Dental Managment Of Allergy Definition of allergy Types of allergy Dental management Type 1 - anaphylaxis management

1. Dental Management
of
Allergy
AHMED A. ABDULWAHAB
UG:1330095
1

2. Definition
Is an abnormal response of the immune system to a substance introduced into
the body.
The four principal types of hypersensitivity reactions are:
I. Anaphylactic
II. Cytotoxic
III. Immune complex
IV. Cell-mediated (or delayed -type) reactions.
2

3. 3

4. Dental management
 Medical history
• Drug history
• Allergy – Type of allergy
 Laboratory tests
Local anesthetics, analgesics, and antibiotics are the most common drug classes used
in dental practice, and allergic or pseudoallergic reactions have been reported for
each.
4

5. Local Anesthetics
 Most adverse reactions involving local anesthetics are misstated as allergy.
 (Syncopal episodes) including brief seizure-like activity, and cardiovascular events.
 Cutaneous reactions or airway compromise should be regarded as potentially
allergic in nature.
Pruritus (itching) Rash Urticaria (hives)
5

6. Local Anesthetics
1. Para-aminobenzoic acid (PABA) esters (procaine and tetracaine)
2. Amides (articaine, bupivacaine, lidocaine, mepivacaine, and prilocaine)
 Esters of para-aminobenzoic acid are the most common offenders and amide
derivatives are rarely if ever implicated.
 Cross-reactions do not occur among
amide derivatives.
6

7.  Nonsteroidal Anti-Inflammatory Drugs
Nausea and dyspepsia (upset stomach) are the most common events labeled by patients as
being allergic reactions.
True IgE-mediated reactions to aspirin and NSAIDs have been confirmed, but they are rare.
 Antibiotics
The penicillins and cephalosporins are the most commonly used antibiotics in dental
Both have been confirmed as producing allergic and pseudoallergic reactions.
Approximately 50% of patients with actual IgE reactions to penicillin lose their sensitivity after
5 years.
 Latex
Managing a patient with a history of a severe reaction to latex.
7

8. Management
 Cutaneous reactions include pruritus (itch), rash, and urticaria.
 These reactions are generally mediated by histamine and can be managed using
an antihistamine such as diphenhydramine (Benadryl).
 It can be administered as 25–50 mg by intramuscular (IM) injection in the deltoid
muscle using a 50-mg/mL concentration (0.5–1.0 mL).
8

9. Management of severe type I hypersensitivity reactions
Anaphylaxis is an acute reaction involving
the smooth muscle of the bronchi in which
antigen–IgE antibody complexes form on
the surface of mast cells which causes
sudden histamine release from these cells.
The potential end result is acute respiratory
compromise and cardiovascular collapse.
Anaphylactic reaction usually takes place
within minutes but may take longer.
9

10.  Place the patient in a head-down or supine
position.
 Make certain that the airway is open.
 Administer oxygen.
 Be prepared to send for help and to support
respiration and circulation.
 If an immediate type I hypersensitivity reaction has
resulted in edema of the tongue, pharyngeal tissues,
or larynx, the dentist must take additional
emergency steps to prevent death from respiratory
failure.
The dentist must take the following actions immediately:
10

11.  Activate emergency medical service (EMS).
 Inject 0.3 to 0.5 mL of 1 : 1000 epinephrine by an intramuscular (into the tongue) or subcutaneous
route.
 Supplement with intravenous diphenhydramine 50 to 100 mg if needed.
 Support respiration, if indicated, by mouth-to-mouth breathing or bag and mask; the dentist should
make sure the chest moves when either of these methods is used.
 Check the carotid or femoral pulse; if a pulse cannot be detected, closed chest cardiac massage should
be initiated.
 Confirm emergency medical service is on their way, and transport to medical facility if needed.
11

12. Thank You
For
Your Attention
12