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.
Absolutely have had this! One patient, who happened to be someone I knew outside of the office, has an allergy to all corn products, including oils which are found in plastics- use metal suctions!!!! Just the plastic suctions would cause an angioneurotic edema. And of course these reactions tend to be on patients who have severe asthmas, etc. I have tons of photos of these allergies over the years- if you would like I will share with you. Turns out one patient was on an antihypertensive which causes angio edema when you give a block, lovely! I have several patients with anaphylaxis histories to some flavorings so like you we use flour of pumice. Really spending time in history taking and exercising caution is critical- trips to the ER are expensive and tedious for the patient, but if you have to use epi in the office, you just bought a trip to at least the allergist or the ER… so caution! I use excessive caution in these patients- no plastic bibs, etc. I have one patient that cannot be in a building where there are strawberries she is so allergic!!! Boggles the mind, but as a parent of a child with allergies, I am relieved when people display caution!
Muna,
You are right about ER visits, not fun!!!!!
PS, always good to have an excellent allergist helping to diagnose- one patient we would document what was used, then send her right to him for testing when she would swell- he was able to find her antihypertensive rare response this way!
Was she from Sedona?
http://www.melisa.org
the MELISA test will check for any metal allergies that you suspect. titanium, gold, palladium allergies are more prevalent than i thought!
Thanks Will this is good to know, sometimes I refer folks to the allergist and now I can be specific. I was also not aware that folks were alletgic to noble metals.
Just a thought, but one presenter when I was in dental school showed us a number of cases similar to what you’re describing that turned out to be a bizarre presentation of Type 1 Herpes Simplex Virus. One of the strangest looked like desquamative gingivitis. Next time she comes in for an appointment give her viral prophylactic medication and see if she does any better.
Adam,
Great idea, I did not even think about this!!!
that is very informative information you have sheared with us. first i was tell you thanks for shearing this. and really its very good whom are not have enough knowledge of that.
Not from Sedona, just moved to Colorado, so good luck to my fellow dentist that gets her!!! ;-)
This may not be the best place to ask this, but, I’m looking for Atlanta dentists and I don’t know who is good and who is not… do you know anyting about this Atlanta dental care? They’reIt’s in Atlanta, near my home. I am not able to find reviews on them – Exceptional Smile LLC, 4420 Bankers Cir, Atlanta, GA 30360 – (678) 841-8800
Not to hijack this thread, but, I’d like to see Atlanta dentists and I have no idea who is good and who is not… has anyone ever heard of this Atlanta dental care? They’reIt’s located Atlanta, 20 min from my office. I am not able to find reviews on them – Exceptional Smile LLC, 4420 Bankers Cir, Atlanta, GA 30360 – (678) 841-8800
I see this is a pretty old thread, but I thought I’d write anyhow. i am writing from the patient perspective. I have many of the same allergies listed in the initial comments…..corn, sulfites, nickel, latex….also rice, oats and a host of other foods; molds, dust….yep, sucks to be me. But back to the reason I was joining in. I too have noticed in the past several years at each dental cleaning appointment. (2 a year). Later that day and in the following days my gums on the lower jaw, back by the last molars, and on the outside gum (base of tooth down to where it meets the cheek) get white spots and are very painful. I had no clue what caused it. But it generally lasts several days to a week then goes away. Never have it otherwise. Though many years ago, popcorn would produce inflamed gums and severe burning pain. Not exactly the same, and was before i was diagnosed with corn allergy. I am pretty sure it is a reaction to the prophy paste used at the cleaning. I can’t find any info on the ingredients so it makes it really hard to prove. My thinking is some of the paste that falls from the bristles accumulates back in these pockets between the lower back teeth and cheeks and sits for a while until I am allow to rinse. I’m wondering if the contact is long enough to produce the allergic response. At one time i thought it might be a metal allergy reaction to the tools, but dismissed this, since the rest of my mouth didn’t react at all. And there is more time spent cleaning the front teeth area than the molars. Another thought is that there might be a chemical used for sanitizing the tools? If anyone has had a patient with a similar reaction I’d love to hear what they think caused it.
I had my teeth cleaned and after I left I started burning and stinging in my gums. Worse in my back teeth. A month later after 3 dentist er dr and no one can tell me what’s wrong..gums still burn face still swelling up into face tissues and eyes..no help here.. all that was used was prophy paste and tools and water..antibiotics steroids zrytec..nothing stops it
Any advice from anyone would be helpful
It may be an allergic reaction to the prophy paste, which contains Fluoride, pumice, flavoring and other additives. Next time you are at the dentist ask that they use plain pumice instead of prophy paste. It can also be an irritation type response., and often the back teeth are scaled or hand cleaned more as this is where plaque and calculus build up. Most dental instruments are sterilized in an autoclave, which uses heat and steam. They may be soaked first in a liquid to clean and disinfect them, but if you were allergic to this I would expect the reaction to be generalized and not isolated to the molar regions. I’d of course advise you discuss this with the dentist and hygienist, and I would want to see the reaction if it happens after your next cleaning, as the visual appearance, plus their knowledge of the actual procedure and your teeth will be needed to find an answer.
My sister had her teeth cleaned and checked, then broke out in a rash on her forehead. It spread down her face and neck. Several days later she had two teeth extracted. Now, after three weeks from the initial cleaning she is broken out in a rash all over her body. The worst is on her trunk. She has seen two doctors and has tried several ointments but nothing has helped. Her doctor made her an appointment with a dermatologist who can’t see her until the middle of July. I think the rash is systemic. Can you offer any help or advice?
Dr.Brady, my dentist of many,many years retired two years ago & I found a new, very reputable dentist. I’ve now had my teeth cleaned with them three times (every 6 months). Last year, I had what was like a second degree chemical burn to my lip. I saw a dermatologist & was asked all the usual questions: any new toothpaste, floss, mouth wash, cosmetics, etc. All the answers were no. I don’t have any allergies what so ever (I’ve been tested – even the metals). Six months ago, out of the blue, the same thing happened. And now, 6 months later, it is happening again. After a lot of thinking, I believe the only thing I can narrow it down to is my cleaning every 6 months. A couple of days after the cleaning, my lips start to burn, then a couple of days after that, they really burn, then I develop blisters, cracks/fissures in the corners and then eventually, they heal (after a lot of pain & inability to eat). After some research, I was thinking it was probably the type of prophy paste they’re using. However, after reading this thread, now I’m questioning if it could be the plastic handles on the instruments. My former dentist used all metal instruments. I’d love to know your thoughts & I can send along pictures if you’d like.
Almost same thing with my son. We are going to get allergy test done tomorrow. My son is non-verbal due to his autism. So it is extremely difficult bc he cant tell me what is hurting him; I can only make an educated guess by this exact thing happening at his last cleaning 6 months ago. Hope somebody can figure this out soon. It is absolutely terrorizing us both!
I have the same reaction when i get my teeth cleaned. my lips are sore then they blister for several days after.
Recently had my teeth cleaned by a new dental hygienist and after returning from home the roof of my mouth had been like a chemical burn and blistered. It was difficult to eat 4 a few days and after 2 weeks there still is some residual sensitivity. I don’t know if it was from the paste from the cleaning or what