The Journal of the American Dental Association
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Case Reports
Hypersensitivity to procaine, tetracaine, mepivacaine, and methylparaben: report of a case.
The patient who comes for dental treatment with a history of hypersensitivity to local anesthetics is often denied the benefits of adequate pain control during dental therapy. Ninety percent of the patients challenged by Incaudo and associates were being evaluated because they needed local anesthesia for dental treatment. These same patients may some day need local anesthetic agents for minor surgery or for the treatment of cardiac arrhythmias. For those cases in which an allergic reaction is suspected, consultation with an allergist may prove beneficial to the patient by providing information and a local anesthetic that the patient can receive safely for both medical and dental needs.
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Necrotizing sialometaplasia cannot be diagnosed clinically and has frequently been misdiagnosed microscopically. The fact that the disease can be misinterpreted as cancer is sufficient cause for the clinician to question a malignant diagnosis of an ulcerated or nodular lesion, especially one of the hard palate, that developed rather rapidly. When performing a biopsy of these lesions, care should be taken to ensure adequate size and depth of the specimen, as small biopsy tissue samples might include only the necrotic and actively regenerating portions of the lesion, thus causing diagnostic problems. Necrotizing sialometaplasia certainly should be considered in a differential diagnosis of soft tissue lesions arising in the vicinity of intraoral minor salivary glands, especially on the hard palate.