Download 1 ALLERGIES IN ORAL CAVITY,CLINICAL SYMPTOMS CAUSING

ALLERGIES IN ORAL
CAVITY,CLINICAL
SYMPTOMS CAUSING
FACTORS AND TREATMENT
The phenomenon of allergy was discovered in
1906 by Clemens von Pirquet. The word allergy
comes from greek’s words allos - other and
ergos - work.
Allergy – an inappropriate, genetically
determined response innitiated by
exposure to certain substances (allergens),
the immune reaction involves antibodies
(IgE) ,T lymphocytes, eosinophils and
mastocytes.
lek.dent Monika Hemerling
Clasiffication of immune reactions :
Type I – immediate hipersensitivity involving IgE
Ex. Anaphylactic shoc , angioedema
Allergens :


Type II – hypersensitivity caused by IgG and IgM antibodies
directed towards cell surface antigens
Ex.drug induce reactions:
hemolitical anemia, agranulocytosis,thrombocytosis

drugs
local anaesthetics
antiseptics

toothpaste ingredience

acrylic stains and acrylan
Type III – immune complex reaction involving IgG, IgA, IgM
Ex. Serum disease

metals (nickel, chromium, cobalt, !! tytanium,
tantalum, niobium)
Type IV – delayed hypersensitivity with T-limphocytes
Ex. Contact dermatitis, tuberculin reaction

filling materials (amalgams, composites and bonding
agents)
ANAPHYLACTIC SHOCK

The most severe type of allergic response,
involves multiple organs and may be fatal.

There are seconds or minutes between
exposure to antigen and onset of clinical
symptoms (the faster manifestation the more
severe course).
Symptoms :
anxiety
itching
 skin covered with cold sweat
 paleness
 filiform pulse or hard to measure
 tachycardia



nausea and vomiting
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ANGIOEDEMA
Treatment :

call an ambulance
stop exposure to antigen
lying position
adrenaline subcutaneously or intramusculary
(0,1% solution) 0,2-0,5 ml every 10-20 min
hydrocortisone 200 mg intravenously
antihistamines intramusculary

oxygen (4-6 l/min)




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
Local example of anaphylaxis.

May be congenital or acquired.

First type is more severe– involves internal organs of
the body.

Angioedema is caused by plasma filtration from vesels
to surrounding tissues, most commonly involves lips,
tongue, soft palate and bucal mucosa.

When localized in larynx may be fatal.
Causing factors : beta-lactams
sulphonamides
latex
Treatment : oral antihistamines
in severe cases corticosteroids
ALLERGIC STOMATITIS

Immune reaction type I due to systematical
drug therapy or food.

Eruptions in oral cavity may differ and
clinicaly resumbles erythema multiforme.
Symptoms :


dry, shiny red eruptions
white eruptions

numerous exfoliating vesicles →
ulcerations

pain and itching
This type of oral hypersensitivity may be
localized only on bucals, gingivae, lips, tongue
or may involve whole oral cavity.
Treatment : antihistamines
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List of allergens most often causing
contact dermatitis :
Allergen
1. Nickel
2. Tiommersal
3. Perfume
4. Cobalt
5. Formaldehyde
6 .Colophony
7. Chromium
Female (%)
11,1
3,1
1,0
1,4
1,0
1,0
0,3
2,2
3,6
1,1
0,7
1,1
0,4
0,7
Has the highest allergic potency - 20-30% of
population suffer from nickel
hypersensitivity.

A lot of food contains nickel for ex. : oats,
wheat, cocoa, tea, bean, margarine.

Items like coins, kitchen utensils, catlery,
bath plugs, metal zips, jewery, buttons and
many others may be composed of nickel.

Positive skin reactions to metals are not
necessairly associated with intra-oral
allergic reactions.

It is said that if symptoms of
hypersensetivity are primarly localized
on skin oral changes rerely appear.


Metals used in dentystry have a tendency to
connect with cells and enzymes of human body,
such cells and enzymes are recognized as
allergens.

The highest amounts of metal ions are observed
in fat cells and cells with collagen.

Metal cumulation can last without any clinical
symptoms.
Male(%)
Nickel

METAL ALLERGY :
If allergic reaction at first developed
in oral cavity, skin lesions appear after
some period.

In dentystry nickel is a component of many
alloys, stainless steel, it is added to dental
braces to improve the durability.

Skin reactions to nickel are often and well
described in the literature. Nickel ions can
cause eruptions like vesicles, papulas,
erythemas and iching.

Allergical lesions are localized on every
part of skin toutched by nickel.

Intra oral allergic reactions to nickel and
other metals used in dentystry
restorations are less often.
No intra-oral response is due to :

changes in morphology and anatomy

saliva flow

keratinization of hard palate(inhibits
resorption of nickel ions)
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
The studies carried out by Spiechowicz
and Grochowski showed that small doses
of digested nickel ions can act not as
allergens but lead to desensitization.

Patients with verified (using patch test)
hypersensitivity to nickel, were provided
with fixed prostheses: crowns and bridges
made of 70% alloy of nickel.

During 7- year follow-up no excerbation of
hypersensitivity was observed, more over in
some cases the decrease of allergic
reactions was noticed.

In histological examination of oral mucosa
taken from marginal gingivae no patological
changes were seen.
ACRYLIC RESIN ALLERGY
Patch tests are used to detect metal
allergy
Treatment :
 In case of oral mucosa reactions
remove dental restorations composed
of nickel alloy
 Corticosteroids
Symptoms :
 reddening
 swelling
 papulas
 vesicles
 itching
Differential diagnosis :
denture stomatitis
Occurs soon after denture placement, on
every part of oral mucosa toutching acrilan.
 Allergy dissapears few hours or days after
denture removing.
 It is caused by free monomer that relieves
after incorrect polimerization or after direct
denture relining.
 Acrylic stains may also cause hypersensitivity.

AMALGAM FILLINGS ALLERGY

Amalgam fillings can rarely trigger the
allergic response.

Oral mucosa lesions are simillar to the
eruptions in lichen planus and localized on
mucosa contacting the filling.

It is advised to avoid amalgam in skin
diseases, autism, multiple sclerosis and other
diseases of immunological etiology.
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ALLERGY TO FORMALDEHYDE :
Symptoms :
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lips swelling
swelling of the oral mucosa
rash on face
lichenoid reactions
Treatment :
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replacement of amalgam by composite filling
It mostly affects bronchi, damaging the
process of bronchi tubes self-cleaning.
Symptoms :
• lacrimation, burning sensation in the eye
• cough, asthmatic reaction
• throat irritation
• hoarseness
• skin rashes and erythema
LATEX ALLERGY
CHLORHEXIDINE ALLERGY
In dentystry chlorhexidine is used in
concentration 0,1-0,2 %
(CORSODYL, LISTERIN, ELUDRIL).

15-30 % OF DENTISTS SUFFER FROM LATEX
ALLERGY!!




Seldom can induce allergic or photoalergic
reactions.
There are known anaphylaxis after using
chlorhexidine on mucosa and skin.

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Some people are born with genetic
predisposition to be allergic to latex.
However repeated exposure to latex is
necessary for an allergy to develope
There is also an interesting association
of unique food allergy among persons
allergic to latex. People with
hypersensitivity to latex are frequently
( in 50% ) allegric to bananas, kiwi and
papayas.

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Latex is a product which comes from the light
milk fluid extracted from the rubber tree.
May induce both type I and IV hypersensitivity
reactions.
Latex protein can easily sticks to powder
commonly used in surgical gloves and cause
reaction type I .
Chemical agents added to latex during the
manufacture proces are responsible for type IV
reactions.
Symptoms :

urticaria

conjunctiva inflammation

allergic rhinitis

asthmatic reaction


angioedema
anaphylactic shock (frequent surgery,
catheter use or intubation)
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How to detect ?
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Treatment :
skin patch test
provocation test
Provocation test is performed by placing
material with latex on the arm or by wearing
latex gloves for 15 minutes.

avoidance of latex

latex free gloves

powderless gloves
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