Delayed type allergic reaction following the use of nonlatex rubber dam during endodontic treatment

AIM: To describe the development of a delayed type allergic reaction 24 h following the use of nonlatex rubber dam during endodontic treatment. The symptoms were alleviated with adequate medication; however, the patient rejected any further analysis. SUMMARY: In recent years, allergic reactions because of latex rubber dam and gloves have received more attention. Nonlatex products are advocated in clinical use in cases where the patient presents an allergic background. Although rare, adverse reactions may be encountered even with these products. In this article, a very rare case is presented in which a patient developed signs of allergy 24 h after the utilization of nonlatex rubber dam and gloves during endodontic treatment. Signs including visible redness on the mucosa, submucosal oedema and desquamation in the vestibular mucosa were observed. With proper medication, the signs and symptoms were alleviated. Although the patient was referred to an allergy specialist for patch testing, she did not accept any further analysis. KEY LEARNING POINTS: This case emphasizes the necessity of precautions during the management of latex-allergic patients in clinical practice. The unusual response encountered in this patient does not undermine the usefulness of nonlatex rubber dam and gloves in sensitive individuals.     

Management of the latex hypersensitive patient in the endodontic office

This case report documents the treatment of an endodontic patient who experienced a type 1 hypersensitivity reaction to latex. The dental, medical, and environmental aspects of treating latex allergic patients are reviewed. Because gutta-percha and latex rubber are similar compounds, the possible cross-reactivity of these materials is discussed.     

Latex glove allergy in dental practice

Skin reactions due to the use of latex examination gloves occur frequently in dental practice. They consist of immediate type I allergy to natural latex protein, type IV delayed hypersensitivity to rubber additives and irritant dermatitis. Type I allergy to latex protein can cause contact urticaria, angioedema, rhinoconjunctivitis and asthma in the dentist, the dental assistant and also in the patient. Exceptionally, latex allergy can cause a life-threatening anaphylactic reaction. Cross reactions to tropical fruit can occur in the latex allergic patient. Type IV allergy causes allergic contact dermatitis. Rubber additives are also present in synthetic rubber. Glove advice for latex allergic patients are presented.     

Hypersensitivity to sodium hypochlorite

Sodium hypochlorite (NaOCl), the most commonly used irrigant in endodontics, is known to produce allergic reactions. This fact, however, is rarely mentioned in endodontic texts. Until now, only two cases of adverse reaction describing accidental injection of NaOCl have been reported. In the current study a case is presented in which hypersensitivity to household bleach was proven with skin patch tests. The clinician was warned of the possible health hazard from using NaOCl in this patient by the past medical history. Endodontic therapy was carried out with an irrigant not containing NaOCl after the allergy to NaOCl was verified. Treatment was uneventful. It is suggested that before any endodontic treatment in which sodium hypochlorite is to be used, the patient should be asked about hypersensitivity to household bleaching materials.     

Latex allergy: A review for the dental professional

Reactions to latex products are reportedly occurring with an increased frequency both in patients and in health care providers. Natural rubber latex is found in numerous products, and adverse latex reactions range from contact dermatitis to life-threatening anaphylaxis. A complete understanding of the pathophysiology of latex allergy provides the foundation for the proper diagnosis and treatment of patients with latex allergy. This article provides the reader with a review of latex allergy and suggests strategies for the management of patients with latex hypersensitivity. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:5-11)     

Latex allergy in an orthognathic patient and implications for clinical management

A 19-year-old girl with mild asthma had had 16 months of orthodontic treatment as part of the joint orthodontic/orthognathic approach to her 9.5 mm overjet. At the time of banding her second molars she developed latex protein allergy as a reaction to the operator's non-sterile powdered latex gloves. She also gave a history of allergy to other substances as well as of eczema. The patient was confirmed as allergic to latex protein by radioallergosorbent test (RAST) for IgE, requiring precautions be taken during further orthodontic procedures as well as during the subsequent orthognathic surgery for the underlying Class II skeletal pattern.     

Contribution of Endodontic Pathology to Persistent Orofacial Pain: A Case Report

Identifying the etiology and correct diagnoses for long-standing orofacial pain can be very challenging, especially in patients who have both odontogenic and nonodontogenic pain. This case report describes the successful management of a complex case of chronic orofacial pain in a patient with nonodontogenic chronic pain conditions and a maxillary molar tooth with persistent periapical pathology after endodontic treatment. The debilitating orofacial pain began after initial nonsurgical root canal treatment of the maxillary molar 3 years before presenting to our clinic. The initial clinical and radiographic assessment by our multidisciplinary team found that there were potentially both peripheral endodontic pathology and central pain mechanisms contributing to the long-standing pain. The diagnosis was shared with the patient's neurologist, who prescribed gabapentin, a centrally acting analgesic, and partial pain reduction was achieved. The odontogenic component of the orofacial pain was then addressed, by treating the persistent periapical infection and buccal bone fenestration of the roots of the maxillary molar. Treatments included both nonsurgical retreatment and surgical endodontic therapy (including root resection, root-end preparation, and retrofilling), and each significantly improved the patient's ongoing orofacial pain. After the successful endodontic treatments, the patient reported minimal pain and normal oral function. The case report highlights the importance of systematically treating endodontic pathology in a patient with long-standing orofacial pain, with both odontogenic and nonodontogenic components.     

Reported latex allergy in dental patients

OBJECTIVE: The purpose of this study was to alert doctors of dental surgery to the possibility of latex sensitivity in both outpatients and inpatients. STUDY DESIGN: The study involved 2 groups: group A was composed of 21 subjects with a history of immediate reaction in dental environment; group B was composed of 24 healthy individuals. Patients underwent skin prick tests with common inhalant allergens, with latex cross-reacting foods, with a commercial extract of non-ammoniated latex, and the incremental challenge test with local anesthetics. Specific IgE to latex and to latex cross-reacting foods were measured with the fluorescent enzyme immunoassay. RESULTS: All patients in group A and none in group B were latex-allergic. Subjects who were latex-allergic were significantly more likely to be atopic and had positive IgE test to cross-reactive foods. CONCLUSIONS: Dentists and people working in a dental surgery environment must obtain detailed patient history to help identify individuals at risk of latex allergy or those actually allergic to latex. If an allergy exists, equipment used should be made of alternative materials.     

Complications of endodontic therapy in florid osseous dysplasia

A case in which endodontic therapy triggered an exaggerated inflammatory reaction in a patient with preexisting florid osseous dysplasia is presented. We suggest prophylactic antibiotic treatment before endodontic therapy in patients with this condition.     

Clinical Judgement And Decision Making In Endodontics

Clinical judgement in endodontics consists of much more than diagnosis and treatment planning for the affected tooth. The issues involved in clinical judgement and decision making can be summarised by three questions:

• 1 Is endodontic treatment appropriate for the patient? Endodontic treatment should be undertaken only as part of an agreed, comprehensive treatment plan that takes into account patient concerns as well as objective clinical findings.
• 2 How difficult is the endodontic treatment? The difficulty of the case should be balanced with the skill and experience of the dentist, in deciding whether to manage the case in general practice or to refer the patient to an endodontist. The use of a standard form for assessing the difficulty of each endodontic case will aid in consistent, systematic assessment of patients. An example of such a form is provided.
• 3 What is the prognosis for the tooth? The outcome of endodontic treatment depends not only on the endodontic treatment but on other factors such as restorability and periodontal status. The prognosis will be compromised by procedural problems and by restorative and periodontal factors.

In all but routine cases, the steps involved in decision making may be more complex and less easily resolved than the practical clinical aspects of endodontic therapy.     

Strategies and dental care in the treatment of patients with myelomeningocele

Myelomeningocele (MMC) is a congenital malformation that occurs in the embryonic period, characterized by failure in closure of the caudal portion of the neural tube during central nervous system formation. Alterations and complications can be associated with this condition, such as hydrocephalus, neurogenic bladder, orthopedic problems, and motor and cognitive impairment. This patients with MMC also have predisposition to develop latex allergy and high caries risk and activity due to deficient oral hygiene, fermentable carbon hydrate‐rich diet and prolonged use of sugar‐containing oral medications. This paper reports the oral findings and dental treatment in a 15‐year‐old female patient diagnosed with MMC and describes the strategies used to improve dental treatment conditions and reduce the impact of associated risks to her health. The measures and precautions adopted in this case could be useful to reduce the barriers for patients with the same condition to access oral health care: regular visits to the dentist, initiating as early as possible; frequent reinforcement of oral homecare instructions and diet counseling; minor adaptions to the dental chair and dental office to improve ease of access due to patients’ mobility problems; prevention of latex‐related allergic reactions; reduction of gag reflex during dental procedures.     

Endodontic treatment and immunopathology of periapical granuloma in an AIDS patient

Abstract The complications of endodontic treatment in an AIDS patient are described and related to the immunopathological findings in a periapical granuloma. The lesion contained abundant polyclonal immunoglobulin-producing plasma cells but was virtually devoid of CD4-positive T cells (putative “helper” phenotype), indicating compromised local immune function. Delayed healing of apical periodontitis after endodontic treatment of teeth with periapical lesions was found in several teeth in this case. Root canal treatment of teeth with vital pulps was performed successfully. Extraction of teeth and endodontic treatment in combination with root resection were uneventful.     

Conventional endodontic therapy of upper central incisor combined with cyst decompression: a case report

Treatment of a maxillary central incisor with an associated cystic lesion by conventional endodontic therapy combined with decompression is reported. Although small cystic lesions frequently heal simply with endodontic therapy, larger lesions may need additional treatment. If surgical enucleation is elected, other teeth or structures may be damaged unnecessarily. Therefore, a case can be made for first attempting the more conservative treatment of decompression, and a workable protocol for this is presented. In this case, 6 weeks with latex tubing in place and daily irrigation with 0.12% chlorhexidine led to complete healing with no need for further surgery or other root canal therapy on teeth initially surrounded by this lesion. At the 2-year recall, the lesion has completely resolved, and the adjacent teeth remain vital and normal.     

Latex allergy in dentistry. Review and report of case presenting as a serious reaction to latex dental dam

Latex allergy may have severe consequences including development of anaphylaxis. This report describes a patient who underwent a reaction to latex dental dam manifesting as erythema, facial swelling and mild airway compromise. Restorative procedures under latex dental dam were performed under local anaesthesia on two occasions resulting in reactions of increasing severity. Following the first event the cause of the reaction was undetermined, but attributed to a possible allergy to local anaesthetic, and managed with corticosteroids and antihistamines. On a subsequent occasion the swelling was more severe, associated with difficulty in swallowing and mild airway compromise, and was managed as previously with adrenaline also being required. Latex allergy was subsequently confirmed.     

Mesenchymal chondrosarcoma mimicking apical periodontitis

This report describes the case of a patient with mesenchymal chondrosarcoma in the region of tooth #18 that mimicked apical periodontitis. Forty-five days after endodontic treatment, gingival swelling and intense pain were observed. The endodontist suspected a furcation lesion, and the treatment option that the patient chose was extraction of the tooth. Seven days after suture removal, a rapidly growing swelling was seen in the region. The patient was referred to an oral and maxillofacial surgeon, who recommended an incisional biopsy after evaluating imaging and clinical findings. Microscopic examination confirmed the diagnosis of mesenchymal chondrosarcoma. The patient underwent hemimandibulectomy with wide surgical margins. This clinical case draws attention to the fact that endodontic lesions should be carefully evaluated because malignant tumors such as mesenchymal chondrosarcoma might mimic apical periodontitis.     

Apical root end resection (Apicoectomy) as treatment option in cases of dental trauma in young patient

Apical root end resection is becoming popular procedure as a treatment option in cases of ortho-grade endodontic failure. In this case report it has been shown that root end resection (Apicoectomy) had succeed to preserve a tooth after dental trauma with root fractured in the apical third. Any other conservative endodontic treatment failed. One-year follow-up revealed complete healing of the area. Apical root end resection might serve as a viable treatment option in cases of dental trauma in young patient in carefully selected patients.     

Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study

Outcome assessment of endodontic treatment is critical for appropriate case selection and treatment planning. However, reports on outcomes of nonsurgical endodontic treatment vary considerably. Epidemiological studies done in a large patient population and over a long follow-up period can provide the clinician with useful tools for clinical decision-making and assessment of tooth prognosis. In this study, outcomes of initial endodontic treatment done in 1,462,936 teeth of 1,126,288 patients from 50 states across the USA was assessed over a period of 8 yr. Treatment was done by private general practitioners and endodontists participating in the Delta Dental Insurance plan that insures approximately 14 million individuals in the USA. Overall, 97% of teeth were retained in the oral cavity 8 yr after initial nonsurgical endodontic treatment. The combined incidence of untoward events such as retreatments, apical surgeries, and extractions was 3% and occurred mostly within 3 yr from completion of treatment. Analysis of the extracted teeth revealed that 85% had no full coronal coverage. A significant difference was found between covered and noncovered teeth for all tooth groups tested (p < 0.001). In conclusion, it appears that initial nonsurgical endodontic treatment is a predictable procedure with high incidence of tooth retention after 8 yr.     

Rapid periapical bone destruction during endodontic treatment of a patient with rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease with an unknown etiology. Azathioprine is an immunosuppressive drug that is used to treat rheumatoid arthritis. This case report describes the rapid periapical bone destruction that occurred during the endodontic treatment of a rheumatoid arthritis patient taking azathioprine and a corticosteroid. The cause of the rapid destruction is unclear. However, severe side effects can occur after administering azathioprine to rheumatoid arthritis patients. Therefore, dentists should check the patient's medical state thoroughly in order to prevent side effects when performing endodontic treatment.     

Endodontic treatment in patients at risk

The course of the endodontic treatment of periapical process in a patient with renal engraftment is described. Such a patient is under a constant cytostatic therapy suppressing the immune system, thus the risk of the endodontic treatment failure being higher, with the possibility of patient's health impairment. Preparation, premedication and performance of endodontic therapy applicable in patients at risk are described and explained. Consultations with respective medical professionals were necessary, pointing to the need of an interdisciplinary approach in such patients.     

Long-term Complications of Previously Successful Regenerative Endodontic Procedures after Orthodontic Movement: A Report of 3 Different Complications after 4, 8, and 11 Years

There is a paucity of literature on late complications of regenerative endodontic procedures. The aim of this article was to report 3 cases of previously successful regenerative endodontic procedures with long-term follow-up that developed different complications after the application of orthodontic forces. In the first case, an 8-year-old female patient received a regenerative endodontic procedure in her previously intruded tooth (tooth no. 21) that had been rendered necrotic after a successful spontaneous repositioning procedure. The 5-year follow-up revealed uneventful healing, continuous root development, dentinal wall thickening, and regaining of pulp vitality for tooth no. 21. Four years later, the patient received orthodontic treatment with mild forces that lasted 2 years. The 11-year follow-up revealed severe external invasive cervical resorption, and the tooth had to be extracted. In the second case, a 6-year-old female patient suffered a lateral luxation injury in tooth no. 11. Six months after the injury, the tooth developed symptoms and discoloration and tested negative in pulp vitality testing. Single-step regenerative endodontic procedures were applied, and successful continuous root development, dentinal wall thickening, and apical closure were achieved at the 3-year follow-up. Two months after the initiation of orthodontic treatment, the tooth developed symptomatic apical periodontitis. Root canal treatment was performed to treat the disease, and the orthodontic treatment was continued. In the third case, a previously published successful regenerative endodontic procedure developed a perforating internal resorption 6 months after the application of orthodontic forces. The internal resorption was arrested with root canal treatment, the resorptive defect was repaired with bioceramic obturation, and the orthodontic treatment plan was modified. Previously successful regenerative cases might develop external invasive cervical resorption, regenerative tissue necrosis, or internal resorption after the application of orthodontic forces. Best practice/evidence-based guidelines on the appropriate orthodontic management of successful regenerative endodontic therapy teeth are lacking. Whenever possible, careful monitoring and partial or complete exclusion off orthodontic treatment might be necessary. In some cases, preventive root canal treatment before the initiation of orthodontic movement might be considered.