Hypersensitivity Dental Management Flashcards
(20 cards)
What is the primary role of the dentist in managing patients with allergies?
Identify patients with true allergies to avoid medical complications. Recognize oral soft tissue changes due to allergic reactions. Modify dental care as necessary. Recognize and manage acute allergic reactions.
What are the four types of hypersensitivity reactions, and which immune components are involved in each?
Type I: IgE-mediated (immediate, anaphylaxis, urticaria). Type II: IgG or IgM-mediated cytotoxic (e.g., transfusion reactions). Type III: Immune complex-mediated (e.g., serum sickness). Type IV: T-cell-mediated (delayed, contact dermatitis).
What are the common clinical manifestations of Type I anaphylactic hypersensitivity reactions in a dental setting?
Urticaria, angioedema, bronchospasm, hypotension, anaphylactic shock.
How should a dentist manage a patient experiencing anaphylaxis?
Position patient supine, call 911, administer oxygen. Administer epinephrine 0.3-0.5mg IM (adult) or 0.15mg IM (child). Monitor vital signs and provide CPR if necessary.
What dental products are commonly associated with Type IV hypersensitivity reactions?
Latex gloves, rubber dams, dental amalgam, topical anesthetics, eugenol, nickel (ortho wires).
What are the typical allergens involved in a Type I IgE-mediated reaction?
Dust mites, pollen, animal dander, foods (nuts, shellfish), drugs (penicillin, sulfonamides).
How should a dentist handle a patient with a history of penicillin allergy requiring antibiotic prophylaxis?
Avoid penicillin and cephalosporins if history of anaphylaxis. Use macrolides (azithromycin, clarithromycin) or clindamycin. Verify allergy status and consider allergy testing.
Describe the presentation and treatment of urticaria in a dental setting.
Presentation: Red, itchy welts on the skin (hives). Treatment: Discontinue causative agent, administer diphenhydramine 50mg qid.
What is the difference between angioedema and urticaria?
Angioedema: Deep tissue swelling, often involves lips, tongue, and pharynx, can cause airway obstruction. Urticaria: Superficial skin reaction, characterized by red, raised, itchy welts.
What are the risks associated with local anesthetics in patients with a documented allergy?
Ester anesthetics (e.g., procaine) have higher allergenic potential due to PABA. Amide anesthetics (e.g., lidocaine, articaine) have lower allergenic potential but can still cause reactions.
How is a local anesthetic allergy managed when the specific anesthetic is unknown?
Refer for allergy testing to identify safe anesthetic. Use diphenhydramine as a local anesthetic alternative (1-4ml of 1% solution with 1:100,000 epinephrine).
How does a latex allergy typically present in the dental office?
Contact dermatitis, urticaria, respiratory distress, anaphylaxis in severe cases. Use nitrile gloves and latex-free products.
What is the protocol for managing angioedema involving the lips or eyelids but not the airway?
Administer diphenhydramine 50mg qid until symptoms resolve. Monitor for progression to airway involvement.
What systemic conditions can predispose a patient to drug-induced angioedema?
Use of ACE inhibitors, ARBs, NSAIDs. Impaired bradykinin degradation leads to fluid leakage and swelling.
What signs and symptoms indicate a toxic reaction to local anesthetics rather than an allergic reaction?
CNS symptoms: Talkativeness, slurred speech, dizziness, convulsions. Cardiovascular symptoms: Tachycardia, hypotension, arrhythmias.
What percentage of patients with penicillin allergy will also have a reaction to cephalosporins?
Approximately 1-10%, particularly with first and second-generation cephalosporins.
How does epinephrine help in the management of anaphylaxis?
Reverses bronchospasm, increases blood pressure, reduces vascular permeability.
What is the recommended protocol for a patient with a Type IV hypersensitivity to dental materials?
Identify specific allergens, avoid implicated materials, consider allergy testing. Use hypoallergenic alternatives for restorations and appliances.
Why is it important to differentiate between allergic and non-allergic drug reactions in a dental setting?
Non-allergic reactions (e.g., gastrointestinal upset) do not warrant the same emergency interventions as true allergies. Accurate documentation prevents unnecessary avoidance of effective medications.
How should a dentist document a confirmed allergic reaction in the patient’s record?
Include specific allergen, reaction type, severity, and emergency management plan. Highlight in medical alerts section and patient history in axiUm or eRx systems.
