Clinical evaluation of fifty-six patients referred with symptoms tentatively related to allergic contact stomatitis.

During a 7-year period, 56 patients were referred to the Department of General Pathology and Internal Medicine and the Department of Dental Materials, University of Amsterdam, to determine whether contact allergic reactions to dental materials were the cause of their complaints. On the first consultation with the patient a detailed history focusing on the complaints themselves, general medical history, and special clinical history of allergic skin reaction was obtained. Oral examinations were performed, and all patients were referred to the allergy clinic at the department of dermatology for skin tests. There was a strong female predominance in the referred group. Most of the patients with allergic contact stomatitis mentioned a burning sensation in the mouth. In only 16 of the 56 patients could the diagnosis of allergic contact stomatitis be established. From this study it can also be concluded that the combination of a positive allergic history and positive allergic skin reactions with or without visible oral signs are important for the diagnosis of allergic contact stomatitis.     

Contact allergy to cinnamon: case report

Allergic contact stomatitis is a rare disorder that is unfamiliar to most clinicians. The vast majority of cases are associated with consumption of products containing cinnamaldehyde or cinnamon essential oil, which are used as flavourings because of their pleasant taste and sensation of freshness. We report here the case of a patient who was diagnosed with alllergic contact stomatitis due to cinnamon-flavoured chewing gum. The clinical features of allergic contact stomatitis, which may occur indiscriminately on any of the oral mucosa, include edema and erythroplakic, ulcerous or hyperkeratotic changes, generally accompanied by a burning sensation. The histopathologic aspect of allergic contact stomatitis is nonspecific but tends to support the clinical diagnosis. Treatment generally consists of eliminating the causal agent. To avoid unnecessary diagnostic procedures and treatments, it is important for clinicians to recognize this disorder to be able to diagnose it quickly and accurately.     

Clinical characteristics of an allergic reaction to a polyether dental impression material

Allergic and hypersensitivity reactions to dental impression materials may occur throughout dental treatment, with diverse manifestations from slight redness to severe pain and a burning mouth with total stomatitis. Patients are often unaware of these allergic reactions, which makes early identification of the cause almost impossible. In addition, symptoms usually begin after 24 hours and mostly in patients with a preexisting history of allergic responses. This report describes a patient with a suspected allergic reaction to a polyether dental impression material during prosthetic rehabilitation associated with a mandibular telescopic denture. Although instances of such occurrence are rare, clinicians need to be aware of these symptoms and select materials carefully for patients with a history of allergy.     

Allergic contact stomatitis from colophony

Colophony is an ubiquitous contact sensitizer which may be present in dental materials, such as periodontal dressings, impression materials, cements, fix adhesives and varnishes. Exposure to a sensitizer in a hypersensitive person may initiate an allergic contact dermatitis/stomatitis.This usually occurs after direct skin/mucosa contact with the sensitizer. This paper reports the case of a colophony hypersensitive male who developed contact stomatitis after dental treatment with a colophony-containing product. CLINICAL RELEVANCE: Sensitizing colophony is present in Duraphat 2.26%F varnish, a fluoride varnish used all over the world. A case of hypersensitivity to Duraphat 2.26%F varnish is presented in a patient who, at the initial visit, indicated only an allergy to sticking plasters.     

Amalgam. VI. Allergy to mercury in dental materials; oral and systemic reactions

Allergy for mercury in dental alloys can be responsible for the induction of allergic contact stomatitis. Evidence is also available for a role of mercury sensitization in the pathogenicity of oral lichen planus in particular. Aspects related to the development of allergic processes in the oral cavity are summarized. Allergy for mercury as the cause of oral mucosal reactions is rather rare in spite of the frequent use in dental amalgam, but probably underestimation of the incidence should be considered. Recent views with respect to the role of mercury as allergen in allergic contact stomatitis, oral lichen planus, the so-called Burning mouth syndrome and in systemic allergic reactions are summarized. Immunologic aspects in the pathogenesis are briefly discussed. Especially in cases in which the site or oral lesions is opposite to the dental alloy it is important to establish sensitization for mercury by use of epicutaneous path testing. When a positive test to mercury is obtained replacement of mercury containing alloys should be considered.     

Characterization of nickel-induced allergic contact stomatitis associated with fixed orthodontic appliances.

INTRODUCTION: In some orthodontic patients, an oral inflammatory response is induced by corrosion of orthodontic appliances and subsequent nickel release. This inflammatory response is manifested as stomatitis (nickel-induced allergic contact stomatitis [NiACS]). The etiology and diagnosis of NiACS are difficult to determine. The purpose of this retrospective analysis was to investigate the roles of age, sex, previous allergic history, and time of exposure to fixed orthodontic appliances in the etiopathogeny of NiACS. METHODS: Forty-four orthodontic patients (range, 10-44 years) were divided into 2 groups, depending on their NiACS clinical manifestations. RESULTS: Young patients, especially females with a history of allergic reactions, had a greater predisposition to NiACS clinical manifestations; time of exposure to orthodontic appliances was not a significant factor. CONCLUSIONS: A previous allergic reaction should be considered a predictive factor of NiACS clinical manifestations and should be noted in the patient's medical history.     

Propolis allergy: a cause of oral mucositis with ulceration

Propolis has been used since ancient times in folk medicine for its alleged beneficial effects. It is a potent sensitizer and is well recognized as a cause of occupational allergic eczematous contact dermatitis in apiarists. Recently, there has been an increase in allergic eczematous contact dermatitis because of nonoccupational exposure to propolis in "natural products" and biocosmetics. This report describes a patient who had acute oral mucositis with ulceration as a result of using propolis-containing lozenges.     

Delayed hypersensitivity or geographic tongue: A diagnostic dilemma

Delayed hypersensitivity can occur following the use of a wide range of materials used in dentistry. These adverse reactions can be either localized or diffuse, and can mimic oral lesions of other aetiology. Delayed hypersensitivity to dental amalgam commonly presents as lichenoid oral lesions. We report the case of a patient who presented to us with burning and itching sensations on the tongue three days after restoration of his lower permanent molars with silver amalgam. Within a day, the initially well circumscribed lesions of the tongue became diffuse. Atrophy of the lingual papillae gave an appearance of a geographic tongue. Following replacement of the amalgam restoration, symptoms rapidly subsided and there was a significant improvement of the lesion.     

Contact allergy to Duraphat

Skin-sensitizing rosin is present in Duraphat, a fluoride varnish used all over the world. Two cases of hypersensitivity to Duraphat are presented: a dental nurse with dermatitis of the hand and a patient with allergic contact stomatitis.     

Type 3 burning mouth syndrome: psychological and allergic aspects

A subgroup of patients with burning mouth syndrome was investigated. The clinical history of these patients differed from the norm in that symptoms were intermittent and affected unusual sites. In addition, routine investigations were supplemented with a more detailed psychological evaluation than reported previously and also a possible allergic component was studied by patch testing. The study has shown that this subgroup differs from burning mouth syndrome patients overall in that emotional instability and allergic reactions, particularly to food additives, are of etiological significance and require to be taken into consideration in terms of patient management.     

Allergic contact dermatitis associated with the use of facemask on a patient with a history of atopy

Allergic contact dermatitis (ACD) is a skin inflammation caused by an allergic reaction after contact with small external substances capable of being absorbed by the skin. There are several studies describing allergic reactions to intraoral orthodontic appliances, especially those containing nickel. Allergic reactions due to extraoral appliances are not as frequent, and there are relatively few studies about them. Extraoral eactions are attributed to metallic, elastic, or textile parts of the extraoral appliances. This article's purpose was to report the appearance of an allergic contact dermatitis reaction in a 9-year, 2-month-old female patient, with a history of atopic dermatitis, after an orthodontic facemask was fitted. Rapid maxillary expansion was also performed with a Hyrax appliance while a facemask was used. Early diagnosis of this pathology is essential in order to achieve a total regression of the reaction. Orthodontists should be aware that ACD can be caused by facemasks in predisposed patients.     

Abnormal reaction to subgingivally placed dental amalgam studied by transmission electron microscopy and microprobe analysis. Case report

An abnormal clinical response to dental amalgam is reported. The patient presented with a generalized burning sensation having a focus of pain in a region approximating a subgingivally placed dental amalgam restoration. Replacement of the amalgam restoration with glass ionomer cement relieved the pain and burning. Gingival tissue associated with the amalgam, excised to render the new restoration supragingivally, displayed ultrastructural changes in both the epithelium and connective tissue, with mercury demonstrated in the connective tissue and the epithelium by electron microprobe analysis. The significance of the presence of mercury and absence of the other constituents of dental amalgam are discussed.     

Astra Tech single-tooth implants: an audit of patient satisfaction and soft tissue form

AIM: To investigate patient centred outcomes, soft tissue morphology, and bone levels. MATERIAL AND METHODS: Sixty-six subjects, who had completed treatment for a single implant restoration at least l year previously. Appearance was recorded photographically and bone levels and interdental contact points measured from intra-oral radiographs using a x 7 scale loupe. Subjects completed a satisfaction questionnaire. RESULTS: Subjects were highly satisfied with all aspects of the restoration including the appearance of the soft tissue (median shape/colour score 6 on scale 1-6). Twenty-eight sites in 20 subjects had no contact point between implant crown and adjacent tooth. A normal height papilla was judged to be present in 19 of these sites. These were excluded from the subsequent analysis. In the remaining 46 subjects with contact points the presence (JEMT score 3) or deficiency (score 1/2) of the papilla was significantly related to the distance to the bone level on the adjacent tooth and implant head. Differences were observed between the mesial and distal aspects of the implant restoration. CONCLUSIONS: Examining clinicians were more critical of the restorations than the patients. The presence of a complete papilla was associated with a slightly greater distance from contact point to bone level than previously reported.     

A measurement of galvanic current and electrical potential in extracted human teeth

When opposing teeth with amalgam and gold restoration are in contact, current flows in the mouth at the instant the dissimilar metals touch. In this study, this condition was simulated by use of resistors and extracted human teeth with amalgam and MOD gold inlay restorations. When both teeth were in contact in a physiological saline solution, we measured current and electrical potential generated in each pulp chamber. Galvanic current generated in the tooth with amalgam was always larger (as much as 18.2 times at the instant of contact) than that in the tooth with gold. Electrical potential generated in the tooth with amalgam was always larger (as much as 9.7 times at the instant of contact) than that in the tooth with gold. It should be emphasized that the larger current generated in the tooth with amalgam was caused mainly by its larger electrical potential. These results correspond well with the clinical phenomenon of galvanic pain, which occurs in the tooth with amalgam rather than in the tooth with gold.     

Oral manifestations of drug reactions

The clinical manifestations of oral reactions to the more commonly prescribed drugs have been presented. These reactions include the following conditions: stomatitis, ulceration and necrosis, opportunistic infections, hemorrhage, gingival hyperplasia, pigmentation, altered salivary function, and altered taste sensation. A patient who complains of any of these signs and symptoms should be thoroughly questioned regarding medication. If an offending drug can be identified, its alteration or elimination, in consultation with the prescribing clinician, will often result in resolution of the clinical problem.     

Allergic reaction to orthodontic wire: report of case

This case illustrates the importance of a thorough clinical history and the benefit of histopathologic examination. The history of contact allergy to jewelry provided an early clue, and the microscopic features confirmed the clinical impression of allergic stomatitis.     

Proximal contour modifications for fixed partial dentures: a clinical report

An often-neglected aspect of fixed prosthodontics is the contour of the tooth adjacent to the cast restoration. The adjacent surfaces should be surveyed to reveal compatibility with the path of insertion of the restoration. Adjacent contacts may have to be altered to permit the placement of the fixed partial denture and to ensure proper contact size/shape and embrasure size. The need for guide planes on teeth adjacent to fixed partial denture abutments in fixed prosthodontics is described.     

Oral adverse reactions due to cinnamon‐flavoured chewing gums consumption

Cinnamon‐flavoured products (toothpaste, chewing gum, food, candy and mouthwash) can cause oral adverse reactions; among these, the most common is contact stomatitis (cinnamon contact stomatitis, CCS). Signs and symptoms of contact allergic reactions affecting the oral mucosa can mimic other common oral disorders, making diagnosis difficult. As CCS may be more prevalent than believed and its clinical features can frequently determine misdiagnosis, we reviewed case reports and case series of oral adverse reactions due to cinnamon‐containing chewing gums, emphasizing clinical aspects, diagnostic and management procedures. We also proposed an algorithm to perform a diagnosis of CCS as in the previous published literature the diagnostic approach was not based on a harmonized and shared evidence‐based procedure. Moreover, as patients can refer to different specialists as dentists, dermatologists and allergists, a multidisciplinary approach is suggested.     

Systemically induced contact dermatitis from dental rosin

Rosin is a ubiquitous contact sensitizer which may be present in dental materials such as periodontal dressings, impression materials, cements, and cavity varnishes. When a hypersensitive person is exposed to a sensitizer, allergic contact dermatitis/stomatitis may develop, most commonly after direct skin/mucosa contact with the sensitizer. However, widespread dermatitis may develop after systemic administration of the sensitizer, and this paper reports the case of a rosin-hypersensitive man who developed widespread eczematous dermatitis after dental treatment with a rosin-containing product.     

Ciguatera neurotoxin poisoning mimicking burning mouth syndrome.

Burning mouth syndrome is a condition in which the patient perceives a sensation of intraoral burning, typically of the anterior tongue. This article presents a case report of a patient presenting for orofacial pain evaluation in whom ciguatera neurotoxin poisoning is diagnosed. The clinician should be aware of neurotoxin poisoning as a possible cause of symptoms of burning mouth, especially among patients who have recently traveled to a tropical area. Recognition of this condition in this case highlights the need for a detailed and accurate patient history.