FYI

In 2019, an 11-year-old girl died after using a toothpaste prescribed by her dentist. The toothpaste contained milk proteins and the girl, who was acutely allergic to dairy, had a severe anaphylactic reaction. Tragically, despite being treated immediately with an injection of epinephrine and receiving CPR, she couldn’t be revived.

This is a chilling reminder that being aware of both your patients’ allergies and what might trigger them is crucial when providing care. While you’re probably aware of your patients’ allergies to medications and anesthesia, being aware of uncommon allergies to common dental products is equally important.

Here are a few tips to help ensure you’re prepared.

Make sure your patients disclose all their allergies — do some digging

When providing you with their medical history, patients may disclose only the allergies they assume are relevant. Be sure to explain to patients that you need to be aware of all their allergies, even those that are seemingly unrelated to their treatment, such as allergies to foods or dyes. It’s also a good idea to ask how severe those allergies are and what their typical reaction is.

Know what’s in the products you use

Be diligent about knowing what the products you use contain and which ingredients may be allergy risks, and have alternatives available for patients with sensitivities. Here are some possible allergens to be aware of.

Latex

Latex is frequently found in dental products other than gloves, including a few that might not be immediately obvious, such as:

• Dental dams
• Interdental picks
• Mouth props
• Prophy cups
• The nose bridge of patient safety glasses

Gluten

While gluten is commonly associated with breads and grains, it can pop up in a surprising number of dental products, including:

• Fluoride products
• Oral prostheses and appliances made with methyl methacrylate or MMA, such as dentures, retainers and temporary crowns
• Prophy pastes
• Sample products for patients
• Therapeutic agents
• Whitening systems

Dairy

As noted earlier, certain dental products contain dairy, most commonly toothpastes and sugar-free gums that contain an ingredient called Recaldent, which is made from a milk protein.

Food additives

Additives used to enhance the taste or appearance of certain oral hygiene products may cause allergic reactions. Triclosan, sodium lauryl sulphate and sodium lauryl sarcosinate in toothpaste, and cinnamic aldehyde, proflavine, benzydamine, chlorhexidine and alcohol in mouthwashes have been shown to cause allergic reactions in people sensitive to these substances.

Metals

Metals found in fillings, dentures, implants and orthodontic appliances have caused reactions in patients sensitive to them. Possible culprits are nickel alloys, mercury and titanium. For fillings, consider composite resin, glass ionomer or porcelain materials as options. 

Tragic outcomes are rare, but the risk is always present. But with due diligence and a few questions, you can minimize the risk of allergic reactions and ensure that you provide your patients with the safest care possible.