Sometimes we encounter situations int he practice of dentistry that are unique. The first response can be to dismiss it as an anomaly or even the patient’s imagination. On the other hand a little detective work can f=go along way in helping the patient feel heard and our team to learn something we can use to help our patients. Today I had a new patient in the office who reported that she hasn’t had her teeth cleaned for ten years because the last 3-4 times all of her gums in her mouth swelled, were painful and took days to calm down. It is possible to have an isolated area that gets tender or even feels swollen with more aggressive scaling, and I have had patients report generalized tenderness if they present with gingival inflammation, but this was new to me. The patient added that when she has reported this to the last 2 dentists that dismissed it and then when it happened she came int o show them and they were shocked.
Now, at first blush I have no idea what the cause might be, but I do know that I never want to be shocked when a patient proves me wrong by having an adverse reaction so I started asking questions. The patient reported having an allergy to sulfites in wine, base metals like Nickel and a medication called Vioxx. It might be possible that the use of metal currettes and scalers could be the cause of a reaction, although I have never sen this before. I started doing some research and it turns out that there are reported cases of patients being allergic to prophy paste. Some have a true allergy to fluoride, while others are allergic to other filler or preservative chemicals int he prophy paste. It surprised me to learn that there have been proven cases of being allergic to OTC toothpaste as well.
Of course we are all familiar with how common latex allergies are these days, so I asked that question right up front. I also found articles reporting allergic reactions to most of the common products we use in a dental office, so where does that leave me? I’m operating under the belief that she is allergic to something during a hygiene visit. We will try and eliminate as many of the variables as possible, so we can polish with fine flour of pumice and not risk prophy paste. In addition on recommendation from her physician we will use one tab of 5mg prednisone as a pre-med.
If you have dealt with anything similar, I;d love to hear what happened and how you helped the patient int he future.