Delayed orofacial reaction to dental rubber gloves 
  
  Patient information      Main complaint     Referral     Diagnosis    Results and Treatment   Source
   
Patient information 
A 61 year old female with
  • a history of hand dermatitis due to wearing rubber gloves
  • a history of reactions to jewellery
  • contact dermatitis from metal in suspenders
  • but with no history of atopy
Main complaint 
This patient had several episodes of facial and oral swelling that occurred within 2 hours of dental examinations. Her dentist routinely wore disposable latex gloves.
Referral 
The patient was referred to the Dermatology department for patch testing to determine whether local anaesthetic, or dental work performed, caused this adverse reaction.
Diagnosis 
Patch testing

Patch testing was performed according to the European Standard, preservative, vehicle and emulsifier, dental , medicament and metal series. It was found that;

  • positive reaction to thiuram mix (1% in petrolatum), carba mix (3% in petrolatum), nickel sulphate (5% in petrolatum) and palladium chloride (1% in petrolatum) at both 2 and 4 day readings.
  • a positive reaction to gentamicin (20% in petrolatum) after 4 days
  • the total serum IgE was normal

Radioallergosorbent test (RAST)

  • a negative reaction to latex

Prick and intra-dermal test

  • negative reactions to the local anaesthetics, lignocaine, prilocaine and bupivacaine
  • a negative reaction to latex 
Results and Treatment 

The diagnosis confirmed that this patient had contact sensitivity to the chemicals in the dental gloves worn by her dentist. This adverse reaction is a delayed (Type IV) hypersensitivity reaction.

The patients dentist was informed about her allergies. She had no adverse reactions in future dental treatment when her dentist wore polyvinyl chloride (PVC) gloved. 
Source:  

Delayed and immediate orofacial reactions following contact with rubber gloves during dental treatment.  Shah M, Lewis FM and Gawkrodger DJ.  British Dental Journal 1986; 181(4): 137-139.