Introduction

Oral hygiene products include toothpaste, dental floss, denture cleaners, and mouthwashes. Contact reactions to oral hygiene products affect all age groups.

Toothpaste consists of flavorings, preservatives, coloring agents, abrasives, detergents, binding agents, moisturizers, antiseptics, antacids and fluoride salts. Flavors are the leading cause of allergic contact reactions to toothpaste and there is considerable overlap with food.

Toothpaste and other oral hygiene products can cause cheilitis (swollen lips) and stomatitis (swollen mouth) Specific conditions include:

• Allergic contact cheilitis
• Irritating contact cheilitis
• Contact stomatitis
• Newspaper eczematous dermatitis due to allergic contact dermatitis or irritant contact dermatitis
• Contact leukoderma
• Contact urticaria
• Discoloration of teeth

However, such reactions are fortunately rare considering how often and how often these products are used.

Allergic contact reactions to oral hygiene products.

Who has allergic contact reactions to oral hygiene products?

Allergy For oral hygiene, ingredients are rare, probably due to rinsing after use. About 30 Allergens They have been identified in toothpaste and these are present in most.

Females present more frequently than males with a contact. allergic reaction for toothpaste and other oral hygiene products. This may be because women are first sensitized to other products that contain fragrances and perfumes.

General toothpaste is the second most common cause of contact cheilitis after lipsticks, but the most common cause in men.

Clinical presentation

How is a contact allergy to oral hygiene products diagnosed?

Patch The test is the first investigation for suspected contact allergy. Base Standard series are often not helpful in diagnosing contact allergy to dental hygiene products as the common allergens present in these products are not included. Therefore, it is important to add an extended series of toothpaste and the patient's own products.

There is some discussion in the literature on “as is” toothpaste patch testing due to irritating reactions to detergents and abrasives. However, some studies report that it is possible to distinguish between irritating and allergic patch reactions to toothpaste. The advantage of testing with the patient's product is that in a significant proportion of cases, the only positive reaction is the product. However, patch testing for the product may give a false negative result if the allergen is present in low concentrations.

Some authors recommend confirming product patch test results using a start-restart test or a repeat open application test (ROAT).

Toothpaste companies generally cooperate with dermatologists, providing more information about their product so that the allergen can be identified.

Testing can also be helpful in identifying alternative products that may be safe for the patient.

The cause of an immediate reaction (type I) (contact urticaria) is identified by a skin prick / scratch test. However, the low concentration of the allergen in a product may be too low to give a positive reaction. In one case, the prick test with a mint leaf was positive, but a negative reaction was observed with the patient's mint-flavored toothpaste.

The final test is to leave the suspect product and observe the improvement for several weeks.

What is the treatment for contact reactions to oral hygiene products?

As with all forms of contact allergy, the best treatment is to avoid the product and the allergen if identified. The reaction should resolve in a few weeks.

Allergens reported in oral hygiene products

Toothpaste

The flavors in toothpaste give the "clean and fresh taste" and cover up the bitter taste of the pyrophosphates in the tartar.control toothpaste. And these are the most common ingredients that cause contact allergy. The most common responsible substances are derived from the peppermint plant:

• Green mint
• Mint
• Menthol
• Carvona

Other reported allergens include:

• Cinamal - flavoring derived from cinnamon
• Anethole - flavoring derived from star anise, fennel and anise

• Propolis - antiseptic

• Hexylresorcinol - license plate control
• Azulene - antiinflammatory
• Dipentene: solvent used in cleaning products.
• Cocamidopropyl betaine - surfactant

• Parabens - preservatives

• Fluorine salts.

Floss

Common allergens found in dental floss are rosin (E915) and flavorings.

Mouthwash

Many of the same allergens are found in mouthwashes as toothpaste, added for "clean fresh tasting" flavoring. Cocamidopropyl betaine in a "2-in-1 toothpaste mouthwash" has been reported to cause allergic cheilitis.

Denture Cleaner

Denture cleaner has very rarely been reported to cause contact allergy. However, the use of a denture cleanser containing ammonium persulfate on a heavily worn acrylic denture was reported to cause allergic contact cheilitis, as the persulfate adsorbed onto the porous denture with slow subsequent release.

Irritant contact reactions to oral hygiene products.

Sodium lauryl sulfate (SLS) is a common detergent and surfactant present in toothpaste. Promotes foaming and may have some antimicrobial effect. As it is a detergent, it can cause irritant contact dermatitis, especially of the perioral skin. Several studies suggest that SLS may increase the frequency of canker sores. ulcers in those prone to them, although one study failed to show any improvement after switching to toothpaste that does not contain SLS.

Irritant contact cheilitis can also be caused by the high concentration of pyrophosphates in tartar control toothpaste.

Tooth discoloration due to oral hygiene products.

Chlorhexidine is a common ingredient in mouthwashes, as it kills bacteria. Prolonged use of a mouthwash containing chlorhexidine can cause tooth discoloration and dental restorations. Chlorhexidine can also affect the sensation of taste.