Iatrogenic reactions following dental treatments
Whether it’s the composition of the materials used, compliance with the indications or the way the dentist handles them, dental office procedures can sometimes have a different outcome than expected.
Before starting the actual treatment, the dentist should analyze all the factors that may negatively interfere with the success of the therapy. Eliminating these factors or adapting the therapeutic conduct to the existing conditions ensures the success of the maneuvers without endangering the patient’s health in any way.
The leading causes of iatrogenicity can have several origins and concern both the patient and the practitioner. The most common are the following:
Defective doctor-patient collaboration: the first contact between doctor and patient must include a thorough history, a dialogue informing about existing pathologies, physical and psychological condition. The patient will have to mention each health problem and inform about current medication.
Incomplete diagnosis: bad doctor-patient collaboration results in the wrong diagnosis leading to the wrong therapy.
Mistakes on the part of the practitioner or technician: errors can sometimes occur in the dental surgery. Patients are different, the anatomy and morphology of oral structures are also different. This, combined with a state of tiredness or inattentiveness on the part of the practitioner, can lead to iatrogenicity. The patient should be informed and treatment should be resumed or, in particular cases, referred to a practitioner with another expertise.
Potentially iatrogenic materials: metals can have an allergic effect and monomers can irritate mucous membranes.
Iatrogenic reactions in prosthetic treatments
Prosthetic treatments are characterized by increased complexity, consisting of several clinical steps and the need for the involvement of the dental laboratory.
Therefore, the risk of iatrogenicity is also increased.
Prostheses, when in contact with the oral mucosa, can induce inflammatory reactions.
These usually do not occur immediately after the dentures are fitted. The reaction occurs after some time and manifests itself as stomatitis.
It is often asymptomatic and is discovered by chance during routine check-ups.
Stomatitis is characterized by the presence of small, red patches. Initially, they are limited in extent, but later they cover the entire contact area between the dentures and the oral mucosa. In the late stages, the spots become prominent and lead to prosthesis instability, associated with tenderness and a burning sensation of the mucous membranes.
In the case of full dentures, adjustments, called relining, have to be made at certain intervals to ensure a better fit of the dentures with the mucosa.
The monomer found in the material with which the relining is carried out may be allergenic if the proportions indicated by the manufacturer and the method of preparation are not respected.
Iatrogenic reactions in endodontic treatments.
Root canal treatment is done by a wide variety of mechanical and chemical maneuvers. In certain circumstances, after the treatment has been carried out, there is a possibility of pain and inflammatory manifestations, which may occur:
– if it (root canal treatment) was done untimely
– if the apex (root tip) has been overgrown with filling material
– if the apex has been overrun with gutta-percha cone
– if root canal treatment was incomplete
iatrogenic reactions in dental treatments
Coronal fillings or fillings if not perfectly executed can cause iatrogenic reactions.
excruciating and continuous pain immediately after treatment (pulp chamber floor has been compromised, the indication is for vital removal)
painful chewing – the filling is not correctly adapted in occlusion
food retention – the filling has been incorrectly adapted – it is recommended to remove the thresholds otherwise periodontal pockets and bone resorption will occur there.
damage to the interdental papilla during mastication (the contact point must be restored)
pain to chemical and thermal stimuli – these usually fade over time due to the process of neo-dentinogenesis.
fractures of the dental crown walls proximal to dental fillings. In the case of oversized crown fillings and fragile remaining crown walls or the existence of prisms not supported by enamel. In such cases a crown cap is recommended.
Oral hygiene is a factor that is often not taken into account when talking about iatrogenesis.
Plaque is a constant deposit on dental surfaces, in varying amounts, which is directly related to dental hygiene.
Plaque is formed by bacterial interaction, which, through the compounds removed, can generate oral cadidosis that sensitizes the entire oral cavity.
Iatrogenic reactions are frequently encountered in the dental surgery but following the steps prior to a therapeutic intervention and adapting the techniques and materials according to the patient’s health condition considerably reduces the risk of error.