ALLERGIC PROBLEMS IN DENTISTRY
Pubblication S.I.D.O. (Italian Ortodontic Association)
DR. MED. MARKUS GREWE
Heinrich-Heine University Düsseldrof
Department of Dermatology
D-40225 Düsseldrof, Germany
August 26,1964, born in Rheine in Westf.,
1983.1990 Medical school, Albert-Ludwings-Universität
1990 M. D.
1990.1992 Resarch Fellowship in Biochemistry with
Prof. Dr. K. Decker, Biochemisches Institut and
SFB " Clinical and Experimental Hepatology",
University of Freiburg.
1992 M. D. thesis (grade: summa cum laude),
University of Freiburg.
1992.1994 Residency in Dermatology, Dept. Of Dermatology,
University of Freiburg (Chairman: Prof. Dr. E. Schöpf)
1993 Residency in Dermatology, Dept. Of Dermatology,
University of Düsseldrof (Chairman: Prof. Dr. T. Ruzicka)
1987 Franz-Friedrich-Nord scholarship,
University of Freiburg
1994 Gödecke research award, University of Freiburg
1995 Herbert-Herxheimer award, Deutsche Gesellschft
Für Allergie- und Immunitätsforschung
Allergic reactions to materials used in dentistry may be assigned to type 1 (immediate type) and type IV (delayed type hypersensitivity / contact dermatitis) reactions according to Gell and Coombs. Both types of allergic reaction require repetitive or prolonged exposure to the relevant allergen. Delayed type hypersensitivity reactions are not associated with antigen specific antibody production, but critically depend on attraction and activation of allergen specific T-cells to the site of exposure and inflammation.
This explains the delayed (app. 24 h latency) character of this reaction. In contrast, immediate hipersensitivity reactions are antibody mediated by preformed IgE antibodies present in the peripheral blood. This causes immediate allergic reactions sometimes within seconds, and may result in lif-threatening shock events. Dental materialsleading to type IV reactions are mainly polymeric substances or catalysts used e.g. for prosthetics, and metals. Latex containig materials are the utmost important inducers of type 1 reactions.
TYPE IV ALLERGY
The clinical picture of type IV reactions is the contact dermatitis. At the site of contact, earliest 24 h after exposure, pruritus or burning sensations may occur, followed by erytema, formation and rupture of vescicles with subsequent erosion. Additional tissue challenge (machanic, toxic, infectious) may
complicate the situation leading e. g. to
ulcer formation. The oral manifestation
of allergic contact dermatitis is the
contact stomatitis or stomatitis venenata, most often characterized by a
sharp delineated erythema or erosion.
Fig. 1: Allergic contact stomatitis
It is currently under debate, whether the
lichen ruber mucosae (Fig. 2) in some
cases is also a result of allergic reactions to dental materials.
Fig. 2 : Liche ruber mucosae
Secondary allergic reaction may occur at other skin sites than the contact region of the allergic material, and has also been described
for dental materials. The immunologic mechanism leading to the spreading of allergic reactions is currently unknow.
Removal of allergenic material and substitution with chemically not related substances, to respected a accurate record.
ALLERGENIC DENTAL MATERIALS
Amalgam may cause allergic problems by sensitizazion towards Mercury as well as copper. Amalgam is discussed as a pathogenetic Factor for lichen ruber mucosae, and, by its electrogalvanic Whit lesion.
Nickel is the most frequent sensitizing agent in industrialized countries. Sensitizations towards nickel and its salts is more frequent
in females than in males. This is thought to result from a higher contact frequency of females with nickel by the use of jewelry and
Only few reports exist on allergic reactions towards gold. Nevertheless, in case of localized mucosal reactions near gold containing materials together with a positive test reaction, a replacement of gold
containing materials should be considered. Gold is also considered to be involved in the pathogenesis of lichen ruber mucosae.
More rare than chromium in allergic sensitization. In contrast, salts
Formed by platinum are relatively potent contact sensizizers.