Allergy is the most common chronic disease in Europe. Up to 20% of affected patients endure a daily struggle, driven by the fear of a possible asthma attack, anaphylactic shock or even death.[i] From food allergies to hay fever, atopic eczema to asthma, there are many allergic diseases to be aware of.
Occupational allergies are also a risk; immune system reactions to workplace substances. This is especially true in dentistry – the UK’s Health and Safety Executive highlighted clinicians, dental nurses and general nurses as being at a high risk of occupational allergic reactions.[ii] Furthermore, various dental materials pose a potential risk of inducing an allergic reaction to the patient. Identifying and managing these situations is a vital part of performing safe and ethical dental treatments, ensuring that the risks are understood by the patient for optimal consent.
Allergies in da house
For the dental team, the most common reactions are allergies to latex, acrylates and formaldehyde.[iii] These can have a delayed hypersensitivity reaction, whereas more metallic substances like sodium metabisulphite and nickel can have an immediate effect. Manifestations may vary from burning to pain and dryness of the mucosa, whilst more visible signs include swelling, a rash, rhinorrhea, and more life-threatening outcomes like anaphylaxis and cardiac arrhythmias.iii This makes allergy control a daily imperative.
Glove actually
Contact dermatitis affects 22-43% of dental professionals globally and can present as an acute, subacute, or chronic inflammatory skin condition.ii It affects women twice as frequently as it does men, with natural rubber latex allergies found to be the leading cause in occupational environments due to wearing latex gloves. There are two types of latex allergy: Type I, which is an immediate reaction, and Type IV, which is a delayed reaction, often 6-48 hours after exposure.
One way of identifying the risk of contact dermatitis is that 30-50% of natural rubber latex allergies also show hypersensitivity reactions to foods like avocados, bananas, chestnuts and kiwis – such patients should be closely monitored.ii Further risk factors include people who are regularly exposed to latex (from healthcare workers to patients who have frequent appointments) and those with a familial history of allergies.[iv]
In the cosmetic dental workflow, there are several other components that run the risk of inducing an allergic reaction for patients and dental practitioners. These include:
- Chlorhexidine – Type I (immediate) hypersensitivity reactions reported
- Acrylics – used for dental prostheses but can penetrate through latex gloves
- Dental restorative materials – these must be included in patch tests for dental professionals.ii
Prepared for shock
As allergies are becoming more prevalent in the general population, the materials used in dentistry must meet the biocompatibility specifications of each patient for long term treatment success.iii Clinicians must consider the documented allergies of their patients before starting any treatment. In cases of extreme Type I reactions, such as anaphylaxis, clinicians should be able to recognise and respond to one quickly – key symptoms include swelling of the throat, difficulty breathing and skin that feels cold to the touch. Delivering an adrenaline jab, calling emergency services and laying down is the recommended response.[v]
The dental practice can also enhance understanding through leaflets and posters. Whether in the waiting area or in the dental treatment room, adorning the walls or shelves with educational material on allergies encourages patients to share their concerns and further highlights the risk of a reaction occurring.
Safety and security
Alongside improving patient understanding and consent, as well as meeting a professional ethical standard, carefully explaining the risks of an allergic reaction affords greater legal protection for the clinician – especially if audibly recorded. An allergic reaction can be a traumatic experience that leads to litigation, but having written and recorded consent from the patient that acknowledges the risk ensures clinicians are confident to proceed and deliver the dental treatment.
To support clinicians in practising safe and ethically-driven treatments, the British Academy of Cosmetic Dentistry (BACD) offers its members excellent rates on a range of products and services. This includes a 10% discount with leading insurance indemnity provider Densura. With reliable legal protection, clinicians can continue delivering first-class smiles with confidence.
Allergic reactions can be unexpected in the dental practice, both for team members and patients. Navigating the different risk factors and how to manage affected people is essential for a safe patient experience.
For further information and enquiries about the British Academy of Cosmetic Dentistry visit www.bacd.com
Author: Dr. Carol Somerville President of BACD
[i] Allergy UK | National Charity. (2016). Statistics and Figures | Allergy UK | National Charity. [online] Available at: https://www.allergyuk.org/about-us/media-centre/statistics-and-figures/.
[ii] Sahni, R., Rajpal Tattar, Samer Al-Habba, Senathirajah Ariyaratnam, Barry, S., Coulthard, P., Patel, N., Noha Seoudi, Walton, G., Lear, J.T., Young, H. and Dave, M. (2022). A review of allergic contact dermatitis for dental professionals. Faculty Dental Journal, 13(1), pp.4–5. doi:https://doi.org/10.1308/rcsfdj.2022.8.
[iii] Syed, M. (2015). Allergic Reactions to Dental Materials- A Systematic Review. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, [online] 9(10). doi:https://doi.org/10.7860/jcdr/2015/15640.6589.
[iv] Anaphylaxis UK. (n.d.). Latex Allergy. [online] Available at: https://www.anaphylaxis.org.uk/fact-sheet/latex-allergy/.
[v] NHS (2023). Anaphylaxis. [online] NHS. Available at: https://www.nhs.uk/conditions/anaphylaxis/.
