Allergies are a common occurrence and it is essential that we take all necessary precautions to ensure that no reactions occur while patients are in our care. As a dental professional, I believe that we can all learn from this unfortunate situation and be prepared for any emergency that may arise in the dental office. It is important to note that allergies can have an impact on dental health. People who suffer from hay fever (also known as allergic rhinitis) may experience dental issues such as pain or malocclusion (crooked teeth).
Local anesthetic agents (e.g. lignocaine) are widely used in dentistry, but allergic reactions are rare. The least allergenic local anesthetic agents are mepivacaine and simple prilocaine. Allergic reactions are more likely to occur with local anesthetic ester agents, as they are metabolized into paraaminobenzoic acid, a known allergen.
Benzocaine is the only local anesthetic ester used in dentistry (in topical preparations applied before administering the local anesthetic). Mast cells are found in connective tissues, particularly beneath the skin and mucosal surfaces, including the upper and lower respiratory tract, where many allergic reactions occur. Even a small amount of gluten (1/8 teaspoon) can damage the small intestine of someone with this condition, so caution should be taken when using dental products on affected patients. The dental team must be prepared to respond effectively and manage any life-threatening situation according to the guidelines of the UK Resuscitation Council.
Anaphylaxis is a serious and potentially fatal allergic reaction1 that could occur in the dental office. Patients may not always provide us with all the information we need when updating their medical history, but other types of allergies, such as those caused by ingredients in commonly used dental products, should not be overlooked. Epinephrine is usually mixed with local anesthetics to constrict small blood vessels in the mouth and reduce bleeding during dental procedures. There are several causes related to dentistry, such as mouthwashes, local anesthetics, latex, and antibiotics.
When exposed to a perceived threat, the immune system produces immunoglobulin E (IgE) antibodies. Local anesthetics, analgesics and antibiotics are the most commonly used drugs in dentistry and allergic or pseudo-allergic reactions have been reported for each of them. In reality, issues related to allergic versus pseudo-allergic reactions are more academic than practical; the signs and symptoms are attributed to the action of several autacoids, not to the specific mechanism of their release. Once a person is sensitized, subsequent exposure to the allergen can cause an allergic reaction.
It is essential for dental professionals to be aware of these potential risks and take all necessary precautions to ensure that no reactions occur while patients are in our care. We must also be prepared to respond effectively and manage any life-threatening situation according to the guidelines of the UK Resuscitation Council.