ALLERGY IN ODONTOSTOMATOLOGY

Allergies in dentistry are rare diseases but when they occur they can

Be serious or even fatal.

The risk of an allergic reaction occurring in the dental office is linked to the handling of a multitude of products included on the list of allergenic products during the various therapies.

Local anesthetics were long considered the main cause of allergic reactions, but recent studies have changed this and now refer to these reactions as ” adverse effects” rather than ” allergic reactions .”

Currently, it is ” contact allergens ” that cause in many cases allergic accidents such as allergic stomatitis known as ” contact dermatitis “.

1. DEFINITIONS

1. Allergy:

The term allergy derives from the Greek: ” Allos ” means other and ” ergon ” means to react, otherwise it is: the state of an individual who reacts specifically or otherwise to the penetration of a substance capable of behaving as an antigen. This reaction can be both protective and pathogenic.

2. Allergen:

It is an  antigen  capable of sensitizing the organism of  certain individuals and determining

pathological manifestations upon its reintroduction,

3. Atopy:

It is the abnormal ease of an individual to synthesize specific IgE with respect to the “allergens” of his environment, normally harmless “ dust”.

4. Cross allergy:

the coexistence in the same individual of two allergies to substances which have all or part of their structure identical.

5. The major histocompatibility complex (MHC):

It is a set of molecules present on the surface of antigen-presenting cells to present the peptide code of a non-self antigen for recognition by lymphocytes.

There are two classes: class I (CMH I) and class II (CMH II);

6. Complement:

It is composed of around thirty proteins synthesized in the liver;

Its role is to : complement the action of serum immunoglobulins, hence their name “complement”.

Complement activation can take two routes:

• The classical pathway, activated by antigen-antibody complexes – retained in the allergic reaction;
• Alternate pathway, activated by certain bacterial polysaccharides.

2. PATHOPHYSIOLOGY OF ALLERGIC REACTIONS:

Cells and mediators involved in the allergic reaction :

1.1 – Mast cells and basophils

Chronologically These are the  first  cells involved in hypersensitivity reactions

Immediate thanks to the expression on their surface of the high affinity receptor for immunoglobulins E;

Upon contact with IgE, these cells release the mediators of the allergic reaction.

1.] .2. Macrophages:

Of medullary origin, they belong to the mononuclear phagocyte system.

The role of macrophages is represented by:

• Phagocytosis;
• Antigen presentation ;
• The production of cytokines.

1.1.3. Langerhans cells:

Dendritic cells found in the epidermis.

1.1 .4. Eosinophils:

They are so named because of their dye affinity for eosin.

1.1.5. Antigen-presenting cells:

Among the previously mentioned cells, the CPA antigen-presenting cells are:

• Dendritic cells ;
• B lymphocytes and T lymphocytes;
• And macrophages.

2. Mediators:

The allergic reaction involves a number of mediators, the most important of which are:

1. Histamine:

Synthesized and stored in tissue mast cells and blood basophils.

When histamine is released it starts to bind to the receptors of endothelial cells to induce the LEWIS triad consisting of:

• Edematous papules;
• Reflex peripheral erythema;
• Itching and vasodilation.

2. Leukotriene “lipooxygenase pathway” Leukotrienes are lipids . There are two classes:

• Leukotrienes B4: they attract leukocytes to the site of inflammation by chemotaxis;
• Leukotrienes C4 and D4 play a role in bronchodilation.

3. Prostaglandins

Prostaglandins are metabolites of arachidonic acid through the “cycloxygenase pathway”

2. Mechanism of allergic diseases: Gell and Coombs classification:
   1. Type I hypersensitivity reaction = Immediate hypersensitivity reaction = anaphylactic reaction: This reaction is called immediate because it occurs within less than 30 minutes. The type I hypersensitivity reaction occurs in two phases
      • The awareness phase:
      • The allergic reaction phase:

Immediate hypersensitivity is the mechanism of occurrence of anaphylactic shock, asthma and urticaria.

2. Type II hypersensitivity reaction:

Type II hypersensitivity or cytotoxic hypersensitivity occurs within 1 to 3 hours.

The effectors of this reaction are immunoglobulin M (IgM) and immunoglobulin G (IgG) in addition to the complement system.

This mechanism is found in autoimmune hemolytic anemia.

3. Type III hypersensitivity reaction = Hypersensitivity by immune complexes: It occurs 6 to 6 hours after contact with the allergen, it involves “IgM” and “IgG”.

This type of hypersensitivity is found in certain pneumonias, glomerulonephritis and vasculitis.

4. Delayed hypersensitivity reaction ⁼ type IV hypersensitivity reaction: The stages of the delayed allergic reaction:
   • When the allergen penetrates the epidermis, Langerhans cells capture it and then release cytokines which increase the expression of MHI and MHIII molecules. This first step

sensitization is carried out without apparent clinical signs.

• Then, when the allergen is reapplied to the skin, the allergic reaction occurs. This type of allergic reaction is found in contact eczema and atopic dermatitis.

Note! Hypersensitivity reactions encountered in dentistry are mainly represented by type I and type IV reactions.

3. MAIN ETIOLOGIES OF ALLERGIC REACTIONS
   1. In dentistry
      1. Latex allergy:

It is composed of: water (65%) and rubber (33%) suspended in a viscous protein solution. These proteins would represent the allergenic fraction but they are not the only ones that can trigger allergic reactions. Rubber and slip agents (talc and starch powder) must also be taken into account.

Latex is contained in surgical gloves, rubber dams, and also in anesthesia cartridges at the diaphragm level.

The clinical expressions of latex allergy can take two forms:

• A delayed type IV hypersensitivity reaction involving additives incorporated into the latex;
• An immediate type I hypersensitivity reaction involving, in the majority of cases, the water-soluble proteins of natural latex

2. Alloy allergy:

Nickel is the top allergenic metal, followed by chromium and cobalt.

These metals mainly induce allergic contact stomatitis of the erythematous, erosive or lichenoid type.

Although chromium allergy has become less common, it can result in blistering ulcers.

3. Amalgam allergy:

Conventional amalgams consist of 50% mercury and 50% tin-silver alloy .

copper and zinc. These amalgams have been widely used throughout the world for many years. Mercury allergy occurs following contact with or inhalation of mercury and occurs in the form of itchy, maculopapular rashes.

Given this allergenic risk of amalgams,

4. Gold allergy

Gold is currently on the list of allergenic materials after nickel. Gold allergy usually results in:

• isolated lichenoid stomatitis in the oral cavity;
• ulcers and burning mouth pain .

5. Titanium allergy

Titanium is known for its high biocompatibility, making it widely used in oral implantology. Certain situations favor implants and the release of metal ions, which then bind to proteins, which are identified as foreign elements that the body will tend to eliminate.

The allergic reaction to titanium can be: type I; or type IV ( like facial eczema, psoriasis or inflammatory reactions)

6. Allergy to local anesthetics:

Currently, complications related to the use of local anesthetics are much more adverse effects of pharmacological origin (vasovagal syncope or spasmophilia crisis) than allergic accidents.

In fact, allergic accidents linked to local anesthetics are rare, they can be due to

preservatives; to esters (eczema) or to procaine (some anaphylactic shocks).

Note : Adverse effects of local anesthetics are considered as a differential diagnosis with allergic reactions.

7. Allergy to antiseptics and disinfectants

Aldehydes: They are used in the composition of disinfectants for suction systems and X-ray film fixers.

They can cause allergic reactions such as:

• Ulcerations;

•Eczema;

• or contact urticaria.

Allogens : such as sodium hypochlorite or bleach can induce contact allergies. Iodine: in alcoholic solution (iodized alcohol) or combined (iodoform), it can induce reactions such as urticaria or contact eczema.

Chlorhexidine: Hypersensitivity is rare but can range from simple contact dermatitis to anaphylactic shock.

Ethyl alcohol : Repeated application of ethyl alcohol promotes the penetration of allergens , but its allergenic power is extremely low.

8. Acrylates allergy:

Acrylic resins have a variety of uses in dentistry, hardening agents could

cause contact stomatitis such as:

• Diffuse erythema;

•Edema;

• Erosions or vesicles located in the areas of contact with the prosthesis.

Furthermore, allergic dermatitis of the fingertips has been caused by these resins.

9. Allergy to orthodontic appliances

Whether removable, fixed or extra-oral, orthodontic appliances can be responsible for clinical manifestations

• Erosive then ulcerative stomatitis or even urticaria of the oral mucosa
• Eczematous cheilitis with pruritus;
• Angioedema;
• Dyshidrosis of the feet (distant manifestation).

20. Toothpastes and dental solutions:

Allergies to toothpastes and dental solutions are rare. Among its constituents, it is the aromas, particularly derivatives from different varieties of mint, that are said to cause allergies such as:

• contact urticaria;
• of rhinitis;
• of perioral eczema
• and lichenoid lesions

2. Other allergens
   1. Lipstick: These allergies are linked to

• Dyes;
• Excipients: the waxes used may contain propolis;
• Preservatives: parabens, cresols, antioxidants such as propyl gallate;

•Perfumes;

• Cold protection agents: Peruvian balsam.

2. Nail polishes:

They contain formalin and resins in their structure. Contact cheilitis is possible in cases of nail biting.

3. Food allergies:

Because they can constitute a differential diagnosis with allergies due to the different allergenic products used in dentistry, cross-allergies are increasingly common with this type of allergy.

The main foods responsible for food allergies are: Eggs, peanuts, cow’s milk, fish,

4. Drug allergies:

The most common medications that cause allergies are:

• Gold salts: cause lichenoid toxidermias;
• D-penicillin: causes pemphigus;
• Sulfonamides and nonsteroidal anti-inflammatory drugs: cause fixed pigmented erythema or Lyell’s syndrome.

4. STOMATOLOGICAL MANIFESTATIONS OF ALLERGY:

These manifestations can be either immediate (type I) or late ( type IV ).

1. Immediate allergic reactions
   1. Anaphylactic shock

It is caused by the reintroduction into the body of a foreign protein to which the subject has already been sensitized during previous contact.

The clinical symptoms, very characteristic, are

1. 1. 1. Functional signs

• A prodrome marked by anxiety, a sensation of heat, tingling, itching and that of discomfort and imminent death;
• Upper respiratory tract involvement marked by difficulty swallowing and/or breathing, dysphonia, hoarseness, suffocation, sensation of a foreign body in the pharynx, bronchospasm with coughing, sneezing and nasal obstruction;
• Digestive disorders in severe forms characterized by dysphagia, abdominal pain, nausea, vomiting and diarrhea.

1. l .2. Physical signs
   • Pallor , sweating and then a grayish tint at the tips of the fingers ;
   • Skin involvement with acute urticaria plaques, angioedema and erythema multiforme.

l.1.3. Evolution

It is done either towards healing or towards death in the absence of urgent therapeutic care by

asphyxia or vascular collapse in the first ^hour sometimes.

i.1.4. Differential diagnosis

The differential diagnosis is made with

• Vagal syncope which also associates a feeling of discomfort with pallor, sweating, bradycardia, but whose origin is generally linked to intense fear, pain linked to an act, in this case surgical;
• Toxic accidents : unlike anaphylactic shock, they do not present prodromal signs; the origin may be related to the use of an anesthetic.

2. Anaphylactic urticaria

It is a common inflammatory dermatosis, most often benign, limited to the dermis. It is easy to diagnose and its progression can be acute or chronic.

It is characterized by vasodilation caused by the release of histamine. The increase in vasopermeability allows the passage of fluid which then forms papules.

As for pruritus, it is the result of the release of chemical mediators such as histamine and serotonin and the excitation of nerve endings: scratching is a reflex response mediated by the spinal cord.

1.2.1 . Functional signs

A prodrome characterized by pruritus, tingling of the palms of the hand and the arches of the feet in particular and a sensation of heat ;

Secondary signs include nausea , vomiting, chest tightness, and dyspnea.

2. Physical signs
   • The basic lesion is a well-circumscribed papule with raised erythematous edges and a pale colored center;
   • Urticarial lesions tend to coalesce, forming large infiltrated areas. The preferred areas are exposed parts of the skin.
3. Evolution

Hives may disappear spontaneously, but they can also be a warning sign of impending angioedema or anaphylactic shock.

4. Differential diagnosis
   • Contact irritation not involving any immunological mechanism.
5. Contact urticaria

This is a cutaneous inflammatory reaction following the action of vasoactive substances; the vasomotor phenomena are localized at the very contact with the allergen.

The papule is induced by circulatory disturbance and increased capillary permeability.

1.3. l. Functional signs

• Very itchy papules appear suddenly on the skin;
• Burning and stinging are reported in the oral mucosa.

2. Physical signs
   • Raised erythematous papules appear 30 to 60 minutes after the allergen first contacts healthy skin;
   • They have sharp edges, paler in the center, reminiscent of nettle stings;
   • Their dimensions vary from millimeter to centimeter;
   • Sometimes signs of angioedema are associated with it.
3. Evolution

These signs generally disappear within a few minutes or even a few hours, but rarely beyond 24 hours.

4. Differential diagnosis
   • Papular erythema multiforme;
   • Dermatitis herpetiformis;
   • Bullous pemphigoid;
   • Urticarial manifestations of bullous diseases;
   • Insect bite;
   • Annular erythema;
   • Serum diseases.

Urticaria of the oral mucosa

• It is very rare;
• It results in edema sometimes preceded by pruritus;
• The affected mucous membranes can be labial, palatal or endojugal and can spread rapidly over distances.
• The agents incriminated are: latex from gloves, rubber objects carried in the mouth (balloons, baby bottle teats, toys, condoms, etc.) certain foods: fruits and spices.
• In patients with urticaria, aspirin and non-steroidal anti-inflammatory drugs containing codeine should be contraindicated, as they aggravate the clinical picture.

4. Angioedema or Quincke’s edema angioneurotic edema:

This is a variant of urticaria. Characterized by infiltration of serosity into the tissues, particularly the connective tissue. This edema affects the dermis and epidermis.

1.4. l. Functional signs

• Of sudden appearance ;
• lasts a few hours but less than 72 hours;
• The patient sometimes complains of painful sensations, tension and burning , but the angioedema may remain painless ;
• Concomitant general manifestations are: headache, dizziness, nausea, abdominal pain, arthralgia and difficult breathing.

2. Physical signs:
   • The edema is firm , fairly well limited, pale, whitish or pinkish white,
   • asymmetrical and distorting the lips, tongue and eyelid;
   • It can be cutaneous-mucosal or obstructive when it is located in the tongue , pharynx or

larynx;

• The preferred areas are: lips, eyelids, pharynx, extremities , genital region ;
• Breathing is rapid and shallow;
• Blood pressure is collapsed with reflex tachycardia;
• Can be associated with:
  • Respiratory signs: asthma;
  • Rhinitis;
  • Conjunctivitis;
  • Signs of anaphylaxis: deep hives.

3. Evolution
   • Most often the edema disappears within a few minutes or hours, but it can persist for several days;
   • Respiratory and digestive complications are to be feared: edema of the glottis can cause significant suffocation or even asphyxia which can be fatal.
4. Differential diagnosis:
   • Contact dermatitis;
   • Lymphedema;
   • Melkersson-Rosanthal syndrome.
5. Respiratory manifestations:

Represented by asthma and allergic rhinitis.

l .5.1. Asthma

It is an eosinophilic bronchial inflammation . This inflammation causes bronchial spasm that only results in coughing or wheezing . Bronchial hyperactivity is nonspecific.

1.5.2. Allergic rhinitis

It is linked to eosinophilic inflammation of the nasal mucosa. This inflammation is responsible for the release of histamine.

2. Delayed allergic reactions
   1. Dermatitis or eczema:

Remember that stomatitis is the mucosal equivalent of dermatitis and contact eczema. They appear

• That is, 24 to 48 hours after the first ^contact ;
• Sometimes within a week of contact;
• Other times, several years when contact is continuous.
• Functional signs
  • They may be absent in minor forms;
  • Prodromes: severe pruritus, sometimes perioral ;
  • Eczema may be accompanied by paresthesia, numbness or even anesthesia

in severe cases;

• At the oral level , hypersalivation, loss of taste, a localized burning sensation on the tongue aggravated by food can be observed.

• Physical signs
  • Eczema appears at the point of contact with the allergen 1 to 2 days after this contact;
  • The well-defined lesion may be localized or diffuse;
  • Lesions can affect the entire mucosa and even extend to the lips and pharynx.
• Clinical signs of allergic eczema:

Eczema is characterized by:

• Inconstant vesicles;
• A generally constant erythema;
• An exudation which reflects the presence of oozing followed by crusts and edema which characterize allergic eczema, at least in its early form;
• Accompanying itching is common but of unequal intensity.
• Differential diagnosis
  • A malignant lesion;
  • An aphthosis;
  • Immune bullosis;
  • A drug eruption;
  • A lichen planus.

1. Contact eczema of the oral mucosa:
   • Contact eczema is much more common than immediate allergic manifestations.
   • The manifestations of delayed hypersensitivity are dominated by the subjective signs “ageusia, paraesthesia”, pruritus is rare.
   • We can also find: a bright and widespread erythema, edema, purpuric pitting of the palate, erosions and ulcerations, a smooth depapillated tongue.
   • Perioral skin involvement is common.
   • The agents incriminated are cosmetics, topical medications and metals.
   • The association with cheilitis is an element of orientation for an allergic origin.
   • In erosive or ulcerated forms, it is necessary to rule out a malignant lesion ; which is rare; and an aphthosis or immunological bullosis or a drug eruption as well as a lichen planus. Candida infections are also ruled out in prosthesis wearers.
2. Cheilitis:

Allergic cheilitis can present in an acute vesicular, oozing and then crusty form, but most often it is chronic; dry, fissural, it is isolated or associated with contact eczema. Other non-allergic cheilitis are:

• Irritant cheilitis: affects the lower lip due to repeated dental trauma.
• Drug-related: mainly antifungals.
• Actinic cheilitis after sun exposure e
• Factitious cheilitis in anxious patients.
• Infectious cheilitis: syphilitic or mycotic.

•Glandular cheilitis: rare due to inflammation of the opening of the salivary glands

• Etiology of allergic cheilitis: They are varied, dominated by cosmetics:
  • Musical instruments;
  • Medicinal topicals: zovirax® propylene glycol;
  • Toothpastes: Toothpastes are implicated in allergic reactions when, in addition to cheilitis, glossitis and associated gingivitis are found, however, cheilitis alone is rarely caused by a toothpaste allergy.

3. Lichenoid contact dermatitis:
   • Functional signs
     • Itching in acute dermatitis ;
     • Pains ;​
     • A burning sensation in erosive forms.
   • Physical signs
     • A typical appearance of lichen planus confined to the contact zone ;
     • Raised keratotic plaques on the skin;
     • At the mucosal level, 3 clinical forms can be observed: reticulation, purplish plaques and papules, erosions ;
     • At the level of the oral mucosa, isolated white lesions or associated with skin lesions

can be observed.

2. Drug eruption

Several clinical forms are described: Lyell syndrome, Stevens-Johnson syndrome and drug-induced erythema multiforme.

1. Lyell’s syndrome

It is an epidermal necrosis with sub-epidermal detachment, the dermis being respected and the Nickolsky sign present.

Mucosal lesions precede skin lesions.

We find a drug intake

• sulfonamides,
• nonsteroidal anti-inflammatory drugs,

•acetylsalicylic acid,

2. Stevens-Johnson syndrome and drug-induced erythema multiforme:

The clinical signs are identical to the previous form but it is less severe.

3. Erythema multiforme:

These are acute ulcers that extend throughout the oral cavity, the lips are crusted and skin lesions are also possible.

4. Allergic parotitis:

It manifests itself by a sudden increase in the volume of one or both parotid glands:

• The gland is firm, homogeneous, not indurated and not painful;
• The orifice of the stenosis canal is sometimes swollen but saliva is normal;
• The patient describes a feeling of non-painful tension;
• General signs are absent.

5. Orofacial granulomatosis:

It combines oral and facial reactions and is characterized by the following cardinal signs

• Swelling of the face or lips;
• Angular cheilitis;
• Generalized gingivitis;
• Oral ulcers.

3. Stomatodynia and allergy:

Stomatodynia is pain localized to the tongue (glossodynia), the gum or generalized to the entire oral mucosa without obvious cause, they are either idiopathic or autoimmune or of psychogenic origin.

According to a retrospective study carried out in 2007 by L. Machet et al., stomatodynia has an allergic cause

• Of the 40 patients, 16 had at least one positive skin test.
• In decreasing order of frequency, these were mercury-derived metals: Nickel then chromium then palladium then cobalt then gold and mercury without forgetting that acrylic resins were found.

4. Occupational allergies of the dentist:
5. Skin diseases

Whether allergic or not , they can occur following the many products used in our profession:

The following cases are the most common:

• Eczema of the hands, back of the hands, possibly interdigital spaces, wrists

when it comes to a contact allergy to rubber gloves;

• Eczema occurs in exposed areas, particularly on the face, in cases of allergy to decontamination products such as glutaraldehyde.

– All these eczemas improve during the holiday period and worsen upon returning to work.

2. Respiratory tract disorders

They are caused by volatile substances in the self-curing resin or by dust produced by grinding.

5. DIAGNOSTIC APPROACH TO ALLERGY IN DENTAL MEDICINE

The dentist plays a key role in the diagnosis of allergies.

1. The anamnesis:

The anamnesis should note:

• Personal history of allergies, their frequency and the circumstances of their occurrence;
• Personal history of atopy;
• Family history of allergy;

In conclusion, we can be faced with two scenarios:

• Either the patient has a proven allergy and has a card issued by their allergist containing the different allergenic substances;
• Either the patient has no known allergies up to now but he may or may not have an allergic or atopic background

If, despite a well-conducted interrogation, the patient has an allergic reaction, it should be noted

• The chronology of appearance of clinical signs;

•The initial appearance of oral lesions;

• Note the substances handled;

2. Clinical examination:

• It consists of a general examination focused on the organs often affected by the allergy (skin, mucous membranes, etc.)
• It allows the allergist to assess the repercussions of the allergy.
• The clinical manifestations found are represented by the lesions cited previously.
• Allows, with the help of the interview, to guide the positive diagnosis and the differential diagnoses.
• It directs towards possible additional explorations which may be necessary (tests).

3. Allergy tests:

• These tests can be carried out as soon as they are necessary, and with no age limit.
• They are most often indicated by the allergist but can also be indicated by the dentist.
• However, careful consideration must be given to these tests regarding their choice.
• In fact, the choice will be made on the one hand according to the suspected allergen and on the other hand according to the general condition of the patient because certain acquired dermatological diseases of the patient will direct more towards one test compared to another.

1. . Skin prick tests:

These tests use batteries of allergens. Placed on a break in the skin, these are the simplest of the tests. The results are given quickly.

• Indications for skin prick tests:
  • In case of immediate hypersensitivity;
  • When a latex allergy is suspected;
  • When an allergy to antiseptics is suspected: e.g.: Chlorhexidine.

2. Epicutaneous tests

The test substance is applied to the skin and kept under occlusion. The results are delayed.

• Indication for epicutaneous tests:
  • In the presence of contact eczema;
  • Detect a mercury allergy;
  • Detecting an allergy to orthodontic appliances.

3. The provocation test:

This is the re-exposure of the patient to the allergen through the general route. The patient is deliberately put in contact with the allergen, which he must inhale or ingest. It must be carried out in a hospital environment under supervision.

• Indication of the provocation test:
  • Detect an allergy to orthodontic appliances;
  • Detect a latex allergy.

4. Biological tests by IGE dosage:
   1. lgE totals

• Indication of the dosage of total IgE:
  • When skin tests are uninterpretable or contraindicated in cases of bullous dermatosis;
  • In conjunction with anti-allergy therapy;
  • detect a drug allergy or allergy to local anesthetics e.g.: beta-lactams, rocuronium, suxamethonium, insulin, mepivacaine, etc.

Their positivity demonstrates sensitization and not allergy and must be compared with the data from the interview.

• IgE present in large quantities can indicate an allergic pathology.

However, they are not very specific and can also be found in high amounts in other diseases.

2. Specific lgE:

• These tests are indicated:
  • if the patient has extensive skin lesions or is using antihistamines chronically
  • to detect a latex allergy.
• Caution! Allergy tests should be repeated at varying intervals depending on how symptoms progress. New allergens may appear, and conversely, people may become tolerant to certain allergens.

5. Immunological tests:
   1. Lymphocyte transformation test (LTT)
      • TTL indications:
        • This is the reference test indicated in the diagnosis of drug allergy;
        • Explore delayed hypersensitivity type 4;
        • Determine sensitivities to quinolones and β-lactams;
        • Looking for an allergy to the following products:
          • Titanium dioxide ( TiO2) is used in dentistry as a whitening pigment and for its bactericidal properties.
          • Titanium ( Ti ), mercury (Hg), nickel (Ni), zinc (Zn), indium (In), gold (Au), copper (Cu) and platinum (Pt), silver (Ag), gold (Au), nickel (Ni), copper (Cu) and tinplate ;
          • Cadmium ( Cd ), palladium (Pd) and lead (Pb) are found in dental stain preparations.
          • Mercury derivatives (thimerosal, ethylmercury, phenylmercury) used in dentistry as preservatives.
   2. The MELISA test for Memory Lymphocyte Jmmuno-Stimulation Assay
      • Allows immunological detection of antigen receptors present on the outer membrane of cells.
      • The test is based on the fact that: The memory of contact with the antigen is maintained for years on the surface of certain T lymphocytes “memory lymphocytes”.

Indications for the MELISA test:

• screening for intolerances to heavy metals and before the placement of titanium implants.
• detect a mercury allergy.

Conclusion :

– Allergies in oral medicine , although rare, it is important to know how to identify allergic reactions because even if many manifest in a delayed and minimal way, they can sometimes be immediate and serious and to know the action to take in the face of each manifestation.

ALLERGY IN ODONTOSTOMATOLOGY

  Untreated cavities can cause painful abscesses.
Untreated cavities can cause painful abscesses.
Dental veneers camouflage imperfections such as stains or spaces.
Misaligned teeth can cause digestive problems.
Dental implants restore chewing function and smile aesthetics.
Fluoride mouthwashes strengthen enamel and prevent cavities.
Decayed baby teeth can affect the health of permanent teeth.
A soft-bristled toothbrush protects enamel and sensitive gums.
 

ALLERGY IN ODONTOSTOMATOLOGY