# Impact of Dental Procedures on Hereditary Angioedema Attacks: An Exploratory Observational Study

## TL;DR

This study explores how dental procedures affect hereditary angioedema (HAE) patients, finding that many avoid dental care due to fear of attacks and are often mismanaged before diagnosis.

## Contribution

The study is the first to explore the impact of dental procedures on HAE attacks and treatment changes after diagnosis in a registry-based observational setting.

## Key findings

- Over half of HAE patients avoided dental care due to fear of attacks or anticipated refusal.
- Before diagnosis, most patients received ineffective medications like glucocorticoids and antihistamines for dental swelling.
- After diagnosis, most patients received appropriate HAE-specific treatments like Icatibant and C1-INH.

## Abstract

To evaluate hereditary angioedema (HAE) attack frequency associated with dental procedures, determine whether patients with post-dental procedural attacks receive more appropriate treatment after their condition is diagnosed, and investigate the potential impact of perceived risk on patients seeking dental care and dental professionals providing it.

The observational study included all the eligible adults from the Romanian Hereditary Angioedema Registry who provided informed consent. The impact of dental procedures on the HAE attacks was measured using a structured questionnaire including 20 questions administered via telephone.

Patients experienced dental procedure-related symptoms suggestive of HAE both before (47.6%) and after their condition was diagnosed (51.9%). Before the HAE diagnosis, 86.2% of the patients received glucocorticoids and antihistamines for post-procedural swelling. After diagnosis, 85.3% of the patients were given Icatibant and C1-INH. More than half (55.3%) of the patients reported not seeking dental interventions because of fear of HAE attacks or anticipation of refusal, and 24.7% of them declared they had been denied dental care by dental health professionals at least once.

Swelling related to dental procedures was common among the studied HAE patients. Unwarranted medications used before HAE diagnosis for dental post-procedural symptoms were replaced by adequate HAE-specific medications in most patients with established HAE diagnosis. A statistically significant proportion of patients refrained from undergoing dental interventions, and some of them were refused dental care by oral health professionals due to fear of HAE attacks.