Dental local anaesthetics and latex: advice for the dental practitioner Joanne McEntee Dental Update 2024 39:7, 707-709.
Authors
JoanneMcEntee
BPharm, MRPharmS
Medicines Information Pharmacist, North West Medicines Information Centre and National Dental Medicines Information Service, Pharmacy Practice Unit, 70 Pembroke Place, Liverpool L69 3GF, UK
Natural rubber latex (NRL) is present in many medical products, including disposable gloves, adhesive tape and bungs in medicine vials. People sensitized to NRL are at risk of developing allergic reactions, which can present with delayed symptoms such as a localized red itchy rash, or with immediate symptoms such as itching of the skin and eyes, sneezing, bronchospasm or anaphylactic shock. People sensitized to NRL should avoid contact with all products that contain it, either in the product itself, in the packaging or introduced during the manufacturing process or storage. This paper highlights the implications of latex allergy in patients for dental healthcare staff, and provides a list of local anaesthetic preparations used in dentistry in the UK which are latex free.
Clinical Relevance: All dental staff need to be aware of latex allergy and know where to find information on latex content of dental local anaesthetics.
Article
Natural rubber latex (NRL) is a strong, flexible, hard-wearing and protective material used to make many medical products, including disposable gloves, adhesive tape, bandages, dental dams, bungs in medicine vials, syringes and venepuncture-related equipment.1,2 Between 1% and 6% of the general population are potentially sensitized to proteins in NRL and at risk of developing an allergic reaction after contact or after inhaling powder containing NRL.3,4 Allergic reactions to NRL include a type IV reaction, resulting in a red itchy rash in the area in contact with NRL that can become widespread or, less commonly, a type I reaction presenting as immediate hypersensitivity with itching of the skin and eyes, sneezing, bronchospasm or anaphylactic shock.2,3 Type I reactions occur immediately after exposure to NRL in sensitized individuals and can be life-threatening; type IV reactions usually occur 6–48 hours after exposure and may be in response to chemicals used in the rubber manufacturing process, rather than NRL itself.3 NRL can also cause irritant contact dermatitis, but this is not a true allergy.3
People sensitized to NRL should avoid contact with all products containing NRL.1,4–7 Contact between NRL and a mucosal surface (such as mouth and nose) causes a more severe reaction than contact with intact skin.4,6 Unfortunately, most products are not labelled to warn that they contain NRL.1 Natural rubber latex may be found in the product itself, in the packaging, or be introduced during the manufacturing process (for example, through contact with powdered latex gloves worn to ensure sterility of the product) or storage.
The UK Medicines Information Service has produced a document which lists local anaesthetic preparations used in dentistry in the UK and their latex content. The document will be updated annually and can be viewed on their website (www.nelm.nhs.uk/en/NeLM-Area/Evidence/Medicines-Q--A/Which-dental-local-anaesthetics-are-latex-free/). There are two tables. The first table lists products that are latex-free – there is no latex in the product or packaging, and the product has not been in contact with latex during the manufacturing process (Table 1). The second table lists products that contain latex (red highlighting), or may contain latex (orange highlighting) because, although the products and/or packaging do not contain latex, they cannot be guaranteed to have been free of contact with latex during manufacture or storage (Table 2).
Brand name
Ingredients
Presentation
Company
Ref
Articaine
Artikent
Articaine 4% with adrenaline 1:100,000
2.2 mL cartridge
Kent Express
8
Bartinest
Articaine 4% with adrenaline 1:100,000
2.2 mL cartridge
Dental Directory
8
Espestesin
Articaine 4% with adrenaline 1:100,000
1.8 mL cartridge
3M ESPE AG
9
Articaine 4% with adrenaline 1:200,000
1.8 mL cartridge
9
Isonest
Articaine 4% with adrenaline 1:100,000
2.2 mL cartridge
Henry Schein
8
Septanest
Articaine 4% with adrenaline 1:100,000
2.2 mL cartridge
Septodont
8
Articaine 4% with adrenaline 1:200,000
2.2 mL cartridge
8
Lidocaine
Eurocaine
Lidocaine 2% with adrenaline 1:80,000
2.2 mL cartridge
Septodont
8
Lignokent
Lidocaine 2% with adrenaline 1:80,000
2.2 mL cartridge
Kent Express
8
Lignospan Special
Lidocaine 2% with adrenaline 1:80,000
1.8 and 2.2 mL cartridge
Septodont
8
Rexocaine
Lidocaine 2% with adrenaline 1:80,000
2.2 mL cartridge
Henry Schein
8
Utilycaine
Lidocaine 2% with adrenaline 1:80,000
2.2 mL cartridge
Dental Directory
8
Oraqix periodontal gel
Lidocaine 2.5% and prilocaine 2.5%
25 g tube
Dentsply
10
Xylonor gel
Lidocaine 5%
15 g tube
Septodont
8
Xylonor spray
Lidocaine 10% spray
36 g bottle
8
Mepivacaine
Scandonest Special
Mepivacaine 2% and adrenaline 1:100,000
2.2 mL cartridge
Septodont
8
Scandonest Plain
Mepivacaine 3%
2.2 mL cartridge
8
Prilocaine
Citanest with Octapressin
Prilocaine 3% and felypressin 0.03 units/mL
2.2 mL standard and 2.2 mL self-aspirating cartridge
Dentsply
10
These products are latex-free – there is no latex in the product or packaging, and the product has not been in contact with latex during manufacture.
2.2 mL standard and 2.2 mL self-aspirating cartridge
Dentsply
10
Emla cream
Lidocaine 2.5% and prilocaine 2.5%
5 g tube (with or without dressings)
AstraZeneca
11
Xylocaine spray
Lidocaine 10% spray
50 mL bottle
11
Tetracaine
Ametop gel
Tetracaine 4%
1.5 g tube
Smith & Nephew Healthcare
12
These products contain latex (red highlighting) or may contain latex because, although the products and/or packaging do not contain latex, they cannot be guaranteed to have been free of contact with latex during manufacture (orange highlighting).
*The product has not been tested for presence of latex – it is assumed, therefore, to contain latex.
