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Have you ever experienced swollen lips after dental work? It can be a surprising and worrisome situation. In this article, we will delve into a real-life case of a 23-year-old patient who encountered lip swelling after undergoing dental treatment. Let’s explore the details and understand what might have caused this unusual reaction.
The Patient’s Complaint and Dental History
Our department received a visit from a young female patient who was concerned about the discoloration of her teeth. She had noticed yellowish stains on her teeth since childhood, and similar discolorations were also present in her family and neighborhood. It is important to note that she had not taken tetracycline or any medication that could explain the discoloration. On examination, we observed yellowish chalky white patches and enamel pitting on all her teeth. Despite these issues, the overall tooth morphology was normal. The patient maintained good oral hygiene, and her gingival tissue was in a healthy condition. Based on the Deans fluorosis index, we diagnosed her with a moderate form of dental fluorosis.
The Treatment Plan
To address the aesthetic concerns, we proposed indirect composite veneering for the upper anterior teeth and direct composites for the lower anterior teeth. The preparation involved a reduction of 0.5-0.75 mm on the labial surfaces of the teeth. After applying a retraction cord, we took elastomeric impressions and sent them to the laboratory for further processing.
The Dental Procedure
On the next day, the patient returned for the dental procedure. We placed a cheek retractor and proceeded with acid etching on the prepared teeth surfaces. Then, a bonding agent was applied and cured. Indirect composite veneers were luted on the upper teeth (13-23), while direct composites were applied to the lower teeth.
The Unforeseen Swellings
Approximately an hour after the dental procedure, we noticed localized swellings on the patient’s upper lip. The swellings were diffuse, painless, and edematous, with the right side more prominent. They were pale, soft, and non-tender, measuring approximately 3 cm × 2 cm on the right side and 2 cm × 1 cm on the left side. Notably, there were no signs of pruritus, erosion, or ulceration.
Monitoring and Treatment
As the patient’s vital parameters were normal and there was no respiratory difficulty, we kept her under observation. We inquired again about her family history but found no relevant information. To alleviate any discomfort and manage potential allergic reactions, we prescribed prednisolone 10 mg and cetirizine 10 mg orally, once daily for 3 days. The patient remained stable throughout the observation period.
Investigating the Cause
To determine the cause of the swelling, we conducted several investigations including complete blood tests, eosinophil count, IgE antibodies, complement levels, C1 esterase inhibitor levels, and patch tests. The patch test was performed on the volar region of the forearm using the same materials used during the dental procedure (etchant, bonding agent, and resin luting cement). Skin reactions were evaluated after 24 and 48 hours, and no positive reactions were observed. All investigations yielded negative results except for elevated absolute eosinophil count and IgE antibody levels.
Based on the criteria observed – sudden onset swelling limited to oral mucosal regions, absence of pain, pruritus, pitting, and erythema, with symptoms subsiding within 24 hours – the patient was diagnosed with acute allergic angioedema of the upper lip.
Understanding such cases and their potential causes can help both dental professionals and patients. If you experience similar symptoms, it is crucial to consult with your dentist or healthcare provider promptly. Remember, dental treatments can occasionally lead to unexpected reactions, but with proper diagnosis and treatment, these issues can be effectively managed.
For more information on dental health and treatments, visit Make You Smile.
Figure 1: Patient presenting with discolored teeth and yellowish stains.
Figure 2a and b: Lip swelling after dental procedure.
Figure 2c and d: Patch test on forearm.
Figure 2e: Application of test materials during patch test.
Figure 2f: Negative reaction observed after 24 and 48 hours.