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Guidelines to Promote Safe Practice in the Dental Environment for Latex Allergic Patients

Introduction

Include questions regarding the possibility of latex allergy in your history

Ensure patient notes and ID bands are suitably identified with latex allergic status  

1. General Dentistry

a) Dentists/Dental Chairside
Assistants
Non latex gloves (eg neoprene, nitrile, vinyl).
Latex powder free environment
b) Rubber dam Do not use Rubber Dam
Can use:
Silicone Dam (Roeko products from various dental supply houses)
c) Local Anaesthetic Use local anaesthetics from plastic ampoules and latex free syringes.
Pre-loaded cartridges - check with manufacturers.
d) Syringes Many single use syringes are latex free. Check with manufacturer. E.g Terumo are latex free.
e) Mouth props Use a plastic, disposable mouth prop eg; "Denta-Pops Great Aspirations" from Horseley Dental Company.
f) Eye Protection Check the bridge piece of glasses for latex containing components.
g) Impression materials No contra indications - rubber based impression materials are synthetic rubber
h) Other dental products Polishing disks have a latex backing; probably low risk, use with caution.
Rubber "prophy" polishing cup - use polishing brush.
i) Toothbrushes Avoid toothbrushes with a rubber interdental pic and rubber handles.

2. Specialist Dentistry

a) Endodontics

GP points

GP points are derived from trees in the same botanical family as natural rubber, and there in lies the potential for cross allergenicity. This problem has been highlighted by a report which emphasises the problems with over filling root canals with GP points. If one can guarantee there is no over filling with GP then it can be used, however the potential for over filling and resulting allergic response must be remembered. REF:J Allergy Clin Immunol 1994;93;943-4
rubber stoppers on
endodontic files
measure with a tweezer grip or make an informed assessment of risk.
b) Orthodontics Check head gear components for latex containing items. Elastic/surgical ligatures and power chain may be a problem - check with manufacturer. As alternative, use wire ligatures.
Check for rubber grips on ortho wire cutters, band removers and band placers.

3. Latex Safe General Anaesthesia for General and Restorative Dentistry

a) Scheduling Schedule latex allergic patients first in the morning to lessen their exposure to air borne latex particles.
b) Anaesthesia personnel The anaesthetist and anaesthetic nurse must be advised well in advance of the scheduling of latex allergic patients.
c) Theatre staff All theatre staff to wear non latex gloves.
d) Gloves eg. Ansell Dermaprene
Baxter Duraprene
J & J Allergard
e) Masks Non Latex masks are to be used in all situations.
(King System, Promedica, Rusch, Smith).
f) IV Equipment
Latex Bungs
Braun Reflux Valves
3 Way Taps
IV Line Braun line with reflux valves
Smith
OR replace latex bungs prior to running IV fluid through line
Fluid Bags All IV fluids to come from non latex bags
Remove or tape latex port
Colloids - Haemaccel Albumex 5
Drugs may have latex
stoppers

Remove all stoppers
Emergency Drugs IMS Minijet drugs
Syringes Terumo
g) Gas tubing Examples of latex free circuits are
Fisher & Paykel, Promedica, Bain Circuit.
h) Reservoir bag Use non-latex alternative.
(King, Promedica, Rusch).
i) Mouth props Plastic "Denta-Pops Great Aspirations" from Horseley Dental Company.
j) Monitoring
Oximeter Probes
Datex, Ohmeda are latex free
Or place vinyl glove over finger or toe
BP Cuff Leads Cover the limb prior to placing BP Cuff
Critikon Soft Cuffs
ECG Dots Medtel
3M
Kendall
k) Post op Similar precautions to the operating room as listed above.

4. IV Sedation

The same precautions apply as for general anaesthesia.

5. Emergency/Resuscitation

Equipment

 

Content updated March 2010

Similar precautions to the O.R.

 

 

Notes

1. Susceptible children or children with susceptible parents, are not to be given balloons at the end of the session.

2. For OMFS please also refer to Operating Suite Guidelines page 11

3. All recommended products are available in Australia - check with your local supply company.

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