Lichenoid Contact Reactions from Dental Restorative Materials:

Question 1

Lichenoid Contact Reactions from Dental Restorative Materials:

ACHL:

Answer 1

• The vast majority of hypersensitivity reactions to dental restorative materials are to dental amalgam, usually associated with the mercury content, but sometimes with copper, zinc, or tin and is also known as Amalgam Contact Hypersensitive Lesions (ACHL)
• Reactions have been seen much less frequently to other dental restorations containing materials such as gold, beryllium, chromium, cobalt, or composite resins

Question 2

Lichenoid Contact Reactions from Dental Restorative Materials:

These chronic contact reactions:

Answer 2

• These chronic contact reactions appear clinically and histopathologically similar to lichen planus but demonstrate a different mucosal distribution
• Represent chronic type IV hypersensitivity reactions

Question 3

Lichenoid Contact Reactions from Dental Restorative Materials:

The patients with LP:

Answer 3

• Exhibit no direct correlation to contact with dental materials
• Do not demonstrate a significantly increased positive patch testing to dental restorative materials
• Exhibit minimal-to-no clinical improvement on removal of their amalgams

Question 4

Lichenoid Contact Reactions from Dental Restorative Materials:

The diagnosis of a lichenoid contact reaction is made from:

Answer 4

• the clinical appearance of the lesion
• the lack of lesional migration, and
• the correlation to adjacent dental metal

Question 5

Lichenoid Contact Reactions from Dental Restorative Materials:

Differential Diagnosis:

Answer 5

1. Lichen planus
2. Allergic contact stomatitis(ACS)
3. Discoid lupus erythematosus
4. Traumatic irritation /erosion

Question 6

Lichenoid Contact Reactions from Dental Restorative Materials:

Treatment and Prognosis:

Answer 6

• For chronic lichenoid reactions
• Local measures, such as improved oral hygiene, smoothing, polishing, and recontouring of the amalgam restoration, should be attempted before more aggressive measures, because clinically similar lesions have been noted as a result of surface plaque accumulation
• If this is unsuccessful, then the amalgam should be replaced
• Because patients rarely may exhibit hypersensitivity to composite resins, use of inert materials (such as, glass ionomer, porcelain, or porcelain-fused-to- metal) is recommended
• Lichenoid lesions that fail to resolve following removal of the adjacent metal should be evaluated further