Stomatitis venenata

Stomatitis venenata (other name : Contact stomatitis) is relatively rare when compared to contact dermatitis. The inherent qualities of the oral mucosa and the oral environment make it more resistant to potentially allergic agents than the keratinized skin. Saliva dilutes and digests or washes away allergic agents. It also contains a high concentration of epidermal growth factor which aids in healing of mucosal injuries if any. The oral epithelium, which is non-keratinized in nature, has fewer proteins; as a result there are fewer targets for the allergens. Allergens in contact with the oral mucosa are removed very rapidly because of the higher epithelial turnover rates of the oral epithelium.

However, in spite of the inherent protective mechanism of the oral mucosa, topical application of medicaments can elicit a localized mucosal reaction in some individuals.

Types of contact stomatitis

Irritant contact stomatitis

• No previous history regarding exposure to suspected irritant.
• Clinical signs are seen within minutes to hours of exposure to irritant.
• Activation of immunologic mediators without involvement of memory T-cell function.

Allergic contact stomatitis

• Previous history regarding exposure to allergen is required.
• Clinical manifestations usually seen after 48 hours of subsequent exposure (a type IV hypersensitivity reaction).
• Activation of memory T-cells.

Common agents causing contact stomatitis

Oral cleansing aids

• Dentifrices (contain peppermint, cinnamon)
• Mouth rinses (chlorhexidine)
• Dental floss (contains colophony or rosin)

Dental materials

• Free monomer (in acrylic appliances)
• Nickel (content of orthodontic wires)
• Mercury (dental amalgam fillings)
• Gold (constituent of crowns, fillings)
• Denture adhesives (contains rosin which is resin obtained from conifers)
• Eugenol (in periodontal packs, cements)
• Phenol

Cosmetics

• Lipsticks
• Lip balms
• Sunscreens

contain rosin derivatives, propolis and ricinoleic acid.

Food substances

containing preservatives, coloring and flavoring agents, sea food, fruits such as apples, pears, etc.

Management

The first step in managing contact stomatitis is by avoiding contact with the identified or suspected irritant or allergen.Patients are instructed to avoid smoking. Toothpaste and mouthwashes with strong flavoring agents are best avoided (baking soda can be an effective alternative to tooth pastes). Topical triamcinolone acetonide or flucinonide 0.05% gel can be used.