Whilst we are not in peak allergy season, every dental professional will know that threats can be encountered daily in the dental practice. Some solutions used in the practice can be troublesome for susceptible patients or clinicians, but thankfully, unfortunate outcomes can be avoided with an appropriate armamentarium.
Allergies can impact oral health over time – potentially resulting in dry mouth or malocclusion from mouth breathing because of irritated airways – but the greatest risks to a person’s health may be posed by the products used in everyday treatments.
Powerful reactions
When an at-risk patient interacts with an allergen, they can experience a variety of different effects. At their mildest, an individual may have a running nose or extensive sneezing, maybe even itchy skin or a raised rash.
In the most unfortunate situations, patients in the dental practice could experience anaphylaxis. This is an extreme allergic reaction that may transpire as swelling of the tongue and throat, and difficulty breathing or swallowing, amongst other symptoms, and it is life-threatening.
Harmful allergic responses in the dental practice are uncommon, but not implausible. Just this past summer, tabloid news outlets reported on allergic reactions to veneers that left a patient with ‘elephant skin’. Historically, multiple cases have seen young people with dairy and milk product allergies develop anaphylaxis after using toothpaste and mousses containing Recaldent.
These are outliers from standard daily proceedings, but it’s important to know that such cases exist. Clinicians should put in place provisions for those with known allergies and be able to proceed appropriately if a patient suffers a reaction whilst under the dental team’s care.
On the front foot
Allergic reactions may take both patient and clinician by surprise. Neither party may be able to predict the effect that a singular ingredient will have, and if a patient has not displayed such symptoms before, a severe reaction could be a shock.
In mild cases, an antihistamine may be enough to treat a patient and alleviate any symptoms. When a reaction is more severe and poses an extreme threat to the patient’s health, then an alternative response could be needed.
The GDC states that dental professionals must follow the guidance on medical emergencies and training updates issued by the Resuscitation Council UK. In their standards for primary dental care, they specify that dental professionals must be educated in cardiopulmonary resuscitation (CPR) and provide other advanced life support skills if trained to do so. This may include specific reactions to anaphylaxis. An ambulance must be called immediately, and the patient placed in a comfortable position to aid in the restoration of blood pressure or the relief of breathing problems.
The administration of adrenaline is the first-line treatment in such cases and is allowed to be provided unprescribed by an “appropriate practitioner” (including dentists) when used from an emergency drug supply. Adrenaline is part of the equipment that practices must ensure they have in case of emergency.
Reactionary measures of this ilk can save lives, and by quickly identifying major problems, patients can receive the highest standard of care needed in any given situation. However, as always, prevention is better than cure.
Avoiding a turn for the worse
Within the dental practice, accurate record keeping will help to ensure that people at risk of certain medical emergencies are identified in advance of any proposed treatment. Consulting patients and their records can help dentists to select the appropriate treatment solutions and minimise the risk of a severe reaction occurring.
There are several potential dental-centric stimuli to trigger an allergic reaction. Antibiotics are the main cause of perioperative anaphylaxis in the UK with an incidence of 4.0 per 100,000 administrations, and amoxicillin, in particular, is most likely to be associated with such a response.
However, perhaps the most prominent allergen risk in dental practices is, of course, latex. The natural rubber proteins found within latex have the potential to cause asthma, urticaria, and, although rare, anaphylaxis. Allergies to this specific substance are more common among health professionals than the general population, potentially around 9.7 per cent and 4.3 per cent, respectively, which increases the need for appropriate measures to be in place for latex-free workflows.
This means providing suitable alternatives throughout the practice to ensure completely latex-free workflows can be achieved. Practices must be able to demonstrate that they have carried out an assessment to judge which types of gloves they should provide. They should also have an effective glove use policy that takes into account individuals – including both clinicians and the general public – who may have a latex allergy.
In any case, the practice should always be prepared for allergen needs. With Initial Medical, dental practices can stock up on a wide range of medical supplies, including latex-free gloves. The company’s glove range is available in sizes extra-small to extra large and can be bulk bought as 10 boxes of 100 for ultimate convenience, delivered to your door.
Although allergen risks are always likely to be present in the dental practice, with adequate training and preparation, potentially harmful stimuli can be negated from treatments.