ALLERGIES IN ORAL CAVITY,CLINICAL SYMPTOMS CAUSING FACTORS AND TREATMENT

ALLERGIES IN ORAL

CAVITY,CLINICAL

SYMPTOMS CAUSING

FACTORS AND TREATMENT

lek.dent Monika Hemerling

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.

Clasiffication of immune reactions :

Type I – immediate hipersensitivity involving IgE Ex. Anaphylactic shoc , angioedema Type II – hypersensitivity caused by IgG and IgM antibodies

directed towards cell surface antigens Ex.drug induce reactions:

hemolitical anemia, agranulocytosis,thrombocytosis Type III – immune complex reaction involving IgG, IgA, IgM

Ex. Serum disease

Type IV – delayed hypersensitivity with T-limphocytes Ex. Contact dermatitis, tuberculin reaction

Allergens :

 drugs

 local anaesthetics

 antiseptics

 toothpaste ingredience

 acrylic stains and acrylan

 metals (nickel, chromium, cobalt, !! tytanium,

tantalum, niobium)

 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 :

itching

_{skin covered with cold sweat}  _paleness

filiform pulse or hard to measure  _tachycardia

Treatment :

_{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)

ANGIOEDEMA

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

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.

List of allergens most often causing

contact dermatitis :

Allergen Female (%) Male(%)

1. Nickel 11,1 2,2 2. Tiommersal 3,1 3,6 3. Perfume 1,0 1,1 4. Cobalt 1,4 0,7 5. Formaldehyde 1,0 1,1 6 .Colophony 1,0 0,4 7. Chromium 0,3 0,7

METAL ALLERGY :

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

.

Nickel

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.

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.

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.  If allergic reaction at first developed

in oral cavity, skin lesions appear after some period.

No intra-oral response is due to :

saliva flow

_{keratinization of hard palate(inhibits} resorption of nickel ions)

_{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.

Patch tests are used to detect metal

allergy

Treatment :



In case of oral mucosa reactions

remove dental restorations composed

of nickel alloy



_{Corticosteroids}

ACRYLIC RESIN ALLERGY

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.}

Symptoms :

reddening

swelling

papulas

vesicles

itching

Differential diagnosis :

denture stomatitis

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.

Symptoms :

_{swelling of the oral mucosa} _{rash on face}

lichenoid reactions

Treatment :

replacement of amalgam by composite filling

ALLERGY TO FORMALDEHYDE :

process of bronchi tubes self-cleaning. Symptoms :

• lacrimation, burning sensation in the eye • cough, asthmatic reaction

• throat irritation • hoarseness

• skin rashes and erythema

CHLORHEXIDINE ALLERGY

concentration 0,1-0,2 %

(CORSODYL, LISTERIN, ELUDRIL).

 Seldom can induce allergic or photoalergic reactions.

There are known anaphylaxis after using chlorhexidine on mucosa and skin.

LATEX ALLERGY

15-30 % OF DENTISTS SUFFER FROM LATEX ALLERGY!!

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.

_{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.

Symptoms :

How to detect ?

Provocation test is performed by placing material with latex on the arm or by wearing latex gloves for 15 minutes.

Treatment :