Oral contact allergies: a comprehensive narrative review on etiology, clinical manifestations, diagnosis, and management

Abstract

Purpose

Oral contact allergies (OCAs) are increasingly recognized in dental practice and commonly manifest as oral lichenoid reactions (OLRs), allergic contact stomatitis (ACS), and burning mouth syndrome (BMS). This narrative review aims to synthesize current knowledge on etiological factors, diagnostic challenges, and management strategies to enhance clinical guidance.

Methods

A comprehensive literature search was conducted across major medical and dental databases focusing on studies from 2000–2024 addressing OCAs related to dental materials, oral hygiene products, and food allergens. Emphasis was placed on clinical features, diagnostic methodologies—including patch testing and emerging biomarkers—and therapeutic approaches documented in recent literature.

Results

Common precipitants of OCAs include metals such as nickel, mercury, cobalt, and acrylates, with prevalence estimates ranging from 5 to 20%, predominantly affecting middle-aged women. Diagnosis primarily relies on clinical evaluation supported by patch testing, though emerging techniques such as salivary biomarkers and histopathological analyses show promise. Management centers on allergen avoidance and topical corticosteroids, with immunotherapy approaches such as sublingual immunotherapy (SLIT) gaining preliminary support despite a lack of comprehensive guidelines.

Conclusion

Enhanced detection and recognition of OCAs are critical to improving patient outcomes and quality of life. Dentists should incorporate OCAs into differential diagnoses for chronic oral mucosal disorders and remain informed about advances in diagnostics and therapeutics.