A collection of case reports published in the journal European Archives of Paediatric Dentistry shows how dentists can safely numb the mouths of children who have a high risk of severe allergic reaction to local anesthesia.
The authors noted that it can be trickier to give anesthesia to children than to adults because adverse reactions are harder to spot in children: Kids are more likely to feel anxious, leading to symptoms like flushing and dizziness — symptoms that often serve as early hints of an allergic reaction. This can make a reaction easy to miss at first. What’s more, children may not be able to communicate as well when something is wrong.
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The paper describes the cases of four children who needed dental work at Marmara University in Turkey: a 7-year-old boy with systemic mastocytosis (SM); a 9-year-old boy with asthma and a latex allergy; a 10-year-old boy who had a serious skin reaction in the past and had reacted badly to some antibiotics and pain medicines; and an 11-year-old girl who once had anaphylaxisAnaphylaxis A severe allergic reaction that can turn fatal without treatment. Patients with SM are at a higher risk of developing anaphylaxis. during surgery, and also had epilepsy.
All four children needed a local anesthetic to numb pain during dental treatment, but dentists were worried that they might have a bad reaction to the anesthetic given their medical history.
“In the absence of established, evidence-based guidelines in paediatric dentistry for managing children with complex allergic backgrounds requiring dental treatment under local anaesthesia, we propose a structured, safety-oriented clinical protocol,” the authors said.
The step-by-step plan involved consultations with other medical specialists like allergy doctors before the dental treatment, giving the child preventive medicine if necessary, preparing for a possible emergency, using a local anesthetic without preservatives and watching the child closely from the moment of anesthesia until two hours later.
Learn more about dental visits with SM: “How to prepare for dental care when you have SM“
The 7-year-old boy with systemic mastocytosisMastocytosis Rare disease caused by the buildup of mast cells. Cutaneous mastocytosis primarily affects the skin and is more common in children, while systemic mastocytosis affects internal organs and is more common in adults. needed dental care for cavities. He had no recorded serious allergic reaction, but was considered high-risk. Following the advice of the specialist doctor, he took antihistamine pills starting the night before and on treatment day, plus an IV steroid 30 minutes beforehand. The specialist also advised keeping an epinephrineEpinephrine Also called adrenaline, this hormone is used in emergency situations to reverse symptoms during a severe allergic reaction (anaphylaxis). autoinjector (EpiPen) handy during the dental treatment.
His dental work was done in an operating room with an IV line, emergency medicines and continuous monitoring. The dentists used a local anesthetic called mepivacaine, without preservatives. The boy had no problems.
Learn more about kids and mastocytosis: “What to know about SM in children“
