Allergic contact stomatitis caused by acrylic monomer in a denture

Maxillary resection prosthesis fabricated from urethane dimethacrylate for a patient with polymethyl methacrylate allergy: A clinical report

The surgical resection of malignant tumors often leads to severe bone and soft-tissue deficits that can result in difficulty swallowing, impaired speech, and facial disfigurement. Prosthetic rehabilitation of these patients becomes an integral part of the patient's recovery and allows for improvement in quality of life. This clinical report describes a patient who underwent an anterior maxillectomy secondary to squamous cell carcinoma. After the insertion of a polymethyl methacrylate (PMMA) interim resection prosthesis, the patient developed a severe allergic stomatitis reaction in the oral cavity and oropharynx. By using the patch test approach, true PMMA allergy was diagnosed along with a suitable PMMA replacement for the prosthesis. A subsequent prosthesis was fabricated from urethane dimethacrylate in place of the standard PMMA.

The Use of Acrylate Polymers in Dentistry

The manuscript aimed to review the types of acrylate polymers used in dentistry, as well as their chemical, physical, mechanical, and biological properties. Regarding their consistency and purpose, dental acrylate polymers are divided into hard (brittle), which includes acrylates for the production of plate denture bases, obturator prostheses, epitheses and maxillofacial prostheses, their repairs and lining, and soft (flexible), which are used for lining denture bases in special indications. Concerning the composition and method of polymerization initiation, polymers for the production of denture bases are divided into four types: heat-, cold-, light-, and microwave-polymerized. CAD/CAM acrylate dentures are made from factory blocks of dental acrylates and show optimal mechanical and physical properties, undoubtedly better monomer polymerization and thus biocompatibility, and stability of the shape and colour of the base and dentures. Regardless of the number of advantages that these polymers have to offer, they also exhibit certain disadvantages. Technological development enables the enhancement of all acrylate properties to respond better to the demands of the profession. Special attention should be paid to improving the biological characteristics of acrylate polymers, due to reported adverse reactions of patients and dental staff to potentially toxic substances released during their preparation and use.

Acrylates as a significant cause of allergic contact dermatitis: new sources of exposure

Acrylate monomers have a wide range of applications. Since the 1950s, many reports of occupational origin allergic contact dermatitis due to (meth)acrylate monomers have been published. During last decades, (meth)acrylate allergy has undergone an occupational shift from dentistry toward beauty industry and medical devices. The aim of the study was to conduct a literature review on acrylates as a cause of allergic contact dermatitis, current sources of exposure as well as identification of professional groups with an increased risk of this allergy and methods of effective prevention. Database review: Medline search (PubMed), Wiley Online Library and Web of Science base in years 1956–2019 using the following keywords: acrylates, manicurists, dentists, dental technicians, medical devices, occupational exposure, and allergic contact dermatitis. 204 346 articles containing the term ‘acrylates‘ have been found. They include 2 042 articles with the word ‘manicurists’, 169 919 – ‘dentists’, 218 236 – ‘dental technicians’, 2 427 418 – ‘medical devices’. Fifty-nine articles were chosen based on analysis of abstracts and full texts. In the past allergy to acrylates was mainly of occupational origin and dental technicians were the most often affected professional group. Since the long-lasting manicure has become popular, this problem concerns both manicurists and their customers. Moreover, the new significant trend is non-occupational allergic contact dermatitis caused by medical devices especially dedicated to diabetes patients.

Determination of Salivary Myeloperoxidase, Immunoglobulin E, and Tumor Necrosis Factor-α after Complete Denture Insertion

OBJECTIVE

To detect activities of salivary myeloperoxidase (MPO) and concentrations of salivary tumor necrosis factor (TNF)-α as indicators of inflammatory reaction and salivary immunoglobulin E as an indicator of allergic reaction after complete insertion of acrylic dentures.

SUBJECTS AND METHODS

Complete dentures were made for a uniform group of elderly patients, and saliva samples were taken immediately before they were given to the patients, as well as 2, 3, 7, and 30 days after insertion of the dentures, with simultaneous monitoring of changes in the oral mucosa.

RESULTS

After 7 and 30 days of wearing upper and lower complete dentures, nonsignificant increases in salivary MPO and TNF-α were proven to be indicators of inflammation. No changes were observed in the values of salivary immunoglobulin E during a 30-day observational period, which excluded the appearance of allergic reactions to acrylic materials in the tested group of patients.

CONCLUSION

A nonsignificant increase in the levels of MPO was observed on day 7; it decreased after 30 days. TNF-α also tended to increase in a nonsignificant manner.

Five hundred patients reporting on adverse effects from dental materials: Frequencies, complaints, symptoms, allergies

OBJECTIVE

Information on patients with real or claimed adverse reactions towards dental materials in large patient cohorts is rare. Therefore, the aim of the present study was to investigate patients reporting on complaints and symptoms to dental materials over a 16-year period.

METHODS

Five hundred patients were characterized by one single dental team regarding age and sex distribution, subjective complaints and objective intraoral symptoms, and allergy status relevant to dental materials.

RESULTS

Elder patients and females predominated. Subjective complaints were reported by 490 patients, ranging from 1 to 12 complaints per patient. Most often, burning mouth (44%), tooth-/jawache (22%) and dry mouth (20%) were reported. In 54% no objective intraoral symptom was diagnosed. The main objective intraoral symptoms were tongue anomalies (lingua plicata or geographica; 14%), gingivitis adjacent to restorations (12%), redness of the palate or the edentulous ridge (7%), oral lichen planus (6%), grayish discolorations, lichenoid contact lesions, and leukoplakia (<5%). Patch testing of 416 (83%) patients revealed that allergy was diagnosed as contributing to the complaints or symptoms in 70 (14%) patients with metals being the most frequent allergens. Gingivitis adjacent to restorations (3.2%), redness of the palate or edentulous ridge (1.4%) and whitish lichen-like lesions (1.8%) were associated to allergy from dental materials.

SIGNIFICANCE

The high number of subjective complaints per patient and their wide variety suggests that most patients seriously suffered. Furthermore, the fact that only 46% of the patients had objective intraoral symptoms demands for an interdisciplinary collaboration to elucidate other than dental causes.

Sublingual administration of 2-hydroxyethyl methacrylate enhances antibody responses to co-administered ovalbumin and Streptococcus mutans

OBJECTIVE

The oral mucosa of patients undergoing dental procedures is often exposed to residual monomers leaking from incompletely cured acrylic resins. We investigated whether 2-hydroxyethyl methacrylate (HEMA) monomers applied to the sublingual mucosa in mice modulate the antibody responses towards co-administered ovalbumin (OVA) or live oral bacteria.

MATERIAL AND METHODS

OVA, live mouse oral commensal Lactobacillus murinus or live human oral commensal Streptococcus mutans were administered sublingually with or without HEMA to BALB/c mice on four weekly occasions. One week after the last administration, the experiment was terminated and serum antibody levels were analyzed using ELISA.

RESULTS

Significantly increased IgG and IgE anti-OVA antibody activity was found in the sera from mice immunized with OVA together with HEMA, as compared to mice immunized with OVA alone. Likewise, S. mutans together with HEMA induced an IgG anti-S. mutans antibody response that was significantly higher than the antibody response detected after application of S. mutans alone. No IgG anti-L. murinus antibody response was detected in mice immunized with L. murinus together with HEMA, as compared to the background activity.

CONCLUSIONS

We report that HEMA monomers have adjuvant properties when sublingually administered in combination with OVA or S. mutans.

Proposed ICDRG Classification of the Clinical Presentation of Contact Allergy

The International Contact Dermatitis Research Group proposes a classification for the clinical presentation of contact allergy. The classification is based primarily on the mode of clinical presentation. The categories are direct exposure/contact dermatitis, mimicking or exacerbation of preexisting eczema, multifactorial dermatitis including allergic contact dermatitis, by proxy, mimicking angioedema, airborne contact dermatitis, photo-induced contact dermatitis, systemic contact dermatitis, noneczematous contact dermatitis, contact urticaria, protein contact dermatitis, respiratory/mucosal symptoms, oral contact dermatitis, erythroderma/exfoliative dermatitis, minor forms of presentation, and extracutaneous manifestations.

Triethylene glycol dimethacrylate: adjuvant properties and effect on cytokine production

Objective: Leakage of monomers from dental fillings due to incomplete curing is very common. The objective of the present study was to examine the cytokine profile in cells exposed to triethyleneglycol dimethacrylate (TEGDMA) and the adjuvant properties of TEGDMA.

Materials and methods: Human peripheral blood mononuclear cells were exposed to TEGDMA (500 and 1000 μM) for 24 h in vitro. Bio-Plex Pro™ assays were used for analysis and detection of cytokines. In vivo, BALB/c mice were immunized subcutaneously in the base of the tail with TEGDMA in combination with ovalbumin (OVA).

Results: The cytokine levels of IL-8, IL-18, GRO-α and MCP-1 were significantly increased for both concentrations. IL-1β, IL-6 and TNF-α was only significantly increased in cultures exposed to 500 μM TEGDMA. The concentration of TNF-α was significantly decreased in cultures exposed to 1000 μM TEGDMA. Animals immunized with OVA co-administrated with TEGDMA had a significantly higher IgE and IgG anti-OVA antibody levels in blood than animals immunized with OVA only.

Conclusions: TEGDMA affects production of proinflammatory cytokines IL-1β, IL-6, IL-8, IL-18 and TNF-α. This inflammatogenic capacity renders TEGDMAs adjuvant properties, which may interfere with the homeostasis between the immune system and the indigenous microflora in the oral cavity.

Evaluation of dental material series from patients with dental prostheses and suspicion of delayed hypersensitivity

BACKGROUND

Patients with oral sensitivity are common in our practice. Allergic contact dermatitis is one of the most frequent etiologies.

OBJECTIVES

Evaluate oral contact dermatitis using the Brazilian standard series and complementary dental series in patients using dental prostheses, with or without oral complaints. Determine specific dental Brazilian series.

METHODS

Patients using dental prostheses with or without oral complaints realized patch tests. Brazilian standard series and complementary dental series were used according to ICDRG recommendations. The results were analysed according to age, sex, race, atopic conditions and symptoms associated.

RESULTS

From 54 patients tested, 34 (63%) were positive at least to one substance. Nineteen had oral complaints, such as burning mouth, itch or oral erythema. There was no association between atopic condition and tests results. Without the oral series, just 23(42,6%) patients had a positive result. Using the Brazilian standard series with the complementary dental series we improved the positivity of the patch test to 47%.

CONCLUSION

In patients using prostheses and with oral complaints, patch tests with Brazilian standard series with complementary dental series improve the tests positivity.

Allergic effects of the residual monomer used in denture base acrylic resins

Denture base resins are extensively used in dentistry for a variety of purposes. These materials can be classified as chemical, heat, light, and microwave polymerization materials depending upon the factor which starts the polymerization reaction. Their applications include use during denture base construction, relining existing dentures, and for fabrication of orthodontic removable appliances. There have been increased concerns regarding the safe clinical application of these materials as their biodegradation in the oral environment leads to harmful effects. Along with local side effects, the materials have certain occupational hazards, and numerous studies can be found in the literature mentioning those. The purpose of this article is to outline the cytotoxic consequences of denture base acrylic resins and clinical recommendations for their use.

Recommendations for post-adaption care of an ocular prosthesis: A review

An ocular prosthesis must be maintained in a suitable state of cleanliness, fit and preservation. Otherwise its functioning may be compromised, leading to a variety of diseases. However, there is a lack of consensus on the care of such prostheses. This review assembles and attempts to update existing knowledge in this area and discusses the most appropriate care regimes.

Investigation of contact allergy to dental materials by patch testing

BACKGROUND

Dental products are widely used by patients and dental personnel alike and may cause problems for both. Dental materials could cause contact allergy with varying manifestations such as burning, pain, stomatitis, cheilitis, ulcers, lichenoid reactions localized to the oral mucosa in patients, and hand dermatitis in dental personnel. Patch testing with the dental series comprising commonly used materials can be used to detect contact allergies to dental materials.

AIM

This study aimed to identify contact allergy among patients who have oral mucosal lesions after dental treatment and among dental personnel who came in contact with these materials.

MATERIALS AND METHODS

Twenty patients who had undergone dental procedures with symptoms of oral lichen planus, oral stomatitis, burning mouth, and recurrent aphthosis, were included in the study. Dental personnel with history of hand dermatitis were also included in the study. Patch testing was performed using Chemotechnique Dental Series and results interpreted as recommended by the International Contact Dermatitis Research Group (ICDRG).

RESULTS

Out of 13 patients who had undergone dental treatment/with oral symptoms, six patients with stomatitis, lichenoid lesions, and oral ulcers showed positive patch tests to a variety of dental materials, seven patients with ulcers had negative patch tests, seven dental personnel with hand dermatitis showed multiple allergies to various dental materials, and most had multiple positivities.

CONCLUSION

The patch test is a useful, simple, noninvasive method to detect contact allergies among patients and among dental personnel dealing with these products. Long term studies are necessary to establish the relevance of these positive patch tests by eliminating the allergic substances, identifying clinical improvement, and substituting with nonallergenic materials.

Effect of thermocycling on the shear bond strength of different resins bonded to thermoplastic foil applied in occlusal splint therapy

PURPOSE

Temporomandibular disorders are a group of symptoms related to the impaired function of the temporomandibular joints and associated muscles. Occlusal splint therapy is a common treatment in the aforementioned syndrome. One of the methods of manufacturing occlusal splints is to place a polymer on thermoplastic foil. The aim of this study was to evaluate the shear bond strength of light- and self-cured resins bonded to thermoplastic foil dependent on artificial aging.

MATERIALS AND METHODS

Thirty cylinders composed of light-cured resin and 30 cylinders made of self-cured resin were attached to 60 rectangular thermoplastic plates. All specimens were divided into six groups. A control study was conducted for groups 1 and 2. The other preparation groups were subjected to thermocycling by setting appropriately 1000 cycles for groups 3 and 4 and 3000 cycles for groups 5 and 6 in distilled water. Bond strength was measured in a universal testing machine. The results were subjected to statistical analysis using the Mann-Whitney U test (p ≤ 0.05).

RESULTS

The statistics revealed that the values of the shear bond strength for specimens composed of self-cured resin after 1000 and 3000 thermocycles were significantly higher than on those made of light-cured resin (p = 0.003 and p = 0.002).

CONCLUSION

The shear bond strength between the self-cured resin and the thermoplastic foil was higher and more resistant to aging than the shear bond strength between the light-cured resin and the thermoplastic foil.

Contact dermatitis in older adults: a review of the literature

Contact dermatitis is a significant health problem affecting the elderly. Impaired epidermal barrier function and delayed cutaneous recovery after insult enhances susceptibility to both irritants and allergens. Exposure to more numerous potential sensitizers and for greater durations influences the rate of allergic contact dermatitis in this population. Medical co-morbidities, including stasis dermatitis and venous ulcerations, further exacerbate this clinical picture. However, while these factors tend to increase the degree of sensitization in the elderly, waning immunity can actually decrease such a propensity. This interplay of both intrinsic and extrinsic factors makes a generalization on trends for contact dermatitis in older adults challenging. The literature has varying reports on the overall incidence of allergic contact dermatitis with advancing age. Nevertheless, it does clearly show that sensitivity to topical medicaments increases with age. Irritant contact dermatitis studies are more consistent, with less reactivity (to irritants) in older compared with younger skin. Diagnosis of both irritant and allergic contact dermatitis is based on a thorough history, complete skin examination, and comprehensive patch testing. The mainstay of therapy is avoidance of the offending chemical substances and the use of topical along with systemic therapies, depending on the severity of the condition.

Biocompatibilidade dos materiais em Ortodontia: mito ou realidade?

O objetivo deste trabalho é apresentar uma revisão sobre os conceitos relacionados à biocompatibilidade dos materiais empregados em Ortodontia. Fatos relacionados às reações de hipersensibilidade aos diversos materiais ortodônticos são discutidos, sendo apresentadas as condutas recomendáveis nestas situações.

Accuracy, comprehensibility, and use of material safety data sheets: a review

OBJECTIVES

Material safety data sheets (MSDSs) are used in workplaces to communicate to workers the hazards of chemical products. This article describes a review of the peer-reviewed scientific literature regarding the accuracy, comprehensibility and use of MSDSs in the workplace.

METHODS

Articles were retrieved via a systematic search of indexes and databases, followed by hand searching and citation index searching. Two reviewers independently read and coded the articles using an iterative matrix.

RESULTS

Of the 280 unique articles retrieved, 24 fit the review criteria. Eligible articles included a range of methodologies: laboratory analyses, site audits, surveys and qualitative inquiry. Articles were grouped into three main topic categories: accuracy and completeness, awareness and use, and comprehensibility. Accuracy and completeness were found to be relatively poor, with the majority of studies presenting evidence that the MSDSs under review did not contain information on all the chemicals present, including those known to be serious sensitizers or carcinogens. Poor presentation and complex language were consistently associated with low comprehensibility among workers. Awareness and use of MSDSs was suboptimal in workplaces where these factors were studied.

CONCLUSIONS

Despite the fact that these studies varied in methodology and spanned a period of more than 15 years, a number of common themes emerged regarding inaccuracies, incompleteness, incomprehensibility and overall low use of MSDSs. The results of the literature review suggest that there are serious problems with the use of MSDSs as hazard communication tools. The article concludes with recommendations for governments, regulatory bodies, and occupational health and safety personnel to seriously reassess the ways in which MSDSs are written, monitored, regulated, and used.

Cytotoxicity of Two Autopolymerized Acrylic Resins Used in Orthodontics

Objective: To test in vitro the null hypothesis that the toxic effect of different acrylic resins used in orthodontics cannot be reduced when a prior elution is performed.

Materials and Methods: Three established cell lines were used (HeLa, NIH3T3, and Hep2) and cultured under standard conditions. Resin segments were immersed in a culture medium and left to elute for 24 and 48 hours. Cells were exposed to medium containing eluates for 24 or 48 hours. The 3-(4,5 dimethyl-2-thiazolyl)-2.5-diphenyl-2H-tetrazolium bromide (MTT) assay was used as the cytotoxicity test. Control cells contained standard medium with no eluate. Analysis of variance and Tukey test were used for statistical analysis.

Results: Fibroblastic viability was not affected when the elution time was 24 hours, but treatments showed higher cell viability than controls when the elution time was 48 hours. When left to elute for 24 hours, both resins had a cytotoxic effect on epithelial cells, but this effect was not observed when the elution time was 48 hours.

Conclusions: The hypothesis was rejected as both tested materials showed lower cytotoxic effect when treated with 48-hour elutes compared with 24-hour elutes, which indicates that a longer elution time reduces resin toxicity.

[Allergy towards bone cement]

Bone cements based on polymethylmethacrylate are typically used for fixation of artificial joints. Intolerance reactions to endoprostheses not explained by infection or mechanical failure may lead to allergological diagnostics, which mostly focuses on metal allergy. However, also bone cement components may provoke hypersensitivity reactions leading to eczema, implant loosening, or fistula formation. Elicitors of such reactions encompass acrylates and additives such as benzoyl peroxide, N,N-dimethyl-p-toluidine, hydroquinone, or antibiotics (particularly gentamicin). Upon repeated contact with bone cement components, e.g., acrylate monomers, also in medical personnel occasionally hand eczema or even asthma may develop. Therefore, in the case of suspected hypersensitivity reactions to arthroplasty, the allergological diagnostics should include bone cement components.

Contact allergy to (meth)acrylates in the dental series in southern Sweden: simultaneous positive patch test reaction patterns and possible screening allergens

Contact allergy to dental allergens is a well-studied subject, more so among dental professionals than dental patients. 1632 subjects had been patch tested to either the dental patient series or dental personnel series at the department of Occupational and Environmental Dermatology, Malmö, Sweden. Positive patch tests to (meth)acrylate allergens were seen in 2.3% (30/1322) of the dental patients and 5.8% (18/310) of the dental personnel. The most common allergen for both groups was 2-hydroxyethyl methacrylate (2-HEMA), followed by ethyleneglycol dimethacrylate (EGDMA), triethyleneglycol dimethacrylate, and methyl methacrylate. 47 (29 dental patients and 18 dental personnel) out of these 48 had positive patch tests to 2-HEMA. All 30 subjects who had a positive reaction to EGDMA had a simultaneous positive reaction to 2-HEMA. One dental patient reacted only to 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]propane (bis-GMA). From our data, screening for (meth)acrylate contact allergy with 2-HEMA alone would have picked up 96.7% (29/30) of our (meth)acrylate-allergic dental patients and 100% (18/18) of our (meth)acrylate-allergic dental personnel. The addition of bis-GMA in dental patients would increase the pick-up rate to 100%.

Application of HEMA on intact mouse skin - effects on the immune system

Previously, we have shown that 2-hydroxyethylmethacrylate (HEMA) can bind to protein and that autoantibodies were induced in mice by immunization with a self-protein in vitro conjugated with HEMA. The present study aimed to develop a model for HEMA-induced sensitivity by the application of the substance on intact skin. Female BALB/c mice were painted on the dorsum of each ear with 50% HEMA in vehicle twice a week for 6 weeks. The anti-CD3epsilon-stimulated lymph node production and the spontaneous spleen-cell production of the cytokines interleukin (IL)-2, IL-4, IL-6, IL-10 and interferon-gamma were assessed by enzyme-linked immunosorbent assay. In another experiment, the cytokines were followed after subcutaneous HEMA injections. Animals painted with HEMA had a significantly higher IL-6 production by anti-CD3epsilon-stimulated lymph node cells and significantly suppressed IL-10 production by spleen cells compared to vehicle-treated mice. This correlated to some extent with the spontaneous spleen-cell production induced by subcutaneously administered HEMA. An injection of 20 micromol of HEMA induced an increased production of IL-6, while injection of 40 micromol depressed both IL-6 and IL-10 production. Although there was no sign of inflammation on the ears, findings suggest that HEMA had penetrated the skin and induced a reaction in the immune system.

Inflammatogenic and adjuvant properties of HEMA in mice

2-Hydroxyethylmethacrylate (HEMA), a common constituent in dental materials, is known to cause hypersensitivity reactions. While the means by which this small molecule causes adverse responses has not been ascertained, we have previously demonstrated that it binds to protein and in mice induces the production of autoantibodies to HEMA-conjugated self-protein. The present study explores the inflammatory and adjuvant properties of HEMA in response to the subcutaneous injection of HEMA and a protein. Ovalbumin (OVA) was used as a 'reporter antigen', and mouse serum albumin (MSA), conjugated in vitro with HEMA (MSA(H)) to a low degree (0.5 molecules of HEMA per molecule of MSA on average), was used to mimic a possible in vivo situation. Inflammatory responses at injection sites were scored by using an ordinal scale, and immunoglobulin (Ig)G1, IgG2a, and IgE activities to OVA or MSA were assessed by enzyme-linked immunosorbent assay (ELISA). Injections of 20 micromol HEMA induced overt inflammatory skin responses, the severity of which was influenced by the co-administered substances. A significantly higher IgG1 and IgE response to OVA was induced by the presence of HEMA. Interestingly, injections with low conjugated MSA(H) only induced the production of autoantibodies if free HEMA was included at the time of immunization. These findings suggest that HEMA is an inflammatogenic substance with adjuvant properties.

Investigation of reactions to dental materials

Patients undergoing dental treatment can be exposed to a wide range of potential allergens, but adverse events seem infrequent. Patients with symptoms or signs of stomatitis, burning, tingling, cheilitis, oral lichenoid lesions, lip and facial swelling may relate their problems to dental treatment or to the use of dental products. Investigation for immediate type or delayed type hypersensitivity is indicated using patch testing, prick testing and blood tests for allergen-specific IgE. The main allergic reactions found in patients include contact allergy to metals, cosmetics, food additives, flavours and acrylates, and immediate type allergy to latex. Adverse reactions following the administration of local anaesthetics are seen in about 0.5% of cases, but immediate type allergy to these agents is rare. In dental staff, occupationally related problems are common and usually take the form of hand or facial dermatitis or respiratory disease. The most common allergic reactions in dental staff are immediate type allergy to latex, and contact allergy to rubber additives, fragrances, acrylates and formaldehyde. Occupational irritant problems causing hand dermatitis are probably more common in dental personnel than is dermatitis caused by contact allergy. Patch testing and tests for immediate type allergy are useful investigative methods in the investigation of patients who present with oral or facial symptoms possibly related to dental treatments and are also beneficial in dental personnel who present with hand or facial dermatitis or respiratory symptoms.

HPLC determination of residual monomers released from heat-cured acrylic resins

HPLC was used to examine the leachability of three non-phthalic and four phthalic post-polymerized residual monomers from three commercially available heat-cured acrylic resins. Specimens of equal dimensions were constructed from each brand of material by following the standardized procedure and were stored under three different conditions, namely, distilled water, artificial saliva, and a binary mixture of ethanol/water. The resulting liquids provided samples for analysis by HPLC. Three different experiments were performed for each brand of acrylic and each storage condition in order to examine the effects of parameters, particularly time and temperature. The results obtained from this study suggest that a wide spectrum of residues diffuse out of the three examined acrylic resin materials. The non-phthalic compounds were leached at high concentrations, whereas all the phthalates examined exhibited different degrees of elusion commensurate with the storage condition, brand of material, and type of experiment. It seems that a significant quantity of non-phthalic and phthalic residues diffuse out of the acrylic resin materials examined. The main component extracted was methyl methacrylate, the level of which seems to be time-dependent and decreases for a period of up to 5 days when resins are stored in distilled water at room temperature.

Fatal systemic allergic reaction following acrylic cranioplasty: a case report

South Africa has a high death rate as a result of motor vehicle collisions. The motor vehicle accident fund is struggling with compensation claims made by the next of kin of the deceased. This report presents an unusual case of death as a result of systemic allergic reaction to acrylic material used to cover the frontal bone defect in a head injury patient. In independent forensic pathologist hired by the independent complaint directorate concluded that the cause of death was not related to the motor vehicle accident, and therefore the family cannot be compensated. The history, post mortem findings, management and issue of compensation claim are discussed.

Monomer permeability of disposable dental gloves

STATEMENT OF PROBLEM

Studies have suggested that monomers may be able to permeate dental gloves.

PURPOSE

This study examined the permeability of disposable dental gloves to 6 kinds of dental monomers.

MATERIAL AND METHODS

The permeability of 6 kinds of dental monomers (methyl methacrylate [MMA], 2-hydroxyethyl methacrylate [HEMA], triethyleneglycol methacrylate [TEGDMA], ethyleneglycol dimethacrylate [EGDMA], urethane dimethacrylate [UDMA], and Bis-glycidyl methacrylate [Bis-GMA]) through 5 kinds of dental gloves (latex, powder-free latex, coated latex, polychloroprene, and polyvinyl chloride) was examined for up to 180 minutes at 37 degrees C. The fingers of unused gloves without pin holes were cut and used in the experiments. Five specimens per test group were examined. One type of monomer was poured into each finger and dipped in ethanol. The ethanol for extraction was measured by a spectrophotometer at a wavelength of 210 nm, and the results were analyzed by analysis of variance and the Kruskal-Wallis test (P<.05).

RESULTS

Four of the monomers tested (MMA, HEMA, TEGDMA, and EGDMA) permeated the gloves tested, whereas 2 (UDMA and Bis-GMA) did not (P>.01). The amount of monomers permeating the latex in 10 minutes was 0.8 +/- 0.6, 0.6 +/- 0.6, 0.07 +/- 0.1, 0.07 +/- 0.1, 0.1 +/- 0.1 and 0.06 +/- 0.1 microL/mL for MMA, HEMA, EGDMA, TEGDMA, UDMA, and Bis-GMA, respectively. The amount of permeated monomer was then increased in relation to the examination time, and in MMA and HEMA, permeation occurred rapidly during the initial 60 minutes at 3 times the 10-minute values, then continued gradually and linearly. The polyvinyl chloride glove showed the greatest monomer permeability. Two-way analysis of variance showed significant correlations between MMA, HEMA, EGDMA or TEGDMA and UDMA or Bis-GMA (P<.01). Statistical significance was shown between polyvinyl chloride and latex, powder-free latex, coated latex or polychloroprene (P<.01). However, there was no significant relation between any kind of dental monomer and any kind of dental glove.

CONCLUSION

Within the limitations of this study, 4 of the monomers tested permeated all of the gloves tested.

Contact stomatitis

Contact stomatitis is inflammation or pain of the oral mucosa due to both irritant and allergic substances. Irritants include heat, frictional trauma, and chemicals. Oral flavorings, preservatives, and dental materials are common allergens. Simplification of oral care and avoidance of contactants is the primary mode of therapy. Patch testing to a broad series of antigens may be required to identify specific causes of allergic contact stomatitis.