Contact stomatitis and dermatitis

1. Contact stomatitis and
dermatitis
Dr.D.Angelin
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3/19/2021

2.  Angioedema
 Drug allergy-stomatitis medicamentosa and dermatitis medicamentosa
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3/19/2021

3. Contact stomatitis and contact dermatitis
(stomatitis and dermatitis venenata)
 Contact allergy is a type of reaction in which a lesion of
the skin or mucous membrane occurs at a localized site
after repeated contact with the causative agent
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4. Pathogenesis
 The process occurs with the aid of intraepithelial Langerhans cell where
the hapten is converted into a competent antigen
 The antigen is presented to T lymphocytes for sensitization and production
of IgE with specific receptors
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5. Classification of materials which cause
oral lesions
Materials
1.Dental and cosmetic preparations
a) Dentifrices
b) Mouthwashes
c) Denture powders
d) Lipsticks, candy, cough drops,
chewing gum
2.Dental materials
a) Rubber dam
b) Vulcanite
c) Acrylic
d) Metal alloy base
3. Dental therapeutic agents
a) Alcohols
b) Antibiotics
c) Iodides
d) Phenols
e) Procaine
f) Volatile oils
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6. Clinical features in skin
 Contact dermatitis is manifested by
o Itching or burning sensation at the site of contact
o Followed by appearance of erythema
o Then vesicle formation
o After rupture of vesicles,lesion becomes extensive
o If secondary infection occurs lesion becomes severe
o In chronic contact the skin becomes thickened and dry
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7. Contact dermatitis
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8. Oral manifestations
 Frequency of true allergic reaction to any one antigen from contact is rare
 Because the oral cavity is less sensitive than the skin surface
- Due to shorter period of contact in the oral cavity
- saliva dilutes and removes the antignes
- possibility of rapid dispersal and absorption in oral mucosa is prevented
- Fewer chances of antigen to be recognized
- Lower density of Langerhans cells and T lymphocytes
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3/19/2021

9. Contact stomatitis
 After contact the mucosa becomes inflamed and edematous
 Imparts a smooth shiny surface
 When gingiva is involved the tissue is bright red in all quardrants
 Buccal mucosa is puffy and dark red,revealing engorged blood capillaries
 Small vesicles form,which rupture to form areas of erosion and ulceration
 Erosion and ulceration common in lips
 Secondary infection common
 Other features include burning sensation,itchng,stinging,tingling and edema
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10. Contact stomatitis
 In chronic cases, the affected mucosa is in contact with causative agent
 It may be erythematous or white or hyperkeratotic
 Erosions,
 widespread erythema,
 lip lesions-dryness, scaling,fissuring, cracking of vermilion border of lip
 Symptoms similar to orolingual parasthesia and plasma cell gingivitis
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3/19/2021

11. Dental and cosmetic preparations
 Allergy is not common
 Most cases it is the flavouring agent
 In cases of lips- lipstick will incite violent reaction with severe edema and
ulceration
 Dental materials like acrylic when used as denure base or filling material
causes allergy
 It may take a period of time,even months
 Tissue becomes inflamed and painful
 Most cases patient is sensitive to monomer in cases of improper
polymerization
 In some cases it is not allergy but ill fitting dentures
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3/19/2021

12. Dental materials
 Erythematous mucosa in relation to dentures may be candida infections
 True acrylic sensitivity is rare
 Epoxy resins can be allergic-resin modifier and amine curing agent
 Therapeutic agents- alcohols,phenols,antibiotics
 Here also the most of the times flavouring agent is the allergen
 Allergy to procaine is common
 If dentist is allergy,use of procaine should be avoided,or rubber gloves is to be
used
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14. Dental restorations
 Cinnamon
 Amalgam
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15. Histologic features
 Intra and intercellular edema of epithelium
 Vesicle formation within the epithelium
 Engorged and dilated blood vessels are seen in the connective tissue
 Background of edema and an infiltrate of lymphocytes and plasma cells
 Some allergens elicit a heavy plasma cell response –plasma cell gingivitis
 Increased number of eosinophils also found
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3/19/2021

16. Contact stomatitis from cinnamon
flavouring
Cinnamon oil-flavouring agents used in
 confessionary,
 ice cream,
 soft drinks,alcoholic beverages,
 processed meat,
 gum,candy,
 toothpaste,mouth freshners
 Mouth washes
 Dental floss
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3/19/2021

17. Clinical features
 Allergy common in products in frequent contact like candy,chewing
gum,toothpaste
 Allergy due to toothpaste-lesions of gingiva like plasma cell gingivitis,alog
with enlargement ,edema and erythema
 Erythematous mucositis of buccal mucosa and tongue,exfoliative
cheilitis,circumoral dermatitis
 Lesions also in vermilion border of lip or circumoral skin
 Lesions in buccal mucosa are hyperkeratotic with an erythematous base
 Lesions seen also in lateral border of tongu,may mimic oral hairy leukoplakia
or carcinoma
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18. Circumoral dermatitis due to cinnamon
allergy
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19. Histologic features
 Acanthotic epithelium,
 Elongated rete ridges
 Thinned suprapapillary plates
 Hyperkeratosis
 Neutrophil exocytosis
 Connective tissue shows chronic diffuse inflammation of lymphocytes
 Pervascular infiltration of lymphocytes
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20. Treatment and prognosis
 Reactions disappear within a week of discontinuation of products
 Lesions reappear within 24 hours if it is used again
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21. Chronic oral mucosal contact with
dental amalgam
Dental amalgam has been associated with various ailments like
 Neurotoxiity
 Kidney dysfunction
 Reduced immunocompetence
 Alterations of oral and intestina flora
 Birth defects
 Adverse effects on general health
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3/19/2021

22. Clinical features
 The reactions clinically and histologically mimic lichen planus
 Contact lichenoic reactions to amalgam-subgroup exhibits lesions that
do not migrate,usually involving only the mucosa directly in contact
with amalgam restorations and resolving rapidly after removal of the
dental amalgam
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3/19/2021

23. Clinical and histologic features
 Seen in
 posterior buccal mucosa,
 ventral border of tongue
 gingival cuffs adjacent to subgingival amalgam restorations
 Lesions appear white or erythematous with or without striae
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24. Amalgam allergy
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25. Histologic features
 Similar to lichen planus
o Hydropic degeneration of basal cell layer
o Hyperkeratotic or atrophic epithelium
o Dense band of chronic inflammatory infiltrate chiefly lymphocytes
o Perivascular lymphoid aggreagates
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26. Treatment
 Improving oral hygiene
 Smoothening
 Polishing
 Recontouring of the restoration
 Replacement with a non metallic restoration
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27. Perioral dermatitis
 Occurs in response to use of
 Tartar control toothpaste
 Bubblegum
 Moisturisers
 Night creams
 Other cosmetic products
This conditioned is worsened by the application of topical corticosteroids
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3/19/2021

28. Clinical features
 Papules or papulopustules involving skin surface wurrounding vermillion
border of lipes
 Small zone of spared skin adjacent to the vermillion border
 Such zones seen in women using cosmetics
 Use of tartar control toothpaste-zone of erythema without the papules or
pustule immediately adjacent to vermillion border
 These are called cirucumoral dermatitis
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29. Perioral dermatitis
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30. Histologic features
 Chronic lymphohistiocytic dermatitis or a rosacea like pattern mimicking
sarcoidosis
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31. Treatment and management
 Discontinue topical corticosteroids
 Use topical metronidazole with or without tetracycline
 Recurrences are uncommon
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32. Latex allergy
 Dental surgeons,dental students and other healthcare workers
 Type I hypersensitivity reactions
 Immediately urticaria, rhinits and edema around eyelids occurs
 Use of nonlatex products or cotton liners advised
 Sometimes acute systemic reactions occur which may be life threatening
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