Optimizing emergency management of anaphylaxis in dentistry: a systematic review of current practices

This review characterizes anaphylaxis in dental practice, including patient demographics, clinical presentations, implicated allergens, diagnostic approaches and emergency management, to provide actionable guidance for safer dentistry.

A systematic search was conducted across PubMed/Medline, Embase, and Web of Science for case reports of dental-related anaphylaxis published between 2000 and 2025.

Fifty-five cases from 44 studies were analyzed. Patients were predominantly male (63.64%), with a median age of 43 years. Most anaphylaxis (76.36%) occurred within 30 minutes, primarily during oral/maxillofacial surgery, endodontic treatments, and extractions. Dental materials (34.55%, mainly formaldehyde) were the leading triggers, followed by combined anesthesia (18.18%), antibiotics (10.91%), chlorhexidine (9.09%) and lidocaine (5.45%). Prior exposure was notable for dental materials (36.84%) and lidocaine (100%). Initial presentation patterns were trigger-specific: cutaneous symptoms dominated for dental materials and lidocaine; hypotension for combined anesthesia and antibiotics; and gastrointestinal distress for chlorhexidine. Alarmingly, epinephrine was administered in only 56.36% of cases, with the recommended intramuscular route utilized in merely 7.72%. Diagnosis relied primarily on skin prick and sIgE testing, supplemented by drug provocation.

Anaphylaxis remains a persistent risk in dentistry. Enhancing dentist training, standardizing allergen testing, and increasing vigilance for atypical symptoms are critical to mitigating risks and improving patient outcomes.