January 19, 2004
Referring Doctors > Information Letters
As you know, dentistry is enjoying an explosion of new technological advances. Endodontics is no exception. From time to time we would like to communicate with you about something new in the literature that might be of practical clinical use to you on a daily basis. A paper was published in the Journal of Endodontics in November, 2002, entitled "Endodontic Treatment in Cases of Allergic Reaction to Rubber Dam" by E. Kosti and T. Lambrianidis. With true latex allergy a patient can exhibit contact dermatitis-stomatitis resulting in swelling and redness on the lips, perioral, and intraoral region in combination with swelling of the tongue and burning sensation followed by difficulty breathing. Endodontic treatment in patients with rubber latex allergy could be uneventful if the following protocol is followed:
- Take a complete medical and dental history or key questions regarding allergies, latex allergy, and prior allergy events. Allergy to fruits has a strong link to latex allergy therefore, be aware of latex —fruit syndrome.
- In high risk patients or positive latex allergy history, a definitive diagnosis is essential with either in-vitro tests, like serological tests, or with more reliable in-vitro tests (e.g. skin prick, use or patch tests).
- Be in contact with the patient's physician, informing him/ her about the procedure planned and consult on the need for pre-medicating with corticosteroids.
- Have your first aid kit ready and equipped with epinephrine and corticosteroids for IV or a subcutaneous injection as well as an oxygen mask just in case they are needed.
- A latex-free operatory must be created and the patient must be the first of the day to prevent aerosolized latex allergens from being carried into the room.
- Non latex gloves (e.g. nitrile or styrene ethylene butadiene styrene (SEBS) are available on the market.
- Use polyethylene or polyvinylchloride dams.
- Rubber stops on endo files should be avoided. An alternative is indelible ink markings for the working length can be used.
Reports have been published indicating that gutta percha and natural rubber seem to be chemical isomers. Gutta percha could trigger an allergic reaction, also, in patients with latex sensitivity. Since gutta percha is the only widely acceptable material*, special care should be taken to avoid its extrusion into the periapical tissues to prevent any possible allergic reactions.
It is the dentist's responsibility to be able to perform endodontic therapy without endangering the patient's life. We are more frequently encountering the latex allergic patient. Fortunately, to date, we have succeeded without incident by following the above protocol.
If you should have any questions on this subject or any other endodontic related subjects, please feel free to call us at any time.
* THIS IS NO LONGER TRUE, RESILON IS AN ACCEPTABLE MATERIAL WITH WHICH TO FILL ROOT CANALS.