ALLERGIES IN DENTISTRY
In dentistry, just as nearly everywhere else in society, allergies seem to be on the rise. Experts give us many reasons for this, but suffice it to say more people are allergic to items commonly in use today than in the past.
To a doctor, an allergic reaction is a very specific thing. To many non medical people, an “allergy” can mean anything from, “I didn’t like the smell of that stuff”, to “I used that, and I had to go to the hospital because I couldn’t breathe.” To a doctor, an allergic reaction is a reaction to a normally harmless substance that causes a certain kind of inflammatory response which might include swelling or redness in the area of contact, hives, sneezing, coughing, wheezing, itching, sinusitis, etc. A true allergic reaction can become dangerous because it can affect the airway making breathing difficult or impossible. This is why when a patient says he is allergic to something when medical history questions are asked, the dentist has several follow up questions. A true allergy can be dangerous, so usually when a patient says he is allergic or might be allergic to something, a dentist will not use that item. A medical doctor (not a dentist) can do tests to determine if a person truly is allergic to something.
It is surprising how many people believe they are allergic to items that are basic to the practice of dentistry, but have not had the items checked by a doctor. For instance, about 10% of the people in Canada are allergic to Penicillin. What does this mean to dental treatment? If a person has a toothache caused by infection (which is the usual cause of a tooth ache), penicillin cannot be used. Furthermore, none of the entire group of antibiotics related to penicillin, and an entire group of common antibiotics that are related to the penicillin group cannot be used either. So what? What’s the big deal? Can’t another antibiotic be used instead? The answer to that is usually another antibiotic can be used. However, a more powerful antibiotic will usually have to be used and this extra “power” causes an increased chance of possibly dangerous side effects. A less powerful antibiotic can be used, but this choice has a lower chance of reducing the infection (and the pain it is causing). All of that is just fine if in fact the patient is truly allergic to penicillin. If he is not, several compromises have just been made to optimum treatment and all for nothing. Your medical doctor could give some interesting “what ifs” for what might happen in a medical situation if penicillin or one of its closely related medications was needed and a suspected allergy made it impossible to use the medication. The short answer is if you think you are allergic to something, ask to have it checked out.
Here’s another example for you. Sometimes people are allergic to some metals. If a crown is needed on a posterior (back) tooth, all metal or porcelain fused to metal are the strongest options. If the person insists he is allergic and will not be tested to figure exactly which metals have to be avoided, the crown will have to be made without metal. This will reduce the strength of the crown which will make it more likely to be broken (ruined and have to be done over at patient expense) because of regular chewing. Again, avoiding metal is unfortunate, but necessary IF the patient is actually allergic to the metal being used. If the patient is not actually allergic, a weaker and more costly choice (like a crown without metal) is just not smart. Ask your dentist what to do if you think you are allergic to something used in dentistry but you are not sure.
This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)