Allergies to Dental Materials and Contact Stomatitis

With sensitivities to chemical and environmental irritants so prevalent in the general population, dentists sometimes encounter patients in their patient pool with a history of allergies to dental materials. The incidence of contact dermatitis associated with a dental procedure is less than 1% of all patients.

However, when your patient falls into the 1% group, their discomfort level is highly disruptive and impactful on their daily life. So, what are the treatment alternatives available for patients who suffer from dental-related allergic contact stomatitis?

The Materials

While it is possible for any individual to become overly sensitive to almost anything present in the environment, there are specific materials commonly used in dentistry that have a higher likelihood of eliciting dental allergies in some individuals. The Journal of Clinical and Diagnostic Research offers a comprehensive literature review on the causative agents of allergies to dental materials.

Dental materials with suspected biocompatibility issues that can contribute to contact allergy reactions include resins, latex gloves, local anesthetic agents, endodontic materials, impression materials, dental amalgams, and metals used in prosthodontics and orthodontics.

Let’s focus on allergic contact stomatitis caused by the three most common materials:

Latex

When the AIDS crisis began in the mid-1980s, dentists began wearing gloves for the first time in their careers. At the time, latex gloves were the standard and were the only mainstream product available to protect yourself and your patients from the spread of disease. As exposure to latex increased, so did adverse reactions to latex in our patients.

But the bigger issue and impetus for change were dental professionals and staff who began experiencing symptoms of contact dermatitis (estimated at 17%) from wearing latex gloves.

Fortunately for everyone, more alternatives have been developed, such as nitrile and vinyl, that have a much lower incidence of producing contact dermatitis. Latex and latex allergy has largely been eliminated from most dental practices and incidents of latex-related intraoral contact allergy have decreased.

Metals

Allergies to dental materials can be a symptom of nickel sensitivity when wearing a cast metal partial denture or a prosthesis with metal components. The rash or erythema associated with dental metal allergy and tissue response often is characteristically limited to the exact area that comes in contact with the metal. Removing the partial for a few days solves most adverse reactions.

Resins

Allergies to acrylic resins are often attributed to under-processed free methyl methacrylate monomer being leached from the denture base for weeks or months after a denture was fabricated. While the immune response in some patients adapts as they continue to wear their new dentures, and the irritation clears up over time, the burning sensation of contact stomatitis only goes away for other patients when the dentures are left out of the mouth.

However, not wearing a prescribed dental appliance is not a proper dental treatment for burning mouth syndrome.

Allergies to Dental Materials: Symptoms

Type IV t-cell-mediated delayed allergic reactions can occur one or two days following exposure to the allergen, whereas Type I immediate allergic reactions prompt almost immediate reactions. Both can present as a range of symptoms that can include itching of the skin or oral mucosa, a burning sensation, erythema, contact urticaria oral, lichenoid reactions, edema localized to the area of contact, rhinitis, cheilitis, or lightheadedness.

Since a majority of allergies to dental material symptoms involve exposure to metals or appliances made using two-part powder and liquid methyl methacrylate, what can dentists do to minimize or eliminate the offending chemicals from the prostheses they deliver?

Checking for positive patch test reactions is an option, but contact reactions are still painful and stressful for the patient. Additionally, an oral disease such as oral lichen planus can be triggered by contact allergies, making a test patch not worth the inherent risk.

One method of approach includes employing materials that are more biocompatible and kinder to the tissue, helping to not cause contact stomatitis and systemic allergic contact dermatitis. Let’s talk about some of the alternative materials that are currently available that don’t risk allergic reactions.

Digital Dentures

Digital dentures offer a number of benefits over dentures that are made using traditional reverse image processing methods. Because they are designed to exact specifications, they fit more precisely and require fewer adjustments which translates into improved patient comfort. As an added benefit, digital denture fabrication methods utilize a manufacturing process that completely avoids patient exposure to monomer.

Milled dentures take their shape from blocks of pre-processed hardened resins, while 3D-printed dentures utilize light-cured resins as they are constructed incrementally with CAD/CAM technology. This technology is easily incorporated with impression data collected via a chairside intraoral scanner, yielding a completely digital workflow.

In addition to reducing errors and creating better-fitting appliances, scanning also eliminates patient discomfort and the possibility of sensitivity to components present in impression materials.

Nightguards

Like digital dentures, clear resin nightguards can be produced using the same technology for excellent comfort and fit. Gone are the days when using the salt-and-pepper technique to construct a nightguard was standard procedure.

While a skilled lab technician can make a great fitting protective appliance using this method, the process often releases free monomer that could prove harmful to your patient. Digitally-produced nightguards provide a safer treatment alternative.

Acetal Resin Partial Dentures

Zirlux acetal partial frameworks are computer designed and milled from void-free disks of co-polymer resin via CAD/CAM technology for a precise fit. Acetal resin is a semi-flexible material in framework form, allowing it to adapt comfortably to the contour of the mouth.

Its strength allows the manufactured framework to be supported by the existing dentition, much like a metal framework. Clasps are made from the same resin material and have elastic memory that is designed to engage securely into the natural undercuts of the abutment teeth for maximum hold.

The use of tooth-colored or clear resin makes this framework nearly invisible when fully-seated. This is a great alternative treatment option for patients who are concerned about using dental metals in their mouth or who want to avoid the look of metal entirely.

Valplast Partial Dentures

Made from a combination of bio-compatible nylon and thermoplastic resin, Valplast partial dentures feel much closer to a natural dental restoration than other removable tooth replacement options, such as cast metal partial dentures.

Valplast partials hug the patient’s gum tissue, and the flexible clasps snap securely into place around the existing dentition and gingiva, providing a comfortable, contoured fit. The clasps are made to blend with the surrounding gingiva, making them much less noticeable than metal clasps.

Because Valplast doesn’t use traditional monomers in its manufacture, it is safer to use for your patients who have a history of allergies to dental materials used to construct traditional removable prosthetics.

Titanium Framework Partials

Titanium is probably the most biocompatible metal known to man. Its strength and its long history of documented uses in joint replacement prosthetics and dental implants make it an excellent choice as the basis for a removable dental prosthesis.

While traditional cobalt/chrome frameworks contain small amounts of nickel or other elements that can provoke an allergic response in some dental patients, frameworks milled from titanium bars provide strength, corrosion-resistance, and precise fit while eliminating the potential for red, inflamed tissue caused by a metal sensitivity.

Comprehensive Allergy Solutions

At Stomadent, we understand the challenges that come with managing allergies and dental materials. Patients with sensitivities require special attention and customized solutions. We offer a wide range of non-allergenic materials designed to minimize adverse reactions and maximize patient comfort.

Expertise in Custom Design

Our team of experienced lab technicians is dedicated to creating the most inert removable dental appliances possible. Utilizing our extensive knowledge base, we carefully select materials that are less likely to cause allergic reactions.

Advanced Materials and Techniques

We employ state-of-the-art technology and advanced techniques to craft our dental appliances. Our experts stay up-to-date on the latest developments in dental materials science, and we offer products that not only reduce the risk of allergic reactions but also provide superior durability and functionality.

Collaborative Approach

We believe in a collaborative approach to patient care. Our lab works closely with dental professionals to understand the unique requirements of each patient. We can tailor our solutions to deliver optimal outcomes and enhance patient satisfaction.

Commitment to Quality

Quality is at the heart of everything we do at Stomadent. From the selection of materials to the final fabrication of the dental appliance, we adhere to the highest standards to ensure that our products are safe, effective, and reliable.