Procedures

Patch testing (see the image below) is useful to distinguish irritant reactions from allergic reactions.^{[54, 55, 56, 57]}Patch testing before placement of a prosthesis is not indicated. Reading at 10 days is recommended because reactions to gold, palladium, and mercury salts may be delayed. A patch test series for contact stomatitis should include the following^{[58, 59]}:

Nickel sulfate 5% pet
Beryllium chloride 1% pet
Gold sodium thiosulfate 2% pet
Metallic mercury 1% pet (see image below)
Ammoniated mercury 1% pet (mercury ammonium chloride)
Palladium chloride 1% pet
Copper sulfate 2% pet
Amalgam without mercury 20% pet (contains silver 13.9%, copper 2.36%, tin 3.54%, and zinc 0.2%)
Amalgam with mercury 5% pet (contains mercury 2.5%, silver 1.73%, copper 0.3%, tin 0.44%, and zinc 0.03%)
Methacrylates: 2-Hydroxyethylmethacrylate 2% pet
2,2-bis (2-Hydroxy-3-methacryloxy-propoxyl)-phenylpropane (BIS-GMA) 2% pet
Balsam of Peru 25% pet
Menthol 1% pet
Eugenol 1% pet
Cinnamic aldehyde 1% pet
Propolis 10% pet
Fragrance mix 8% pet
Colophony 20% pet
Benzalkonium chloride 0.1% pet
Benzocaine 5% pet

Positive patch test result to mercury.

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For direct testing of the oral mucosa, the suspected allergen is placed on the lip mucosa as is, or it is incorporated in Orabase. Reading is performed at 24 hours.

Skin prick tests are routinely used for diagnosing a latex allergy. They are also useful in cases of suspected food allergy (see the image below).

Positive prick test result to latex.

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Use test with rubber latex gloves is often positive in patients with a latex allergy.

Biopsy may be performed.

Histologic Findings

Histologic study excludes neoplasia in long-standing lesions. A 3- to 4-mm punch biopsy is usually sufficient. Histopathologic examination in contact stomatitis can show changes similar to those in allergic contact dermatitis, with epithelial spongiosis and perivascular lymphohistiocytic infiltration. In addition, lichenoid changes of lymphocytic effacement of the dermoepithelial junction with, at times, vacuolar changes and necrotic epithelial cells, may be seen.

Histopathology findings cannot help distinguish between oral lichenoid reactions associated with amalgam and oral lichen planus.

Treatment & Management

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Media Gallery

Irritant contact stomatitis of the tongue.
Close-up view of irritant contact stomatitis of the tongue.
Acute allergic stomatitis involving the oral mucosa and the lip due to benzocaine.
Allergic contact dermatitis involving the lips and the perioral area due to propolis.
Allergic contact reaction due to nickel in a dental brace.
Allergic contact stomatitis on the gingiva in a patient with a positive patch test result to nickel, palladium, and mercury.
Leukoplakialike lesion in a patient who is allergic to mercury.
Lichen planus–like lesion adjacent to a dental restoration.
Contact urticaria of the lip due to food allergy.
Contact urticaria of the tongue in a patient with latex allergy.
Close-up view of contact urticaria of the tongue in a patient with latex allergy.
Positive patch test result to mercury.
Positive prick test result to latex.

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Author

Antonella Tosti, MD Professor of Dermatology, Department of Dermatology and Cutaneous Surgery, University of Miami, Leonard M Miller School of Medicine

Antonella Tosti, MD is a member of the following medical societies: American Academy of Dermatology, International Society of Dermatology, European Academy of Dermatology and Venereology, Women's Dermatologic Society, Canadian Dermatology Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: PharmaDerm<br/>Received income in an amount equal to or greater than $250 from: Valeant; Pharmaderm.

Coauthor(s)

Massimiliano Pazzaglia, MD, PhD Fellow, Department of Dermatology, University of Bologna, Italy

Disclosure: Nothing to disclose.

Bianca Maria Piraccini, MD, PhD Professor, Chief, Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Chief, Department of Medical and Surgical Sciences, University of Bologna, Italy

Bianca Maria Piraccini, MD, PhD is a member of the following medical societies: American Academy of Dermatology, Council for Nail Disorders, European Academy of Dermatology and Venereology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Dermatology of Southwest Ohio

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Craig A Elmets, MD Professor and Chair, Department of Dermatology, Director, Chemoprevention Program Director, Comprehensive Cancer Center, UAB Skin Diseases Research Center, University of Alabama at Birmingham School of Medicine

Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, Society for Investigative Dermatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: University of Alabama at Birmingham; University of Alabama Health Services Foundation<br/>Serve(d) as a speaker or a member of a speakers bureau for: Ferndale Laboratories<br/>Received research grant from: NIH, Veterans Administration, California Grape Assn<br/>Received consulting fee from Astellas for review panel membership; Received salary from Massachusetts Medical Society for employment; Received salary from UpToDate for employment. for: Astellas.

Contact Stomatitis Workup

Procedures

Histologic Findings

References

Tables

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