Pathogenesis of Contact Stomatitis

Rahaf NajjarPediatric Dentistry Master (M2)

Lecture Outline:• Introduction.• Types of Allergic Stomatitis.• Pathogenesis.• Diagnosis.• Treatment.• Discussion.

Introduction:Stomatitis:- Inflammation of the soft tissue  lining of any of the 

oral cavity.- It can be caused by conditions occurs  in the mouth: • Poor oral hygiene• Ill fitted dentures• Mouth burn from hot food or drinks• Systemic conditions that affect whole body as allergy,

infection or medications.

• Patient's complaints in adverse allergic reaction include signs and symptoms of stomatitis, burning sensation, cheilitis and lip swelling.

• Sometimes general symptoms and anaphylaxis may appear.

• Saliva play a protective role to the oral epithelium by:- washing away harmful substances- diluting allergenic substances entered the oral cavity.

• Saliva may, on the other hand, help in antigen presentation by providing small molecules of amino acids and small proteins, thereby accelerating sensitization.

Lecture Outline:• Introduction.• Types of Allergic Stomatitis.• Pathogenesis.• Diagnosis.• Treatment.• Discussion.

Types of Allergic Stomatitis1) Contact allergic stomatitis:• rarely occurs

• The high risk materials consider to cause contact allergic stomatitis are nickel sulfate, mercury-based products & gold.

• Cobalt chloride currently is considered the most common allergen in children.

prosthetic allergic stomatitis.• reaction of contact allergy to acrylate, denture metal

alloys, and cobalt-chromium pastes for denture fixation

• The pathologic changes appear on the locations where the prosthesis base comes in contact with the surrounding oral tissues.

• Erythema, edema, vesicles, bullae, erosions and ulcerations.

Types of Allergic Stomatitis

2) Stomatitis (cheilitis) venenata: • Contact allergic reaction caused by different

chemical and cosmetic substances that cause inflammation of the lips and inflammation of the entire oral mucosa.

• They are presented as inflammation with severe edema, followed by small erosions, and usually appear in multiple forms.

Types of Allergic Stomatitis

Lecture Outline:• Introduction.• Types of Allergic Stomatitis.• Pathogenesis.• Diagnosis.• Treatment.• Discussion.

Pathogenesis• Delayed type hypersensitivity reaction (Type IV

allergic reaction) is cellular immunity manifesting primarily by T- cells.

• Delayed hypersensitivity can occur mainly in patients who are previously have been in contact with a specific antigen and then the cells become sensitized.

No Inflammation

Edema and tissue damage

Lesion Regression due to PGE secretion

by macrophages

Lecture Outline:• Introduction.• Types of Allergic Stomatitis.• Pathogenesis.• Diagnosis.• Treatment.• Discussion.

Diagnosis:• The result of this test is

read tow times, at 48 h and 72 h

• painless and can be safely employed in older schoolchildren

• Patient should be informed not to take anti-allergic drugs

Patch (epicutaneous) Test

Lecture Outline:• Introduction.• Types of Allergic Stomatitis.• Pathogenesis.• Diagnosis.• Treatment.• Discussion.

Treatment• It is treated orally by local application of

corticosteroids and antiseptics

• Systemic administration of corticosteroids, non-steroid anti-inflammatory drugs and immunosuppressants.

Lecture Outline:• Introduction.• Types of Allergic Stomatitis.• Pathogenesis.• Diagnosis.• Treatment.• Discussion.

Discussion• Researchers reported that patients who suffer from

contact stomatitis are mainly middle-aged women, especially 50-60 years old.

• While dental patients exhibit different signs and symptoms, mainly on oral soft tissue, dental staff (dentists and assistants) commonly suffer from hands dermatitis

• Awareness of reactions that can occur with different dental materials in treatment is important to the dentists.

References1) Bakula A, Lugovi_c-Mihi_c L, _Situm M, Tur_cin J, _Sinkovi_c A (2011). Contact allergy in the mouth: diversity of clinical presentations and diagnosis of common allergens relevant to dental practice. Acta Clin Croat 50: 553–561.

2) Ahlgren C, Axell T, Moller H, Isaksson M, Liedholm R, Bruze M. Contact allergies to potential allergens in patients with oral lichen lesions. Clin Oral Investig. 2014;18(1):227-37

3) Joneja P. Contact allergic stomatitis in Orthodontics. International Journal of Dental Clinics. 2012;4(1):29-31

4) http://encyclopedia.thefreedictionary.com/