What to do about angioedema from dental care?

Angioedema can be the result of dental care. Whether it is from the physical trauma or emotional stress of the event is unclear but it is a known risk.

Why is it important for a dentist to know about angioedema?

There are instances of patient death following routine dental care from angioedema so early recognition and treatment is critical. Although the swelling may occur minutes to hours following the dental procedure, most swelling occurs 12-24 hours later. The swelling can start on one side in a small area and spread to be larger and bilateral over the next several hours.

How do you treat angioedema?

Dentists don’t treat it. Antihistamines, corticosteroids, and epinephrine are ineffective in treatment of truly acute attacks. For a dentist the only thing we can do is a quick referral to a hospital ER for monitoring. Maintaining the airway is obviously critical. Most attacks spontaneously resolve. The medical team will use C1-esterase inhibitor replacement, antithrombolytics (tranexamic acid), plasma products (fresh frozen plasma), and attenuated androgens (danazol) if they feel necessary. Kalbitor is another drug they can use. There is some prophylactic treatment options. We have seen patients pre-med with ruconest and benedryl.

What causes angioedema from dental care?

Dental and medical procedures, emotional stress, hormonal changes, infections, and medications (including oral contraceptives and ACE-inhibitors) are among the most common causes of a angioedema event. The dental and medical procedures likely fall under the emotional stress category.

What is angioedema?

It is simply a swelling underneath the skin. It’s an overreaction of the body to something or some sort of allergen. The most common areas to have angioedema are the eyes, lips, and mouth for the dentist. Other common areas that we don’t deal with are the hands and feet and the genitals.

Who suffers angioedema episodes?

Hereditary angioedema (HAE) and the very rare acquired angioedema are the two syndromes that cause angioedema. HAE occurs in around 1 in 10-50,000 people and AAE is about 10 times more rare. There are multiple classifications and sub classifications, however these are clinically irrelevant to a dentist. They all result from a mutation of the C1-inhibitor gene, which prevents excessive inflammation. The gene it codes for acts as an off switch for inflammation, therefore lacking it creates excessive inflammation.

Medication that causes angioedema

The number one medication that causes angioedmea is ACE inhibitors, such as the very common Lisinopril. These represent 20-40% of the total of angioedema cases in the ER. The muscle relaxer, methocarbamol is another common cause of angioedema. People of African decent are the most likely to have ACE inhibitor induced angioedema.