Elimination of allergies is possible when removing problematic constructions from the oral cavity and carrying out re-prosthetics with indifferent materials after a complete cupping of the manifestations of allergic stomatitis.
Sometimes screening of an existing denture is used (its isolation from the mucous membrane of the prosthetic bed) by metallization with biologically inert materials (most often it is gold-platinum alloys).
Treatment of allergic contact stomatitis is carried out using local antiseptic and anti-inflammatory drugs, antihistamines, sometimes glucocorticoid hormones are used for local use.
Allergy to prosthetic materials – an inflammatory reaction of an allergic nature, often found in prosthetic dentistry and developing in the oral cavity in response to the installation of a dental prosthesis of metal, acrylates and other materials. Hypersensitivity to a particular prosthetic material is characterized by the development of a delayed-type allergic reaction, and the symptoms of the disease are more often associated with damage to the oral cavity, and more rarely, the upper respiratory tract and skin.
According to statistics, intolerance of the material of dentures is observed in 6-10% of patients who apply for an appointment with an orthopedic dentist, and signs of allergies to prosthetic materials may appear both during the first days after the prosthesis is installed and several years after the prosthesis.
Causes of Allergy to Dentures
The development of allergy to prosthetic materials is more often noted on the metal inclusions of the prosthesis, as well as on acrylates, cements, pastes, dyes, plasticizers and other materials used in prosthetic dentistry.
In the manufacture of metal dentures use about twenty metals. These are stainless steel, alloys of chromium and cobalt, silver and palladium, gold and platinum, nickel, iron, titanium, manganese, silicon, molybdenum and other materials used for the prosthesis itself, stamping, joining its parts. Each of these metals can cause an allergic reaction at different times after dental prosthetics.
The development of allergies is promoted by electrochemical processes in the oral cavity, the intensity of which depends on the specific composition of the alloy, the degree of heterogeneity of the metallic inclusions contained in it, the quality of the prosthesis, the acidity of saliva and other factors.
Allergies to prosthetic materials made from polymeric compounds (acrylates) are often found. Most often these are full removable laminar dentures consisting of hard (acrylic) or soft plastic. At the same time, the main etiological factor of the occurrence of an allergic reaction to acrylates is residual monomer methyl methacrylate, the content of which in plastic prostheses is from 0.2 to 1%, and if the production technology is not followed, it can increase to 8%.
The above substances that are part of metal and acrylic dentures are incomplete antigens (haptens) and they turn into real allergens (conjugated antigens) when interacting with proteins of the oral cavity tissues. This causes a delayed allergic reaction with the development of contact stomatitis and other clinical manifestations of allergy to prosthetic materials. The risk of developing the disease increases with mechanical injury of the oral mucosa, micro-damage of the prosthesis, an increase in the acidity of saliva and the corrosion processes of the dental-prosthetic structure.
Symptoms of Denture Allergies
Clinical signs of allergy to prosthetic materials are more often associated with the development of allergic contact stomatitis. The main complaints – the appearance of a metallic taste, burning sensation and dry mouth, pain when eating. In this case, the symptoms usually develop not immediately after the prosthesis is installed, but after a few months, or even 10-15 years after the prosthesis.
The clinical picture of an allergy to metal prosthetic materials has its own characteristics. These are, first of all, complaints of patients about swelling of the oral mucosa in the area of the cheeks, tongue, and soft palate. An increase in the tongue and swelling of the mucous membranes of the cheeks leads to their frequent biting, difficulty in chewing and swallowing food. Very often worried about the burning sensation in the area of the tongue, which is felt constantly and increases with the intake of spicy, acidic foods, as well as in the evening and at night. Another characteristic symptom is a change in taste sensitivity with the appearance of a metallic taste or acid in the mouth.
Allergy to prosthetic materials from metal and its alloys is accompanied by dry mouth, thirst, a change in the consistency of saliva, which becomes viscous, stingy and difficult to swallow. With a long course of allergic stomatitis, general state of health may be disturbed with the appearance of increased fatigue, irritability, anxiety and anxiety, often exacerbation of chronic diseases of the stomach and intestines (gastroduodenitis, colitis), biliary tract (cholecystitis).
In case of allergy to prosthetic materials made of plastic (acrylates), the main complaint is a pronounced burning sensation in the prosthetic bed, often in the upper jaw, due to which the use of a removable prosthesis often becomes impossible. Burning is also noted in the cheeks, lips, soft palate, on the tongue. Allergy to prosthetic materials made of plastic can also be manifested by lesions of the skin of the face, hands (redness, swelling, rash in the form of bubbles, erosion, then shrinking into crusts, dry skin, cracks), signs of allergic rhinitis, conjunctivitis, gastritis.
Diagnosis of Allergy to Dentures
Diagnosis of allergy to prosthetic materials is based on a study of the history, data of an objective examination of a patient by a dentist and an allergist-immunologist, laboratory results, skin and provocative tests.
Examination of the oral cavity reveals hyperemia, edema, dryness of mucous membranes, the presence of petechial hemorrhages, traces of tooth imprints on the mucous membrane of the cheeks and the lateral surfaces of the tongue.
With the development of allergies to metal prosthetic materials, it is possible to detect the violation of the integrity of the bridge, especially in the place of soldering, the presence of oxide films. Contact allergic stomatitis that has arisen after the installation of plastic dentures, in addition to the above symptoms, is characterized by the appearance of papillomatous growths on the prosthetic bed on the mucous membrane.
To identify allergies to prosthetic materials, various diagnostic tests used in clinical allergology are used, in particular, skin drip, scarification and intradermal, as well as elimination and exposure tests. Elimination consists in removing the problematic prosthesis for a period of 1-2 days to a week and observing the state of the oral cavity and prosthetic bed in dynamics. After stopping the signs of allergic inflammation, exposure is performed, that is, reinstalling the same denture and checking the body’s response to such an installation.
In addition, in prosthetic dentistry, a test can be used to isolate a prosthesis from the mucous membrane with gold foil, which is glued and cemented to the prosthesis. The complete disappearance of the symptoms of allergy to prosthetic material indicates its intolerance.
It is also possible to confirm the allergic nature of the disease when conducting special immunological tests with the detection of specific antibodies in the serum and individual cellular elements. Differential diagnosis of allergies to prosthetic materials is carried out with mechanical contact stomatitis, viral, bacterial and fungal stomatitis, beriberi, diabetes mellitus and other endocrine disorders, gastritis with low acidity, neurotic disorders.
Prevention of Allergy to Dentures
Prevention of allergies to prosthetic materials is based on thorough preparation for dental prosthetics with the collection of allergological anamnesis; materials to be used.
The performance of such tests should be carried out only in specialized institutions by certified allergists.