Data Management & Record Keeping

Allergic Reactions

Contact allergy involving the oral mucous, is a poorly understood clinical entity that is infrequently described. Contact allergy is also often mistaken for chronic trauma caused by fractured teeth, fractured restorations, ill-fitting prosthesis or parafunctional oral habits. These lesions have a similar clinical appearance.

Dental materials contining DL-camphorquinone, 4-dimethylaminobenzoic acid ethyl ester (DMABEE), drometrizol, 1,7,7 – trimethylbicyclo /2,2,1/ heptane, 2,2-dimethoxy /1,2/ diphenyletanone (DMBZ), ethyleneglycol dimethacrylate (EGDMA), and triethyleneglycol dimethacrylate (TEGDMA), all of these materials may potentially cause allergic reaction. In addition latex is also one of the important material to cause allergy.

Several manifestations of allergic reactions that have oral and facial involvement, these include angio-oedema of the lips and tongue, urticaria of the face and erythema multiforme of the skin, lips and oral mucous.

Management :

• Dental personnel should be familiar with the major signs and symptoms of allergic reactions, including anaphylaxis should arise during a consultation. Previous allergic status of patients and personnel should be noted.
• Dental personnel should always keep records of dental materials used. If allergic reaction occurs, backtracking is necessary in order to identify the specific allergen.
• Do not mistake contact allergy for chronic trauma.
• Nitrile, vinyl, or 4H gloves should be used by the dental practitioner if acrylate or latex sensitivity is suspected.
• If sensitivity is suspected inform the patient about possible clinical tests to determine origin of allergy, e.g. acrylate patch testing. Delayed sensitivity may be prevalent in certain cases.
• Be aware of cross-sensitivity towards colouring agents of dentures.
• Create a latex-free environment for personnel and patients with latex sensitivity.
• Local exhaust ventilation systems can significantly reduce the peak concentration of acrylate vapour in the breathing zone of dental technicians. (However, the local exhaust ventilation is not efficient in reducing the concentration of airborne acrylic dusts).

Types of consent

In order to practice in a professionally responsible manner, a dental practitioner must assist patients to make well-informed decisions about treatment procedures. Consent may be of three types; implied, verbal or written. For consent to be obtained the patient must have:

1. Capacity to consent
2. Understand the implications of treatment including:
   1. material risk
   2. time, extent and frequency
   3. outcome
   4. possible complications
   5. cost
3. Understand alternative treatment options, including undertaking no treatment
4. Given the consent freely, not under duress.

The patient’s signature on a document does not of itself establish that consent has been obtained. Among the matters, which would be considered by a court of law to establish consent, are:

• the patient was given sufficient and appropriate information on all aspects of the procedure;
• the information was provided in such a form that the patient could fully understand it;
• the patient, before consenting, had sufficient time to deliberate in an unfettered way on the relevant information;
• all possible complications, their frequency, the degree of incapacity they may cause and the possibility of permanence, were fully outlined in a way that the patient could completely understand;
• the cost of treatment was fully outlined and understood;
• the patient’s expectations of treatment outcomes were realistic;
• an appropriate referral was offered;
• an appropriate diagnosis was established;
• an accurate medical history was established and appropriately accounted for in treatment.

A written general consent is obtained when the patient comes for their first appointment.

Capacity to Consent

People may be considered not to have the capacity if they are:

1. Minors (< 16 years)
2. Mentally ill
3. Intellectually impaired
4. Affected by drugs or alcohol rendering them incapacitated.

In the case of minors or other persons with a legal disability the consent of the parent, guardian, or adult guardian should be obtained.

Clinical Consent

Every patient should have a treatment plan for each course of care recorded in his or her record in the patient management system. The plan should be discussed with the patient or their guardian and the discussion documented in the clinical notes. A print out of the treatment plan should be provided to the patient:

1. On request by the patient
2. The treatment is complex involving numbers of appointments
3. The treatment involves partial dentures, crown and bridge work, implants, molar endodontics, or surgery.

Verbal consent

Verbal consent is acceptable for simple general dental care and should be documented in the records.

Written consent

Written consent should be obtained for more complex treatment by asking the patient to sign a copy of the print out of the treatment plan. In addition all minors and cases of adult guardianship require written consent (see section on guardianship).

IDA has drawn out a set of guidelines on providing information to patients and recommends that dentist discuss:

1. The possible or likely nature of the care
2. The proposed approach to treatment including:
   1. numbers and length of appointments
   2. possible referrals to other practitioners or specialists
3. Other options for treatment
4. The likely outcomes
5. Any possible complications
6. The likely outcome of have no treatment
7. Cost (see section on financial consent)

Financial Consent

Any treatment undertaken will require the patient to give financial consent. Patients or their guardians should be informed prior to their next appointment of the likely costs.

Guardianship