__________________________________________________ DCA02AR Allergic Reactions in Dental Patients
Titanium One of the more recently identified metals to cause a hypersen- sitivity reaction is titanium. The use of titanium in prosthetic dentistry has increased dramatically, with most dental implants today composed of this material. Although generally safe, titanium is capable of causing type I or type IV reactions in susceptible patients, particularly patients with a hypersensitiv- ity to other metals [47]. If a patient is at risk for or is suspected of having a hypersen- sitivity to titanium, he or she should be tested by an allergist prior to the surgical placement of the implant. When removal of an implant is necessary due to a patient’s incompatibility with titanium, it negates the initial surgical placement, requires additional surgery to remove the implant, and may require a bone graft to replace the bone removed to place the original implant. TREATMENT OF HYPERSENSITIVITY REACTIONS IN DENTAL PATIENTS In a type I reaction, the release of histamine and bradykinins causes vasodilation and edema, while the release of prosta- glandin D2 and leukotrienes results in bronchoconstriction [48]. These biochemical events can cause a transfer of as much as 50% of intravascular fluids to extracellular spaces [49]. A steep decline in blood pressure and cardiovascular collapse can ensue—anaphylaxis. Immediate emergency treatment and contact of emergency medical services is mandatory to save the patient’s life. While the patient is conscious, any dental materials in the patient’s mouth must be removed to prevent their aspiration and further complication of efforts to treat the patient. The patient should be placed in a supine position with the legs slightly elevated to facilitate blood flow to the brain. The basics of airway, breathing, and circulation should be constantly monitored. Epinephrine remains the medication of choice to treat ana- phylactic shock. Commercially prepared pre-loaded syringes of 0.3 mg of 1:1,000 epinephrine (usually referred to by their brand name, EpiPen) can be injected into the deltoid or vas- tus lateralis muscles or in the sublingual region. The highly vascular sublingual region can promote rapid absorption of the drug. Subcutaneous administration does not provide as much bioavailability of epinephrine as the intramuscular or sublingual routes [50].
Once absorbed, epinephrine targets the alpha and beta recep- tors of the cardiovascular system, inducing vasoconstriction and increasing the systolic blood pressure. Epinephrine also acts as a bronchodilator and can relieve the respiratory distress associated with anaphylaxis. The dose of 0.3 mg epinephrine can be administered every 5 to 15 minutes until hypotension and respiratory distress are stabilized. An intramuscular injec- tion of a histamine blocker such as diphenhydramine can also help by reducing the effects of the histamine release from the mast cells [50]. Positive pressure oxygen delivered through a mask can pro- vide supplemental oxygen. Some patients will exhibit severe pharyngeal and laryngeal swelling and require intubation for the proper exchange of oxygen. All patients with anaphylaxis should be transferred to a hospital for further treatment and observation, as some patients have a biphasic response and begin to display symptoms of anaphylaxis even after seemingly effective treatment. After recovery from the anaphylaxis reac- tion, the patient should consult with his or her physician or allergist to identify which substance(s) caused the event and to prevent recurrence. In less severe cases of allergic responses, the usual treatment is removal or discontinuation of the triggering substance and avoidance of the material in the future. Clear documentation of any allergic responses is the best first step to prevent future occurrences. CONCLUSION This course has provided a brief overview of the complex issue of allergic reactions in dental patients and dental staff. Some of these reactions are minimally problematic, while others can lead to anaphylaxis and even death in a matter of minutes. Despite meticulous attention to a patient’s medical history, allergic reactions can occur, even to medications or materials that a patient has previously tolerated. Although it is rare for an anaphylactic response to occur in the dental office, appropriate training and preparedness should be a priority. In addition, clinicians should take steps to prescribe and use medications in a responsible fashion and to educate patients about the appropriate use and the potential adverse effects of over-the-counter medications. A dental staff with proper training, knowledge, and equipment can save a life
WORKS CITED https://qr2.mobi/allergic-reactions
.
56
EliteLearning.com/Dental
Powered by FlippingBook