✅ Abstract
Angioedema is a potentially life-threatening condition characterized by rapid swelling of the dermis, subcutaneous, or submucosal tissues.
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✅ Introduction
Angioedema is an acute, localized swelling caused by increased vascular permeability in deeper layers of the skin or mucosa. It can be triggered by allergic reactions, medications, trauma, or hereditary factors (Cicardi & Zuraw, 2018). In pediatric dental practice, angioedema may occur as a result of exposure to anesthetics, latex, antibiotics, or other allergens. Recognizing early signs and initiating prompt treatment can be life-saving.
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➤ Signs and Symptoms
Angioedema typically presents as painless, non-pitting swelling of the lips, cheeks, eyelids, or tongue. Intraoral involvement may lead to dysphagia, hoarseness, and airway obstruction. Other systemic signs include urticaria, hypotension, or respiratory distress (Banerji et al., 2021).
➤ Common clinical features:
▪️ Rapid-onset swelling (minutes to hours)
▪️ Symmetrical or asymmetrical edema of soft tissues
▪️ Absence of pruritus in non-allergic forms
▪️ Difficulty breathing or swallowing in severe cases
➤ Differential Diagnosis
Angioedema must be differentiated from other acute facial swellings such as abscesses, cellulitis, or trauma-related edema. The absence of erythema, pain, and fever can help distinguish it from infectious causes.
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In pediatric dentistry, common triggers include:
▪️ Local anesthetics: Especially those containing preservatives like methylparaben.
▪️ Antibiotics: Penicillin and cephalosporins are frequent culprits.
▪️ Latex exposure: Gloves, rubber dams, and dental materials.
▪️ Physical stimuli: Mechanical trauma or stress.
▪️ Genetic predisposition: Hereditary angioedema (HAE) due to C1 esterase inhibitor deficiency.
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➤ Immediate Actions
1. Stop the procedure and assess airway patency.
2. Administer oxygen if respiratory distress is evident.
3. Epinephrine (0.01 mg/kg, max 0.3 mg IM) for suspected allergic etiology.
4. Antihistamines (Diphenhydramine 1 mg/kg, max 50 mg IV or IM).
5. Corticosteroids (Methylprednisolone 1–2 mg/kg IV) to reduce inflammation.
6. Call emergency services if airway compromise is imminent.
➤ Follow-Up Care
After stabilization, referral to an allergist or pediatric immunologist is recommended to identify causative agents and prevent recurrence.
馃搳 Comparative Table: Types of Angioedema in Pediatric Dentistry
| Type | Key Features | Dental Management |
|---|---|---|
| Allergic Angioedema | Rapid swelling after exposure to allergens (e.g., anesthetics, latex) | Immediate epinephrine, antihistamines, corticosteroids |
| Drug-Induced Angioedema | Triggered by medications such as penicillin or NSAIDs | Discontinue drug, administer antihistamines and steroids |
| Hereditary Angioedema (HAE) | Recurrent, non-itchy swelling without urticaria, due to C1-INH deficiency | Avoid trauma; C1-INH concentrate or icatibant if available |
| Idiopathic Angioedema | Unknown cause, may persist despite treatment | Symptomatic therapy; refer for immunologic evaluation |
馃挰 Discussion
Recognizing angioedema in pediatric dental patients is crucial to prevent respiratory compromise and mortality. Dentists must differentiate allergic from hereditary forms, as treatment approaches differ. Allergic cases require immediate pharmacologic management, whereas hereditary forms may demand specific agents such as C1-INH replacement or bradykinin receptor antagonists (Craig et al., 2021).
Preventive strategies include detailed medical history-taking, latex-free materials, and test doses of anesthetics in sensitive patients. Preparedness with emergency drugs and airway management equipment should be standard protocol in pediatric dental settings.
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Angioedema, though rare in pediatric dentistry, poses a severe risk when unrecognized or mismanaged. Prompt identification of swelling, airway monitoring, and timely pharmacologic intervention are critical to patient safety. Preventive measures, including allergen avoidance and emergency preparedness, are essential responsibilities of the pediatric dental practitioner.
馃摎 References
✔ Banerji, A., Weller, P. F., & Sheikh, J. (2021). Angioedema: Pathogenesis and management. The New England Journal of Medicine, 385(16), 1502–1512. https://doi.org/10.1056/NEJMra2037085
✔ Cicardi, M., & Zuraw, B. L. (2018). Angioedema without wheals: An update. The Journal of Allergy and Clinical Immunology, 141(3), 883–895. https://doi.org/10.1016/j.jaci.2017.09.015
✔ Craig, T., Busse, P., & Gower, R. (2021). Hereditary angioedema in children: Diagnosis and treatment. Pediatric Allergy and Immunology, 32(4), 721–729. https://doi.org/10.1111/pai.13446
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