Allergy to prosthetic materials is an intolerance to dentures used in orthopedic dentistry, with the development of a delayed allergic reaction and the appearance of clinical symptoms of prosthetic stomatitis (burning sensation, soreness in the oral cavity when eating, changes in taste), signs of allergic damage to other organs and disorders of the general condition. The diagnosis of allergy to prosthetic materials is based on the data of anamnesis, clinical examination of the oral cavity, the results of elimination, exposure and skin tests, immunological tests. Treatment includes replacement or correction of the prosthesis, the use of antihistamines, in severe cases – glucocorticoids.
ICD 10
T78.4 Allergy, unspecified
General information
Allergy to prosthetic materials is an inflammatory reaction of an allergic nature, often occurring in orthopedic dentistry and developing in the oral cavity in response to the installation of a denture made of metal, acrylates and other materials. Hypersensitivity to a particular prosthetic material is characterized by the development of an allergic reaction of a delayed type, while the symptoms of the disease are more often associated with damage to the oral cavity, less often – the upper respiratory tract and skin.
According to statistics, intolerance to the material of dentures is noted in 6-10% of patients who seek an appointment with an orthopedic dentist, while signs of allergy to prosthetic materials may appear both during the first days after the installation of the prosthesis and several years after prosthetics.
Causes
The development of allergy to prosthetic materials is more often noted for metal inclusions of the prosthesis, as well as for acrylates, cements, pastes, dyes, plasticizers and other materials used in orthopedic dentistry.
About twenty metals are used in the manufacture of metal dentures. 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, and joining its parts. Each of these metals can cause the development of 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 metal inclusions included in its composition, the quality of the prosthesis, the acidity of saliva and other factors.
It is not uncommon to be allergic to prosthetic materials made of polymer compounds (acrylates). Most often these are complete removable plate prostheses consisting of hard (acrylic) or soft plastic. At the same time, the main etiological factor in the occurrence of an allergic reaction to acrylates is the residual monomer methyl methacrylate, the content of which in plastic prostheses ranges from 0.2 to 1%, and in case of non-compliance with the production technology can increase up to 8%.
The above substances, which are part of metal and acrylic dentures, are incomplete antigens (haptens) and they turn into real allergens (conjugated antigens) when interacting with proteins of oral tissues. In this case, an allergic reaction of a delayed type occurs with the development of contact stomatitis and other clinical manifestations of allergy to prosthetic materials. The risk of developing the disease increases with mechanical trauma of the oral mucosa, micro-injuries of the prosthesis, increased acidity of saliva and the resulting corrosion processes of the dental structure.
Symptoms
Clinical signs of allergy to prosthetic materials are more often associated with the development of allergic contact stomatitis. The main complaints are the appearance of a metallic taste, burning sensation and dry mouth, soreness when eating. At the same time, symptoms usually do not develop immediately after the installation of the prosthesis, but after a few months, or even 10-15 years after prosthetics.
The clinical picture of 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 cheeks, tongue, and soft palate. The enlargement of the tongue and swelling of the cheek mucosa leads to frequent biting, difficulty chewing and swallowing food. A burning sensation in the area of the tongue is very often bothered, which is felt constantly and increases when taking spicy, sour food, as well as in the evening and at night. Another characteristic symptom is a change in taste sensitivity with the appearance of a taste of metal or acid in the mouth. Allergy to prosthetic materials made of metal and its alloys is accompanied by dry mouth, thirst, a change in the consistency of saliva, which becomes viscous, viscous and difficult to swallow. With a prolonged course of allergic stomatitis, general well-being may be disturbed with the appearance of increased fatigue, irritability, anxiety and anxiety, exacerbation of chronic diseases of the stomach and intestines (gastroduodenitis, colitis), biliary tract (cholecystitis) is often noted.
If you are allergic to plastic prosthetic materials (acrylates), the main complaint is a pronounced burning sensation in the area of the prosthetic bed, more often on the upper jaw, which is why 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 manifest itself by damage to the skin of the face, hands (redness, swelling, rashes in the form of bubbles, erosion, then drying into crusts, dry skin, cracks), allergic rhinitis, conjunctivitis, gastritis.
Diagnostics
The diagnosis of allergy to prosthetic materials is based on the study of anamnesis, the data of an objective examination of the patient by a dentist and an allergist-immunologist, the results of laboratory tests, skin and provocative tests.
When examining the oral cavity, the phenomena of hyperemia, edema, dryness of the mucous membranes, the presence of petechial hemorrhages, traces of tooth prints on the mucous membrane of the cheeks and the lateral surfaces of the tongue are revealed. With the development of allergies to metal prosthetic materials, it is possible to detect a violation of the integrity of the bridge prosthesis, especially at the soldering site, the presence of oxide films. Contact allergic stomatitis that has arisen after the installation of plastic removable dentures, in addition to the above signs, is characterized by the appearance of papillomatous growths on the mucous membrane of the prosthetic bed.
To detect allergies to prosthetic materials, various diagnostic tests used in clinical allergology are also used, in particular cutaneous 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 monitoring the dynamics of the state of the oral cavity and prosthetic bed. After the relief of signs of allergic inflammation, an exposure is performed, that is, the re-installation of the same denture and checking the body’s reaction to such an installation.
In addition, in orthopedic dentistry, a test of isolation of the prosthesis from the mucous membrane with gold foil, which is glued and cemented to the prosthesis, can be used. The complete disappearance of symptoms of allergy to prosthetic material indicates its intolerance.
It is also possible to confirm the allergic nature of the disease by conducting special immunological tests with the detection of specific antibodies in the blood serum and individual cellular elements. Differential diagnosis of allergy to prosthetic materials is carried out with contact stomatitis of mechanical nature, viral, bacterial and fungal stomatitis, beriberi, diabetes mellitus and other endocrine disorders, gastritis with low acidity, neurotic disorders.
Treatment of allergy to dentures
Elimination of allergies is possible by removing problematic structures from the oral cavity and performing repeated prosthetics with indifferent materials after complete relief of allergic stomatitis manifestations. Sometimes screening of an existing denture is used (its isolation from the mucous membrane of the prosthetic bed) by metallization with biologically inert materials (more often these are 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 topical use.
Prevention
Prevention of allergy to prosthetic materials is based on careful preparation for dental prosthetics with the collection of an allergic history, conducting preventive skin tests with components of materials that are supposed to be used in persons at risk (anacid gastritis, allergic reactions in the anamnesis, age 40-60 years, data on intolerance to metal inclusions and plastics). The performance of such tests should be carried out only in specialized institutions by certified allergists.
