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Managing the patient claiming to be allergic to dental materials

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I recently sent the following message to the members of the JCDA Restorative Dentistry Expert Panel

Question

A lady called the CDA office today distraught because she has called 21 dental offices seeking treatment, and all have refused her. She tells us that she is allergic to 9 different materials using in dental offices. She claims that because of the complications she would present to a general dental office, they are refusing to treat her.   Do you have any advice that we could give her please? Is there any practical “next steps” advice that we can pass on to Canadian dentists and their team, when they are contacted by patients who claim to have allergies to substances used in dental offices?

Initial responses

Panel Member 1

I have a patient just like this who came to see me one month ago, and I still do not know how to manage/accept her as a patient.  She has seen other specialists and has refused their treatment options.  She also cannot travel until the afternoon as morning appointments stress her too much.

I look forward to responses from my colleagues as I think that she may be untreatable, by me.

Panel Member 2

What are the 9 different materials used in the dental office that the patient is allergic to? Do we know?

Panel Member 3

Most dental schools have some sort of GPR/hospital program that might be able to sort out some of these issues including expertise in “supra-maxillary” issues.  Consults could probably be arranged to actually identify the offending agents, and treatment could be rendered were necessary life support is available.  I think if the patient is not willing to take this route then they may have an inappropriate/exaggerated sense of the condition and would most likely cause problems for the practitioner.  I think the practitioners who are not treating this patient are probably being prudent.

Panel Member 4

I don’t think it’s possible to make a generic recommendation. I would want to know what the allergies are and that each has been confirmed by an allergist that they are true allergies. Only then can options for care be considered.

Panel Member 5

This is a very interesting e-mail. I have had some experience of this kind in the UK where these cases were handled by NHS regional consultant service/ hospital dental service.  In some regions Community Dental Service (Senior Dental Officer (special needs)) would also deal with them.  I have roughed out a sensible strategy from memory on the attached file – Allergic patient management.

1 Comment

  1. Dorothy McComb September 12, 2012

    Advice is good in last document but only if these are true allergies confirmed by a recognized specialist in the allergy field. So the first thing is to know the facts concerning the allergies.
    There is one thing that has not been mentioned and that is the quasi “medical” field of alternative diagnosis/treatment and a tendency by some to suggest multiple allergies (food, environment, dental restorative materials etc) as the cause of any of a patients problems.
    There is a lab in Toronto called “Red Paw” (yes, actually named after the originators cat) that claims to do allergy testing on hundreds of materials on one person in one sitting without any actual contact with the material. They have a web site that has some information. I used to get patients who had been given a list of dental materials they were “allergic” to that was difficult to believe. For instance the list of about 100 materials would have a number beside it. If the number was above 50 the patient was allergic and if it was below 50 they were not. One such list had the patient allergic to Herculite shade A3 but not shade A2 which just does not make sense.
    Such a patient can truly believe this testing even tho it is nonsense! And these patients can also be very difficult to handle – a lot of assurance that only certain shades or materials will be used despite total disbelief by the dentist in the actual need for this! These patients also tend to distrust conventional medical/dental practitioners.
    So, again, the facts concerning the allergies must be known and the patient should be requested to bring in the information they have if it was not performed in a recognized medical facility and cannot be requested by customary channels from the specialist.

    Reply

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