ADC Practice Question — Latex Sensitivity

Given Mrs Martinez's chlorhexidine allergy, why is subgingival irrigation with chlorhexidine during periodontal debridement particularly dangerous?

Infection control in the ADC exam tests decision-making around exposure incidents, instrument classification, and decontamination protocols. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.

Mrs Angela Martinez (48F) presents for periodontal treatment including subgingival scaling and debridement. Her medical history reveals a documented allergy to latex (Type 1 hypersensitivity) and a previous allergic reaction to chlorhexidine mouthwash. During the procedure, the dental assistant accidentally drops a loaded anaesthetic syringe into the sharps container and then notices the sharps container is above the three-quarter fill line. Given Mrs Martinez's chlorhexidine allergy, why is subgingival irrigation with chlorhexidine during periodontal debridement particularly dangerous?

A. Chlorhexidine is ineffective against subgingival bacteria
B. Chlorhexidine causes staining of subgingival tooth surfaces
C. Chlorhexidine on bleeding sites can access systemic circulation, triggering anaphylaxis via IgE-mediated mast cell degranulation
D. Chlorhexidine interacts with local anaesthetic agents

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Sources cited

Therapeutic Guidelines v4 Odell's 3rd & 4th Ed IADT 2020 Code of Conduct CMS (Evans) Infection Control + more

Show the answer and cited explanation

Correct answer: C

Chlorhexidine has two identical epitopes that can cross-link IgE antibodies on mast cells and basophils, causing degranulation and histamine release with potential anaphylaxis. The greatest risk is when chlorhexidine gains access to the systemic circulation. Therefore, chlorhexidine rinses, irrigants or gels should NOT be applied onto bleeding sites such as during subgingival irrigation or into extraction sites. (ICG p.79)

Source: ICG Section H: Chlorhexidine Allergy

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How should I prepare for Infection Control in the ADC exam?

Build competence across all topics. The exam tests application of guidelines to clinical scenarios, not memorisation.

How do I approach an unfamiliar Latex Sensitivity vignette?

Extract key clinical data from the stem before reading options. There are usually 3–4 critical variables that determine the correct answer.

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Given Mrs Martinez's chlorhexidine allergy, why is subgingival irrigation with chlorhexidine during periodontal debridement particularly dangerous?

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