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MANIFESTARI ALERGICE IN STOMATOLOGIE

medicina












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MANIFESTĂRI ALERGICE ĪN STOMATOLOGIE



GENERALITĂŢI

Cavitatea bucala ca prim segment al aparatului de import al materiei este confruntata permanent cu multiple substante alergizante, alimentare, medicamentoase, produse de higiena, materiale si substante dentare etc.




CLASIFICARE

Pāna īn prezent īn literatura exista relativ putine studii privind incidenta reactiilor alergice īn sfera stomatologica. Cele existente se refera īn special la reactiile alergice de contact la nivelul cavitatii bucale.

Probabil din acest motiv, pentru moment, nu exista nici o clasificare si nici un punct de vedere unitar privind acest subiect.

I. Reactii generale cu manifestari bucale

1. Reactii alergice de tip anafilactic - reactii de tip I

  • Angioedem
  • Stomatita anafilactica sistemica
  • Stomatita de contact (atopica) - vezi reactiile locale

2. Granulomatoza orofaciala

3. Eritemul fix postmedicamentos

4. Reactii alergice purpurice, hemoragic - reactie de tip I 313o1413d I

5. Eritemul polimorf

6. Eruptii ulcerative acute (toxidermii buloase) (reactiile 5, 6, au mecanism fiziopatologic partial comun) - reactii tip III

7. Lichen plan medicamentos - reactie tip IV

II. Reactii alergice de contact (locale)

1. Stomatita de contact (stomatita atopica)

  • Gingivita cu plasmocite/Glosita cu plasmocite

2. Reactii lichenoide/ keratoze de contact



I. REACŢII ALERGICE GENERALE CU MANIFESTĂRI

ORO-FACIALE

Forme clinice


Sunt rezultatul unui conflict imunitar general avānd ca localizare gura si uneori regiunile īnvecinate. Prezinta aspecte clinice variate, polimorfe si au la baza mecanisme fiziopatologice atāt imunitare cāt si neimunitare.

O parte din ele pot fi īncadrate īn tipurile mari de reactii de hipersensibilitate descrise de Gell si Coombs īn 1975 (1) desi nu este exclusa nici posibilitatea asocierii si a unor mecanisme diferite.



1. Reactii alergice de tip anafilactic (tip I)

Presupun un contact prealabil cu antigenul, au la baza un mecanism alergic cu mediere IgE, fixarea complexelor alergen-IgE - mastocite, urmata de degranulare si eliberarea de amine vasoactive. Īn aceasta categorie putem īntālni:

A. DATE GENERALE

Contrar parerii generale, aceste manifestari, sunt evenimente relativ rare, desi mucoasa bucala este confruntata cu multiple alergene potentiale (alimentare, produse de higiena, materiale dentare, etc.)

Aceasta "rezistenta" a mucoasei bucale la alergeni ar avea cāteva explicatii (23, 24):

  • Prezenta salivei si a substantelor active pe care le contine (Ig.A secretor, lactoferina peroxidaza, etc) dilueaza si inactiveaza antigenele īmpiedicānd contactul lor fizic si absorbtia pe suprafata mucoasei.

B. SUBSTANŢE sI PRODUSE ALERGIZANTE

1. Alergene alimentare

C. MANIFESTĂRILE CLINICE ALE REACŢIILOR ALERGICE DE CONTACT


D. DIAGNOSTIC POZITIV sI DIFERENŢIAL

Au la baza mecanisme fiziopatologice atāt imune cāt si neimune;



Alergenele producatoare sunt de natura medicamentoasa, alimentare, conservanti sau alte substante;

Ca forme clinice, cel mai frecvent īntālnite sunt: toxidermiile buloase, eritemul polimorf, stomatita anafilactica si angioedemul;

Aspectul lor clinic este deseori nespecific, prezentānd ca semne: eritemul, edemul, vezicule/bule, ulceratii;

Aspectul histopatologic este si el de multe ori nespecific;

Diagnosticul pozitiv se face de cele mai multe ori pe baza unui istoric amanuntit si riguros si a semnelor clinice, confirmat prin teste epicutanate de contact si ocazional prin examen histopatologic.

Tratamentul se aplica īn functie de natura fiziopatologica presupus cauzala, constānd īn antihistaminice si corticoizi pe cale generala si locala.


Reactii alergice de contact:

Sunt produse de antigene alimentare, din produsele de higiena sau din materialele stomatologice;

Pentru a declansa aceste reactii este necesar un contact repetat si prelungit al antigenelor cu mucoasa;

Mecanismele fiziopatologice care stau la baza lor sunt atāt imunitare (tip I si tip IV) cāt si neimunitare;

Simptomatologia si semnele clinice sunt deseori nespecifice putānd simula o serie de alte afectiuni ale mucoasei. Din aceasta cauza uneori diagnosticul este pus cu īntārziere.

Uneori, chiar dupa īnlaturarea alergenului leziunile pot persista (este cazul reactiilor lichenoide sau keratozele de contact), situatii care impun corticoterapia sau retinoterapia īn aplicatii locale.

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