Allergies in Dentistry
Allergies to Dental Materials
Allergy to Medicines used in Dentistry
Allergy to Over the Counter (OTC) Dental Consumer Products
Millions of patients receive safe and effective dental treatment each year, thanks to our country having the most highly trained dentists in the world who also use the highest quality dental materials, prescribe safe and effective medicines and recommend or dispense the best OTC dental products. While patients reap the valuable dental health benefits of all this excellent care, problems can sometimes occur during the course of treatment in the forms of allergic or other adverse reactions to dental materials, medicines and/or OTC dental products.
Before a dental material, medication or OTC dental product is allowed to be used, prescribed or sold for patient treatment, the material/drug/product is thoroughly researched for safety and efficacy and tested for allergic reactions, toxicity and side effects. Data from scientific studies peformed in the laboratory and from human clinical trials are reviewed by agencies such as the U.S. Food and Drug Administration (FDA), American Dental Association (ADA), the American National Standards Institute (ANSI) and the International Organization for Standardization (ISO). A dental material, drug or product is approved for use only after being certified as both safe and effective by one or more of the above organizations.
Although all dental materials, medications or OTC products have passed these demanding safety tests and have been in use for years by millions of people every day, a very small percentage of people can and do experience allergic or other adverse reactions to some of these substances. In some cases the patient’s reaction is in fact an allergy, such as having an allergy to Penicillin. In most other cases the reaction is not an allergy, but may be a medication side effect or an irritant type of inflammatory reaction, similar to a rash. These sensitivity or irritant types of reactions can be accompanied by pain, redness, swelling, burning or itching at the affected site.
If the problem involves dental materials, whether the situation involves an allergy or not, the key to resolving the problem is to identify the dental material that is the source of the problem and have the material removed from the mouth. In most cases, the patient’s family Dentist will be able to identify the problem and correct it. Some cases may require further diagnosis and treatment from a dental specialist such as a Periodontist, Prosthodontist, Oral Pathologist and/or Oral Medicine expert. An Allergist/Immunologist may also be needed to help identify and treat the problem.
If the problem involves medications or OTC products, the Dentist, Dental Specialist and/or Physician will take a detailed history of the patient’s problem, examine the patient and attempt to identify the medication or product that is causing the reaction. Once a diagnosis is made, treatment usually consists of discontinuing a medication or product, or may involve modifying how a certain medicine or product is used. For example, some patients overuse OTC products like tooth whiteners and can experience adverse reactions. In cases like this, the Dentist will examine the problem and educate the patient on proper use of the product, and then monitor the patient for any future problems. If a medication or product can no longer be taken or used, alternative medicines or products will be prescribed or recommended.
Dental materials used in the United States have a long history of safety, effectiveness and biocompatibility. Biocompatible materials are not harmful to the body – they are meant to be non-toxic, non-allergic, non-irritant and non-carcinogenic. Ideally, biocompatible materials are meant to function in such a way that mimics or enhances the tissue being replaced or repaired. For example, dental implants are made of titanium, a material that is “friendly” to the jaw bone – when a dental implant is surgically placed in the jaw, the bone grows onto the surface of the implant, a process known as “osseointegration”. So, one of the primary reasons why dental implants work so well is due to biocompatibility – the dental implant literally becomes “anchored” to the jaw bone.
Typical materials used in Dentistry are amalgam (“silver fillings”) and tooth-colored composites for fillings; Gold and other metal alloys as well as Porcelain ceramics, are used to make crowns, inlays, bridgework and veneers; Cements, such as glass ionomers and resin ionomers are used to temporarily or permanently cement crowns and bridgework; Acrylic is used to make dentures and orthodontic appliances; Chromium-Cobalt alloy is used to make the metal framework for partial dentures; gutta-percha, a rubber material, is used in root canal treatment; and titanium is used for dental implants. Allergic reactions to dental materials are rare, but some studies have associated exposure to Nickel (which is contained in some crowns and bridges) with allergic reactions. Studies also suggest that women may have a higher incidence of allergy to Nickel. Although gutta-percha is a rubber material, it has not been shown to produce allergic reactions in individuals who have a Latex allergy.
Dental Amalgam (“silver filling”)
There has been some recent controversy about the safety of dental amalgam used as a filling material to restore cavities/decay in teeth. Dental amalgam has been used for over one hundred years, with a scientifically documented excellent safety record. In the past decade, US Public Health Service statistics report that of the approximately 200 million dental restorations placed each year, almost 100 million were dental amalgam fillings. Dental amalgam is composed of mercury (43-54%) and varying percentages of silver, tin, and copper (46-57%). When mixed together, these substances create a composite material, or amalgam, that has remarkable qualities to be used as a filling material in teeth.
The primary concerns recently expressed about the safety of amalgam is that it contains mercury. In high concentrations, mercury can be a toxic substance that can affect nerve and brain function, so addressing concerns about human exposure to mercury from a variety of possible sources is a valid issue. The key health issue, however, is the amount of mercury exposure.
As far as dental amalgams are concerned, the good news is that the latest scientific studies have found that mercury exposure, if any, from dental amalgams consist of trace amounts and that this is not considered to be a health risk. Most Americans have seven or eight silver fillings, and according to a World Health Organization (WHO) report, the amount of mercury that can be released daily from seven silver fillings is about one microgram, which is one-millionth of a gram. According to the Environmental Protection Agency (EPA), we absorb five to six times that amount of mercury daily (5-6 micrograms), from food and water sources. All these types and amounts of trace mercury exposure are considered safe, as the EPA has determined that the maximum safe limit for mercury exposure is 460 micrograms per day.
Putting all this in perspective, it is a wise health practice to limit exposure to mercury wherever and however possible. For example, EPA studies show that the primary exposure to mercury in the U.S. population is due to fish such as tuna and swordfish and eating these kinds of fish is not advised, especially in pregnant and nursing women and in young children, due to the potential health risks. As for silver fillings, the World Health Organization has determined that toxic levels of mercury exposure would need to equal approximately 300 fillings in one person’s mouth, so having seven or eight silver fillings is simply not an amount that could be considered toxic. Given all this information, an expert panel of the FDA that is reviewing the safety of dental amalgam has recently noted that “dental amalgam is safe for most people.”
Furthermore, studies have also confirmed that dental amalgams are not associated with medical conditions such as alzheimer’s disease, parkinson’s disease, autism, cancer, multiple sclerosis, and others. The FDA has reported some rare hypersensitivity reactions to the metals contained in dental amalgams, and these symptoms can be successfully resolved by removing the dental amalgam filling(s). An important report from the American Dental Association about the safety of dental amalgam entitled “What Others Say” is contained as an online link in the “For More Information” section at the end of this article.
Patients need to talk to their Dentist about any concerns about having dental amalgam restorations placed in or removed from their teeth. The Dentist can provide all the information needed to help the patient make treatment decisions that are in their best interests.
Medications Used in Dentistry
Medications that are most frequently used in dentistry fall into a few basic categories such as antibiotics, analgesics, anesthetics, topical fluorides and chemical bleaching (tooth whitening) agents. Other medicines that are also used in dentistry are sedatives, corticosteroids, anti-fungals, anti-virals and antihistamines. Dentists are well-trained in Pharmacology and are very familiar with the safety, effectiveness and side effects of the medicines they prescribe. Dentists also work closely with the patient’s physician and pharmacist whenever necessary to ensure that the patient receives the most appropriate and safe medications, especially if the patient has other medical conditions.
All medications prescribed by dentists are FDA approved for safety and efficacy, however, many medications have certain potential side effects and some medications carry the potential for adverse and allergic reactions. It is the dentist’s responsibility to be aware of the possible side effects and allergies associated with certain medicines they may prescribe, and discuss this information with patients in order to minimize side effects and lessen or eliminate risk of allergic reactions. It is the patient’s responsibility to provide the dentist with a complete medical history, especially with respect to particular side effects and/or allergies the patient has had with any medicines. With the dentist and patient working together, the dentist and patient can both have more confidence and peace of mind that the medicines prescribed for the patient’s condition will serve to help and not harm the patient.
If it is determined that the patient has a particular sensitivity or allergic reaction to a medication, the dentist will place an alert on the patients chart about the medication and review and update the patient’s medical history before each dental visit. The dentist will also work with the patient’s physician and pharmacist in prescribing appropriate medications that the patient is not allergic to and that do not have adverse interactions with other medications the patient may be taking.
Over The Counter (OTC) Dental Consumer Products
OTC Dental Consumer Products primarily consist of toothpastes, toothbrushes, floss, mouth rinses and bleaching (tooth whitening) agents. Dental medicaments are also available in OTC form, including topical pain relievers (topical anesthetics) and medicines used to treat oral sores such as aphthous ulcers.
The FDA Center for Drug Evaluation and Research, Office of Nonprescription Products oversees all OTC drugs and products to insure they are safe and effective and properly labeled. According to the FDA, OTC dental and medical products generally have the following characteristics:
Products are available without a prescription
Products benefits outweigh their risks
Potential for misuse and abuse is low
Consumer can use the products for self-diagnosed conditions
Products can be adequately labeled, and include thorough directions and precautions
Health practitioners are not needed for the safe and effective use of the products
OTC Dental Consumer Products are quite safe and are used millions of times each day. However, some chemical detergent ingredients in these products such as Sodium Laurel Sulfate (SLS) have been associated with sensitivity or irritant reactions to oral tissues in susceptible individuals. Toothpastes that contain natural oils and flavoring agents such as cinnamon have also been associated with sensitivity or irritant reactions. A small percentage of individuals can become allergic to benzocaine, which is contained in OTC dental pain relieving gels and in some sore throat medications.
Last updated: Aug-29-06