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Current Oral Health Reports

, Volume 3, Issue 4, pp 347–355 | Cite as

Oral Cavity and Allergy: Meeting the Diagnostic and Therapeutic Challenge

  • Eleni PapakonstantinouEmail author
  • Ulrike Raap
Epidemiology (M Laine, Section Editor)
  • 242 Downloads
Part of the following topical collections:
  1. Topical Collection on Epidemiology

Abstract

Allergic reactions of the oral mucosa are associated with diverse symptoms and can severely affect patients’ quality of life. Oral mucosa changes such as stomatitis or lichenoid reactions can be the first evidence of a contact allergy, with oral lichenoid reactions after contact with dental restorations, especially amalgam fillings, being among the most common clinical reactions. Additives in foods and oral hygiene products may also cause allergic mucosal reactions. Subjective symptoms, such as pain, burning feeling, or dryness of the oral mucosa, as well as cheilitis or lip and facial swelling, may not only have an allergic component but may also be associated with other diseases that have to be excluded. A complete and thorough clinical examination of the oral mucosa is the first step in the diagnosis of a contact allergy. A detailed history of the patient’s oral care products, drugs, and dental materials is both essential and helpful for the clinician. As a result of the presence of mucosal changes, a patch test can be used for the diagnosis of contact allergy of delayed type. Although the patch test is the standard diagnostic tool for such types of contact allergy, proper interpretation of patch-test results and their clinical relevance can be challenging. As the number of patients with allergies resulting from different materials increases over the years, and a larger number of different dental materials are found to induce an allergy, it is essential for dentists to be aware of the possible allergic reactions to dental materials. Thus, we aimed to develop a systematic approach for contact allergy of the oral cavity, focusing not only on clinical manifestations and diagnosis but also on management and prediction of the risk of oral allergic reactions. A multidisciplinary approach for patients with an oral allergy is essential, with participation of physicians of different specialties, including dentists, allergists and dermatologists.

Keywords

Oral cavity Contact allergy Mucosal changes Patch test Dental materials 

Notes

Compliance with Ethical Standards

Conflict of Interest

Eleni Papakonstantinou and Ulrike Raap declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Funding Source

None.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Ditrichova D et al. Oral lichenoid lesions and allergy to dental materials. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007;151(2):333–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Van Hoogstraten IM et al. The frequency of nickel allergy upon oral nickel contact at an early age. Clin Exp Immunol. 1991;85(3):441–5.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Lygre GB et al. Reporting on adverse reactions to dental materials: intraoral observations at a clinical follow-up. Community Dent Oral Epidemiol. 2006;31(3):200–6.CrossRefGoogle Scholar
  4. 4.•
    Kamath VV et al. Oral lichenoid lesions: a review and update. Indian J Dermatol. 2015;60(1):102. Important review works focusing on oral allergy including a big amount of patients.Google Scholar
  5. 5.
    Thronhill MH. Oral lichen planus and allergy to dental amalgam restorations. Arch Dermatol. 2004;140(12):1434–8.Google Scholar
  6. 6.
    Edwards PC, Kelsch R. Oral lichen planus: clinical presentation and management. J Can Dent Assoc. 2002;68(8):494–9.PubMedGoogle Scholar
  7. 7.
    Karabucak B, Stoopler ET. Root canal treatment on a patient with zinc oxide allergy: a case report. Int Endod J. 2007;40(10):800–7.CrossRefPubMedGoogle Scholar
  8. 8.•
    Raap U et al. Investigation of contact allergy to dental metals in 206 patients. Contact Dermatitis. 2009;60(6):339–43. Important review works focusing on oral allergy including a big amount of patients.Google Scholar
  9. 9.•
    Chaturvedi TP. An overview of the corrosion aspect of dental implants (titanium and its alloys). Indian J Dent Res. 2009;20(1):91–8. Important articles refering to oral allergy and individual dental materials or products.Google Scholar
  10. 10.
    Fischer MM, Bowey J. Alleged allergy to local anaesthetics. Anaesth Intensive Care. 1997;25(6):611–4.Google Scholar
  11. 11.•
    Spencer AJ. Dental amalgam and mercury in dentistry. Aust Dent J. 2000;45(4):224–34. Important articles refering to oral allergy and individual dental materials or products.Google Scholar
  12. 12.
    Goodrich JM et al. Exposures of dental professionals to elemental mercury and methylmercury. J Expo Sci Environ Epidemiol. 2016;26(1):78–85.CrossRefPubMedGoogle Scholar
  13. 13.
    Kal BI et al. An unusual case of immediate hypersensitivity reaction associated with an amalgam restoration. Br Dent J. 2008;205(10):547–50.CrossRefPubMedGoogle Scholar
  14. 14.
    Henriksson E, Mattsson U, Håkansson J. Healing of lichenoid reactions following removal of amalgam. A clinical follow-up. J Clin Periodontol. 1995;22(4):287–94.CrossRefPubMedGoogle Scholar
  15. 15.
    Ellison R et al. Orofacial granulomatosis related to amalgam fillings. Scott Med J. 2013;58(4):24–5.CrossRefGoogle Scholar
  16. 16.
    Rachmawati D et al. Dental metal-induced innate reactivity in keratinocytes. Toxicol in Vitro. 2015;30(1):325–30.CrossRefPubMedGoogle Scholar
  17. 17.•
    Ahlgren C et al. Contact allergies to potential allergens in patients with oral lichen lesions. Clin Oral Investig. 2014;18(1):227–37. Important articles refering to oral allergy and individual dental materials or products.Google Scholar
  18. 18.
    McParland H, Warnakulasuriya S. Oral lichenoid contact lesions to mercury and dental amalgam-a review. J Biomed Biotechnol. 2012;2012:589569.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Little MC et al. Activation of oral keratinocytes by mercuric chloride: relevance to dental amalgam-induced oral lichenoid reactions. Br J Dermatol. 2001;144(5):1024–32.CrossRefPubMedGoogle Scholar
  20. 20.
    Pigatto PD et al. Linking allergy to mercury to HLA and burning mouth syndrome. J Eur Acad Dermatol Venereol. 2007;21(8):1118–20.CrossRefPubMedGoogle Scholar
  21. 21.
    Pigatto PD, et al. Systemic allergic contact dermatitis associated with allergy to intraoral metals. Dermatol Online J. 2014;20(10).Google Scholar
  22. 22.
    Pigatto PD et al. Recovery from mercury-induced burning mouth syndrome due to mercury allergy. Dermatitis. 2004;15(2):75–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Ahlgren C et al. Contact allergy to gold is correlated to dental gold. Acta Derm Venereol. 2002;82(1):41–4.CrossRefPubMedGoogle Scholar
  24. 24.
    Wataha JC, Drury JL, Chung WO. Nickel alloys in the oral environment. Expert Rev Med Devices. 2013;10(4):519–39.CrossRefPubMedGoogle Scholar
  25. 25.
    Curtis A et al. The effects of nickel and chromium on human keratinocytes: differences in viability, cell associated metal and IL-1 alpha release. Toxicol in Vitro. 2007;21(5):809–19.CrossRefPubMedGoogle Scholar
  26. 26.
    Sebastiani S et al. Nickel-specific CD4(+) and CD8(+)T cells display distinct migratory responses to chemokines produced during allergic contact dermatitis. J Investig Dermatol. 2002;118(6):1052–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Dwivedi A et al. Release of nickel and chromium ions in the saliva of patients with fixed orthodontic appliance: an in-vivo study. Natl J Maxillofac Surg. 2015;6(1):61–6.CrossRefGoogle Scholar
  28. 28.
    Noble J et al. Nickel allergy and orthodontics, a review and report of two cases. Br Dent J. 2008;204(6):297–300.CrossRefPubMedGoogle Scholar
  29. 29.
    Büyüköztürk S et al. Nickel dental alloys can induce laryngeal edema attacks: a case report. J Dermatol. 2013;40(9):740–2.CrossRefPubMedGoogle Scholar
  30. 30.
    Büyüköztürk S et al. Oral nickel exposure may induce type I hypersensitivity reaction in nickel-sensitized subjects. Int Immunopharmacol. 2015;26(1):92–6.CrossRefPubMedGoogle Scholar
  31. 31.•
    Sicilia A et al. Titanium allergy in dental implant patients: a clinical study on 1500 consecutive patients. Clin Oral Implants Res. 2008;19(8):823–35. Important articles refering to oral allergy and individual dental materials or products.Google Scholar
  32. 32.
    Nawaz F, Wall BM. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome: suspected association with titanium bioprosthesis. Am J Med Sci. 2007;334(3):215–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Müller K, Valentine-Thon E. Hypersensitivity to titanium: clinical and laboratory evidence. Neuroendocrinol Lett. 2007;28(5):31–5.Google Scholar
  34. 34.
    Schwitalla A, Müller WD. PEEK dental implants: a review of the literature. J Oral Implantol. 2013;39(6):743–9.CrossRefPubMedGoogle Scholar
  35. 35.•
    Hosoki M et al. Allergic contact dermatitis caused by titanium screws and dental implants. J Prosthodont Res. 2016;60(3):213–9. Important articles refering to oral allergy and individual dental materials or products.Google Scholar
  36. 36.
    Marquardt W et al. Volatile methacrylates in dental practices. J Adhes Dent. 2009;11(2):101–7.PubMedGoogle Scholar
  37. 37.
    Johns DA, Hemarai S, Varoli RK. Allergic contact stomatitis from bisphenol-a-glycidyl dimethacrylate during application of composite restorations: a case report. Indian J Dent Res. 2014;25(2):266–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Blomgren J et al. Adverse reactions in the oral mucosa associated with anterior composite restorations. J Oral Pathol Med. 1996;25(6):311–3.CrossRefPubMedGoogle Scholar
  39. 39.
    Leggat PA, Kedjarune U. Toxicity of methyl methacrylate in dentistry. Int Dent J. 2003;53(3):126–31.CrossRefPubMedGoogle Scholar
  40. 40.
    Wingfield Digby SS, Thyssen JP. How should we advise patients with allergic contact dermatitis caused by (meth-)acrylates about future dentalwork? Contact Dermatitis. 2016;74(2):116–7.CrossRefPubMedGoogle Scholar
  41. 41.
    Snyder HA, Settle S. The rise in latex allergy: implications for the dentist. J Am Dent Assoc. 1994;125(8):1089–97.CrossRefPubMedGoogle Scholar
  42. 42.
    Primeau MN, Adkinson NF, Hamilton RG. Natural rubber pharmaceutical vial closures release latex allergens that produce skin reactions. J Allergy Clin Immunol. 2001;107(6):958–62.CrossRefPubMedGoogle Scholar
  43. 43.
    McEntee J. Dental local anaesthetics and latex: advice for the dental practitioner. Dent Updat. 2012;39(7):508–10.Google Scholar
  44. 44.
    Chin S, Ferguson J, Bajurnow T. Latex allergy in dentistry. Review and report of case presenting as a serious reaction to latex dental dam. Aust Dent J. 2004;49(3):146–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Nainar SM. Dental management of children with latex allergy. Int J Paediatr Dent. 2001;11(5):322–6.CrossRefPubMedGoogle Scholar
  46. 46.
    Kean T, McNally M. Latex hypersensitivity: a closer look at considerations for dentistry. J Can Dent Assoc. 2009;75(4):279–82.PubMedGoogle Scholar
  47. 47.
    Hamann CP, DePaola LG, Rogers PA. Occupation-related allergies in dentistry. J Am Dent Assoc. 2005;136(4):500–10.CrossRefPubMedGoogle Scholar
  48. 48.
    Speca SJ, Boynes SG, Cuddy MA. Allergic reactions to local anesthetic formulations. Dent Clin N Am. 2010;54(4):655–64.CrossRefPubMedGoogle Scholar
  49. 49.
    Lukawska J et al. Hypersensitivity to local anesthetics: 6 facts and 7 myths. Clin Immunol Curr Allergy. 2009;22(1):117–20.Google Scholar
  50. 50.
    Batinac T et al. Adverse reactions and alleged allergy to local anesthetics: analysis of 331 patients. J Dermatol. 2013;40(7):522–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Baluga JC. Allergy to local anesthetics in dentistry. Myth or reality? Rev Allerg Mex. 2010;50(5):176–81.Google Scholar
  52. 52.
    Montebugnoli L et al. Heart rate variability: a sensitive parameter for detecting abnormal cardiocirculatory changes during a stressful dental procedure. J Am Dent Assoc. 2004;135(12):1718–23.CrossRefPubMedGoogle Scholar
  53. 53.
    Terai H, Shimahara M. Glossodynia from Candida-associated lesions, burning mouth syndrome, or mixed causes. Pain Med. 2010;11(6):856–60.CrossRefPubMedGoogle Scholar
  54. 54.
    Pigatto PD et al. Photoletter to the editor: exfoliative cheilitis associated with titanium dental implants and mercury amalgam. J Dermatol Case Rep. 2011;5(4):89–90.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Taibjee SM, Prais L, Foulds IS. Orofacial granulomatosis worsened by chocolate: results of patch testing to ingredients of Cadbury’s chocolate. Br J Dermatol. 2004;150(3):595.CrossRefPubMedGoogle Scholar
  56. 56.
    Endo H, Rees T. Cinnamon products as a possible etiologic factor in orofacial granulomatosis. Med Oral Patol Oral Cir Bucal. 2007;12(6):440–4.Google Scholar
  57. 57.
    Samimi M. Cheilitis: diagnosis and treatment. Presse Med. 2016;45(2):240–50.CrossRefPubMedGoogle Scholar
  58. 58.
    Sharma R et al. Role of dental restoration materials in oral mucosal lichenoid lesions. Indian J Dermatol Venereol Leprol. 2015;81(5):478–84.CrossRefPubMedGoogle Scholar
  59. 59.•
    Laine J, Kalimo K, Happonen RP. Contact allergy to dental restorative materials in patients with oral lichenoid lesions. Contact Dermatitis. 1997;36(3):141–6. Important articles refering to oral allergy and individual dental materials or products.Google Scholar
  60. 60.
    Sockanathan S, Setterfield J, Wakelin S. Oral lichenoid reaction due to chromate/cobalt in dentla prothesis. Contact Dermatitis. 2003;48(6):342–3.CrossRefPubMedGoogle Scholar
  61. 61.
    Dunsche A et al. Oral lichenoid reactions associated with amalgam: improvement after amalgam removal. Br J Dermatol. 2003;148(1):70–6.CrossRefPubMedGoogle Scholar
  62. 62.
    Brown RS, Farquharson AA. A topical imiquimod-induced oral mucosal lichenoid reaction: a case report. J Am Dent Assoc. 2014;145(11):1141–5.CrossRefPubMedGoogle Scholar
  63. 63.
    Bäckmann K, Jontell M. Microbial-associated oral lichenoid reactions. Oral Dis. 2007;12(4):402–6.CrossRefGoogle Scholar
  64. 64.
    Koutis D, Freeman S. Allergic contact stomatitis caused by acrylic monomer in a denture. Australas J Dermatol. 2001;42(3):203–6.CrossRefPubMedGoogle Scholar
  65. 65.
    Martin N et al. Orofacial reactions to methacrylates in dental materials: a clinical report. J Prosthet Dent. 2003;90(3):225–7.CrossRefPubMedGoogle Scholar
  66. 66.
    Tang A, Bjorkman L, Ekstrand J. New filling materials: an occupational health hazard. Ann R Australas Coll Dent Surg. 2000;15(1):102–5.PubMedGoogle Scholar
  67. 67.
    Pardo J et al. Allergic contact stomatitis due to manganese in a dental prosthesis. Contact Dermatitis. 2004;50(1):41.CrossRefPubMedGoogle Scholar
  68. 68.
    Wray D et al. The role of allergy in oral mucosal diseases. QJM. 2000;93(8):507–11.CrossRefPubMedGoogle Scholar
  69. 69.
    Aravindhan R et al. Burning mouth syndrome: a review on its diagnostic and therapeutic approach. J Pharm Bioallied Sci. 2014;6 Suppl 1:S21–5.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Mendak M. Algorithm for diagnosis and treatment of the primary and secondary burning mouth syndrome depending on etiological factors. Dent Med Probl. 2006;43(1):585–95.Google Scholar
  71. 71.
    Jimson S et al. Burning mouth syndrome. J Pharm Bioallied Sci. 2015;7(1):194–6.Google Scholar
  72. 72.
    Coculescu EC, Tovaru S, Coculescu BI. Epidemiological and etiological aspects of burning mouth syndrome. J Med Life. 2014;7(3):305–9.PubMedPubMedCentralGoogle Scholar
  73. 73.
    Slebioda Z, Szponar E. Burning mouth syndrome: a common dental problem in perimenopausal women. Prz Menopauzalny. 2014;13(3):198–202.PubMedPubMedCentralGoogle Scholar
  74. 74.
    Milanesi N et al. Aspects of contact cheilitis: analysis of 38 cases. J Eur Acad Dermatol Venereol. 2016;30(6):1052–3.CrossRefPubMedGoogle Scholar
  75. 75.
    O'Gorman SM, Torgerson RR. Contact allergy in cheilitis. Int J Dermatol. 2016;55(7):386–91.CrossRefGoogle Scholar
  76. 76.
    Lee A et al. Two cases of allergic contact cheilitis from sodium lauryl sulfate in toothpaste. Contact Dermatitis. 2000;42(2):111.PubMedGoogle Scholar
  77. 77.•
    Van Baelen A, Kerre S, Goossens A. Allergic contact cheilitis and hand dermatitis caused by a toothpaste. Contact Dermatitis. 2016;74(3):187–9. Important articles refering to oral allergy and individual dental materials or products.Google Scholar
  78. 78.
    Le Coz CJ, Bezard M. Allergic contact cheilitis due to effervescent dental cleanser: combined responsibilities of the allergen persulfate and prothesis porosity. Contact Dermatitis. 1999;41(5):268–71.CrossRefPubMedGoogle Scholar
  79. 79.
    Le Coz CJ, Ball C. Recurrent allergic contact dermatitis and cheilitis due to castor oil. Contact Dermatitis. 2000;42(2):114–5.Google Scholar
  80. 80.
    Kano S et al. Granulomatous cheilitis with intralymphatic histiocytosis possibly associated with calcium deposition caused by chronic inflammation owing to dental metals and periodontitis. J Dermatol. 2015;42(1):84–6.CrossRefPubMedGoogle Scholar
  81. 81.
    Abbas Z et al. Pemphigus vulgaris presented with cheilitis. Case Rep Dermatol Med. 2014;2014:147197.PubMedPubMedCentralGoogle Scholar
  82. 82.
    Balakumar P, Kavitha M, Nanditha S. Cardiovascular drugs-induced oral toxicities: a murky area to be revisited and illuminated. Pharmacol Res. 2015;102(1):81–9.CrossRefPubMedGoogle Scholar
  83. 83.
    Grave B, McCullough M, Wiesenfeld D. Orofacial granulomatosis: a 20-year review. Oral Dis. 2000;15(1):46–51.CrossRefGoogle Scholar
  84. 84.••
    Muñoz-Corcuera M et al. Oral ulcers: clinical aspects. A tool for dermatologists. Part I. Acute ulcers. Clin Exp Dermatol. 2009;34(3):89–94. Important articles which advise clinicians to come along with diagnosis and treatment of oral allergy.Google Scholar
  85. 85.••
    Muñoz-Corcuera M et al. Oral ulcers: clinical aspects. A tool for dermatologists. Part II. Chronic ulcers. Clin Exp Dermatol. 2009;34(4):456–61. Important articles which advise clinicians to come along with diagnosis and treatment of oral allergy.Google Scholar
  86. 86.•
    Siu A, Landon K, Ramos DA. Differential diagnosis and management of oral ulcers. Semin Cutan Med Surg. 2015;34(4):171–7. Important articles which advise clinicians to come along with diagnosis and treatment of oral allergy.Google Scholar
  87. 87.
    Nettis E et al. Reported latex allergy in dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;93(2):144–8.CrossRefPubMedGoogle Scholar
  88. 88.
    Katoh N et al. Dermal contact dermatitis caused by allergy to palladium. Contact Dermatitis. 1999;40(4):226–7.CrossRefPubMedGoogle Scholar
  89. 89.
    de Silva BD, Docherty V. Nickel allergy from orthodontic appliances. Contact Dermatitis. 2000;42(2):102–3.PubMedGoogle Scholar
  90. 90.
    Pigatto PD, Guzzi G. Systemic allergic dermatitis syndrome caused by mercury. Contact Dermatitis. 2008;59(1):66.CrossRefPubMedGoogle Scholar
  91. 91.
    Trombelli L et al. Systemic contact dermatitis from an orthodontic appliance. Contact Dermatitis. 1992;27(4):259–60.CrossRefPubMedGoogle Scholar
  92. 92.
    Shargill I, Asher-McDade C. An unusual allergic response to orthodontic treatment. Dent Updat. 2015;42(6):580–2.Google Scholar
  93. 93.
    Griffin T. Anaphylaxis in general dental practice. Prim Dent J. 2014;3(1):6–38.CrossRefGoogle Scholar
  94. 94.••
    Raap U, Stiesch M, Kapp A. Contact allergy to dental materials. J Dtsch Dermatol Ges. 2012;10(6):391–6. Important review works focusing on oral allergy including a big amount of patients.Google Scholar
  95. 95.
    Neodorost S, Wagman A. Positive patch-test reactions to gold: patients’ perception of relevance and the role of titanium dioxide in cosmetics. Dermatitis. 2005;16(2):67–70.Google Scholar
  96. 96.••
    Summer B et al. Role of the lymphocyte transformation test in the evaluation of metal sensitization. Hautarzt. 2016;67(5):380–4. Interesting article giving a future point of view in matters of an innovative diagnostic method.Google Scholar

Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.Department of Dermatology and AllergyHannover Medical SchoolHannoverGermany

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