Allergic stomatitis is an inflammatory change in the oral mucosa caused by the development of immunopathological reactions (hypersensitivity, hyperergia). Manifestations of allergic stomatitis are edema, hyperemia, bleeding, ulcers and erosion of the mucous membrane, burning in the mouth, pain when eating, hypersalivation, sometimes deterioration of the general condition. Examination of a patient includes collecting an allergic history, identifying the cause of an allergic reaction, examining the oral cavity, conducting provocative, elimination tests, skin tests, saliva examination, etc. Treatment involves the exclusion of contact with an allergen, taking antihistamines, and drug treatment of the mucosa.
Meaning
Allergic stomatitis is a pathological symptom complex that occurs in the oral cavity with microbial, contact, drug allergies or serving as a local manifestation of infectious, skin, autoimmune and other diseases. Allergic lesions of the oral cavity can occur in the form of stomatitis, papillitis, glossitis, gingivitis, pareitis, palatinitis, cheilitis. Among these clinical forms, disease is most common. Consideration of the problems associated with allergic stomatitis requires interdisciplinary interaction of specialists in the field of dentistry, allergology and immunology, dermatology, rheumatology, etc.
Causes
The occurrence of allergic stomatitis may be associated with the penetration of an allergen into the body or direct contact with the mucous membrane of the oral cavity. In the first case, disease will serve as a manifestation of a systemic reaction (to pollen, medicines, mold, food, etc.); in the second, a local reaction to irritating factors directly in contact with the mucosa (toothpaste, dentures, medicinal lozenges for resorption, mouthwashes, etc.).
The development of contact allergic stomatitis is most often associated with increased sensitivity to materials used in dentistry: preparations for application anesthesia, metal fillings, braces, orthodontic plates, crowns, acrylic or metal dentures. In acrylic prostheses, as a rule, residual monomers act as allergic factors, in rare cases – dyes.
When using metal dentures, allergies to alloys containing chromium, nickel, gold, palladium, platinum, etc. may develop. In addition, a certain role in the pathogenesis of allergic stomatitis is played by caries, chronic tonsillitis, as well as pathogenic microorganisms and their waste products that accumulate in the prosthetic bed, which irritate the mucous membrane.
Risk factors
Contact allergic stomatitis is more often observed in patients suffering from chronic gastrointestinal diseases (gastritis, cholecystitis, pancreatitis, colitis, dysbiosis, helminthiasis, etc.), endocrine pathology (diabetes mellitus, hyperthyroidism, menopausal disorders, etc.). This is due to the fact that organic and functional disorders in these diseases change the reactivity of the body, cause sensitization to contact allergens.
Other allergic diseases contribute to the development of severe forms of stomatitis: drug disease, food allergy, rhinitis, urticaria, eczema, Quincke’s edema, asthmatic bronchitis, bronchial asthma, etc. Allergic stomatitis does not always occur in isolation; sometimes it is included in the structure of systemic diseases – vasculitis, hemorrhagic diathesis, multiform exudative erythema, systemic lupus erythematosus, scleroderma, Behcet’s disease, Lyell’s syndrome, Reiter’s syndrome, Stevens-Johnson syndrome, etc.
Classification
Depending on the nature of clinical manifestations, catarrhal, catarrhal-hemorrhagic, bullous, erosive, ulcerative-necrotic form are distinguished. From the point of view of etiology and pathogenesis , pathology includes:
- medications;
- contact (including prosthetic);
- toxic and allergic;
- autoimmune dermatostomatitis;
- chronic recurrent aphthous stomatitis and other forms.
Taking into account the rate of development of symptoms, allergic reactions of immediate and delayed types are distinguished: in the first case, allergic stomatitis, as a rule, proceeds in the form of angioedema Quincke. If an allergic reaction of a delayed type is realized, the symptoms of allergic stomatitis are most often detected a few days after exposure to the allergen. Sometimes allergic stomatitis on dentures develops after 5-10 years of their use, i.e. after a long period of asymptomatic sensitization.
Symptoms
Manifestations of allergic stomatitis depend on the form of the disease. Thus, catarrhal and catarrhal hemorrhagic allergic stomatitis are characterized by xerostomia (dry mouth), burning, itching, impaired taste sensitivity (sour taste, metallic taste), discomfort and pain when eating. An objective examination determines the hyperemic and edematous oral mucosa, the “varnished” tongue; with a catarrhal hemorrhagic form, petechial hemorrhages are distinguished against the background of hyperemia and bleeding of the mucosa is noted.
Bullous allergic stomatitis proceeds with the formation of vesicles of various diameters with transparent contents in the oral cavity. Usually, after opening the blisters, allergic stomatitis turns into an erosive form with the formation of erosions on the mucous membrane covered with fibrinous plaque. The appearance of ulcers is accompanied by a sharp increase in local soreness, especially manifested during conversation and eating. When individual defects merge, extensive erosive surfaces can form on the mucosa. There may be a deterioration in general well-being: loss of appetite, weakness, an increase in body temperature.
The most severe in its manifestations is the ulcerative-necrotic form of allergic stomatitis. At the same time, a sharp hyperemia of the mucosa with multiple ulcers covered with a dirty-gray fibrinous plaque and foci of necrosis is determined. Ulcerative-necrotic allergic stomatitis occurs against the background of severe pain when eating, hypersalivation, high fever, headache, submandibular lymphadenitis.
Common symptoms of allergic stomatitis may include functional disorders of the nervous system: insomnia, irritability, carcinophobia, emotional lability.
Diagnostics
Examination of a patient with allergic stomatitis is carried out by a dentist with the involvement, if necessary, of related specialists: allergologist-immunologist, dermatologist, rheumatologist, endocrinologist, gastroenterologist, etc. At the same time, it is important to collect and analyze an allergological history and identify a potential allergen.
- Inspection. When visually assessing the oral cavity, the doctor notes the moisture content of the mucosa, its color, the presence and nature of defects, the type of saliva. During the dental examination, attention is drawn to the presence of dentures, fillings, orthodontic devices in the oral cavity; their composition and wearing time, discoloration of metal prostheses, etc.
- Saliva examination. Chemical-spectral analysis of saliva and determination of pH make it possible to make a qualitative and quantitative assessment of the content of trace elements and to evaluate the electrochemical processes taking place. Additional studies may include biochemical analysis of saliva with determination of enzyme activity, determination of mucosal pain sensitivity, hygienic evaluation of prostheses, scraping of mucosa for Candida albicans, etc.
- Allergological testing. An allergological examination involves an exposure test (temporary removal of the prosthesis with an assessment of the reaction), a provocative test (return of the prosthesis to the site with an assessment of the reaction), skin allergic tests, an immunogram study.
Differential diagnosis of allergic stomatitis should be carried out with hypovitaminosis B and C, herpetic stomatitis, candidamycosis, mucosal lesions in leukemia, AIDS.
Treatment
Therapeutic measures for allergic stomatitis will depend on the cause that led to the development of the disease. The fundamental principle of the therapy of allergic diseases is the exclusion of contact with an allergen: diet, withdrawal of medication, refusal to wear a denture, change of a mouthwash or toothpaste, etc.
Drug therapy of allergic stomatitis usually involves the appointment of antihistamines, vitamins B, C, PP, folic acid. Local treatment of the oral mucosa with antiseptics, painkillers, enzymes, corticosteroids, healing agents (sea buckthorn oil, etc.) is performed.
Patients whose allergic stomatitis has arisen as a complication of dental treatment, further consultation of a dentist-therapist, orthopedic dentist, orthodontist is necessary; replacement of fillings or crowns, replacement of the bracket system, the basis of the prosthesis, etc.
Prognosis and prevention
Timely diagnosis of allergic stomatitis makes it possible to overcome the disease at an early stage; the duration of therapy for catarrhal and catarrhal ulcerative stomatitis usually does not exceed 2 weeks. In more severe and advanced cases, long-term treatment may be required.
Preventive measures provide for good hygienic oral care, timely treatment of caries and gum diseases. Regular preventive visits to the dentist are necessary to remove dental deposits, adjust dentures, and replace them in a timely manner. An important role in the prevention of allergic stomatitis is played by an individual approach to the treatment and prosthetics of teeth, the use of hypoallergenic materials.