Researchers presented the case of a patient with systemic mastocytosis (SM) who had to undergo oral surgery to remove one of her permanent molar teeth. They published the complexity of planning dental interventions for SM in BMJ Case Reports.

The patient was a 40-year-old woman who had a history of failed treatment including root canal therapy. “She had significant dental anxiety, particularly following attempted extraction of this tooth two years previously, where anesthesia was reported not to have been achieved,” the authors wrote.

There can be several triggers that activate mast cells in patients with SM. These include physical triggers such as heat and friction, physiological triggers like fever, strenuous exercise, and hormonal changes, and medical triggers including nonsteroidal anti-inflammatory drugs, opiate analgesics, muscle relaxants, and antibiotics.

Psychological triggers such as emotional stress and anxiety as experienced by this patient may also activate mast cells. There are also potential dental material triggers such as latex, zinc oxide, eugenol, cobalt, chromium, nickel, gold, palladium, and methacrylate.

Read more about SM complications

The abnormal activation of mast cells may cause dysfunction in several organs and lead to anaphylactic reactions that can be life-threatening.

The patient presented here was successfully treated thanks to effective pain management, anxiolysis through conscious sedation with nitrous oxide, close monitoring, avoidance of histamine-releasing drugs, and the readiness of resus drugs. The researchers noted that a different procedure or even a different patient with the disease needing the same procedure may need to be managed in an acute care environment.

Mastocytosis is characterized by the clonal proliferation of abnormal mast cells. In SM, these mast cells infiltrate 1 or more extracutaneous organs causing damage.

Reference

Legge AR, Whyte A, Heywood S. Dental management of a patient with systemic mastocytosis. BMJ Case Rep. 2022;15:e249039. doi:10.1136/bcr-2022-249039