[Safety problems in the use of local anesthetics in the dental area]

In the last few years particular attention has been given to the adverse reaction to loco-regional anesthesia now widely used in dental practice. It has seemed therefore interesting to investigate the different types of adverse reactions, with particular attention to the anaphylactic-anaphylactoid ones. Although uncommon, these are interesting for the uncertain pathogenesis, the severity of the clinical picture and the complexity of the treatment. In order to find their adequate prevention, a particular approach to risk patients has been suggested to identify the eventual previous anaphylactic-anaphylactoid reactions and the drugs responsible for it. A procedure based on progressive skin test confirmed by a negative incremental challenge test has been worked out. Moreover the need has been felt for a drug surveillance program capable of collecting computerized data which allows real-time investigation of adverse reaction incidence, their typology and finally the effectiveness of prevention. This procedure should further ensure safety in loco-regional anesthesia in dental practice.