Iatrogenic reactions following dental treatments
Whether it is the composition of the used materials, compliance with the indications or the way the dentist handles these, interventions in the dental surgery can sometimes have a different result than expected.
Before starting the actual treatment, the dentist must analyze all the factors that may have a negative impact on 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 causes leading to iatrogenicity can have several origins and concern both the patient and the practitioner. The most common are the following:
- Poor 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: poor doctor-patient collaboration results in the wrong diagnosis leading to the wrong therapy.
- Errors on the part of the practitioner or technician: errors can sometimes occur in the dental practice. Patients are different, the anatomy and morphology of oral structures are also different. This, combined with a state of fatigue or negligence 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 specialization.
- 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 area of contact between the dentures and the oral mucosa. In the late stages, the spots become prominent and lead to denture instability, associated with tenderness and a burning sensation of the mucous membranes.
In the case of full dentures, adjustments, called relining, should 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 remix 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 phenomena, as follows:
– 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 obturations 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)
- mastication pain – 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 odontogenesis.
- 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 variable quantities that are directly related to dental hygiene.
Plaque is formed by bacterial interaction, which, through the compounds removed, can generate oral candidiasis that sensitizes the entire oral cavity.
Iatrogenic reactions are frequently encountered in the dental surgery but by following the steps prior to a therapeutic intervention and adapting the techniques and materials according to the patient’s state of health, the risk of error is considerably reduced.