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Gao L, Kuraji R, Zhang MJ, Martinez A, Radaic A, Kamarajan P, Le C, Zhan L, Ye C, Rangé H, Sailani MR, Kapila YL. Nisin probiotic prevents inflammatory bone loss while promoting reparative proliferation and a healthy microbiome. NPJ Biofilms Microbiomes 2022; 8:45. [PMID: 35672331 PMCID: PMC9174264 DOI: 10.1038/s41522-022-00307-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/04/2022] [Indexed: 12/20/2022] Open
Abstract
Dysbiosis of the oral microbiome mediates chronic periodontal disease. Realignment of microbial dysbiosis towards health may prevent disease. Treatment with antibiotics and probiotics can modulate the microbial, immunological, and clinical landscape of periodontal disease with some success. Antibacterial peptides or bacteriocins, such as nisin, and a nisin-producing probiotic, Lactococcus lactis, have not been examined in this context, yet warrant examination because of their biomedical benefits in eradicating biofilms and pathogenic bacteria, modulating immune mechanisms, and their safety profile in humans. This study's goal was to examine the potential for nisin and a nisin-producing probiotic to abrogate periodontal bone loss, the host inflammatory response, and changes in oral microbiome composition in a polymicrobial mouse model of periodontal disease. Nisin and a nisin-producing Lactococcus lactis probiotic significantly decreased the levels of several periodontal pathogens, alveolar bone loss, and the oral and systemic inflammatory host response. Surprisingly, nisin and/or the nisin-producing L. lactis probiotic enhanced the population of fibroblasts and osteoblasts despite the polymicrobial infection. Nisin mediated human periodontal ligament cell proliferation dose-dependently by increasing the proliferation marker, Ki-67. Nisin and probiotic treatment significantly shifted the oral microbiome towards the healthy control state; health was associated with Proteobacteria, whereas 3 retroviruses were associated with disease. Disease-associated microbial species were correlated with IL-6 levels. Nisin or nisin-producing probiotic's ability to shift the oral microbiome towards health, mitigate periodontal destruction and the host immune response, and promote a novel proliferative phenotype in reparative connective tissue cells, addresses key aspects of the pathogenesis of periodontal disease and reveals a new biomedical application for nisin in treatment of periodontitis and reparative medicine.
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Affiliation(s)
- Li Gao
- Orofacial Sciences Department, School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Department of Periodontology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Ryutaro Kuraji
- Orofacial Sciences Department, School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Department of Life Science Dentistry, The Nippon Dental University, Tokyo, Japan
- Department of Periodontology, The Nippon Dental University School of Life Dentistry at Tokyo, Tokyo, Japan
| | - Martin Jinye Zhang
- Oralome, Inc, 1700 4th Street, Byers Hall Suite 214, San Francisco, CA, USA
| | - April Martinez
- Orofacial Sciences Department, School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Allan Radaic
- Orofacial Sciences Department, School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Pachiyappan Kamarajan
- Orofacial Sciences Department, School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Charles Le
- Orofacial Sciences Department, School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Ling Zhan
- Orofacial Sciences Department, School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Changchang Ye
- Orofacial Sciences Department, School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA, USA
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Periodontology, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Hélène Rangé
- Orofacial Sciences Department, School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Université Paris Cité, Faculty of Health, Department of Periodontology, URP2496 Orofacial Pathologies, Imaging and Biotherapies Laboratory, Montrouge and Paris Center for Microbiome Medicine, PaCeMM, FHU, Hôpital Rothschild, APHP, Paris, France
| | - M Reza Sailani
- Oralome, Inc, 1700 4th Street, Byers Hall Suite 214, San Francisco, CA, USA
| | - Yvonne L Kapila
- Orofacial Sciences Department, School of Dentistry, University of California, San Francisco (UCSF), San Francisco, CA, USA.
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Shi J, Wang Q, Ruan G, Chen Y, Zhao M, Shi D, Pan B, Xu Z, Zhang T, Wang F, Xu C. Efficacy of probiotics against dental caries in children: a systematic review and meta-analysis. Crit Rev Food Sci Nutr 2022; 63:9977-9994. [PMID: 35607893 DOI: 10.1080/10408398.2022.2077693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Dental caries causes serious consequences and the financial burden of society especially in children with high morbidity rate. Here we carried out a meta-analysis to systematically evaluate the efficacy of probiotics against dental caries in children. Forty-three RCTs were eligible for this meta-analysis after searching the PubMed, Cochrane and Web of Science from the inception through October 2021. Pooled estimates demonstrated that treatment with probiotics significantly reduced noncavitated (dicdas2-6mft) (SMD = -0.18, 95% CI: -0.3 to -0.06, p = 0.002) and cavitated (dicdas5-6mft) carious lesions in children (SMD = -0.32, 95% CI: -0.5 to 0.14, p = 0.0004). Probiotics also reduced prevalence of noncavitated (dicdas2-6mft) carious lesions (RR = 0.8, 95% CI: 0.67 to-0.97, p = 0.02). Salivary Streptococcus mutans was declined after intervention (SMD = -1.17, 95% CI: -1.85 to -0.5, p = 0.0007), while Lactobacillus counts were upregulated (SMD = 1.19, 95% CI: 0.46-1.92, p = 0.001). However, no significant effects in total bacteria counts and salivary pH were observed. Our findings suggest that probiotics especially Lactobacillus could be a promising therapeutic strategy for clinical applications in children dental caries.
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Affiliation(s)
- Jiangmin Shi
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qinjian Wang
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Gaoyi Ruan
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yaoxuan Chen
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Min Zhao
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dibang Shi
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Binhui Pan
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhihua Xu
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tiaotiao Zhang
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fangyan Wang
- Department of Pathophysiology, School of Basic Medicine Science, Wenzhou Medical University, Wenzhou, China
| | - Changlong Xu
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Ho JPTF, van Riet TCT, Afrian Y, Sem KTHCJ, Spijker R, de Lange J, Lindeboom JA. Adverse effects following dental local anesthesia: a literature review. J Dent Anesth Pain Med 2021; 21:507-525. [PMID: 34909470 PMCID: PMC8637917 DOI: 10.17245/jdapm.2021.21.6.507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/16/2021] [Accepted: 10/05/2021] [Indexed: 01/23/2023] Open
Abstract
Local anesthesia is indispensable in dentistry. Worldwide, millions of local anesthetic injections are administered annually, and are generally considered safe invasive procedures. However, adverse effects are possible, of which dentists should be aware of. This scoping review aimed to provide an extensive overview of the reported literature on the adverse effects of dental local anesthesia. The types of papers, what is reported, and how they are reported were reviewed. Additionally, the incidence and duration of adverse effects and factors influencing their occurrence were also reviewed. An electronic search for relevant articles was performed in PubMed and Embase databases from inception to January 2, 2020. The titles and abstracts were independently screened by two reviewers. The analysis was narrative, and no meta-analysis was performed. This study included 78 articles. Ocular and neurological adverse effects, allergies, hematomas, needle breakage, tissue necrosis, blanching, jaw ankylosis, osteomyelitis, and isolated atrial fibrillation have been described. Multiple adverse effects of dental local anesthesia have been reported in the literature. The results were heterogeneous, and detailed descriptions of the related procedures were lacking. Vital information concerning adverse effects, such as the dosage or type of anesthetic solution, or the type of needle used, was frequently missing. Therefore, high-quality research on this topic is needed. Finally, the adverse effects that are rarely encountered in real-world general practice are overrepresented in the literature.
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Affiliation(s)
- Jean-Pierre T F Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Northwest Clinics, Alkmaar, The Netherlands
| | - Tom C T van Riet
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Youssef Afrian
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Kevin T H Chin Jen Sem
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - René Spijker
- Medical Library, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jerome A Lindeboom
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amstelland Hospital, Amstelveen, The Netherlands
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Jevon P, Shamsi S. Management of anaphylaxis in the dental practice: an update. Br Dent J 2020; 229:721-728. [PMID: 33311677 PMCID: PMC7729689 DOI: 10.1038/s41415-020-2454-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/25/2020] [Indexed: 01/22/2023]
Abstract
Anaphylaxis is a severe and potentially life-threatening allergic reaction that can occur in the dental practice. There are a number of dental-related causes including mouthwashes, local anaesthetics, latex and antibiotics. The dental team must be able to respond effectively and manage the life-threatening situation appropriately following Resuscitation Council UK guidelines. The timely administration of adrenaline is life-saving; any delays can lead to a poor outcome. With the current national supply issues with adrenaline auto-injector devices, there is an expectation that GDPs should be competent at drawing up adrenaline from an ampoule and administrating it intramuscularly. The aim of this article is to provide an update on the management of anaphylaxis in the dental practice with particular reference to the procedure for intramuscular injection of adrenaline.
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Affiliation(s)
- Phil Jevon
- PGCE Academy Tutor, Walsall Teaching Academy, Manor Hospital, Walsall, UK.
| | - Shaam Shamsi
- Director, Horizons Dental Centre, Stoke-on-Trent, UK; HEWM FD Training Programme Director, CQC Specialist Advisor, RCS Examiner, UK
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5
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Insights into hypersensitivity reactions in dentistry. Porto Biomed J 2020. [DOI: 10.1097/j.pbj.0000000000000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Burcham WK, Romito LM, Moser EA, Gitter BD. Analyzing Medication Documentation in Electronic Health Records: Dental Students' Self-Reported Behaviors and Charting Practices. J Dent Educ 2019; 83:687-696. [PMID: 30910923 DOI: 10.21815/jde.019.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/08/2018] [Indexed: 11/20/2022]
Abstract
The aim of this two-part study was to assess third- and fourth-year dental students' perceptions, self-reported behaviors, and actual charting practices regarding medication documentation in axiUm, the electronic health record (EHR) system. In part one of the study, in fall 2015, all 125 third- and 85 fourth-year dental students at one U.S. dental school were invited to complete a ten-item anonymous survey on medication history-taking. In part two of the study, the EHRs of 519 recent dental school patients were randomly chosen via axiUm query based on age >21 years and the presence of at least one documented medication. Documentation completeness was assessed per EHR and each medication based on proper medication name, classification, dose/frequency, indication, potential oral effects, and correct medication spelling. Consistency was evaluated by identifying the presence/absence of a medical reason for each medication. The survey response rate was 90.6% (N=187). In total, 64.5% of responding students reported that taking a complete medication history is important and useful in enhancing pharmacology knowledge; 90.4% perceived it helped improve their understanding of patients' medical conditions. The fourth-year students were more likely than the third-year students to value the latter (p=0.0236). Overall, 48.6% reported reviewing patient medications with clinic faculty 76-100% of the time. The respondents' most frequently cited perceived barriers to medication documentation were patients' not knowing their medications (68.5%) and, to a much lesser degree, axiUm limitations (14%). Proper medication name was most often recorded (93.6%), and potential oral effects were recorded the least (3.0%). Medication/medical condition consistency was 70.6%. In this study, most of the students perceived patient medication documentation as important; however, many did not appreciate the importance of all elements of a complete medication history, and complete medication documentation was low.
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Affiliation(s)
- Wesley K Burcham
- Wesley K. Burcham, DDS, is a 2018 graduate of Indiana University School of Dentistry; Laura M. Romito, DDS, MS, MBA, is Associate Professor, Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry; Elizabeth A. Moser, MS, is a biostatistician, Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health; and Bruce D. Gitter, PhD, is Clinical Professor, Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry
| | - Laura M Romito
- Wesley K. Burcham, DDS, is a 2018 graduate of Indiana University School of Dentistry; Laura M. Romito, DDS, MS, MBA, is Associate Professor, Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry; Elizabeth A. Moser, MS, is a biostatistician, Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health; and Bruce D. Gitter, PhD, is Clinical Professor, Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry
| | - Elizabeth A Moser
- Wesley K. Burcham, DDS, is a 2018 graduate of Indiana University School of Dentistry; Laura M. Romito, DDS, MS, MBA, is Associate Professor, Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry; Elizabeth A. Moser, MS, is a biostatistician, Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health; and Bruce D. Gitter, PhD, is Clinical Professor, Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry
| | - Bruce D Gitter
- Wesley K. Burcham, DDS, is a 2018 graduate of Indiana University School of Dentistry; Laura M. Romito, DDS, MS, MBA, is Associate Professor, Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry; Elizabeth A. Moser, MS, is a biostatistician, Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health; and Bruce D. Gitter, PhD, is Clinical Professor, Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry
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7
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Zhang B, Li Q, Shi C, Zhang X. Drug-Induced Pseudoallergy: A Review of the Causes and Mechanisms. Pharmacology 2017; 101:104-110. [PMID: 29136631 DOI: 10.1159/000479878] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 07/28/2017] [Indexed: 12/11/2022]
Abstract
Adverse drug reactions occur frequently and can trigger pseudoallergy, which has become a serious threat to public health. Pseudoallergy is a typical non-immune anaphylactic reaction characterized by the independence of antigen-specific immune responses. In the clinic, pseudoallergy is often elicited by the first dose of medication, and here lies its unpredictability and occasional lethal outcome. However, the mechanisms of pseudoallergy are not well understood. This review focusses on the causes and mechanisms of pseudoallergy induced by drugs. Two categories of mechanisms will be considered, namely, (1) complement activation-related pseudoallergy and (2) mast cell activation-related pseudoallergy. The factors that induce pseudoallergy include opioid drugs, complement activation-related pseudoallergenic drugs, nonsteroidal anti-inflammatory drugs and traditional Chinese medicine injections.
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Affiliation(s)
- Bo Zhang
- Department of Pharmacology, Institute of Materia Medica, Zhejiang Academy of Medical Sciences, Hangzhou, PR China
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Kvisselgaard AD, Mosbech HF, Fransson S, Garvey LH. Risk of Immediate-Type Allergy to Local Anesthetics Is Overestimated-Results from 5 Years of Provocation Testing in a Danish Allergy Clinic. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:1217-1223. [PMID: 28988784 DOI: 10.1016/j.jaip.2017.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/14/2017] [Accepted: 08/15/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Local anesthetics (LAs) are used in many health care settings and exposure during a lifetime is almost inevitable. Immediate-type allergy to LAs is considered rare among allergy experts but is commonly suspected by health care workers from other specialties, and by patients. OBJECTIVE The main aim of this study was to investigate the incidence of immediate-type allergy to LAs in our regional allergy clinic over the 5-year period 2010 to 2014. METHODS This was a retrospective single-center study of patients referred to a regional allergy clinic (excluding patients with perioperative reactions) with suspected immediate allergy to LAs, who had undergone subcutaneous provocation with 1 or more LAs. Patients were identified in the hospital clinical coding system and clinical information about the reaction and investigation results was obtained from their medical records. RESULTS A total of 164 patients (123 women/41 men; median age, 56 years; range, 7-89 years) who had 189 provocations with LAs were included over the 5-year period 2010 to 2014. All 164 patients had negative subcutaneous provocations to all 189 tests with LAs (95% CI, 0%-1.83%). Another allergen was identified in 10% (n = 17) of the patients. CONCLUSIONS None of the 164 patients with suspected immediate-type allergy to LAs reacted on provocation. Thus, no patients have been diagnosed with an immediate allergy to LAs in our regional allergy clinic in the 5-year period studied, and allergy to LAs must be considered very rare. Alternative mechanisms should be considered, but if symptoms are consistent with allergy, other potential allergens should be investigated.
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Affiliation(s)
- Ask D Kvisselgaard
- Allergy Clinic, Department of Dermatology and Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Holger F Mosbech
- Allergy Clinic, Department of Dermatology and Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sara Fransson
- Allergy Clinic, Department of Dermatology and Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Seminario-Amez M, López-López J, Estrugo-Devesa A, Ayuso-Montero R, Jané-Salas E. Probiotics and oral health: A systematic review. Med Oral Patol Oral Cir Bucal 2017; 22:e282-e288. [PMID: 28390121 PMCID: PMC5432076 DOI: 10.4317/medoral.21494] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 01/17/2017] [Indexed: 12/14/2022] Open
Abstract
Background Probiotics are microorganisms, mainly bacteria, which benefit the host’s health. Many studies support the role of probiotics as a contributor to gastrointestinal health, and nowadays many authors are trying to prove its influence in oral health maintenance. Objectives To review the published literature with the purpose of knowing the importance of using probiotics as a preventive and therapeutic method for oral infectious diseases management. Material and Methods An electronic search in PubMed database with the keywords “oral health AND probiotics AND dentistry” was conducted. The inclusion criteria were: randomized clinical trials (RCTs) that assess the action of any probiotic strain in the treatment and / or prevention of an infectious oral disease, RCTs that assess the action of any probiotic strain on counting colony forming units (CFU) of oral pathogens, systematic reviews and meta-analysis. The Jadad scale was used to assess the high quality of RCTs. Results Fifteen articles were considered for this review. Of which, 12 were RCTs of good / high quality (Jadad scale), two meta-analysis and one systematic review. Conclusions The literature reviewed suggests probiotics usage could be beneficial for the maintenance of oral health, due to its ability to decrease the colony forming units (CFU) counts of the oral pathogens. However, randomized clinical trials with long-term follow-up periods are needed to confirm their efficacy in reducing the prevalence/incidence of oral infectious diseases. Furthermore, the recognition of specific strains with probiotic activity for each infectious oral disease is required, in order to determine exact dose, treatment time and ideal vehicles. Key words:Probiotics, periodontal diseases, dental caries, oral health.
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Affiliation(s)
- M Seminario-Amez
- Department of Odontostomatology - School of Dentistry, Pabellón de Gobierno - Bellvitge University Campus, C/Feixa LLarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain,
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Kvisselgaard AD, Krøigaard M, Mosbech HF, Garvey LH. No cases of perioperative allergy to local anaesthetics in the Danish Anaesthesia Allergy Centre. Acta Anaesthesiol Scand 2017; 61:149-155. [PMID: 27878813 DOI: 10.1111/aas.12833] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/30/2016] [Accepted: 10/30/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Local anaesthetics (LA) are often suspected as possible causes of allergic reactions. The Danish Anaesthesia Allergy Centre (DAAC) is the national reference centre for investigation of perioperative allergic reactions. The purpose of this study was to investigate the incidence of IgE-mediated immediate type perioperative allergic reactions to LA. METHODS In the period 2004-2013, a total of 409 patients (244 women/165 men; median age 49 years, range 1-86 years) were investigated in DAAC on suspicion of allergy associated with anaesthesia and surgery. A total of 162 (40%) patients were exposed to one or more LA. Suspected allergy to LA was investigated by prick test, intradermal test and subcutaneous provocation with the suspected drug. Patients with positive skin tests still underwent subcutaneous provocation, as false positive skin tests can occur. RESULTS A total of 203 test series with LA were carried out on 162 patients (89 women/73 men; mean age 49 years, range 2-85 years) with the following drugs: Lidocaine n = 80 (49%), bupivacaine n = 82 (51%), ropivacaine n = 31 (19%) and mepivacaine n = 10 (6%). All 162 patients had negative subcutaneous provocation for all tested LA (95% CI: 0-1.8%). Investigations revealed another allergen in 52 of 162 patients. CONCLUSION None of the 162 patients with suspected perioperative allergic reactions and exposure to LA reacted on subcutaneous provocation with the relevant LA. Thus, no patients have been diagnosed with allergy to LA in DAAC in the period 2004-2013 and allergy to LA must be considered very rare in this population.
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Affiliation(s)
- A. D. Kvisselgaard
- Danish Anaesthesia Allergy Centre; Allergy Clinic; Department of Dermatology and Allergy; Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - M. Krøigaard
- Danish Anaesthesia Allergy Centre; Allergy Clinic; Department of Dermatology and Allergy; Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - H. F. Mosbech
- Danish Anaesthesia Allergy Centre; Allergy Clinic; Department of Dermatology and Allergy; Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - L. H. Garvey
- Danish Anaesthesia Allergy Centre; Allergy Clinic; Department of Dermatology and Allergy; Herlev and Gentofte Hospital; University of Copenhagen; Hellerup Denmark
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Abstract
BACKGROUND AND OBJECTIVE Selective killing of pathogens by laser is possible due to the difference in absorption of photon energy by pathogens and host tissues. The optical properties of pathogenic microorganisms are used along with the known optical properties of soft tissues in calculations of the laser-induced thermal response of pathogen colonies embedded in a tissue model. The objective is to define the laser parameters that optimize pathogen destruction and depth of the bactericidal effect. MATERIALS AND METHODS The virtual periodontium is a computational model of the optical and time-dependent thermal properties of infected periodontal tissues. The model simulates the periodontal procedure: Laser Sulcular Debridement.1 Virtual pathogen colonies are placed at different depths in the virtual periodontium to determine the depth for effective bactericidal effects given various laser parameters (wavelength, peak power, pulse duration, scan rate, fluence rate) and differences in pathogen sensitivities. RESULTS Accumulated background heat from multiple passes increases the depth of the bactericidal effect. In visible and near-IR wavelengths the large difference in absorption between normal soft tissue and Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi) results in selective destruction. Diode laser (810 nm) efficacy and depth of the bactericidal effect are variable and dependent on hemin availability. Both pulsed-Nd:YAG and the 810 nm diode lasers achieve a 2-3 mm deep damage zone for pigmented Pg and Pi in soft tissue without surface damage (selective photoantisepsis). The model predicts no selectivity for the Er:YAG laser (2,940 nm). Depth of the bactericidal effect is highly dependent on pathogen absorption coefficient. Highly sensitive pathogens may be destroyed as deep as 5-6 mm in soft tissue. Short pulse durations enable confinement of the thermal event to the target. Temporal selectivity is achieved by adjusting pulse duration based on target size. CONCLUSION The scatter-limited phototherapy model of the infected periodontium is applied to develop a proper dosimetry for selective photoantisepsis. Dosimetry planning is essential to the development of a new treatment modality. Lasers Surg. Med. 48:763-773, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- David M Harris
- Biomedical Consultants & Associates, Inc., Paradise, California 95969.
| | - Lou Reinisch
- Academic Affairs, New York Institute of Technology, Old Westbury, New York 11568
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Abstract
Adverse reactions may occur with any of the medications prescribed or administered in dental practice. Most of these reactions are somewhat predictable based on the pharmacodynamic properties of the drug. Others, such as allergic and pseudoallergic reactions, are less common and unrelated to normal drug action. This article will review the most common adverse reactions that are unrelated to drug allergy.
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Affiliation(s)
- Daniel E Becker
- Associate Director of Education, General Dental Practice Residency, Miami Valley Hospital, Dayton, Ohio
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