Quantification of l-carvone in toothpastes available on the Swedish market

Oral lichenoid lesions in two snuff users with contact allergy to carvone

BACKGROUND

Contact allergy to the mint-tasting flavour carvone has been observed in patients with oral lichenoid lesions (OLL). Mint-flavoured products such as toothpaste frequently contain carvone. Snuff is a smokeless tobacco product that is chewed or placed in the mouth rather than smoked. In Sweden, the use of snuff and its flavoured versions is extremely common.

OBJECTIVES

To investigate whether the consumption of mint-flavoured snuff is associated with contact allergy to carvone and subsequently plays a role in the aetiology of OLL.

METHODS

Regarding the two patients, patch testing with snuff pouches was performed. High-performance liquid chromatography and gas chromatography-mass spectrometry analysis were used for identification of carvone in different snuff samples.

RESULTS

Two patients with OLL were contacted allergic to carvone when patch tested. Both were using mint-flavoured snuffs several hours a day for many years. One patient was contacted allergic to the snuff pouch tested as is. Carvone was detected in the snuff samples of both patients.

CONCLUSIONS

The patients were recommended to avoid the use of mint-flavoured snuffs, toothpaste and foodstuffs. At follow-up 3 months later, the patients had a dramatic clinical improvement of the OLL and oral symptoms. Exposure to mint-flavoured snuffs can be overlooked as a possible aggravating/provoking factor in OLL.

Increased Rates of Gold and Acrylate Allergy in Individuals with Fibromyalgia Tested with an Extended Dental Patch Test Series

Fibromyalgia is a common chronic pain condition. Rates of contact allergy in individuals with fibromyalgia have not been widely studied. Systemic contact allergy can present with muscle and joint pain and general malaise. The aim of this study is to investigate contact allergy rates in individuals with fibromyalgia to the sensitizers in an extended dental series and compare with control groups. Contact allergy to gold was significantly more common in the fibromyalgia group than the dermatitis control group. When corrected for patch test system, contact allergy to gold was significantly more common in the fibromyalgia group than the dental control group. Contact allergy to hydroxyethyl methacrylate and grouped acrylates and methacrylates was significantly more common in the fibromyalgia group than the dental control group. In conclusion, individuals with fibromyalgia may have a propensity to sensitization to gold, either via an increased exposure or an alteration in the oral environment. Gold is also implicated in systemic contact dermatitis and may be a factor in elicitation of symptoms in individuals with fibromyalgia. Acrylate allergy is also common in the fibromyalgia population and may be a consequence of occupational exposure or dental treatment.

Contact sensitisation in oral lichen planus: An Australian perspective

BACKGROUND

The role of contact sensitisation in the pathogenesis of oral lichen planus (OLP) has not been clearly defined.

OBJECTIVE

We aimed to evaluate relevant contact sensitisers in OLP.

METHODS

A retrospective study was conducted on OLP patients who underwent patch testing from 1 January 2006 to 31 December 2020 at an Australian tertiary dermatology institution, compared to cheilitis patients patch tested over the same time period.

RESULTS

Ninety-six OLP patients and 152 cheilitis patients were patch tested during the 15-year period. Seventy-one (73.9%) OLP patients and 100 (65.8%) cheilitis patients recorded one or more relevant reactions. Forty-three (44.8%), 22 (22.9%), 21 (21.9%) and 17 (17.7%) OLP patients had relevant reactions to mercury-related chemicals, amalgam, spearmint and carvone, respectively, compared to 6 (3.9%), 3 (2.0%), 4 (2.6%) and 0 (0%) cheilitis patients, respectively (p-value <0.001 each). Four (4.2%) OLP patients had relevant positive reactions to sodium metabisulfite, compared to none in the cheilitis group (p-value 0.021).

CONCLUSION

While dental amalgam is used less frequently these days, we report that mercury (found in amalgam) and additionally spearmint and carvone are relevant sensitisers in OLP in Australia. Sodium metabisulfite may also be a relevant sensitiser in OLP, which has not previously been reported.

Current and Potential Applications of Monoterpenes and Their Derivatives in Oral Health Care

Plant products have been employed in medicine for centuries. As the world becomes more health-conscious, there is a growing interest in natural and minimally processed products for oral health care. This has led to an increase in research into the bioactive compounds found in plant products, particularly monoterpenes. Monoterpenes are known to have beneficial biological properties, but the specific mechanisms by which they exert their effects are not yet fully understood. Despite this, some monoterpenes are already being used in oral health care. For example, thymol, which has antibacterial properties, is an ingredient in varnish used for caries prevention. In addition to this, monoterpenes have also demonstrated antifungal, antiviral, and anti-inflammatory properties, making them versatile for various applications. As research continues, there is potential for even more discoveries regarding the benefits of monoterpenes in oral health care. This narrative literature review gives an overview of the biological properties and current and potential applications of selected monoterpenes and their derivatives in oral health care. These compounds demonstrate promising potential for future medical development, and their applications in future research are expected to expand.

Effect of limonene associated with bioactive glass-ceramic on dentin/adhesive interface

This study evaluated the effect of pretreatment with limonene and/or biosilicate on the bond strength of a universal adhesive system in self-etch mode to dentin. Occlusal cavities were prepared in 80 human molars and the teeth were randomly allocated to one of four groups (n = 20), according to the pretreatment regimens applied before the adhesive. The pretreatments were (i) Control, no pretreatment, (ii) LIM, 0.5% limonene; (iii) Bio, 10% biosilicate; and (iv) LIMBio, LIM + Bio. After adhesive application and restoration, the specimens were sectioned into sticks, separated, and stored in distilled water at 37°C for 24 h or 6 months. Microtensile bond strength test was carried out and measurements were compared across pretreatment groups and storage times. Fracture patterns and adhesive interfaces were observed. Loss of dry mass was calculated (n = 10). There was no statistically significant difference in the bond strength between the groups and the most prevalent fracture pattern was the non-adhesive. LIM and LIMBio resulted in more open dentinal tubules. LIM and Bio, whether separate or combined, showed particles of those substances, which decreased in size and number after 6 months. All groups lost mass weight after treatment, with no statistically significant differences between them. Limonene and biosilicate pretreatment did not affect the bond strength to dentin of the universal adhesive system, but resulted in more non-adhesive fractures, even after 6 months.

A Short Review of the Toxicity of Dentifrices-Zebrafish Model as a Useful Tool in Ecotoxicological Studies

This review aims to summarize the literature data regarding the effects of different toothpaste compounds in the zebrafish model. Danio rerio provides an insight into the mechanisms of the ecotoxicity of chemicals as well as an assessment of their fate in the environment to determine long-term environmental impact. The regular use of adequate toothpaste with safe active ingredients possessing anti-bacterial, anti-inflammatory, anti-oxidant, and regenerative properties is one of the most effective strategies for oral healthcare. In addition to water, a typical toothpaste consists of a variety of components, among which three are of predominant importance, i.e., abrasive substances, fluoride, and detergents. These ingredients provide healthy teeth, but their environmental impact on living organisms are often not well-known. Each of them can influence a higher level of organization: subcellular, cellular, tissue, organ, individual, and population. Therefore, it is very important that the properties of a chemical are detected before it is released into the environment to minimize damage. An important part of a chemical risk assessment is the estimation of the ecotoxicity of a compound. The zebrafish model has unique advantages in environmental ecotoxicity research and has been used to study vertebrate developmental biology. Among others, the advantages of this model include its external, visually accessible development, which allows for providing many experimental manipulations. The zebrafish has a significant genetic similarity with other vertebrates. Nevertheless, translating findings from zebrafish studies to human risk assessment requires careful consideration of these differences.

Use test with l-carvone in toothpaste on sensitized individuals

BACKGROUND

The mint flavour carvone (l-carvone) is considered a weak contact allergen. However, contact allergy to carvone is more prevalent in patients with oral lichen planus or oral lichenoid lesions (OLP/OLL).

OBJECTIVE

Our aim was to investigate how carvone affects sensitized individuals through a use test with toothpaste containing carvone. Non-flavoured toothpaste served as control.

METHODS

Subjects were patch tested prior to the use test-14 subjects allergic to carvone (11 with OLP/OLL), 20 subjects with OLP/OLL and 3 healthy controls. The month-long use test comprised of using toothpaste twice daily. Subjects were examined fortnightly. Clinical signs were assessed with a mucosal scoring system. The subjects' oral health-related quality of life was measured with the oral health impact profile (OHIP-49).

RESULTS

Local reactions to the carvone toothpaste presented as aggravated OLL (7/10) and peri-oral eczema (2/10) in allergic subjects. They also had significantly higher mucosal and OHIP scores compared with those receiving non-flavoured toothpaste.

CONCLUSION

In sensitized individuals, oral exposure to carvone gives aggravated oral lesions and/or peri-oral eczema. The lesions mimic OLP and allergic individuals are therefore at risk of not being assessed with regard to flavour contact allergy.

The use of carvone in consecutive patch testing

BACKGROUND

Carvone (l-carvone) is a mint-tasting flavour additive that most of us is exposed to and can cause allergic contact reactions.

OBJECTIVES

To analyse the frequency and the relevance of positive carvone reactions in a dermatitis population.

METHOD

A retrospective analysis of dermatitis patients consecutively tested with carvone from 2017 to 2021. Data were retrieved from the department's patch-test database.

RESULTS

Of 3554 patients tested with carvone, 28 (0.79%) had a positive reaction. Carvone-positive patients had higher mean age, were significantly more likely female (p < 0.001) and had often an intraoral/lip involvement (p < 0.001). In the carvone-positive group, 50% (n = 14) had a relevant reaction, and in 4 of 14, the relevance was first revealed after test reading. Of the carvone-positive patients, 18 of 28 did not have a coexisting allergy to a fragrance/flavour allergen and of these 44% had a relevant allergy.

CONCLUSIONS

The study suggests that a significant fraction of relevant carvone contact allergies may be overlooked if the allergen is not tested. Furthermore, as the exposure is widespread, inclusion of carvone in the Swedish baseline series may be justified even if the contact allergy prevalence is below 1%.

Functional Study on Cytochrome P450 in Response to L(-)-Carvone Stress in Bursaphelenchus xylophilus

Bursaphelenchus xylophilus (PWN) causes pine wilt disease (PWD), which is one of the most devastating pine diseases worldwide. Cytochrome P450 (CYP) catalyzes the biosynthetic metabolism of terpenoids and plays an important role in the modification of secondary metabolites in all living organisms. We investigated the molecular characteristics and biological functions of Bx-cyp29A3 in B. xylophilus. The bioinformatics analysis results indicated that Bx-cyp29A3 has a transmembrane domain and could dock with L(-)-carvone. The gene expression pattern indicated that Bx-cyp29A3 was expressed in 0.2, 0.4, 0.6, 0.8, and 1.0 mg/mL L(-)-carvone solutions. The Bx-cyp29A3 expression increased in a dose-dependent manner and peaked at 24 h of exposure when the L(-)-carvone solution concentration was 0.8 mg/mL. However, the gene expression peaked at 0.6 mg/mL after 36 h. Furthermore, RNA interference (RNAi) indicated that Bx-cyp29A3 played an essential role in the response to L(-)-carvone. The mortality rates of the Bx-cyp29A3 knockdown groups were higher than those of the control groups in the 0.4, 0.6, 0.8, and 1.0 mg/mL carvone solutions after 24 h of exposure or 36 h of exposure. In summary, bioinformatics provided the structural characteristics and conserved sequence properties of Bx-cyp29A3 and its encoded protein, which provided a target gene for the study of the P450 family of B. xylophilus. Gene silencing experiments clarified the function of Bx-cyp29A3 in the immune defense of B. xylophilus. This study provides a basis for the screening of new molecular targets for the prevention and management of B. xylophilus.

Patch Testing to Carvone: North American Contact Dermatitis Group Experience, 2009 to 2018

BACKGROUND/OBJECTIVES

Carvone, a flavoring agent, may cause allergic contact dermatitis. This study summarizes patch test reactions to carvone in patients tested by the North American Contact Dermatitis Group, 2009 to 2018.

METHODS

This was a retrospective analysis of patients positive to carvone (5% petrolatum). Demographics were compared with those of patients who were negative. Other analyses included reaction strength, clinical relevance, coreactivity with other fragrance/flavor allergens, and exposure sources.

RESULTS

Of 24,124 patients tested to carvone, 188 (0.78%) were positive. As compared with carvone-negative patients, carvone-positive patients were significantly more likely older than 40 years (P = 0.0284). Women (76.1%) and/or facial involvement (33.0%) were common in the carvone-positive group but not statistically different from carvone-negative patients; 73.3% (n = 138) of the reactions were currently relevant. Relevant sources were personal care products (46.3%, n = 87) and food (14.3%, n = 27). Coreactivity with other fragrance/flavor markers was present in 60.6% of carvone-positive patients, most commonly fragrance mix I (34.6%), balsam of Peru (24.5%), and cinnamic aldehyde (15.4%).

CONCLUSIONS

Ten-year prevalence of carvone sensitivity was 0.78%. Most carvone-positive patients were female, were older than 40 years, and/or had facial dermatitis. Personal care products were the most common source. Two-fifths of carvone reactions would have been missed by relying on other fragrance/flavoring allergens.

Contact Allergy: A Review of Current Problems from a Clinical Perspective

Contact allergy is common, affecting 27% of the general population in Europe. Original publications, including case reports, published since 2016 (inclusive) were identified with the aim of collating a full review of current problems in the field. To this end, a literature search employing methods of systematic reviewing was performed in the Medline^® and Web of Science™ databases on 28 January 2018, using the search terms (“contact sensitization” or “contact allergy”). Of 446 non-duplicate publications identified by above search, 147 were excluded based on scrutiny of title, abstract and key words. Of the remaining 299 examined in full text, 291 were deemed appropriate for inclusion, and main findings were summarised in topic sections. In conclusion, diverse sources of exposures to chemicals of widely-differing types and structures, continue to induce sensitisation in man and may result in allergic contact dermatitis. Many of the chemicals are “evergreen” but others are “newcomers”. Vigilance and proper investigation (patch testing) are required to detect and inform of the presence of these haptens to which our populations remain exposed.