This document outlines the pathogenesis of contact stomatitis, which is an inflammation of the soft tissues lining the oral cavity caused by allergic reactions. It describes the types of allergic stomatitis, including contact allergic stomatitis caused by materials like nickel, mercury, and cobalt, as well as prosthetic allergic stomatitis caused by dental materials. The pathogenesis involves a delayed type hypersensitivity reaction mediated by T-cells. Diagnosis is made using patch testing to identify sensitizing allergens. Treatment involves local or systemic corticosteroids and immunosuppressants to reduce inflammation.

1. Pathogenesis of Contact
Stomatitis
Rahaf Najjar
Pediatric Dentistry Master (M2)

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

3. 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.

4. • 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.

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

6. Types of Allergic Stomatitis
1) 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.

7. 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

8. 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

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

10. 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.

11. No Inflammation

12. Edema and tissue
damage

13. Lesion Regression due
to PGE secretion by
macrophages

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

15. 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

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

17. Treatment
• It is treated orally by local application of corticosteroids
and antiseptics
• Systemic administration of corticosteroids, non-steroid
anti-inflammatory drugs and immunosuppressants.

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

19. 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.

20. References
1) 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/