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Pranadwista ZF, Hidayat W. Immunoglobulin-E (IgE) Screening for Detecting Mouthwash Allergic Reactions with Recurrent Oral Erythema Multiforme: A Case Report. Int Med Case Rep J 2024; 17:573-579. [PMID: 38854841 PMCID: PMC11162238 DOI: 10.2147/imcrj.s468876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024] Open
Abstract
Background Recurrent oral erythema multiforme (ROEM) is an uncommon subtype of erythema multiforme. Immunoglobulin E (IgE) is essential in acute allergy reactions and chronic allergic inflammatory disorders. Purpose This report aims to describe the advantages of total IgE screening for detecting mouthwash allergic reactions associated with ROEM. Case Presentation A 29-year-old woman came to the Oral Medicine clinic complaining of canker sores all over her mouth and swollen lips accompanied by crusts that had been bleeding easily two months prior. Complaints worsened after the patient used alcohol-containing mouthwash without a history of fever or other symptoms. Extra-oral examination showed upper and lower lip edema with hemorrhagic crusts that bleed easily. No lesions were found in other parts of the body. Intra-oral examination showed ulcers, multiple, irregular in almost the entire oral mucosa. Laboratory examination revealed non-reactive anti-HSV-1 IgG and a total IgE serum level of 612.00 IU/mL. The diagnosis based on the examination results is recurrent oral erythema multiforme. Case Management The patient was instructed to stop using alcohol-containing mouthwash, maintain oral hygiene, a healthy lifestyle, adequate hydration, and a balanced diet. Prednisone, benzydamine HCL mouthwash, 0.025% hyaluronic acid mouthwash, multivitamins, and hydrocortisone cream were given as pharmacological therapy. The oral lesions improved in 12 days and the total IgE serum level examination showed a decrease (385 IU/mL). Conclusion The total IgE examination can be a screening tool for mouthwash allergy-related reactions to disease and represents the response of ROEM therapy as evidenced by clinical improvement.
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Affiliation(s)
- Zulfa Fidi Pranadwista
- Oral Medicine Residency Program, Faculty of Dentistry, Padjadjaran University, Bandung, Indonesia
| | - Wahyu Hidayat
- Department of Oral Medicine, Faculty of Dentistry, Padjadjaran University, Bandung, Indonesia
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Canallatos P, Mclean T, Frustino J, Zemer J, Colebeck A, Sullivan M. Maxillary resection prosthesis fabricated from urethane dimethacrylate for a patient with polymethyl methacrylate allergy: A clinical report. J Prosthet Dent 2023; 130:655-658. [PMID: 35305833 DOI: 10.1016/j.prosdent.2022.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Paul Canallatos
- Maxillofacial Prosthodontist, Erie County Medical Center, Department of Oral Oncology and Maxillofacial Prosthetics, Buffalo, NY.
| | - Terrence Mclean
- Maxillofacial Prosthodontist, Erie County Medical Center, Department of Oral Oncology and Maxillofacial Prosthetics, Buffalo, NY
| | - Jennifer Frustino
- Director of Oral Cancer Screenings and Diagnostics, Erie County Medical Center, Department of Oral Oncology and Maxillofacial Prosthetics, Buffalo, NY; Clinical Research Coordinator, Erie County Medical Center, Department of Oral Oncology and Maxillofacial Prosthetics, Buffalo, NY
| | - James Zemer
- Clinical Research Coordinator, Erie County Medical Center, Department of Oral Oncology and Maxillofacial Prosthetics, Buffalo, NY
| | - Amanda Colebeck
- Board Certified Maxillofacial Prosthodontist, Erie County Medical Center, Department of Oral Oncology and Maxillofacial Prosthetics, Buffalo, NY
| | - Maureen Sullivan
- Chief of Department, Erie County Medical Center, Oral Oncology and Maxillofacial Prosthetics, Buffalo, NY
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Zigante M, Spalj S, Prpic J, Pavlic A, Katic V, Matusan Ilijas K. Immunohistochemical and Histopathological Features of Persistent Gingival Enlargement in Relation to Metal Allergic Sensitisation during Orthodontic Treatment. MATERIALS (BASEL, SWITZERLAND) 2022; 16:81. [PMID: 36614420 PMCID: PMC9821443 DOI: 10.3390/ma16010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
This study aimed to analyse the immunohistochemical profile of inflammatory infiltrates in the gingival tissue of patients undergoing orthodontic treatment in relation to patients’ titanium and/or nickel allergy status. Patients with gingival enlargement received initial periodontal therapy, followed by external gingivectomy in the case of persistent gingival enlargement. The sample included 44 patients (22 had metal allergic sensitisation). Histopathological changes were assessed, and an immunohistochemical analysis was performed on formalin-fixed and paraffin-embedded gingival samples using antibodies against CD1a, CD3, CD4, CD8, CD20, CD68, and CD138. Computer-assisted image analysis was performed to evaluate the positive cell count in the gingival tissue. The gingiva of the sensitised patients was characterised by the absence of multifocal inflammatory infiltrates (p < 0.05), while pronounced exocytosis and band-like inflammatory infiltrates were more frequently observed in sensitised patients. In addition, there was an increase in Langerhans cells and T-helper lymphocytes and a decrease in naïve T-lymphocytes, cytotoxic T-lymphocytes, macrophages, and plasma cells in the sensitised subjects compared to non-sensitised. However, the differences were only statistically significant for macrophages, with a moderate effect size (82.8 vs. 133.9; p = 0.041; r = 0.308). The absence of multifocal inflammation appears to be the most characteristic histopathological feature of the gingiva of sensitised patients. Although their gingiva presented certain characteristics of late hypersensitivity immune reactions the observed changes imply dominant irritative effect e.
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Affiliation(s)
- Martina Zigante
- Department of Orthodontics, Faculty of Dental Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
| | - Stjepan Spalj
- Department of Orthodontics, Faculty of Dental Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
- Department of Dental Medicine, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Jelena Prpic
- Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
- Department of Periodontology, Faculty of Dental Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Andrej Pavlic
- Department of Orthodontics, Faculty of Dental Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Department of Pediatric Dentistry, Faculty of Dental Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Visnja Katic
- Department of Orthodontics, Faculty of Dental Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
| | - Koviljka Matusan Ilijas
- Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
- Department of General Pathology and Pathological Anatomy, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
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Arakelyan M, Spagnuolo G, Iaculli F, Dikopova N, Antoshin A, Timashev P, Turkina A. Minimization of Adverse Effects Associated with Dental Alloys. MATERIALS (BASEL, SWITZERLAND) 2022; 15:7476. [PMID: 36363067 PMCID: PMC9658402 DOI: 10.3390/ma15217476] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Metal alloys are one of the most popular materials used in current dental practice. In the oral cavity, metal structures are exposed to various mechanical and chemical factors. Consequently, metal ions are released into the oral fluid, which may negatively affect the surrounding tissues and even internal organs. Adverse effects associated with metallic oral appliances may have various local and systemic manifestations, such as mouth burning, potentially malignant oral lesions, and local or systemic hypersensitivity. However, clear diagnostic criteria and treatment guidelines for adverse effects associated with dental alloys have not been developed yet. The present comprehensive literature review aims (1) to summarize the current information related to possible side effects of metallic oral appliances; (2) to analyze the risk factors aggravating the negative effects of dental alloys; and (3) to develop recommendations for diagnosis, management, and prevention of pathological conditions associated with metallic oral appliances.
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Affiliation(s)
- Marianna Arakelyan
- Therapeutic Dentistry Department, Institute for Dentistry, Sechenov University, 119991 Moscow, Russia
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Napoli, Italy
| | - Flavia Iaculli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Napoli, Italy
| | - Natalya Dikopova
- Therapeutic Dentistry Department, Institute for Dentistry, Sechenov University, 119991 Moscow, Russia
| | - Artem Antoshin
- Institute for Regenerative Medicine, Sechenov University, 119991 Moscow, Russia
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov University, 119991 Moscow, Russia
| | - Peter Timashev
- Institute for Regenerative Medicine, Sechenov University, 119991 Moscow, Russia
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov University, 119991 Moscow, Russia
- Chemistry Department, Lomonosov Moscow State University, 119234 Moscow, Russia
| | - Anna Turkina
- Therapeutic Dentistry Department, Institute for Dentistry, Sechenov University, 119991 Moscow, Russia
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Roach K, Roberts J. A comprehensive summary of disease variants implicated in metal allergy. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2022; 25:279-341. [PMID: 35975293 PMCID: PMC9968405 DOI: 10.1080/10937404.2022.2104981] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Allergic disease represents one of the most prominent global public health crises of the 21st century. Although many different substances are known to produce hypersensitivity responses, metals constitute one of the major classes of allergens responsible for a disproportionately large segment of the total burden of disease associated with allergy. Some of the most prevalent forms of metal allergy - including allergic contact dermatitis - are well-recognized; however, to our knowledge, a comprehensive review of the many unique disease variants implicated in human cases of metal allergy is not available within the current scientific literature. Consequently, the main goal in composing this review was to (1) generate an up-to-date reference document containing this information to assist in the efforts of lab researchers, clinicians, regulatory toxicologists, industrial hygienists, and other scientists concerned with metal allergy and (2) identify knowledge gaps related to disease. Accordingly, an extensive review of the scientific literature was performed - from which, hundreds of publications describing cases of metal-specific allergic responses in human patients were identified, collected, and analyzed. The information obtained from these articles was then used to compile an exhaustive list of distinctive dermal/ocular, respiratory, gastrointestinal, and systemic hypersensitivity responses associated with metal allergy. Each of these disease variants is discussed briefly within this review, wherein specific metals implicated in each response type are identified, underlying immunological mechanisms are summarized, and major clinical presentations of each reaction are described.Abbreviations: ACD: allergic contact dermatitis, AHR: airway hyperreactivity, ASIA: autoimmune/ autoinflammatory syndrome induced by adjuvants, BAL: bronchoalveolar lavage, CBD: chronic beryllium disease, CTCL: cutaneous T-cell lymphoma, CTL: cytotoxic T-Lymphocyte, DRESS: drug reaction with eosinophilia and systemic symptoms, GERD: gastro-esophageal reflux disease, GI: gastrointestinal, GIP: giant cell interstitial pneumonia, GM-CSF: granulocyte macrophage-colony stimulating factor, HMLD: hard metal lung disease, HMW: high molecular weight, IBS: irritable bowel syndrome, Ig: immunoglobulin, IL: interleukin, LMW: low molecular weight, PAP: pulmonary alveolar proteinosis, PPE: personal protective equipment, PRR: pathogen recognition receptor, SLE: systemic lupus erythematosus, SNAS: systemic nickel allergy syndrome, Th: helper T-cell, UC: ulcerative colitis, UV: ultraviolet.
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Affiliation(s)
- Ka Roach
- Allergy and Clinical Immunology Branch (ACIB), National Institute of Occupational Safety and Health (NIOSH), Morgantown, WV, USA
| | - Jr Roberts
- Allergy and Clinical Immunology Branch (ACIB), National Institute of Occupational Safety and Health (NIOSH), Morgantown, WV, USA
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6
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Is Allergy to Titanium Bone Fixation Plates a Problem? COATINGS 2022. [DOI: 10.3390/coatings12020214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Open reduction and internal fixation (ORIF) with titanium fixation plates is the gold standard for maxillofacial fracture treatment. Titanium is considered a fully compatible material. However, reports of allergic reactions to titanium implants do occur. The aim of this work is to answer the question whether titanium devices used in the treatment of fractures in the craniofacial region can cause allergic reactions. The study comprised 50 subjects treated surgically for maxillofacial injuries with the use of titanium composite devices. Allergic tests were performed by the patch method. The control group consisted of 20 healthy people who did not have any titanium elements. There were no skin changes to titanium and its compounds in both the test and control groups. Only one patient had a positive skin test which showed an allergic reaction to silver nitrate. Titanium fixing elements, as well as titanium dental implants, according to our research, do not show allergic skin reactions.
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Bechir F, Bataga SM, Ungureanu E, Vranceanu DM, Pacurar M, Bechir ES, Cotrut CM. Experimental Study Regarding the Behavior at Different pH of Two Types of Co-Cr Alloys Used for Prosthetic Restorations. MATERIALS 2021; 14:ma14164635. [PMID: 34443157 PMCID: PMC8402223 DOI: 10.3390/ma14164635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022]
Abstract
Cobalt-chromium (Co-Cr) alloys are widely utilized in dentistry. The salivary pH is a significant factor, which affects the characteristics and the behavior of dental alloys through corrosion. This study aimed to evaluate the corrosion behavior in artificial saliva with different pH values (3, 5.7, and 7.6) of two commercial Co-Cr dental alloys manufactured by casting and by milling. Corrosion resistance was determined by the polarization resistance technique, and the tests were carried out at 37 ± 1 °C, in Carter Brugirard artificial saliva. After the electrochemical parameters, it can be stated that the cast Co-Cr alloy has the lowest corrosion current density, the highest polarization resistance, and the lowest speed of corrosion in artificial saliva with pH = 7.6. In the case of milled Co-Cr alloy, the same behavior was observed, but in artificial saliva with pH = 5.7, it recorded the most electropositive values of open circuit potential and corrosion potential. Although both cast and milled Co-Cr alloys presented a poorer corrosion resistance in artificial saliva with a more acidic pH value, the milled Co-Cr alloy had better corrosion behavior, making this alloy a better option for the prosthetic treatment of patients suffering from GERD.
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Affiliation(s)
- Farah Bechir
- Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gh. Marinescu Str., 540142 Targu Mures, Romania; (F.B.); (M.P.)
| | - Simona Maria Bataga
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gh. Marinescu Str., 540142 Targu Mures, Romania;
| | - Elena Ungureanu
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 313 Splaiul Independentei, 060042 Bucharest, Romania; (E.U.); (D.M.V.); (C.M.C.)
| | - Diana Maria Vranceanu
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 313 Splaiul Independentei, 060042 Bucharest, Romania; (E.U.); (D.M.V.); (C.M.C.)
| | - Mariana Pacurar
- Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gh. Marinescu Str., 540142 Targu Mures, Romania; (F.B.); (M.P.)
| | - Edwin Sever Bechir
- Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gh. Marinescu Str., 540142 Targu Mures, Romania; (F.B.); (M.P.)
- Correspondence: ; Tel.: +40-72-339-6969
| | - Cosmin Mihai Cotrut
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 313 Splaiul Independentei, 060042 Bucharest, Romania; (E.U.); (D.M.V.); (C.M.C.)
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Simon CP, Motoc AGM, Simon GA, Brezovan D, Muselin F, Cristina RT, Bratu DC. Gingival proliferative growth - stress and cytoarchitecture related with fixed and mobile orthodontic therapy. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:1287-1294. [PMID: 34171076 PMCID: PMC8343617 DOI: 10.47162/rjme.61.4.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The fixed orthodontic measures taken induce significant stress to the gingival growth process during arch wire maneuvers of aligning and leveling. We observed, for a period of one to four years, fixed orthodontic devices in 80 human subjects. From these, we selected 44 subjects (22 women and 22 men) where the inflammatory process exhibited following the orthodontic fixed treatment, and with vacuum-formed orthodontic retainers (VFR) succeeding to fixed treatment. Samples were collected from each patient and histological and immunohistochemical (IHC) methodology was made to analyze the cytoarchitecture. Statistics were made after one-way analysis of variance (ANOVA), with the Bonferroni’s correction. The IHC examination performed in the early stage revealed the presence in the inflammatory infiltrate of CD8-type T-lymphocytes, and of dendritic cells in large numbers. The examination performed in the late stage revealed the presence in the inflammatory infiltrate of CD20-type B-lymphocytes, which are mature cells capable of immunoglobulin synthesis, their activation being an important step in the maturation of the antibody response. The stress generated by arch wires in both genders was significantly higher than in the case of VFR. This observation was pointed out also by the cytohistological investigation outcome but was also based on an original scale conceived by our research team, following gingival hyperplasia evaluation. Also, with statistical significance, the comparative obtained values for men (p=0.01) and for women (p=0.001) illustrate clinical observations, allowing to affirm that, in our case, men were more stressed in bearing arch wire devices (AWD) and VFR, in comparison with women.
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Affiliation(s)
- Cătălin Petru Simon
- Department of Pharmacology and Pharmacy, Faculty of Veterinary Medicine, King Michael I of Romania Banat University of Agricultural Sciences and Veterinary Medicine of Timişoara, Romania;
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Domić I, Budmir J, Novak I, Mravak-Stipetić M, Lugović-Mihić L. ASSESSMENT OF ALLERGIES TO FOOD AND ADDITIVES IN PATIENTS WITH ANGIOEDEMA, BURNING MOUTH SYNDROME, CHEILITIS, GINGIVOSTOMATITIS, ORAL LICHENOID REACTIONS, AND PERIORAL DERMATITIS. Acta Clin Croat 2021; 60:276-281. [PMID: 34744278 PMCID: PMC8564830 DOI: 10.20471/acc.2021.60.02.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022] Open
Abstract
Oral cavity and perioral area are constantly exposed to a variety of antigens, including food and additives, which have a potential role in the development of different oral mucosal and perioral cutaneous diseases since they can cause hypersensitivity reactions. Oral and perioral diseases mainly include angioedema, burning mouth syndrome, cheilitis, gingivostomatitis, oral lichenoid reactions, and perioral dermatitis. Previous studies were focused on delayed-type oral allergies by performing patch testing but did not include tests for immediate-type allergic reactions. Therefore, the objective of this study was to determine common nutritive and additive allergens in the prevalent oral and perioral diseases by using skin prick tests. Our study evaluated 230 participants, i.e. 180 patients with oral/perioral diseases (angioedema, burning mouth syndrome, cheilitis, gingivostomatitis, oral lichenoid reactions, and perioral dermatitis), and 50 healthy control subjects. The results of skin prick tests showed that immediate-type allergic reactions to food and additives were mostly seen in patients with burning mouth syndrome (40%) and cheilitis (33.3%), whereas allergies were least frequently observed in perioral dermatitis (10%) and gingivostomatitis (20%). Fruits, mushrooms, and vegetables were the most frequent causes of nutritive allergies in oral and perioral diseases. The most commonly identified additive allergens were glutaraldehyde, citric acid, and sodium glutamate. Study results suggest the possible association with nutritive and additive allergies be considered in cases of persistent oral mucosal or perioral skin disease accompanied by respective medical history.
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Affiliation(s)
| | - Jozo Budmir
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Ina Novak
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Marinka Mravak-Stipetić
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Liborija Lugović-Mihić
- 1Department of Dermatovenereology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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10
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Histopathologic Spectrum of Intraoral Irritant and Contact Hypersensitivity Reactions: A Series of 12 cases. Head Neck Pathol 2021; 15:1172-1184. [PMID: 33904012 PMCID: PMC8633165 DOI: 10.1007/s12105-021-01330-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Irritant contact stomatitis (ICS) and contact hypersensitivity stomatitis (CHS) are often caused by alcohol, flavoring agents and additives in dentifrices and foods, and contactants with high or low pH. A well-recognized contactant for ICS is Listerine™ mouthwash, while that for CHS is cinnamic aldehyde. However, many other flavoring agents and even smokeless tobacco are contactants that cause mucosal lesions that are entirely reversible. The objective of this study is to 1) present cases of ICS and CHS with a clear history of a contactant at the site and the histopathologic features of the resulting lesion and 2) define the histopathologic features that characterize such lesions. METHODS 12 cases of ICS and CHS with known contactants that exhibited distinct histopathologic patterns were identified. RESULTS ICS are characterized by three patterns in increasing order of severity namely: 1) superficial desquamation, 2) superficial keratinocyte edema, and 3) keratinocyte coagulative necrosis with/out spongiosis and microabscesses. CHS is characterized by two patterns namely plasma cell stomatitis with an intense plasma cell infiltrate and a lymphohistiocytic infiltrate with or without non-necrotizing granulomatous inflammation. Three patterns of the latter are recognized: (1) lymphohistiocytic infiltrate at the interface with well-formed or loosely aggregated non-necrotizing granulomas; (2) lymphohistiocytic infiltrate at the interface with peri- and para-vascular lymphohistiocytic nodules; and (3) lymphohistiocytic infiltrate at the interface with peri- and para-vascular lymphohistiocytic nodules containing non-necrotizing granulomas. The same contactant may elicit ICS and CHS, while one histopathologic pattern may be brought on by various contactants. CONCLUSION ICS and CHS have distinct histologic patterns. Recognizing that these patterns are caused by contactants would help clinicians manage such mucosal lesions.
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Agha-Hosseini F, Gholamrezayi E, Moosavi MS. Patch test of dental materials in Oral Lichen Planus with considering the role of saliva. Sci Rep 2021; 11:8264. [PMID: 33859299 PMCID: PMC8050088 DOI: 10.1038/s41598-021-87778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/05/2021] [Indexed: 12/04/2022] Open
Abstract
Lichen planus is the most common skin disease that affects the oral mucosa. Oral Lichen Planus is a T-cell-mediated autoimmune disorder. In the current study, for the first time, an oral cavity condition in skin patch tests with adding saliva is simulated. In addition, the patch results are compared with healthy subjects. Forty-one OLP patients and 63 healthy subjects were enrolled in the study. All participants were provided with patch tests, including allergens, in combination with saliva in chambers. Allergens from the European baseline (standard) series selected according to the most prevalent positive results in the previous study were applied. Positive results of Mercury and Cobalt tests were significantly higher in the case group. In this study, the differentiation of patients with lichen planus and lichenoid was identified according to the Van der Meij & Van der Waal criteria. The patch test was conducted for healthy individuals as well. The most important of all was the use of patients' saliva in the patch test, done for the first time in this field. In the case of OLP, a patch test can help identify positive reactions to dental materials; thus, the replacement of dental restorations may be needed.
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Affiliation(s)
- Farzaneh Agha-Hosseini
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.,The Academy of Medical Sciences, Tehran, Iran
| | - Elahe Gholamrezayi
- Department of Orthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdieh-Sadat Moosavi
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
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12
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Insights into hypersensitivity reactions in dentistry. Porto Biomed J 2020. [DOI: 10.1097/j.pbj.0000000000000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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13
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Maeno M, Tamagawa-Mineoka R, Arakawa Y, Masuda K, Adachi T, Katoh N. Metal patch testing in patients with oral symptoms. J Dermatol 2020; 48:85-87. [PMID: 32920872 DOI: 10.1111/1346-8138.15606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/17/2020] [Indexed: 11/27/2022]
Abstract
The number of patients with metal allergies has increased recently, and patch testing is useful for investigating such patients. However, the efficacy of restoration removal in patients with oral metal allergies is disputed. This study aimed to investigate the relationships between oral symptoms and metal allergies. We conducted a retrospective analysis of 60 patients with oral symptoms. The most common oral symptom was an abnormal oral sensation. Thirty-eight percent of the patients exhibited positive allergic reactions to one or more metal. Nickel was the metal allergen that produced positive reactions most frequently. Of the seven patients whose restorations were removed, complete and partial remission were achieved in one and two patients, respectively. Interestingly, metal alloy removal was effective in 33% (n = 1) of the positive patch test group and 50% (n = 2) of the non-positive patch test group. Our results demonstrated the difficulty of predicting the efficacy of restoration removal at ameliorating oral metal allergies based on patch testing alone.
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Affiliation(s)
- Misato Maeno
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Risa Tamagawa-Mineoka
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yukiyasu Arakawa
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koji Masuda
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuya Adachi
- Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Norito Katoh
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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14
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Abstract
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.
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Affiliation(s)
| | - Eric T Stoopler
- Department of Oral Medicine, University of Pennsylvania, Penn Dental Medicine, 240 South 40th Street, Room 206, Schattner Building, Philadelphia, PA 19104, USA
| | - Glen H Crawford
- Department of Dermatology, University of Pennsylvania, 822 Pine Street Suite 2A, Philadelphia, PA 19107, USA
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15
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Budimir J, Mravak-Stipetić M, Bulat V, Ferček I, Japundžić I, Lugović-Mihić L. Allergic reactions in oral and perioral diseases—what do allergy skin test results show? Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127:40-48. [DOI: 10.1016/j.oooo.2018.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/29/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
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16
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Mittermüller P, Hiller KA, Schmalz G, Buchalla W. Five hundred patients reporting on adverse effects from dental materials: Frequencies, complaints, symptoms, allergies. Dent Mater 2018; 34:1756-1768. [PMID: 30360901 DOI: 10.1016/j.dental.2018.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/21/2018] [Accepted: 09/22/2018] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Pauline Mittermüller
- University of Regensburg Medical Center, Department of Conservative Dentistry and Periodontology, 93042 Regensburg, Germany
| | - Karl-Anton Hiller
- University of Regensburg Medical Center, Department of Conservative Dentistry and Periodontology, 93042 Regensburg, Germany.
| | - Gottfried Schmalz
- University of Regensburg Medical Center, Department of Conservative Dentistry and Periodontology, 93042 Regensburg, Germany; University of Bern, Department of Preventive, Restorative and Pediatric Dentistry, Bern, Switzerland
| | - Wolfgang Buchalla
- University of Regensburg Medical Center, Department of Conservative Dentistry and Periodontology, 93042 Regensburg, Germany
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17
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Yamashita K, Miyazaki H, Shinoda S, Hagiwara S, Takahashi H, Itagaki H. Assessment of the skin sensitizing potential of chemicals, contained in foods and/or cosmetic ingredients, using a modified local lymph node assay with an elicitation phase (LLNA:DAE) method. J Toxicol Sci 2018; 43:513-520. [PMID: 30078837 DOI: 10.2131/jts.43.513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
We evaluated the skin sensitizing potential of 10 natural organic chemicals, or their derivatives, which are included in foods and/or skin products, using a modified local lymph node assay (LLNA), with an elicitation phase (LLNA:DAE). The following compounds were tested: carminic acid, esculetin, 4-methyl esculetin, coumarin, quercetin, curcumin, naringenin, chlorogenic acid, isoscopoletin, and shikonin. Esculetin, 4-methyl esculetin, isoscopoletin, and shikonin yielded positive results. In particular, shikonin at a very low concentration (0.05%) induced an elicitation response. In conclusion, four of the 10 natural organic chemicals tested had a skin sensitization potential, with shikonin producing serious reaction even at a very low concentration.
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Affiliation(s)
| | | | | | - Saori Hagiwara
- Yoshimi Laboratories, Drug Safety Testing Center Co., Ltd
| | | | - Hiroshi Itagaki
- Faculty of Engineering, Dept. of Materials Science and Engineering, Yokohama National University
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18
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Alnazzawi A. Effect of Fixed Metallic Oral Appliances on Oral Health. J Int Soc Prev Community Dent 2018; 8:93-98. [PMID: 29780732 PMCID: PMC5946530 DOI: 10.4103/jispcd.jispcd_416_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/17/2018] [Indexed: 11/30/2022] Open
Abstract
There is a substantial proportion of the population using fixed metallic oral appliances, such as crowns and bridges, which are composed of various dental alloys. These restorations may be associated with a number of effects on oral health with variable degrees of severity, to review potential effects of using fixed metallic oral appliances, fabricated from various alloys. The MEDLINE/PubMed database was searched using certain combinations of keywords related to the topic. The search revealed that burning mouth syndrome, oral pigmentation, hypersensitivity and lichenoid reactions, and genotoxic and cytotoxic effects are the major potential oral health changes associated with fixed prosthodontic appliances. Certain oral disorders are associated with the use of fixed metallic oral appliances. Patch test is the most reliable method that can be applied for identifying metal allergy, and the simultaneous use of different alloys in the mouth is discouraged.
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Affiliation(s)
- Ahmad Alnazzawi
- Department of Substitutive Dental Sciences, College of Dentistry, Taibah University Madinah, KSA
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19
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Tiwari SM, Gebauer K, Frydrych AM, Burrows S. Dental patch testing in patients with undifferentiated oral lichen planus. Australas J Dermatol 2017; 59:188-193. [DOI: 10.1111/ajd.12692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/27/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Shevya M Tiwari
- Department of Dermatology; Fiona Stanley Hospital; Perth Western Australia Australia
- Department of Dermatology; Royal Perth Hospital; Perth Western Australia Australia
| | - Kurt Gebauer
- Fremantle Dermatology; Fremantle Western Australia Australia
| | - Agnieszka M Frydrych
- Oral Medicine WA; Perth Western Australia Australia
- School of Dentistry; University of Western Australia; Perth Western Australia Australia
| | - Sally Burrows
- School of Medicine and Pharmacology; University of Western Australia; Perth Western Australia Australia
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20
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Feller L, Wood NH, Khammissa RAG, Lemmer J. Review: allergic contact stomatitis. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:559-565. [PMID: 28407984 DOI: 10.1016/j.oooo.2017.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/10/2017] [Accepted: 02/07/2017] [Indexed: 01/28/2023]
Abstract
Allergic contact stomatitis (ACS) is an oral mucosal immunoinflammatory disorder variably characterized clinically by erythematous plaques, vesiculation, ulceration, and/or hyperkeratosis and by pain, burning sensation, or itchiness. ACS is brought about by a T cell-mediated, delayed hypersensitivity immune reaction generated by a second or subsequent contact exposure of an allergen with the oral mucosa, in a genetically susceptible, sensitized subject. Lichenoid contact reaction is a variant of ACS brought about by direct contact with the oral mucosa of certain metals in dental restorations. The features of ACS are neither clinically nor histopathologically specific, so the diagnosis is usually presumptive and can only be confirmed by resolution of the inflammation after withdrawal or removal of the suspected causative allergen. When ACS is suspected but an allergen cannot be identified, patch testing is necessary. In persistent cases, topical corticosteroids are the treatment of choice, but for severe and extensive lesions, systemic corticosteroid and systemic antihistamines may be indicated. In this short review, we highlight the clinical, immunologic, and histopathological features of ACS, and provide some guidelines for diagnosis and management.
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Affiliation(s)
- Liviu Feller
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
| | - Neil Hamilton Wood
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Johan Lemmer
- Department of Periodontology and Oral Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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