© Rawpixelimages | Dreamstime.com
Dreamstime M 116946643 60b9249376275

Preventing life-threatening allergic reactions in pediatric dental patients

June 3, 2021
Once a parent has experienced a child in anaphylactic shock, things are never the same. Here's how you can understand and address allergy concerns instead of seeing them as "crazy" and annoying, and elevate yourself as a provider.

Kelsey Whetten, BS, RDH, EFDA

A nine-month-old is given a graham cracker for the first time and struggles with it. It is one of her first foods to try besides purees, but the struggle develops into more than just inexperienced chewing when the little girl begins throwing up, develops hives all over her chest, and becomes visibly distressed. This is anaphylaxis.

A mischievous toddler makes a new friend at the park who shares a bit of a peanut butter bar with him, causing vomiting, blue lips, and full-body hives, followed by his little body going limp. This is anaphylaxis. 

An older child eats a supposedly safe treat, and develops throat tightness and wheezing. Yet another example of anaphylaxis. After any of these experiences, you can never be the same parent.

When a food allergy mom or dad is bringing a child in for the first visit, she or he has more hesitations than a parent who is bringing in a child simply thinking, “I hope they cooperate and have a good experience!” This parent is nervous about the ingredients in the polish, in the fluoride, what the hygienist, doctor or others in the office may have had for lunch, and even concerned about the scented soap in the bathroom. Not only does she want her child to cooperate and have a good dental experience—she wants them to come out of it unharmed and healthy.

Some families may call ahead of time with specific concerns. Others may arrive and hope that you can accommodate. And in this era, you should be prepared to accommodate. One in every 13 children has a food allergy.1 That equates to about two kids for every classroom in the United States—so how many would that be in your dental office?!

While the severity of allergy symptoms varies, nearly 40% of these children have already experienced a severe reaction. Thirty-two million people in the United States are living with food allergies, and every three minutes a food allergy reaction sends someone to the emergency room.2 That's worth paying attention to on a medical history form and asking further questions. Here are a few other facts that are good to be aware of especially when reviewing a patient's medical history:

  • food allergies are related to eczema, allergic rhinitis, and asthma;
  • family history of food allergies can increase risk; and
  • food allergies are not the same as Celiac disease or food intolerances!3

As both an allergy mom and dental hygienist, I think of myself as having a double sensitivity to infection control and cross contamination. All those years of taking the OSHA classes about washing our hands and cleaning surfaces? Allergy moms care about that stuff too!

Obviously, you are washing your hands, and keeping your operatory surfaces, handles, and instruments clean from contaminants. You should also consider not eating that peanut butter sandwich or handful of almonds prior to an appointment with patient with an allergy. It may even be a good idea to schedule patients with food allergies in the morning, before your office has lunch hour. But food allergy precautions should go beyond that.

So how can you ease an allergy family’s fears? Food allergy precautions to use in the office revolve around knowing what products you use and what could possibly cause a problem. Remember that allergies are an overresponse of the immune system, and potentially anything could cause a possible reaction to anyone, whether they have had issues in the past or not.  The most likely culprits are prophy pastes, topicals, propofol, cements, fluoride, and toothpastes.4

  • Prophy pastes should be checked for pine nuts, nut oils, and gluten
  • The profound general anesthetic propofol contains a protein found in egg yolks.
  • Temporary dental cement could contain an ingredient called eugenol, which is derived from cloves, and can cause reactions.
  • For fluoride treatments, check for ingredients or possible contact with nuts, dairy, peanuts, and gluten. Tree nut rosin is an ingredient used in some fluoride varnishes.
  • When recommending toothpaste, be cautious. Some toothpastes contain milk proteins. Check for an ingredient called Recaldent, a derivative from milk. Recaldent is also found in fluorides and chewing gums.5
  • Latex can still be found in some gloves, prophy angles, and other products, although most manufacturers are moving away from any latex.
  • Flavored or scented products could also pose a problem.

Always be aware of flavor concerns that may come up—don’t just blindly apply strawberries and cream to someone! You will freak out an allergy mom if you apply a fluoride or any product without first checking on the flavor.

Finally, be prepared for an emergency. Hopefully, you’ll never need an automatic epinephrine injector, but you should be familiar with how to use one. If your office is supplied with a good emergency kit, you should have epinephrine on hand. In some instances, kids with food allergies will present with their own set of epinephrine injectors, and the parent or patient may even be the one to administer. But we can’t always assume that will be the case and should be prepared for any medical emergency that could occur in our chair.

Let’s show our communities that we care and have confidence when treating patients with life-threatening food allergies. Chances are, you’ll only be seeing more of these types of patients in days to come. Be prepared, know your toolkit, and allow your patients to feel assured.

If you want to understand more about food allergies, a great resource is the Food Allergy Research and Education (FARE) website.


1. Food allergies. Centers for Disease Control and Prevention. Accessed May 2021. https://www.cdc.gov/healthyschools/foodallergies/index.htm
2. Food allergy 101. Food Allergy Research and Education. Accessed May 2021. www.foodallergy.org/living-food-allergies/food-allergy-essentials/food-allergy-101
3. Food allergy. World Allergy Organization. Published March 2017. Accessed May 2021. https://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-center/professionals/food-allergy
4. Food allergies at the dentist. Autumn's Lunchbox. Published 2016. Accessed May 2021. www.autumnslunchbox.com/food-allergies-at-the-dentist
5. Recaldent. Oral Health CRC. Published 2014. Accessed May 2021. https://oralhealthcrc.org.au/content/recaldent

Kelsey Whetten, BS, RDH, EFDA, lives in a small town in Northern Arizona. She has over eight years of experience as an RDH and loves living and working closely with her patients. Her favorite part of the job is generating genuine smiles. As a mom to an awesome food allergy kiddo, she also shares a passion with spreading awareness for inclusion.