Royal College of
Dental Surgeons of Ontario
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Food Allergies: Their Relevance to Dental Care

The risks of lethal food allergies was recently highlighted in the media.  A young  girl with a severe dairy allergy died after using a toothpaste recommended by her dentist. Read the news article on the CNN website.

This was an extremely rare case of an anaphylactic reaction to MI Toothpaste, which contains Recaldent (casein phosphopeptide-amorphous calcium phosphate), incorporating a milk-derived protein. This story heightened  public awareness of the dangerous consequences of food allergies and their link to dental care.

Possible dental implications of food allergies

Food allergies reported by patients can have dental implications. For example, patients with allergies to certain foods such as avocado, kiwi, pineapple and banana have a greater risk of being allergic to latex as these foods contain the same proteins found in latex. 

Some dental products like fluoride, prophy pastes, gum and sealant materials, may contain allergens such as fruit flavouring, pine nuts, traces of peanuts, clove oil, gluten and milk protein.

What dentist should keep in mind

This story is a signal for all dentists to obtain a thorough medical history and to cautiously consider each of their patient’s positive answers about allergies, medications and existing medical conditions.

Dentists are reminded to:

  • Carefully review the medical history with your patients to identify any potential allergic or adverse reaction to any medication, substance or product.
  • Conduct a review of system and probe further into any positive or unclear response by the patient to determine the history, type and severity of any reported allergic reaction.
  • Review contents or ingredients of dental materials and products used and identify potential allergens associated with a patient’s reported allergy.
  • Postpone treatment if needed and consult with the patient’s physician to request an allergy test, if deemed necessary.
  • Clearly document findings/precautions in the medical alerts and the progress notes of the patient’s chart.
  • Develop training for yourself and your clinical staff to promptly recognize the signs and symptoms of anaphylaxis and efficiently manage a medical emergency when needed. Signs and symptoms suggestive of anaphylaxis are:
    • itching of soft palate
    • nausea/vomiting
    • substernal pressure
    • difficulty breathing
    • hypotension
    • skin rash
    • urticaria
    • laryngeal edema
    • bronchospasm
    • cardiac arrhythmias.
  • Maintain an adequate and current emergency kit containing readily accessible sources of oxygen, diphenhydramine and epinephrine.

Relevant resources

The College encourages dentists to familiarize yourselves with the Medical History Recordkeeping Guide and use the following resources while managing and treating their patients.

  1. Medical History Recordkeeping Guide
  2. Patient Hand-out
  3. FAQs Medical Emergencies 
  4. Food Allergy Canada

 

Questions?
practiceadvisory@rcdso.org
Phone: 416-934-5614