Objective
The aim of this study was to report on clinical experience in Brazil in the dental
treatment and the oral conditions of a group of patients with hereditary angioedema
(HAE).
Study Design
The study analyzed demographic data, type of HAE, intensity of attacks, long-term
and short-term prophylaxis, dental procedures, and occurrence of crises after the
procedures were performed. Radiographic evaluation of the number of teeth and bone
loss was also performed.
Results
Data from 12 patients were collected; most were women, presenting with C1-INH-HAE
type I and a history of severe attacks. All patients reported use of regular medications
(long-term prophylaxis), mostly attenuated androgens, to prevent/attenuate HAE attacks.
These patients had several missing teeth and alveolar bone loss. Tooth extraction
was the most common procedure. In half the patients, the procedures had been performed
without modification in long-term prophylaxis. The others were treated with an additional
prophylaxis protocol (short-term prophylaxis), particularly those who underwent tooth
extraction. None of the study patients developed HAE attacks after dental procedures.
Conclusion
The occurrence and intensity of a possible HAE attack after dental procedures are
unpredictable, but with careful preliminary screening by dental and immunology teams
and the use of therapeutic prophylaxis, the risk could be minimized.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hereditary angioedema: the clinical syndrome and its management in the United States.Immunol Allergy Clin North Am. 2006; 26: 653-668
- Hereditary angioedema with normal C1-inhibitor activity in women.Lancet. 2000; 356: 213-217
- Angioedema due to angiotensin-converting enzyme inhibitors.Immunopharmacology. 1999; 44: 21-25
- The international WAO/EAACI guideline for the management of hereditary angioedema—the 2017 revision and update.Allergy. 2018; 73: 1575-1596
- Hereditary angioedema with normal C1 inhibitor: four types and counting.J Allergy Clin Immunol. 2018; 141: 884-885
- Hereditary angioedema: a prospective study of a Brazilian single-center cohort.Int J Dermatol. 2020; 59: 341-344
- Hereditary angioedema cosegregating with a novel kininogen 1 gene mutation changing the N-terminal cleavage site of bradykinin.Allergy. 2019; 74: 2479-2481
- Hereditary angioedema: treatment, management, and precautions in patients presenting for dental care.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109: 168-172
- Oral manifestations and dental management of patients with hereditary angioedema.J Oral Pathol Med. 1991; 20: 139-142
- Hereditary angioedema and anxiety in oral surgery: a case series report.Quintessence Int. 2015; 46: 417-422
- Consensus statement on the diagnosis, management, and treatment of angioedema mediated by bradykinin. Part II. Treatment, follow-up, and special situations.J Investig Allergol Clin Immunol. 2011; 21: 422-441
- 2010 International consensus algorithm for the diagnosis, therapy and management of hereditary angioedema.Allergy Asthma Clin Immunol. 2010; 6: 24
- Management of dental-oral procedures in patients with hereditary angioedema due to C1 inhibitor deficiency.J Investig Allergol Clin Immunol. 2013; 23: 1-6
- Effect of sex hormones on the complement-related clinical disorder of hereditary angioedema.Arthritis Rheum. 1979; 22: 1295-1299
- Perioperative management of tooth extractions for a patient with hereditary angioedema.J Oral Maxillofac Surg. 2014; 72 (2421.e1-e3)
- Hereditary angioedema.J Allergy Clin Immunol. 2008; 121: S398-S401
- C1 esterase inhibitor concentrates and attenuated androgens [Authors’ reply].Lancet. 2018; 391: 1356
- Hereditary angioedema with normal C1 inhibitor: update on evaluation and treatment.Immunol Allergy Clin North Am. 2017; 37: 571-584
- A single nucleotide deletion at the C1 inhibitor gene as the cause of hereditary angioedema: insights from a Brazilian family.Allergy. 2011; 66: 1384-1390
- Prophylaxis of acute attacks with a novel short-term protocol in hereditary angioedema patients requiring periodontal treatment.Oral Health Prev Dent. 2019; 2: 1-7
- Laryngeal edema and death from asphyxiation after tooth extraction in four patients with hereditary angioedema.J Am Dent Assoc. 2003; 134: 1088-1094
- Lesions of the oral mucosa: an epidemiological study of 23785 Mexican patients.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105: 79-85
- Risk of laryngeal edema and facial swellings after tooth extraction in patients with hereditary angioedema with and without prophylaxis with C1 inhibitor concentrate: a retrospective study.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112: 58-64
- Fatal laryngeal attacks and mortality in hereditary angioedema due to C1-INH deficiency.J Allergy Clin Immunol. 2012; 130: 692-697
- Hereditary angioedema: death after a dental extraction.Aust Dent J. 2017; 62: 107-110
- Hereditary angioedema in oral surgery: overview of the clinical picture and report of a case.J Oral Maxillofac Surg. 2010; 68: 2307-2311
- Successful hereditary angioedema prophylaxis with C1 inhibitor in orthognathic surgery.J Oral Maxillofac Surg. 2012; 70: 1456-1458
- The efficacy of short-term danazol prophylaxis in hereditary angioedema patients undergoing maxillofacial and dental procedures.J Oral Maxillofac Surg. 1999; 57: 404-408
- C-1 esterase inhibitor dysfunction localized to the periodontal tissues: clues to the role of stress in the pathogenesis of chronic periodontitis?.J Clin Periodontol. 2003; 30: 271-277
- Association between self-reported dental hygiene practices and dental procedure-related recurrent angioedema attacks in HAE subjects: a multi-center survey.J Allergy Clin Immunol Pract. 2020; S2213-2198 (30582-1)
- Dental experience and self-perceived dental care needs of patients with angioedema.Spec Care Dentist. 2001; 21: 27-31
- The humanistic burden of hereditary angioedema: impact on health-related quality of life, productivity, and depression.Allergy Asthma Proc. 2010; 31: 407-414
- The hereditary angioedema burden of illness study in Europe (HAE-BOIS-Europe): background and methodology.BMC Dermatol. 2012; 12: 4
Article info
Publication history
Published online: October 01, 2020
Accepted:
August 26,
2020
Received in revised form:
August 22,
2020
Received:
April 18,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
