A rare allergy to a polyether dental impression material

Adverse reactions to dental biomaterials: Experiences from a specialty clinic

OBJECTIVES

The Dental Biomaterials Adverse Reaction Unit was initiated by the Norwegian health authorities in 1992 as a response to the public concern regarding the safety of dental amalgam and other dental materials. In this paper, experiences from the Unit are briefly summarized.

METHODS

The Norwegian health authorities' strategy included four main topics: (i) development of a manufacturer-independent system for monitoring adverse reactions related to dental materials, (ii) funding of a specialty unit for clinical examinations of referred patients, (iii) development of official guidelines for examination and treatment of patients with health complaints attributed to dental materials, and (iv) funding of an experimental treatment project for patients with health complaints attributed to dental amalgam.

RESULTS

From the start, more than 2700 adverse reaction reports were received. In the initial years, amalgam was the most frequent material mentioned in the reports. Reports about polymer-based composite materials have not increased after the prohibition of amalgam in Norway. Clinical examination of referred patients is complex and time consuming, and it is important to consider differential diagnoses. There are methodological challenges associated with the design of experimental treatments used on patients with adverse reactions attributed to dental materials. However, the results from the treatment project indicate lower symptom load after replacement of amalgam with other dental restorative materials.

SIGNIFICANCE

Producer independent adverse reaction reporting can provide valuable information about the safety of these materials and could serve as a complement to the mandatory reporting system described in the European medical device regulations (MDR).

General diseases and medications in 687 patients reporting on adverse effects from dental materials

OBJECTIVES

Examination of patients claiming adverse effects from dental materials can be very challenging. Particularly, systemic aspects must be considered besides dental and orofacial diseases and allergies. Therefore, the aim of this study was to investigate a cohort of 687 patients reporting on adverse effects from dental materials focusing on findings related to known general diseases or conditions or medication-related findings with relevance to their subjective complaints.

METHODS

Six hundred eighty-seven patients visiting a specialized consultation on claimed adverse effects from dental materials were retrospectively investigated for their subjective complaints, findings related to known general diseases or conditions, medication-related findings, dental and orofacial findings, or allergies with relevance to their subjective complaints.

RESULTS

The most frequent subjective complaints were burning mouth (44.1%), taste disorders (28.5%), and dry mouth (23.7%). In 58.4% of the patients, dental and orofacial findings relevant to their complaints could be found. Findings related to known general diseases or conditions or medication-related findings were found in 28.7% or 21.0% of the patients, respectively. Regarding medications, findings related to antihypertensives (10.0%) and psychotropic drugs (5.7%) were found most frequently. Relevant diagnosed allergies toward dental materials were found in 11.9%, hyposalivation in 9.6% of the patients. In 15.1% of the patients, no objectifiable causes for the expressed complaints could be found.

CONCLUSIONS

For patients complaining of adverse effects from dental materials, findings related to known general diseases or conditions and medications should be given particular consideration, while still in some patients, no objectifiable causes for their complaints can be found.

CLINICAL RELEVANCE

For patients complaining about adverse effects from dental materials, specialized consultations and close collaboration with experts from other medical fields are eligible.

A Rare Case of Contact Allergy towards Impression Compound Material

Impression compound has been introduced for more than 100 years. Since then, it has been widely used to obtain a preliminary impression of the edentulous arch. Although the use of impression compound has declined markedly over recent years as newer materials have become available, the cost-effectiveness and desirable physical and mechanical properties make this material indispensable in developing countries and teaching institutions. Its high viscosity characterizes impression compound as a mucocompressive impression material, which enables the full depth of the sulcus to be recorded for the retention of complete dentures. Literature reviews revealed that most contact allergies to impression materials are towards polyether, very few are towards alginate and polysulfide, and no reported cases have been found toward impression compound. This case report demonstrates a recent rare case of contact allergy towards impression compound during a routine impression taking for a fully edentulous arch in a 61-year-old woman. The patient developed symptoms of an allergic reaction, and the management of the condition was described.

Recent update on potential cytotoxicity, biocompatibility and preventive measures of biomaterials used in dentistry

Dental treatment is provided for a wide variety of oral health problems like dental caries, periodontal diseases, periapical infections, replacement of missing teeth and orthodontic problems. Various biomaterials, like composite resins, amalgam, glass ionomer cement, acrylic resins, metal alloys, impression materials, bone grafts, membranes, local anaesthetics, etc., are used for dental applications. The physical and chemical characteristics of these materials influence the outcome of dental treatment. It also impacts on the biological, allergic and toxic potential of biomaterials. With innovations in science and their positive results, there is also a need for awareness about the biological risks of these biomaterials. The aim of dental treatment is to have effective, yet safe, and long-lasting results for the benefit of patients. For this, it is important to have a thorough understanding of biomaterials and their effects on local and systemic health. Materials used in dentistry undergo a series of analyses before their oral applications. To the best of our knowledge, this is the first and original review that discusses the reasons for and studies on the toxicity of commonly used biomaterials for applications in dentistry. It will help clinicians to formulate a methodical approach for the selection of dental biomaterials, thus providing an awareness for forecasting their risk of toxic reactions.

[Manifestations of allergic reactions occurring at a dental appointment]

OBJECTIVE

To analyze the data of modern scientific literature to conduct a study on identifying the true allergic reaction at a dental appointment.

MATERIAL AND METHODS

The article is based on the study of materials from domestic and foreign research databases eLibrary, PubMed, Cochrane Database Systematic Reviews. The research period is 15 years.

RESULTS

Among dental materials, the most common allergens are local anesthetics, metal alloys, components of composite materials, latex.

CONCLUSION

If allergy is suspected, it is necessary to carefully collect an anamnesis and conduct a clinical examination of the patient with the involvement of specialist doctors, with the recommendation of skin tests and test subcutaneous provocation.

Oral Hypersensitivity Reactions

Allergic contact hypersensitivity reactions of the oral mucosa pose a significant medical concern for some patients. Oral hypersensitivity reactions can result from a vast number of allergenic chemicals, but occur commonly from dental materials, flavorings, and preservatives. Clinical presentation is varied and often overlaps with other oral conditions, complicating their diagnosis and management. The most common clinical entities associated with oral hypersensitivity reactions are oral lichenoid reactions and allergic contact cheilitis. In addition to reviewing these conditions and their most common corresponding allergens, this article summarizes the pathogenesis of oral hypersensitivity reactions and addresses patch testing pearls.

Evaluation of cytotoxicity levels of poly vinyl ether silicone, polyether, and poly vinyl siloxane impression materials: An in vitro study

Aim:

To assess the cytotoxicity level of newly introduced poly vinyl ether silicone (PVES) compared to poly vinyl siloxane (PVS) and polyether (PE) elastomeric impression materials.

Settings and Design:

Comparative -Invitro study design.

Materials and Methods:

Mouse cell line NIH/3T3 was grown in Dulbecco's modified Eagle's medium. Samples of three elastomers were dissolved in dimethyl sulfoxide and were tested at various concentrations. Twenty-four well plates with NIH/3T3 cells with different concentrations of elastomeric solutions were incubated at 37°C. 3-(4,5-dimethylthiazol-2-yl)-2-5-diphenyltetrazolium bromide assay was performed on day 1, 3, and 7, with a time interval of 15 min, 30 min, 60 min, and 24^th h to estimate the cytotoxicity for all three elastomers.

Statistical Analysis Used:

Kruskal–Wallis ANOVA test and the period effect within the subjects, repeated-measure ANOVA was done using the Greenhouse–Geisser correction method.

Results:

The mean cell viability (survival rate) of NIH 3T3 cells at the concentrations tested was measured. A repeated-measure Kruskal–Wallis ANOVA determined the mean survival concentration on day 1, 3, and 7. PVES showed significant decrease in the survival rate on day 1 than PVS and PE, while PVS and PE had significant decrease in the survival rates of cells on day 3 and 7 which were statistically significant (P < 0.001).

Conclusion:

PVES shows early cytotoxic signs as compared to PVS and PE, and cell viability for PVS was the highest among all. When making impression with PVES and PE, it is always better to evaluate the impression and gingival sulcus carefully with magnification to prevent adverse reaction, if any material is left inadvertently for longer period of time.

Allergic Reactions to Dental Materials-A Systematic Review

INTRODUCTION

Utility of various dental materials ranging from diagnosis to rehabilitation for the management of oral diseases are not devoid of posing a potential risk of inducing allergic reactions to the patient, technician and dentist. This review aims to develop a systematic approach for the selection and monitoring of dental materials available in the market thereby giving an insight to predict their risk of inducing allergic reactions.

MATERIALS AND METHODS

Our data included 71 relevant articles which included 60 case reports, 8 prospective studies and 3 retrospective studies. The source of these articles was Pub Med search done with the following terms: allergies to impression materials, sodium hypochlorite, Ledermix paste, zinc oxide eugenol, formaldehyde, Latex gloves, Methyl methacrylate, fissure sealant, composites, mercury, Nickel-chromium, Titanium, polishing paste and local anaesthesia. All the relevant articles and their references were analysed. The clinical manifestations of allergy to different dental materials based on different case reports were reviewed.

RESULTS

After reviewing the literature, we found that the dental material reported to cause most adverse reactions in patients is amalgam and the incidence of oral lichenoid reactions adjacent to amalgam restorations occur more often than other dental materials.

CONCLUSION

The most common allergic reactions in dental staff are allergies to latex, acrylates and formaldehyde. While polymethylmethacrylates and latex trigger delayed hypersensitivity reactions, sodium metabisulphite and nickel cause immediate reactions. Over the last few years, due to the rise in number of patients with allergies from different materials, the practicing dentists should have knowledge about documented allergies to known materials and thus avoid such allergic manifestations in the dental clinic.