The incidence of lidocaine allergy in dentists: an evaluation of 100 general dental practitioners.

OBJECTIVES: Local anesthetics are some of the most common drugs used in dentistry and about 6 million people daily around the world are subjected to their effect in procedures performed by a similar number of dentists who, in turn, are usually not aware of the fact of being allergic to this group of medications. Assuming that dentists are also patients, and that in their daily practice the contact with the allergen is very frequent, it is essential to assess the incidence of allergy to lidocaine in general dental practitioners. MATERIAL AND METHODS: The authors evaluated a group of 100 general dental practitioners in whom adverse reactions similar to anaphylaxis occurred after local anesthesia. The study included individuals who, in their thorough medical history, had experienced episodes of such reactions regarding the skin, airways, gastrointestinal tract and other areas. RESULTS: The relations between type I hypersensitivity and certain symptoms, time from exposure to their appearance, as well as time from the last episode were investigated. Allergy to lidocaine was detected in 17 subjects - type I hypersensitivity was diagnosed in 13 cases (skin prick test - 7; intradermic test - 6) and 4 subjects had IgE-independent allergy (patch test). In the group where type I hypersensitivity was detected, urticaria, angioedema and rhinitis were indicated as inclusion criteria more often than among other subjects. According to the results, the occurrence of angioedema increased the risk of detection of type I hypersensitivity 68.8 times, and 1 year longer period from the last episode decreased this risk by circa 55%. CONCLUSIONS: The most important, from the clinical practice point of view, was to show the relation between the medical history indicating the anaphylactic nature of the lidocaine intolerance, and an allergy confirmed by skin tests. Int J Occup Med Environ Health. 2019;32(3):333-9.

Central giant cell granuloma located in the maxilla in a 8-year old boy.

UNLABELLED: Central giant cell granuloma is a rare occurring tumor-like lesion of the facial part of the skull, located more often in mandible (from 2:1 to 3:1), than in the maxilla. It accounts for 7% of all benign tumors of the jaws, whereas the brown tumor is a complication of a primary hyperparathyroidism and occurs in approximately 4.5%, or in 1.5%, when the tumor is a complication of secondary hyperparathyroidism. However, the brown tumor is significantly less often observed than the presented lesion. The authors describe a case of central giant cell granuloma of the maxilla, located in the area of premolar teeth. Pantomograhic x ray showed unilocular osteolytic bone loss of the maxilla with ectopic teeth. As a part of the One Day surgery procedures, the tumor has been removed with the margin and embedded teeth, and oroantral communication closure performed. In follow-up examination after 10 months and 2 years from the surgery, no recurrence of the tumor has been observed. CONCLUSION: In diferential diagnosis of tumors of face and skull, it is needed to consider the giant cell granuloma and also the brown bone tumor.

ATYPICAL DISLOCATION OF IMPACTED PERMANENT TEETH IN CHILDREN. OWN EXPERIENCE.

INTRODUCTION: Disturbances in forming of the hard tissue of teeth and bones can be a cause of their malformation and translocation. The impact of permanent teeth is one of them. It can occur with translocation of the tooth germ. The aim of the study was to present an atypical translocation of impacted permanent teeth in children. MATERIAL AND METHODS: 3.5 year clinical observation was carried out in 14 children (5 girls and 9 boys), aged between 9 and 12 years old. Patients were referred to our Department by orthodontists, paedodontists and General Dental Practitioners, due to impacted permanent teeth. According to the interview, in 8 cases children suffered from a trauma of a facial part of the skull, caused by a fall. On admitance patients were generally healthy. Basing on the clinical and radiological examination, translocation of the impacted permanent teeth has been diagnosed. In 9 cases it concerned medial maxillary incisors, whereas in remaining children--maxillary premolars. The extraction of such teeth has been performed as a part of the one day surgery procedures. CONCLUSION: In the cases where basing on the radiogram, the position of the tooth allows to predict the latter translocation, the germ has to be extracted.

Dental issues in Rett syndrome.

The advancements in science and technology allowed saving the lives of children, who had no chance of survival before. Hence the problem of so called rare diseases, usually genetically determined. It is a new challenge for both the physicians and the health services. These children require a coordinated multi specialist oriented health care, which includes also dentists. This situation is reflected by the case of an 18 years old girl with Rett Syndrome, described by us. In this patient despite numerous visits to various dental practices, no decision of a radical surgical extraction of the tooth has been conducted. In our Department the extraction of teeth 22, 16 and 14 has been performed, as a part of 1 day surgery procedures, thus eliminating the dental infections and pain. Conclusion: Elaboration and introduction into praxis principles of dental care in children and young adults with rare diseases are needed.

Dental problems in a patient with the classic type of Ehlers-Danlos syndrome--a case report.

The huge progress in diagnostic and therapeutic procedures in developmental medicine allowed not only to save lives of many children and adolescents, but also enforced the necessity of close cooperation between many specialists. Unfortunately dental treatment is still not an integral part of taking care of disabled children and youth with chronic diseases. The situation worsens, when we come across the so-called rare diseases. Lack of access to dental services, when it comes to disabled patients, results from financial situation, healthcare system, as well as parents' ignorance of necessity of more frequent prophylactic and treatment visits. Whereas the reluctance of dentists towards the care of disabled patients is caused by difficulties with enforcing the recommendations and lack of procedures for taking care of patients with rare diseases, which was repeatedly signalled by us. Such situation is ideally pictured by yet another described case of the 17 year old patient with Ehlers-Danlos syndrome. Despite many dental visits, no vital treatment decisions have been made. In our Department, in the procedures of 1-day surgery, tooth 48, being the cause of pain, has been extracted. Basing on all of the above, it can be deduced that preserving the continuation and consequence in spreading the knowledge of rare diseases among patients, as well as physicians and dentists, is a responsibility of everyone who even once came across this problem.

[Large dentigerous cyst caused by retained tooth 25]. / Duza torbiel zawiazkowa spowodowana zatrzymanym zebem 25.

Follicular cysts are benign, non-inflammatory odontogenic cysts, usually painless and discovered during routine radiographic examination. The article describes a case of a large follicular cyst with retained tooth 25. Pantomographic x ray showed the presence of a large follicular cyst located on the side of the impacted 25 tooth. The cyst has been enucleated and the tooth extracted surgically with subsequent closure of oro-antral communication. After 3 months orthodontic treatment was initiated.

[Malignant hyperthermia - problem in dental surgery. An introductory report]. / Hipertermia zlosliwa - problem w chirurgii stomatologicznej. Doniesienie wstepne.

Malignant hyperthermia is a genetic defect of uncontrolled hypermetabolic skeletal muscle response to anesthetic triggering drugs. Some congenital myopathies are regarded as risk increasing factors. The use of volatile anaesthetics or suxamethonium (succinylcholine) in patients who are predisposed to malignant hyperthermia leads to an increase in Ca2+ release from sarcoplasmic reticulum, which in turn causes a set of biochemical and clinical symptoms, which can be a cause of death, if dantrolene is not administered adequately. The aim of the study was to draw attention to the problem of malignant hyperthermia, which is hardly ever described in Polish literature, and requires the necessity of intensifying the cooperation between the dentist and specialists from other medical fields. The origin of the article was a case of congenital myopathy with recognized malignant hyperthermia in an 18-year-old patient, in whom surgical extraction of teeth was indicated. The course of diagnostics and treatment showed once more that contemporary medicine is in need of holistic approach, and in consequence, promising and effective cooperation of many specialists.