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SECTION EDITORS
H y p e r s e n s i t i v i t y to t e m p o r a r y s o f t d e
n t u r e l i n er s A c l in i c a lr e p o r t
H u s s e i n S . Z a k i D D S M S a K a t a l i n J . K e t z
a n D M D b a n dR i c a r d o L . C a r r a u M D FACS cUniversity
of Pittsburgh, School of Dental Medicine, Pittsburgh, Pa.
Temporary soft lining materials are often usedduring the healing
phases after maxillectomy or man-dibulectomy and for routine
prosthodontic procedures.They are also indicated when the thickness
of the oral mu-cosa is inadequate or when it exhibits a reduced
toleranceto the loads applied to it. 1 The two main di sadvantages
oftemporar y soft lining materials are the physical propertiesof
the soft lining materials in clinical use and the effect ofthe oral
environme nt on those properties. Physical proper-ties such as
compl iance , resilience, dimensional stability,wettability,
adhesion to the denture base, porosity, andgrowth of Candida a lb
icans on the surface make the use ofsoft lining materials tempora
ry in nature. 16
Denture stomatitis is believed to be caused by parafunc-tional
habits or tr auma from ill-fitting dentures. 5-9 Someauthors
suggest hypersensitivity to components of thedenture material,
which leads to an allergic response,infection with Candida a lb
icans , or poor oral or denturehygiene. 911 However, Turrel112,13
suggested t hat residualmonomer and the sorption of fluids such as
cleansingagents, food, or drugs by the denture base can cause
thedenture base to acquire antigenic properties.
Uncured plastics are responsible for a growing numb er
ofdermatoses. 14 Additives, plasticizers, and ultraviolet-l
ightabsorbers are common sensitizers in plastics. 14 Additivessuch
as phthalates, maleates, and dimethylaniline areamong the common
sensitizers. Dibutyl, diethyl, anddioctyl phthalate in the a mount
of 10 % or more are usedas plasticizers and thought to cause
sensitivity reactions inpolymers. Ultraviolet-light absorbers such
as benzophe-
aAssociate Professor, Department of Prosthodontics and
Directorof Maxillofacial Prosthodontics Program.bResident,
Maxillofacial Prosthodontics Department.CAssistant Professor,
Department of Otolaryngology,University ofPittsburgh Medical
Center.J PROSTHETDENT 1995;73:1-3.Copyright | 1995 by The Editorial
Council of THE JOURNALOFPROSTHETICDENTISTRY.0022-39 13/95/ 3.00 +
O. 10/1/59078
nones and resorcinol monobenzoate in polymers can alsocause
allergic reactions. ~4
Temporary soft liner materials are supplied as powderand liquid.
2 The powder is poly(ethyl me thacrylate) andthe liquid may or may
not contain monomers such as ethyl,methyl, or n-butyl methacrylate.
All temporary soft linerscontain 25% to 60% plasticizers such as
ethyl glycolate,butyl phthalyl glycolate, or n-butyl phthalate.
Patch testing is currently the best method of finding
anoffending allergen. Properly applied and correctly inter-preted
patc h tests are at present the only scientific proofof allergic
con tac t dermatit is. 14
Two treatment approaches for suspected contact der-matitis
should be considered4: identification and elimina-tion of the
specific allergen and, if needed, antiallergictherapy.C L I N I C A
L R E P O R T
A 70-year-old white woman was diagnosed with squamouscell
carcinoma at the junction of the soft and hard palate,which
required excision followed by radiation therapy. Thepatient was
edentulous. After operation the patient' s den-ture flanges were
reduced, occlusion was adjusted, and themaxillary denture was
extended into the defect for tempo-rary obturation. Both dentures
were then relined with asoft liner (Viscogel, Dentsply Int., York,
Pa.)
The soft liner was changed weekly during the healingprocess and
throughout the radiotherapy period. Threeweeks after radiotherapy
was completed the patient ex-hibited minor changes in the
consistency of saliva with novisible changes in the oral mucosa.
The surgical site wascompletely healed and the pati ent was able to
function wellwith the relined dentures.
Forty-eight hours after one of the patient's regularlyscheduled
reline appointments the patient had pain andcould not insert her
dentures. The patient demonstratedmanifestations of edema of the
midface and concomitantintraoral ulcerations and edema (Fig. 1).
The differentialdiagnosis included lymphedema, superinfection,
candidia-sis, and hypersensitivity reaction to drugs, food, or the
lin-ing material. The referring physician was consulted, the
JANUARY 995 THE JOURNAL OF PROSTHETIC DENTISTRY
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THE JOURNAL OF PROSTHETI C DENTIST RY ZAKI KETZAN AND CARRAU
Fig . 1 . Swell ing and ulcerat ions of maxil lary alveolus and
palate unde r rel ined maxil larob tu ra to r .
Fi g. 2 . Pat ch t est o f four soft l iners . 1 , Flexacryl ; 2
, Soft Oryl; 3 , Coe-Com fort ; 4, Visco-gel.
pa t ien t was p rescr ibed an an t imicrob ia l /an t i fungal
med i -ca t ion, and she was ins t ruc ted no t to w ear the den tu
res ex -cept for eat ing.
After 48 hours the swell ing and ulcerat ions in the
mouthintensified with the deve lopm ent of mucosa l s loughing.
Apatch tes t o f the so f t l iner mater ia l was perfo rm ed by p
lac-ing a sample o f Viscogel t em pora ry so f t l iner mater ia l
onthe fo rearm wi th adhes ive tape and leav ing i t in p lace fo
r48 hours. Ves icu lar e ry the ma developed over the fo rearm
where the Viscogel material had been applied. A secondpatc h
test was done with four different soft l iners Table I) .
Fig . 2 and 3 i l lustrate the re sul ts of the second patc h
testof al l four soft l iner materials . The soft l iner was
conse-quen t ly changed to Coe-Comfor t l iner Coe-Comfor t ,
GCAmerica Inc. , Chicago, I l l . ) , which was the only
materialtha t d id no t p rovoke an a l l e rg ic reac t ion . Af
te r comple tehea l ing the den tu re was rebased in hea t -p
rocessed acry l icresin fol lowing customary procedures.
2 VOLUME 73 NUMBER 1
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ZAKI KETZAN AND CARRAU THE JOURNAL OF PROSTHETIC DENTIST RY
F i g . 3 , R e s u l t s o f p a t c h t e s t i n F i g . 2 a
f t e r 4 8 h o u r s .
C O N C L U S I O N S1 . D e n t u r e s t o m a t i t i s i s b
e l i e v e d t o b e c a u s e d b y
p a r a f u n c t i o n a l h a b i t s , t r a u m a f r o m i
l l -f i t ti n g d e n t u r e s ,p o o r o r a l d e n t u r e h
y g i e n e , o r in f e c t i o n f r o m Candida alb icans. T h e
c o n c e n t r a t i o n s o f r e s i du a l m o n o m e r a n d
t h es o r p t i o n o f c l e a n i n g a g e n t s , i n g e s t
e d f o o d , o r d r u g s c a n a l s ob e o f f e n d i n g f a
c t o rs . A l l e r g i c s t o m a t i t i s t o m a t e r i a l
s u s e di n d e n t u r e s s h o u l d b e d i f f e r e n t i a
t e d f r o m a l l o t h e r f o r m s o fs t o m a t i t i s b y
p r o p e r l y a p p l i e d p a t c h t e s t s .
2 . P a t c h t e s t s t h a t u s e d i f f e r e n t m a t e
r i a l s w i ll l i k e l yd e m o n s t r a t e t h e o f f e n d
i n g re a c t a n t .
3 . A c h e m i c a l l y d i f f e r e n t s o f t li n e r s h
o u l d b e u s e d u n t i lh e a l i n g o cc u r s. T h e d e n
t u r e s h o u l d t h e n b e r e b a s e d w i t hh e a t - p r
o c e s s e d a c r y l i c r e s i n b e c a u s e u n c u r e d m
o n o m e rm i g h t c a u s e a d d i t i o n a l a l l e r g i c
o r i r r i t a n t r e a c t i o n s .
R E F E R E N C E S1. Wright PS. Composition and properties of
soft lining materia]s foracrylic dentures. J Dent 1981;9:210-23.2.
Craig R. Restorative dental m aterials. 7th ed. St. Louis,
Missouri: CVMosby, 1985:496.3. Bergman B, Th e effects of
prosthodon tic materials on oral tissues. OralSci Rev
1977;10:75-93.4. Accepted d ental thera peutics. J Am De nt Assoc
1979;38:48-9.5. Zarb GA, Rolender CL, Hickey JC, Carlsson GE.
Boucher's prosth-odontic tr eatm ent for edentulou s patients. 10th
ed. St. Louis, Missouri:CV Mosby, 1990:33.6. Heartwell CM , Ra hn
AO. Syllabus of complete dentures. 2nd ed. Phil-adelphia: Lea
Febiger, 1974:372.7. Nyguist G. A study of denture sore mouth. Acta
Odontol Scand1952;10(Suppl):11-154.8. Bergman B, Carlsson GE,
Hedgard B. A longitudinal two-year stu dy ofa num ber of full dentu
re cases. Acta Odontol Scand 1964;22:3-26.9. Bergendal T . Tr eatm
ent of dent ure stomatitis. [Doctoral Thesis].Stockholm: University
of Stockholm, 1982.10. Kaaba r S. Allergy to de ntal mater ials
with special reference to the useof amalgam and
polymethylmethacrylate. Int D ent J 1990;40:35945.11. Ste nma n E,
Bergm an M. Hypersensitivity reactions to dental materi-als in
referred group of patients. Scand J Dent Res 1989;97:76-83.12. T
urrell AJW. Aetiology of inflamed upp er den ture bearing tissues.
BrDent J 1966;118:542-6.
T a b l e I . S o f t l i n e r p r o d u c t s i n s t u d yP r
o d u c t n a m e M a n u f a c t u r e r I n g r e d i e n t
sFlexacry l - sof t Lang Den ta l Mfg . , N = bu ty l
Whee l ing , I l l. me thacry la te ,d i b u t y l p h t h a l a
t e ,t r i m e t h y l o l p r o p a n et r i m e t h a c r y l a t
e ,d i m e t h y l - p -to lu id ine
Viscoge l Dentsp ly Po ly(e thy lIn te rn a t iona l , York ,
methacry la te ) ,P a . B u t y l p h t h a l y lbu ty l Glyco la
te
(BPBG) , e thanol ,p e p p e r m i n t o il ,l iqu id para f f
in
Sof t Ory l Te ledyn e Getz , E lk Po ly(e thy lGrove , I l l.
me thac ry la te ) ,
d i b u t y l p h t h a l a t e ,n -bu ty l ace ta te ,e t h a n
o l
Coe-Comfor t GC Amer ica , Inc . , E thy l (m ethacry la te )
,Chicago, I l l . Zn undec ylenat e,
e thanol , benzo i lbenzoa te , d ibu ty lp t h a l a t e
13. Tur rell AJW. Allergy to dentu re base materials: fallacy or
reality. B rDent J 1966;120:415.14. Fisher AA. Contac t dermatitis.
3 rd ed. Philadelp hia: Lea Febiger,1986:546.Reprint requests
to:DR. H. S. ZAKIREGIONAL CENTER FOR MkXILLOFACIALPROSTHETIC
REHABILITATIONUNIVERSITYOF PITTSBURGHSCHOOL OF DENTAL MEDICINE3501
TERRACE ST.2059 SALK HALLPITTSBURGH, PA 15261
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