ALLERGIES IN ORAL CAVITY,CLINICAL SYMPTOMS CAUSING FACTORS AND TREATMENT

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1 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 : Allergens : 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 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). anxiety itching skin covered with cold sweat paleness filiform pulse or hard to measure tachycardia nausea and vomiting 1

2 call an ambulance stop exposure to antigen lying position adrenaline subcutaneously or intramusculary (0,1% solution) 0,2-0,5 ml every min hydrocortisone 200 mg intravenously antihistamines intramusculary oxygen (4-6 l/min) ANGIOEDEMA 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 ALLERGIC STOMATITIS Immune reaction type I due to systematical drug therapy or food. oral antihistamines in severe cases corticosteroids Eruptions in oral cavity may differ and clinicaly resumbles erythema multiforme. 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. antihistamines 2

3 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 % 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 : changes in morphology and anatomy saliva flow keratinization of hard palate(inhibits resorption of nickel ions) 3

4 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 In case of oral mucosa reactions remove dental restorations composed of nickel alloy Corticosteroids ACRYLIC RESIN ALLERGY 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. 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. 4

5 lips swelling swelling of the oral mucosa rash on face lichenoid reactions replacement of amalgam by composite filling ALLERGY TO FORMALDEHYDE : It mostly affects bronchi, damaging the process of bronchi tubes self-cleaning. lacrimation, burning sensation in the eye cough, asthmatic reaction throat irritation hoarseness skin rashes and erythema CHLORHEXIDINE ALLERGY In dentystry chlorhexidine is used in 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 % 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. urticaria conjunctiva inflammation allergic rhinitis asthmatic reaction angioedema anaphylactic shock (frequent surgery, catheter use or intubation) 5

6 How to detect? 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 6