Transcript from the HealthFirst Talks Podcast
Hosted by Michelle Dawn Mooney
Welcome to the HealthFirst Talks Podcast
Hello and welcome to the HealthFirst Talks podcast. I’m your host, Michelle Dawn Mooney. Today we’re talking about anaphylaxis, preparedness in dental practices. What to know to be prepared. We have a great conversation for you today. We’re going to bring on two great guests who have more information on this topic. One of the most dangerous emergencies you may encounter in a dental office is anaphylaxis, a severe allergic reaction. That can happen within minutes and can be fatal if not treated immediately with epinephrine.
The American Dental Association or ADA recommends that dental practices have plans in place for responding to allergic emergencies, including using epinephrine autoinjectors to treat anaphylaxis. We asked Doctor J. Wesley Sublett, MD, AKA Doctor Wes, a pediatric allergist in Louisville, Kentucky, and Doctor Donald Cohen, DMD AKA Doctor Don, practicing dentist in New York State, about the key facts every dental practice should know about anaphylaxis and how to prepare for it.
Meet the Experts
Michelle: So first and foremost, welcome Doctor Wes. Doctor Don, thank you so much for being with me today.
Dr. Wes & Dr. Don: Thank you. Look forward to it.
Michelle: I’m looking forward to it as well. Before we kind of dive in—Wes, starting with you, can you give us a brief bio if you can?
Dr. Wes: I’m Doctor Wes Sublett. I’m a practicing allergist in Louisville, Kentucky. I’m also our medical director of clinical research here at Family Allergy and Asthma, located in Louisville, Kentucky.
Dr. Don: I’m Dr. Don Cohen, chief clinical officer at HealthFirst, practicing dentist in New York State for about 100 years, and look forward to this presentation.
Disclaimer: Before we begin, we do want to point out that Doctor Sublette is a paid advisor of Kaleo, and we ask you to be sure to stay tuned for important safety information from Kaleo after this conversation.
What Can Trigger Anaphylaxis in Dental Offices?
Michelle: Many dentists and their staff may be most familiar with anaphylaxis as a severe allergic reaction to certain types of food. I am one of them. I have a severe tree nut allergy. In the dental office, what can trigger anaphylaxis?
Dr. Don: There are a whole number of products that can trigger it. The most common that we think of in a dental office is the latex—the gloves. Luckily, now, almost all dental offices use Nitro gloves, which, of course, eliminates that. But of course, antibiotics, antiseptics, bite wing tabs, adhesive tape… medications as well, NSAIDs, local anesthetics, sedatives even, and many of the materials used in taking impressions and endodontics—any of them can cause this. One of the most common, and that’s pre-medication, especially when we talk about antibiotics.
Dr. Wes: I agree with Doctor Don. I mean, obviously, latex in the past has been a big issue, but currently it’s gonna be antibiotics and medications that are really potentially the biggest.
Recognizing the Symptoms of Anaphylaxis
Michelle: What are the symptoms of anaphylaxis?
Dr. Wes: Anaphylaxis is a potentially life-threatening allergic reaction. That can occur very quickly and rapidly, and it’s obviously critical for our dentist and their staff to recognize symptoms so they can respond immediately.
There’s a number of symptoms:
- Skin changes: hives, urticaria, flushing, itching, angioedema, swelling
- Respiratory: coughing, wheezing, chest tightness, shortness of breath
- GI: nausea, vomiting, occasionally diarrhea
- Cardiac: drop in blood pressure, rapid heartbeat
Dr. Don: What we tend to concentrate in the dental world is—yes, we know about “minor” allergies. The second that any kind of problem with breathing, swallowing, gastric symptoms like nausea… that’s when we have to leap on a fast and appropriate reaction. And it’s epinephrine.
How Symptoms Can Vary
Michelle: How do the symptoms of anaphylaxis vary among dental patients?
Dr. Wes: Medication anaphylaxis occurs very rapidly. We may be aware of skin symptoms, but anaphylaxis usually is a multi-system reaction. Anytime you have skin plus respiratory or GI—that is the signal to respond with epinephrine.
Dr. Don: You can have a patient on an antibiotic for years and suddenly they react. So being prepared and treating fast with epinephrine is essential. Again, if you think it’s anaphylaxis, that’s reason enough to treat early and fast.
Treating Anaphylaxis in the Dental Office
Michelle: How can dentists and their staff treat anaphylaxis?
Dr. Wes: Epinephrine is the first line treatment. Administering it early reduces risk of hospitalization and complications. The ADA recommends practices have a plan including pre-measured epinephrine.
Michelle: Doctor Don, what do you do in your practice?
Dr. Don: You need to react fast. You have an emergency medical kit with appropriate medications. Train your staff. For example, part of the plan is for the receptionist to call 911 and go outside to guide EMS, which prevents delays.
Dr. Wes: There’s a gap between calling EMS and them arriving. That’s why intramuscular epinephrine is critical—fast, reliable delivery without other complicated procedures.
Dr. Don: We use the AUVI-Q—a preloaded, prefilled, ready-to-use device. You don’t want to be drawing up a syringe in an emergency. Every second counts.
Are Dental Offices Prepared?
Michelle: How well are U.S. dentists and their staff prepared?
Dr. Don: We need to train to it. It’s not if, it’s when. Dental practices must be ready for emergencies—especially anaphylaxis. Team training is crucial.
Dr. Wes: Our allergist office runs mock drills. You must know the signs, know where the kit is, and how to use the epinephrine. Document everything—symptoms, treatment, timing—for EMS and follow-up care.
Choosing the Right Epinephrine Device
Michelle: When choosing an epinephrine device, what features should dental practices consider?
Dr. Don: Keep it simple—KISS principle. We use AUVI-Q because it’s simple, has multiple doses for different weights, and can be administered promptly.
Dr. Wes: Devices like AUVI-Q simplify use in emergencies. AUVI-Q has:
- Pre-measured doses
- Voice and visual instructions
- Three dose sizes (0.1mg, 0.15mg, 0.3mg) for different weight categories
Side effects can include fast heartbeat, shakiness, headaches, paleness, nervousness, dizziness, nausea. But the benefits outweigh risks in emergencies.
Additional Preparedness Steps
Dr. Wes: Team preparedness is critical. Know where the kit is. Regular training on recognizing anaphylaxis and using AUVI-Q is essential.
Dr. Don: These devices work even through clothing—no need to remove jeans, etc. Drawing up a dose manually takes too long and risks errors.
Dr. Wes: Literature shows delays in drawing up doses cause dangerous treatment lags. Autoinjectors remove that risk.
Final Thoughts and Farewell
Michelle: Doctor J. Wesley Sublett and Doctor Don Cohen, thank you so much for your time. Such important information. Again—it’s not if, it’s when. Visit HealthFirst.com for more information. Stay tuned for important safety information from Kaleo.
Dr. Don: Truly appreciate the opportunity.
Dr. Wes: And I as well, thank you.
Michelle: I’m your host, Michelle Dawn Mooney. Thanks again for joining us. We hope to connect with you on another podcast soon.
Important Safety Information from Kaleo
Indication: AUVI-Q Epinephrine Injection USP is a prescription medicine used to treat life-threatening allergic reactions, including anaphylaxis in people who are at risk for or have a history of serious allergic reactions.
Important Safety Information: AUVI-Q is for immediate self or caregiver administration and does not take the place of emergency medical care. Seek immediate medical treatment after using AUVI-Q. Each AUVI-Q contains a single dose of epinephrine. AUVI-Q should only be injected into your outer thigh through clothing if necessary
