What is allergy ppt

The diagnosis of contact stomatitis is mainly clinical, based on history and examination. Investigations may be done to exclude other possible diagnoses and to attempt to identify the responsible allergen.

A mucosalbiopsy may be required to exclude other conditions such as various forms of oral leukoplakia, trauma, oral candidiasis (thrush), oral lichen planus and oral lichenoid drug eruption, lupus erythematosus or discoid lupus, or oral cancer.

What is allergy ppt

The histology of contact stomatitis itself is nonspecific. However, the presence of numerous plasma cells may be suggestive of a contact allergy.

The likely source of the allergen will often be identified on the history and examination with improvement when the source is avoided. Recurrence of the stomatitis following rechallenge with the allergen confirms the cause.

What is allergy ppt

Patch testing, including with the patient’s own products, may be helpful in identifying the responsible allergen but untrue negatives are common. The relevance of a positive patch test reaction must be assessed in the clinical setting.



What is stomatitis?

Stomatitismeans a sore mouth.


What is contact stomatitis?

Contact stomatitis is an unusual allergic reaction affecting the inside of the mouth caused by contact with an allergen, generally flavourings, metals or other components in oral hygiene products, foods, dental restorations and medications.

What is allergy ppt

It may also be called allergic contact stomatitis to distinguish this form from intraoral irritant reactions.

Stomatitis to contact with rubber glove during a dental procedure


What are the clinical features of contact stomatitis?

The symptoms and signs of acute contact stomatitis generally develop within hours of contact with the allergen. The chronic form occurs when the allergen is always in the mouth such as with a dental restoration.

The pattern will depend on what form the allergen is in.

What is allergy ppt

For example, if the allergen is in a removable dental prosthesis, the pattern will reflect the shape and area of contact between the prosthesis and the oral mucosa. The reaction may be generalised when due to toothpaste or mouthwash. Stomatitis due to dental restoration or orthodontic devices will be adjacent to the restored tooth or wires.

All parts of the mouth can be affected. However, the most common sites involved in contact stomatitis are:

  1. Gums
  2. Sides of the tongue
  3. Inside of the cheeks
  4. Hard palate.

Contact stomatitis has a number of possible clinical features that may happen in various combinations.

What is allergy ppt

These include:

  1. Cracking
  2. Ulcers, erosions – erosive stomatitis
  3. White patches or lines
  4. Redness
  5. Small blisters
  6. Burning
  7. Swelling – may mimic contact urticaria or angioedema
  8. Peeling
  9. Pain.

A lichenoid amalgam reaction is also a form of contact stomatitis and is a type of oral lichen planus.

Plasma cell gingivitis is another specific form of contact stomatitis.

Contact urticaria and oral allergy syndrome are type 1 hypersensitivity reactions and happen and recover more quickly than contact stomatitis.


Which products cause contact stomatitis?

Foods

  1. Chewing gum
  2. Sweets/candies/lollies
  3. Foods especially flavoured with cinnamon

Dental restorations

  • Orthodontic wires – brackets, bands
  • Dental prostheses – dentures, plates
  • Dental cement
  • Dental restorations
    1. Dental amalgam
    2. Composite resin
    3. Gold

    Major sources of allergens causing contact stomatitis

    There are numerous chemicals that own been identified as responsible for contact stomatitis.

    1. Metals:nickel, palladium, gold, mercury, zinc
    2. Flavourings and preservatives (food additives): cinnamon (cinnamaldehyde, cinnamon essential oil), carvone, spearmint essential oil, menthol essential oil, dodecyl gallate — see perfume allergy
    3. Dental prostheses:formaldehyde, acrylate monomer, colophony
    4. Rubber /Latex: gloves, rubber dams, etc.


    Who gets contact stomatitis and why?

    Contact stomatitis is a delayed hypersensitivity (Type IV) reaction to a chemical in contact with the lining of the mouth.

    It occurs in people already sensitised to the allergen. However, it is fairly unusual compared to contact allergic dermatitis or contact cheilitis, probably because:

    • Saliva constantly flushes the mouth so chemicals are diluted and do not stay in contact with the mucosa for extremely long
    • There is a excellent blood supply to the lining of the mouth meaning any chemical absorbed through the mucosa is quickly removed from the area
    • The lining of the mouth is not well keratinised so chemicals are less likely to bind to keratin protein to form an allergen.

    Rarely,contact urticaria may present as stomatitis.

    Rarely,contact urticaria may present as stomatitis.


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