Management of a patient with Type 1 NRL allergy
- All patients to be screened.
- At risk groups: Spina bifida patients ( 67% chance of latex allergy); Healthcare professionals; Patients with urogenital anomalies; atopic patients; patients with history of multiple surgical procedures; Latex industry workers
- Check history for above, plus: Allergy to foods especially banana, kiwi, avocado; Elastoplast; latex products; Lips / tongue swelling following GA, dental treatment or blowing up balloons; Asthma, problems with eyes, breathing etc at work (especially healthcare workers).
Patients with NRL allergy have often been treated in a General Dental Practice without significant problems when adjustments have been made by the dental team to manage the patient’s allergy. However if the dentist is in doubt or lacks confidence (eg managing a highly reactive patient), the patient may need to be referred for appropriate management, possibly in a community CDS or PDS or in a hospital setting.
- All team members to be aware of and understand implications
- Latex-free items to be available and stored away from latex products
- Appointment to be first of session
- Signs to indicate ‘latex free zone in operation’; patient’s notes marked appropriately
- Fresh protective clothing, face masks with paper ties, wash hands well
- Latex free resuscitation drugs and equipment to be readily available and stored away from latex products
- Be practised at resuscitation
- Wear latex free gloves
- Use Dentsply Citanest with Octapressin local anaesthetic cartridges
- Use latex free plastic medical syringes eg Discardit II for other medication
- Dental and medical equipment to be latex free or covered to prevent skin contact, eg suction tubes, blood pressure apparatus, stethoscopes
- Use non NRL IV tubing, cannulae, airways, anaesthetic masks, adhesive tape
- Use non NRL prophy cups, rubber dam, orthodontic elastics
- Laboratory work to be handled with non NRL gloves — mark the lab sheet
- For the more reactive patient or member of staff, other items should be checked for their latex content eg mixing bowls, spatula, chip syringes, needle guards, dappens pot.
Examples of dental equipment that may contain latex and NRL-free alternatives – please note this is in the process of being updated – please CHECK with your suppliers.
|Examples of Dental Equipment that may contain NRL||NRL-Free alternative||Manufacturer|
|Amalgam Carriers||Teflon amalgam carriers||Austinell|
|Bunsen burner tubing||Heating device|
|Dental Dam||Roeko Flexi-dam
Hygenic Non Latex
|FE Cardozo Ltd.
|Hygenic Wedjets (dental dam stabilising cord)||Not currently available|
|Elastics (Orthodontic)||GAC ELF Latex Free elastics||Orthocare
TOC(The Orthodontic Co)
|Mixing bowls** eg alginate Bowls||NRL-free bowls||Dentsply|
|Polishing equipment||Prophy cups, prophy heads
Disposable Prophy Angle to be used on nosecone of doriot-style handpiece
W+H Dental (UK) Ltd
|Enhance Polishing Cups||Dentsply|
|Shofu Greenies & Brownies polishing points||Minerva|
|Temporary crowns and matrices||Directa crowns (polycarbonate)
Odus cervical matriza
Odus-Pella Crown Form
|*It has been suggested that gutta percha may have the potential to exhibit cross allergenicity with NRL, however, there is no reliable scientific evidence to confirm this
** Please check mixing bowls that are purchased individually or are included with a product; for example the mixing bowl in the Tokuyami Soft kit contains NRL.
Some items (eg “rubber based” impression materials) are free from latex proteins. However manufacturers cannot be 100% certain that the product did not come into contact with any NRL during production.
N.B. Manufacturing processes are constantly changing and it is essential to check with the company that supplies dental equipment that their products are NRL-free.