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.