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Featured Topic: Contact Allergy to Dental Fillingsjerd_289 355..356

Lee W. Boushell, DMD, MS*

Ricardo J. Padilla, DDS†

WHAT IS IT?

Contact allergy to dental fillings isa localized hypersensitivity reactionto various components of dentalfillings. Tooth-colored (compositeresin) fillings contain acrylate com-pounds, and silver-colored(amalgam) fillings contain silver,tin, mercury, and sometimes copper,all of which may initiate an allergicresponse.1,2 The word “mucosa” isused to describe the tissue lining theinside of the mouth. Contact allergymay result when acrylates, metalsalts, or metals are released andabsorbed by mucosa that is in closecontact or proximity to the fill-ing.3,4 The absorbed productsincrease the antigenicity of themucosal lining cells, and these cellsare then damaged or destroyed bythe immune system response.3,4

Most of the time, the filling hasbeen in contact with the affectedmucosa over a period of years.4 Theaffected areas may include the sideof the tongue, cheek, and/or liptissue immediately adjacent to thefilling that contains the allergen(Figure 1).

Your dentist may use the term“oral lichenoid reaction to a dental

filling” to describe the contactallergy that has been observed.Contact allergy varies in appear-ance based on the severity of theallergic response. Some individualsdevelop a thickening of themucosa, which gives it a white,netlike appearance commonlydescribed as “reticular” (Figure 1).More involved contact allergicareas appear red (erythematous),thin (atrophic), and are named“erosive.” The most severe contactallergic response, referred to as“ulcerative,” results in a break inthe mucosal lining that exposesunderlying tissue.4

HOW IS IT DIAGNOSEDAND TREATED?

Your dentist or hygienist maynotice the development of a suspi-cious (reticular or erosive) areaduring a routine dental exam orcleaning. Alternatively, an ulcer-ative area may have begun to causediscomfort leading to your exami-nation. Careful examination willidentify if the changes in themucosa are occurring symmetri-cally on both sides of your mouth,as this may represent other condi-tions not related to an allergic

response to a filling material.Contact allergies usually occur onone side only, unless there are fill-ings in close contact with themucosa on both sides. Your dentistwill also note whether you havetendencies to bite areas of yourmucosa or have sharp, irritatingedges on your teeth, fillings, orother restorations. These sources ofirritation may initiate changes inthe appearance of the mucosa thatare not part of an allergicresponse. Careful charting of thelocation of the suspicious area, aswell as the location of various fill-ings in your mouth, will beaccomplished. If your dentist findsthat the suspicious area is in closecontact with a dental filling(Figures 2 and 3), thenreplacement of the fillingwill likely result in completehealing of the area, althoughthis may take up to12 months or longer.4

It may be necessary to temporarilyapply medication designed to limitthe allergic response while you arehealing. Your dentist will select aninert type of filling material suchas glass ionomer or porcelain to

*Assistant professor, Department of Operative Dentistry,University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC, USA

†Clinical assistant professor, Department of Diagnostic Sciences and General Dentistry,Residency Program Director, Oral and Maxillofacial Pathology,

University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC, USA

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restore your tooth. Only the fill-ing(s) that are in direct contactwith the mucosa with a resultantcontact allergy need to bereplaced.4 Replacement of fillingson the biting surfaces or othersurfaces of the teeth that do notcontact the mucosa isnot necessary.4

CONCLUSIONS

Dental biomaterials, such as fill-ings, rarely cause adverse reac-tions.2 Mucosa that is in directcontact with dental fillings maydevelop a contact allergy, alsoreferred to as “allergic contact

mucositis,” as a result of long-termexposure to various components inthe filling material. The affectedmucosal area will likely heal if theadjacent dental filling is replacedwith an inert filling material. Peri-odic examinations will allow yourdental health care providers tomonitor and recommend appropri-ate treatment for any areasof concern.

DISCLOSURE

The authors do not have anyfinancial interest in manufacturerswhose materials are discussed inthis article.

R E F E R E N C E S

1. Kanerva L, Estlander T, Jolanki R. Occu-pational allergic contact dermatitis causedby acrylic tri-cure glass ionomer. ContactDermatitis 1997;37:49–50.

2. Vamnes JS, Lygre GB, Grönningsæter AG,Gjerdet NR. Four years of clinical experi-ence with an adverse reaction unit fordental biomaterials. Community Dent OralEpidemiol 2004;32:150–7.

3. De Rossi SS, Greenberg MS.Intraoral contact allergy: a literaturereview and case reports. J AmDent Assoc 1998;129:1435–41.

4. Thornhill MH, Pemberton MN, SimmonsRK, Theaker ED. Amalgam-contact hyper-sensitivity lesions and oral lichen planus.Oral Surg Oral Med Oral Pathol OralRadiol Endod 2003;95:291–9.

Figure 1. Localized white, netlike areaon the side of the tongue. Photocourtesy of Dr. Ricardo Padilla.

Figure 2. The bottom right first molarhas a large metallic filling just adjacentto the tongue (arrow). Photo courtesyof Dr. Ricardo Padilla.

Figure 3. Dental examination revealschanges in the mucosa on the side ofthe tongue immediately adjacent to thedental filling (circle). Photo courtesy ofDr. Ricardo Padilla.

TA L K I N G W I T H PAT I E N T S

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