Allergic Reactions and Sensitivity Caused by Dental Materials in the fabrication of Partial Dentures and Complete Dentures

Introduction

Throughout this essay, research will be gathered to explain the types of sensitivity and allergic reactions caused by dental materials in the creation of partial or complete dentures. Different types of materials will be discussed on their sensitivity and allergic reactions to help fully understand why their properties have negative biocompatibility. This essay will include the type of professional care required to prevent a harmful reaction to a patient during a clinical session.

Sensitivity and Allergic reactions from Dental Materials

For many years, new dental materials have been found and tested on patients. These materials can be ground-breaking or create instability inside the oral cavity. Patients can have sensitivity or allergic reactions to materials such as acrylic resins, metals, just to name a few. Although allergic responses have 4 stages that are different.

• Type 1 is Allergic Anaphylaxis and Atopy; this reaction begins when the allergens enter the body causing antigen-antibody reaction to start (Mohammed, 2018).
• Type 2 is a cytotoxic reaction, in which the antibody counters with the antigen (Mohammed, 2018).
• Type 3 is an immune-complex type; this responds by an inflammatory reaction when the antibody and antigen bind (Mohammed, 2018).
• Type 4 is a cell-mediated reaction that shows no negative signs but may occur after 48 hours of the allergen inside the body (Mohammed, 2018).

Oral Hypersensitivity in patients can be shown with “redness or whiteness of mucosa, swelling of lips, tongue, and cheeks and/or possibly ulcers and blisters.” Evidence of this can be seen through these types of reactions: stomatitis, lichenoid reactions, angioedema, erythema multiforme and plasma cell gingivitis (Staff, 2007). Some denture materials that can cause sensitivity or an allergic reaction are monomer, latex, polyether’s, titanium, and many more.

What are different kinds of dental materials used in the fabrication of dentures that can easily develop sensitivity or allergic reactions?

Polyether’s

In 2017, the Journal of Prosthetic Dentistry found that polyether’s can be a hypersensitive material when taking an impression in the clinic. These materials can cause a “slight redness to nerve pain and a burning mouth with total stomatitis.” Polymer allergic reactions often occur after 24 hours and are mostly patients with pre-existing allergies to other materials, etc. The report described a patient that had an allergic reaction towards polyether material during restoration with the prosthetic. Below, a test was completed in 2012 to find the patient reaction to polyether materials.

In Regensburg, Germany, Department of operative dentistry and Periodontology, a test was done in 2012 on the most recent allergic reactions caused by polyether impression materials. Eight patients were tested on their reaction towards the material (redness, swelling or blisters). The Department of Operative Dentistry and periodontology conducted a patch test on 8 people, as well as an extra prick test for two patients with atypical symptoms of an allergy, and the client’s history to an allergy tested by patch. The results for the eight patch testing patients showed a positive reaction to “mixed polyether impression materials, base paste or a base paste component.” in a clinical scenario.

The patients with atypical symptoms found no results in the patch testing experiment. Although, further research showed that the most probable outcome was a component of the base plate. These base plates are used for many different impression materials and are used constantly over the years. It is believed, that an allergic reaction is unlikely to occur, but there may be a rare case in which a client may be allergic to polyether impression materials (Mittermüller, P, Szeimies, R-M, Landthaler, M & Schmalz, G 2012).  Refer to figure 1 for information on symptoms.

Figure 1:

(Mittermüller, Pauline Szeimies, Rolf-Markus Landthaler, Michael Schmalz, Gottfried, 2012)

Titanium

A critical review was conducted in 2018 at the University of Geneva, Switzerland. It was about the impact of corrosion and titanium particles surrounding the body and the implant survival complications. The university researched some clinical cases of titanium particles, and degraded titanium being discovered in oral and nonoral tissues. The evidence shows that surfaces of dental implants can cause material deterioration. Factors such as environmental, chemical and mechanical wear also play a role in the decay of titanium. When titanium particles are released into the body it is called tribocorrosion. Although research from other sources found that peri-implantitis lesions are connected to titanium and inflammation in the oral cavity (Mombelli, A, Hashim, D & Cionca, N 2018).

Monomer

In October to December 2015, researchers have found that monomer can cause allergic reactions when used for polymers. During the self-curing process, if the reaction between some monomer molecules and polymer don’t react, it may cause problems to patients. This is because the unreacted monomer molecules are left out of the curing process. If a larger quantity of unreacted monomer is used, there will most likely be higher toxic effects. The molecules that are left out of the reaction process can cause monomer to leak out into saliva causing cytotoxic problems to the patients. Clinical practices such as 2^nd impressions would most likely be in effect. The researchers found that if the amount of polymer is increased in the mix (ratioy of 5:3), there would a decreased amount of toxic effects on the client. Although when compared to a heat-cured acrylic the results showed that the monomer content is significantly lower than polymerization. Monomer inside the oral cavity can produce a burning mouth or soreness. Although other factors such as poor alignment of dentures or dental hygiene could also be the issue (Rashid, Sheikh, and Vohra, 2015).

Latex

In 2009, the Journal of the Canadian Dental Association released an article regarding latex hypersensitivity. Latex is created from a natural rubber latex, that is “extracted from the sap of Hevea Brasiliensis trees.” These trees contain 11 possible allergens and 256 proteins. Although the steps in creating latex products can be harmful. When latex is processed, 200 chemicals and additives are added into dental products (Kean, T. and McNally, M. 2009).

According to the ADA, signs such as, itchy (nose, throat or eyes), Nausea, abdominal cramps, skin reactions (itching, redness, rash or hives) and/or the difficulty of breathing, runny nose, sneezing, coughing or wheezing may be an indication whether or not the patient is sensitive to latex (Ada.org, 2019).

Explain why some dental materials can cause any sensitivity or allergic reactions? Steps were taken to prevent such reactions and type of professional care you would provide during patient management.

Some reasoning behind dental materials causing irritation, sensitivity or allergic reactions could be activated through many different situations. Allergies can be linked to many different aspects, such as health and food. A material such as Latex may cause hypersensitivity and can be connected to health issues or food allergies. According to the 2009 Journal of the Canadian Dental Association, patients that have spina bifida can be at high risk due to their repetitive experience to latex during their immune system development. Spina Bifida is linked to latex and is believed that 18%-73% are allergic to latex (Kean, T. and McNally, M. 2009). Food can also play a role in sensitivity to latex. Patients that are allergic to foods such as apples, avocados, bananas, carrots, etc. may be at an amplified risk (Ada.org, 2019). When the clinician is dealing with a patient and depending on their history to latex gloves, alternatives can be used. Vinyl, nitrile, neoprene and polyisoprene gloves can be castoff as a substitute (Clarke, 2015). When selecting glove types, allergies should be taken into consideration. To help prevent allergic reactions, a patient record should be kept ensuring that every visit can be organized in a specific way, ask patients about their allergies, and/or contact their dentist to find out more information about their sensitivity to dental materials.

Conclusion

In conclusion, dental materials such as latex, polymers, monomer, and titanium can cause allergies or hypersensitivity to patients. Although these may not be the full problem, food and health issues could also play a role in the sensitivity to dental materials. Therefore, to help prevent reactions, clinicians should take a history of the patient’s issues.

Bibliography

• Mohammed, S. (2018). allergic reaction to restorative materials. [online] Slideshare.net. Available at: https://www.slideshare.net/sohailcanopus/allergic-reaction-to-restorative-materials [Accessed 8 Apr. 2019].
• Staff, S. (2007). Oral Hypersensitivity Reactions. [online] Maaom.memberclicks.net. Available at: https://maaom.memberclicks.net/index.php?option=com_content&view=article&id=125:oral-hypersensitivity-reactions&catid=22:patient-condition-information&Itemid=120 [Accessed 8 Apr. 2019].
• Mittermüller, P, Szeimies, R-M, Landthaler, M & Schmalz, G 2012, ‘A rare allergy to a polyether dental impression material’, Clinical Oral Investigations, vol. 16, no. 4, pp. 1111–1116, viewed 14 April 2019, <https://search-ebscohost-com.tafeqld.idm.oclc.org/login.aspx?direct=true&db=ddh&AN=77873722&site=ehost-live>.
• Mittermüller, Pauline Szeimies, Rolf-Markus Landthaler, Michael Schmalz, Gottfried (2012). Chart. [image] Available at: https://web-a-ebscohost-com.tafeqld.idm.oclc.org/ehost/detail/imageQuickView?sid=46adecd4-fe64-4061-bce4-42c40efa4853@sdc-v-sessmgr05&vid=0&ui=23922051&id=77873722&parentui=77873722&tag=AN&db=ddh [Accessed 14 Apr. 2019].
• Mombelli, A, Hashim, D & Cionca, N 2018, ‘What is the impact of titanium particles and biocorrosion on implant survival and complications? A critical review’, Clinical Oral Implants Research, vol. 29, pp. 37–53, viewed 14 April 2019, <https://search-ebscohost-com.tafeqld.idm.oclc.org/login.aspx?direct=true&db=ddh&AN=133499904&site=ehost-live>.
• Rafael, CF & Liebermann, A 2017, ‘Clinical characteristics of an allergic reaction to a polyether dental impression material’, Journal of Prosthetic Dentistry, vol. 117, no. 4, pp. 470–472, viewed 15 April 2019, <https://search-ebscohost-com.tafeqld.idm.oclc.org/login.aspx?direct=true&db=ddh&AN=122240990&site=ehost-live>.
• Rashid, H., Sheikh, Z. and Vohra, F. (2015). Allergic effects of the residual monomer used in denture base acrylic resins. European Journal of Dentistry, [online] 9(4), p.614. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745248/ [Accessed 17 Apr. 2019].
• Kean, T. and McNally, M. (2009) ‘Latex Hypersensitivity: A Closer Look at Considerations for Dentistry’, Journal of the Canadian Dental Association, 75(4), pp. 279–282. Available at: https://search-ebscohost-com.tafeqld.idm.oclc.org/login.aspx?direct=true&db=ddh&AN=40104277&site=ehost-live (Accessed: 17 April 2019).
• Ada.org. (2019). Latex Allergy. [online] Available at: https://www.ada.org/en/member-center/oral-health-topics/latex-allergy [Accessed 17 Apr. 2019].
• Clarke, A 2015, ‘Is latex allergy still a problem?’, Dental Nursing, vol. 11, no. 9, pp. 508–511, viewed 17 April 2019, <https://search-ebscohost-com.tafeqld.idm.oclc.org/login.aspx?direct=true&db=ddh&AN=109166600&site=ehost-live>.