these products can cause adverse, rash-like irritant reactions to gum and oral tissues and can also damage the teeth by demineralizing the enamel
LATEX ALLERGY There are three types of latex reactions:1. Irritant contact dermatitis2. Allergic contact dermatitis3. Immediate allergic reaction (latex hypersensitivity)
CASE REPORT A 29 year old woman with history of acne rosacea sought treatment in dermatologic clinic for an out break of numerous pustules in the area of nose , chin and to lesser extent cheeks.The pustules began two days after the patient initiated a course of amoxicillin therapy prescribed by her dentist for endocarditis prophylaxis during routine dental cleaning. She reported subjective fever and fatigue.The patients pustules eruption rapidly resolved with in 4 days after discontinuing amoxicillin.
The patient had a history of penicillin allergy . But due to the dentist’s negligence it lead to this serious Allergy.
CASE REPORT 2 A nine year old patient during the anamnesic the mother mentioned that the child presented NRL allergy . The 1st contact with latex happened on her 1st birthday party through a balloon resulting in swelling on her body .A/c to mother’s report the child presented three other strong reactions after contact with latex gloves and elastic band when she was submitted to lab blood test which proved NRL allergy. Her mother also said that she could not use medicines containing acetaminophen or aspirin besides presenting dust allergy and bronchitis crisis.
Considering the reactions noticed and reported by the mother the professional choice was to use vinyl gloves for the treatment.