April 4-8, 2017 Annual Meeting
|Oral Hypersensitivity Reactions|
Hypersensitivity reactions are abnormal reactions of the immune system that occur in response to exposure to otherwise harmless substances. These reactions encompass true allergic and other non-allergic reactions and their severity can range from mild to life-threatening.
The most severe hypersensitivity reaction is called “anaphylaxis” and this allergic reaction usually begins immediately after exposure to the allergen. Hypersensitivity reactions in and around the mouth may produce a wide range of clinical appearances including redness or whiteness of the mucosa; swelling of the lips, tongue and cheeks; and/or ulcers and blisters.
Types of Oral Hypersensitivity Reactions
Stomatitis: Typical signs of stomatitis are redness and swelling that may involve any part of the mouth (see Right) including the tongue, roof of the mouth, cheeks, and lips (cheilitis). There is occasional formation of blisters and ulcers. Affected individuals may complain of a burning sensation and mouth sensitivity to cold, hot, and spicy foods.
Lichenoid reactions: These lesions resemble lichen planus and consist of slightly raised, thin, whitish lines that blend together to form a lacelike pattern. Sometimes ulcers are located within the lesion and surrounded by the whitish lines (see Right). Lichenoid lesions are found most commonly on the mucosa of the cheeks but may occur throughout the mouth.
Angioedema: Angioedema is a soft, painless, non-itchy swelling that usually involves the lips, tongue or cheeks. It typically develops rapidly and can become a serious event requiring emergency treatment, if the swelling spreads to the larynx and results in severe breathing difficulty.
Erythema multiforme: In erythema multiforme both the skin and the mouth may be affected. Mouth lesions begin as swelling and redness of the oral mucosa, followed by the formation of blisters which break and leave areas of ulceration. The lips may become swollen and develop bloody crusts. The typical skin lesion is the “target” or “iris lesion” which consists of concentric rings of red skin surrounded by areas of normal colored skin (see Right). The extent of involvement can be so severe as to require hospitalization.
Plasma cell gingivitis: Plasma cell gingivitis appears as a bright redness and swelling of the gums without ulceration (loss of skin cells). This characteristic appearance (see Right) is due to the gathering of specific white blood cells, called plasma cells, in the gums. Other areas that may be involved include the tongue or lips. This reversible condition is different than gum disease, and symptoms resolve once the cause is removed.
QUESTIONS AND ANSWERS ABOUT ORAL HYPERSENSITIVITY REACTIONS
Q: What should I do if I think that I am experiencing a hypersensitivity reaction?
Q: What can cause a hypersensitivity reaction in the mouth?
Q: Are there any specific foods that are more commonly implicated in intraoral hypersensitivity reactions?
Q: What is the “Latex-Fruit Syndrome”?
Q: Which drugs are responsible for intraoral hypersensitivity manifestations?
Q: Why oral hygiene products are considered as causes of hypersensitivity reactions?
Q: How can dental treatment trigger a hypersensitivity reaction?
Q: The roof of my mouth under my denture is red and burns. Is this an allergy?
Q: Can local anesthetics cause allergic reactions?
Q: How can I determine if I have an allergy?
Q: Can I prevent a hypersensitivity reaction from occurring?
Prepared by M Arava, A Pinto and the AAOM Web Writing Group
The information contained in this monograph is for educational purposes only. This information is not a substitute for professional medical advice, diagnosis, or treatment. If you have or suspect you may have a health concern, consult your professional health care provider. Reliance on any information provided in this monograph is solely at your own risk.