People living with systemic mastocytosis (SM) learn to prepare in advance for all possible eventualities in their daily life to avoid triggering symptom episodes.
Everyday tasks need to be methodically prepared for. One example is planning for a visit to the dentist.
This requires managing anxiety and being aware of potential allergens, the risks of anesthetic and available alternatives, medications to avoid before and after dental care and other factors that might lead to symptoms that can significantly affect your health and well-being.
What is SM?
Systemic mastocytosis (SM) is a rare hematological disease characterized by mast cells that are overactive and accumulate in different parts of the body such as the bone marrow, liver, spleen, gastrointestinal tract and lymph nodes.
The risks of dental care in SM
There are numerous potential SM symptom triggers involved in receiving dental care. The following triggers are to be avoided and carefully managed to prevent mast cell activation and the release of histamine, cytokines and other chemicals into the blood.
- Stress: The apprehension and emotional stress of a visit to the dentist.
- Skin friction: A physical trigger from rubbing contact on the skin.
- Oral hygiene and dental materials: Latex, zinc oxide, eugenol, cobalt, chromium, nickel, gold, palladium and methacrylate.
- Over-the-counter medication: Aspirin, ibuprofen, naproxen, ketorolac.
- Opiate analgesics: Codeine, morphine, pethidine, buprenorphine.
- Antibiotics: Vancomycin, teicoplanin, quinolones.
Symptoms such as flushing, skin itchiness and irritation are the most common result, with anaphylaxis the most severe reaction.
Read more about SM care teams
Mast cells can reside in the connective tissue of the oral cavity, making dental management more challenging. As a result, people living with SM can experience complications related to their disease and treatment, such as bleeding, bone lesions and an increased risk of infection.
Tips to get ready for dental care
Take the time to discuss your upcoming dental visit with your doctor and ask for advice on steps to take.
Communicate with your dentist beforehand and request a proactive approach to ensure risks are minimized. In some cases, a multidisciplinary team is present to monitor the patient during the procedure and intervene when required. Explore the possibilities available to relieve your anxiety.
Taking a dose of antihistamines and mast cell stabilizers prior to your visit will help prevent a mast cell reaction, reducing the risk of symptom activation during the procedure.
General anesthetic can potentially trigger mast cell activity, so a local anesthetic such as nitrous oxide sedation is recommended. After your visit, paracetamol is the safest option for pain relief.
During your dental procedure and afterward, you should be under close supervision, with medication on hand to treat symptoms, including anaphylaxis.
