From Volume 42, Issue 6, July 2015 | Pages 580-582
This paper describes a case of a 13-year-old patient with a systemic hypersensitivity reaction to orthodontic treatment. Her allergy was investigated resulting in a provisional diagnosis of pressure urticaria. The aetiology, diagnosis and clinical management of allergic reactions to dental procedures are discussed.
A 13-year-old girl was referred to her local hospital orthodontic department by her general dental practitioner. Her presenting complaint was that she was unhappy with her crooked teeth. Her medical history revealed a history of mild asthma, well controlled with Salbutamol prn inhaler and Becotide MDI. She appeared to be fit and well.
Her relevant dental history included surgical removal three years previously of an unerupted supernumerary tooth from the maxillary midline, associated with an impacted maxillary left central incisor. The surgical treatment had proceeded uneventfully and the central incisor had erupted spontaneously within the year following surgery. Orthodontic examination revealed a Class II division 1 occlusion with a severely crowded maxillary arch (Figure 1). Panoramic radiography revealed no abnormal tooth or bony pathology.
The orthodontic treatment plan was to correct her malocclusion with a combination of an upper removable appliance initially, using headgear for anchorage reinforcement. With good compliance established, the extraction of four first premolars and upper and lower fixed appliances were planned. She co-operated well with the removable appliance and headgear wear, and she was therefore referred to her dental practitioner for the extraction of all four first premolars. One day after the extractions, she attended the hospital Orthodontic Department as an emergency patient, complaining of severely swollen lips. On examination, her lips were inflamed, oedematous and crusting (Figure 2). The swelling was not associated with any itchiness and there was no swelling elsewhere. To investigate this unusual reaction to extractions she was referred to the hospital's Accident and Emergency Department. The diagnosis at this time was ‘trauma-induced oedema following dental extractions’ and, following subsequent spontaneous subsidence of her symptoms within the next few hours, no active treatment was instigated. There were no further episodes of swelling at this time and it was decided to continue her orthodontic treatment.
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