Allergic stomatitis - the inflammatory changes of a mucous membrane of a mouth caused by development of immunopathological reactions (hypersensitivity, a giperergiya). As displays of allergic stomatitis serve hypostasis, hyperaemia, bleeding, sores and erosion of a mucous membrane, burning in a mouth, pain at meal, a gipersalivation, sometimes deterioration in the general state. Inspection of the patient with allergic stomatitis includes collecting the allergologichesky anamnesis, identification of the reason of allergic reaction, survey of an oral cavity, conducting provocative, eliminative tests, skin tests, a saliva research, etc. Treatment of allergic stomatitis assumes an exception of contact with allergen, reception of antihistamines, medicamentous processing of mucous.
Allergic stomatitis – the pathological simptokompleks arising in an oral cavity at a microbic, contact, medicinal allergy or serving as local display of infectious, skin, autoimmune and other diseases. Allergic damages of an oral cavity can proceed in the form of stomatitis, a papillit, a glossit, a gingivit, a pareit, a palatinit, a heylit. Allergic stomatitis occurs among the called clinical forms most often. Consideration of the problems connected with allergic stomatitis demands cross-disciplinary interaction of experts in the field of stomatology, allergology and immunology, dermatology, rheumatology, etc.
Reasons of allergic stomatitis
Developing of allergic stomatitis can be connected with penetration of allergen into an organism or direct contact with a mucous membrane of a mouth. Allergic stomatitis will serve as manifestation of system reaction in the first case (on pollen, medicines, a mold, foodstuff etc.); in the second – local reaction to the irritating factors which are directly contacting with mucous (toothpaste, dentures, medicinal pastils for a rassasyvaniye, mouthwashes and so forth).
Development of contact allergic stomatitis is most often connected with hypersensibility to the materials used in stomatology: medicines for application anesthesia, to metal seals, briquettes, orthodontic plates, crowns, acrylic or metal dentures. In acrylic artificial limbs as allergic factors residual monomers, in rare instances – dyes, as a rule, act. When using metal dentures the allergy to the alloys containing chrome, nickel, gold, palladium, platinum, etc. can develop. Besides, a part in pathogenesis developing of allergic stomatitis is played by caries, chronic tonsillitis, and also pathogenic microorganisms and products of their activity accumulating in a prosthetic bed which irritate mucous.
Contact allergic stomatitis is more often observed at the patients having chronic gastrointestinal diseases (gastritis, cholecystitis, pancreatitis, colitis, dysbacteriosis, helminthoses, etc.), endocrine pathology (diabetes, gipertireozy, climacteric frustration and so forth). This results from the fact that organic and functional violations at these diseases change reactivity of an organism, cause a sensitization to contact allergens.
Development of severe forms of stomatitis is promoted by other allergic diseases: a medicinal disease, food allergy, rhinitises, a small tortoiseshell, eczema, Quincke, asthmatic bronchitis, bronchial asthma, etc. swelled. Allergic stomatitis not always proceeds separately; sometimes it is included into structure of system diseases – vaskulit, hemorrhagic diathesis, a mnogoformny ekssudativny eritema, a system red volchanka, a sklerodermiya, Bekhchet's disease, Layell's syndrome, a syndrome of Reuters, Stephens-Johnson's syndrome, etc.
Classification of allergic stomatitis
Depending on the nature of clinical manifestations distinguish catarrhal, catarrhal and hemorrhagic, bullous, erosive, ulcer and necrotic allergic stomatitis. From the point of view of an etiology and pathogenesis allergic stomatitises include medicamentous, contact (including prosthetic), toksiko-allergic, autoimmune dermatostomatita, chronic recurrent aftozny stomatitis and other forms.
Taking into account the speed of development of symptoms allocate allergic reactions of the immediate and slowed-down types: in the first case allergic stomatitis, as a rule, proceeds in the form of angioneurotic hypostasis of Quincke. If allergic reaction of the slowed-down type is implemented, symptoms of allergic stomatitis most often are found in several days after allergen influence. Sometimes allergic stomatitis on dentures develops 5-10 years of their use later, i.e. after the long period of an asymptomatic sensitization.
Symptoms of allergic stomatitis
Displays of allergic stomatitis depend on a disease form. So, are characteristic of catarrhal and catarrhal and hemorrhagic allergic stomatitis a kserostomiya (dryness in a mouth), burning, an itch, violation of flavoring sensitivity (sour taste, metal smack), discomfort and morbidity at meal. At objective survey of an oral cavity, the "varnished" language is defined hyperemic and edematous mucous; at a catarrhal and hemorrhagic form against the background of hyperaemia petekhialny hemorrhages are allocated and bleeding mucous is noted.
Bullous allergic stomatitis proceeds with education in an oral cavity of vesicles of various diameter with transparent contents. Usually after opening of bubbles allergic stomatitis passes into an erosive form with formation on a mucous membrane of the erosion covered with a fibrinozny raid. Emergence of sores is followed by sharp strengthening of the local morbidity which is especially shown at a conversation and meal. At merge of separate defects on mucous extensive erosive surfaces can be formed. Deterioration in the general health is possible: appetite loss, weakness, temperature increase of a body.
The heaviest on the manifestations is the ulcer and necrotic form of allergic stomatitis. At the same time sharp hyperaemia mucous decides on the multiple sores covered with rather dirty-gray fibrinozny raid, and the necrosis centers. Ulcer and necrotic allergic stomatitis proceeds against the background of the expressed pain at meal, a gipersalivation, high temperature, a headache, submaxillary lymphadenitis.
Diagnosis of allergic stomatitis
Examination of the patient with allergic stomatitis is conducted by the stomatologist with involvement in case of need of adjacent experts: allergist-immunologist, dermatologist, rheumatologist, endocrinologist, gastroenterologist, etc. At the same time collecting and the analysis of the allergologichesky anamnesis and identification of potential allergen is important.
At visual assessment of an oral cavity the doctor notes moisture content mucous, its color, existence and the nature of defects, saliva type. In the course of dental survey the attention to existence in an oral cavity of dentures, seals, orthodontic devices is paid; their structure and terms of carrying, change of color of metal artificial limbs, etc.
The chemical and spectral analysis of saliva and definition allow to make quality and quantitative standard of maintenance of minerals and to estimate the happening electrochemical processes. Additional researches at allergic stomatitis can include the biochemical analysis of saliva with definition of activity of enzymes, definition of painful sensitivity of a mucous membrane, hygienic assessment of artificial limbs, scrape with mucous on Candida albicans, etc.
Allergologichesky inspection assumes conducting test with an exposition (temporary removal of an artificial limb with reaction assessment), provocative test (return of an artificial limb into place with reaction assessment), skin allergic tests, an immunogramma research.
Treatment of allergic stomatitis
Medical actions at allergic stomatitis will depend on the reason which entailed development of a disease. As the fundamental principle of therapy of allergic diseases serves the exception of contact with allergen: observance of a diet, medicine cancellation, refusal of carrying a denture, change of a conditioner or toothpaste, etc.
Medicamentous therapy of allergic stomatitis usually provides purpose of antihistaminic medicines (a loratadin, a dimetinden of a maleate, a hloropiramin, etc.), vitamins of group B, C, PP, folic acid. Local processing of a mucous membrane of an oral cavity is made by antiseptics, the anesthetizing medicines, enzymes, kortikosteroidny medicines, the healing means (sea-buckthorn oil, etc.).
Consultation of the stomatologist-therapist, stomatologist-orthopedist, orthodontist is necessary further for patients at whom allergic stomatitis arose as a complication of dental treatment; carrying out change of seals or crowns, replacements of breket-system, basis of an artificial limb and so forth.
Forecast and prevention of allergic stomatitis
Timely diagnosis of allergic stomatitis allows to overcome a disease at an early stage; terms of therapy of catarrhal and catarrhal and ulcer stomatitis usually do not exceed 2 weeks. In heavier and started cases, long-term treatment of allergic stomatitis can be required.
Preventive measures provide good hygienic care of a mouth, timely treatment of caries and diseases of gums. Regular preventive visit of the stomatologist is necessary for removal of tooth deposits, correction of artificial limbs, their timely replacement. The importance in prevention of allergic stomatitis plays individual approach to treatment and prosthetics of teeth, use of hypoallergenic materials.