Anaphylaxis: an update for dental practitioners

Abstract

Anaphylaxis is an acutely presenting life-threatening medical emergency. Surveys indicate that dentists feel inadequately able to recognize and treat anaphylaxis. This paper reviews the terminology and pathophysiology of anaphylaxis, and describes the recognition and initial management of anaphylaxis for dentists. Dentists should be able to administer intramuscular adrenaline during anaphylaxis at the appropriate dose. The role of further medical care is also explained. Six cases of anaphylaxis arising from dental oral maxillofacial surgery practice are discussed.

The knowledge of and attitudes toward anaphylaxis emergency management among Polish dentists

“…Anaphylaxis in an operating theater with skilled medical personnel immediately available ends mostly with an excellent outcome [3]. With proper initial management and no delay in adrenaline administration, as well as oxygen availability, there is a high probability of good outcome without any further sequel [3,6]. That is why it is so important to prepare the equipment and medications properly, as well as implement appropriate medical training.…”

“…A specialist in allergy can help exclude allergy to certain substances, such as those applied in dental treatment [4]. The suspicion of a possible anaphylactic reaction in the future means that the dental office must be carefully prepared for medical emergencies, including all necessary equipment, an oxygen source, and adrenaline, as well as a clear action plan [3]. In special cases, the patient should be treated in a well-equipped facility, sometimes even with the possibility of direct support from emergency medical personnel.…”

“…Local anesthesia is among the greatest risk factors for medical emergencies in a dental office, but cardiovascular disease and medical history also play a role [1]. Most dentists believe that local anesthetics are the main cause of anaphylactic reaction [2]; however, these properties were mostly attributed to preservatives (methylparaben and sulfites) and not the local anesthetic itself [3][4][5]. IgE-mediated systemic reactions, true anaphylaxis, may indeed occur after administration of local anesthetics, but this happens very rarely [6,7].…”

“…Dentists in Poland complete a 5-year undergraduate training including medical emergencies, emergency treatment, and basic/advanced life support practical training, but still, there is a concern among them about their practical skills and challenges they have to face in medical emergencies, especially in anaphylaxis [18,19]. Many studies emphasize that dentists feel inadequately trained to recognize and treat medical emergencies in dental offices, especially with reference to anaphylaxis [3].…”

Di̇ş Heki̇mli̇ği̇ Açisindan Ri̇skli̇ Si̇stemi̇k Hastaliklar Ve Bu Hastaliklara Bağli Oluşabi̇lecek Aci̇l Durumlar: Bölüm 2 - Si̇stemi̇k Aci̇l Durumlar Ve Müdahaleleri̇

“…Bu şekilde 20-30 dakika arayla en fazla 3 doz epinefrin yapılabilir. Şiddetli kriz durumunda hava yolunun reaktivitesini azaltması için parenteral glukokortikoidler (500 mg hidrokortizon veya 125 mg metilprednisolone) uygulanabilir 8,[18][19][20] .…”