Glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency) in dentistry
G6PD deficiency is a genetic condition that causes the red blood cells to lyse more easily. It is likely an evolutionary development to malaria, as we find the trait in individuals whose ancestors are from parts of the world with malaria.
G6PD deficiency impact on dental care
There is concern about what drugs can induce hemolysis and the answers are not fully known at this time. Some research shows lidocaine and articaine as acceptable and others not. Prilocaine, benzocaine, codeine, and benzos are drugs that most dental research says to avoid, but they are not found on general research into the condition. Most of the confusion is likely because only the most severe cases are likely to have issues. Despite the condition being fairly common (400 million cases worldwide), the severe cases (Class I) are much rarer.
Who is likely to have G6PD deficiency?
It’s mostly men, and in particular men from areas of the world with malaria. Therefore we are talking about African, Mediterranean, and some Asian decent are most likely to have the condition.
What are the symptoms?
The symptoms will appear in 2 to 3 days and are almost always self limiting and do not need any treatment. The actual symptoms can be found here.
So what can a dentist do for a G6PD deficiency patient?
The answer is still unknown for sure but it seems highly unlikely that we need to change anything we do since if there was adverse impacts from this we would have seen it. Perhaps there are some cases of Class I individuals who have had a negative experience with dental care. My guess is they would have to have large amounts of anesthetics and have an additional risk factor or trigger. Severe cases may know they have this from anemic events in the past and in that case it would be best to speak with the MD on what they feel can use and still be ok. May just have to use what you usually do and know to watch for symptoms after.
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