Angioedema triggered by pulp extirpation--a case report

Hereditary angioedema type II and dental extraction: case report and literature review

Introduction: The hereditary angioedema of type II (HAE type II) is a disease which, in the case of invasive acts such as dental extractions, can trigger potentially fatal laryngeal edema. Observation: A 64-year-old man presented to the hospital to perform dental extractions. The anamnesis revealed a history of hereditary angioedema of type II. The National Reference Center for Angioedema (CREAK) recommended a prophylactic protocol before performing this traumatic dental procedure in order to reduce the risk of post-operative edema. Discussion: The HAE type II is under- or misdiagnosed. The literature reports cases of death related to dental procedures in patients unaware of being a carrier of the disease. Conclusion: In case of certain evocative signs (recurrent edema, abdominal pain, family history, etc.), the odontologist must play an active role in the early detection of HAE type II.

Management of patients with hereditary angio-oedema in dental, oral, and maxillofacial surgery: a review

Hereditary angio-oedema (HEA) is an autosomal dominant, life-threatening genetic disorder that is caused by insufficiency or dysfunction of the C1 esterase inhibitor that develops coincidentally with recurrent oedema in the skin, internal organs, and upper respiratory tract. Increased production of bradykinin secondary to increased plasma kallikrein activity is the primary cause of attacks. Dental procedures cause emotional stress and mechanical trauma and may also initiate attacks. The most feared complication is asphyxiation as a result of laryngeal oedema. Cases that resulted in death after tooth extraction have been reported, so dentists and oral and maxillofacial surgeons should take maximum care in the treatment of patients with HAO, consult with the patient's doctor, and ensure that prophylaxis is given before the procedure. They should work as atraumatically as possible and use procedures to minimise stress. In the event of an attack of HAO, despite all the correct measures having been taken, the procedure should be terminated immediately and treatment of the attack started as soon as possible. The first drugs for the treatment of acute attacks are C1-INH (C1 inhibitor), ecallantide, or icatibant.