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Severe oral and facial reaction to 6 metals in restorative dentistry

Case Report A 26-year-old woman had attended her dentist over a number of years for dental caries and undergone extensive dental restoration with amalgam. After each dental treatment, she developed a well-defined facial dermatitis corresponding to the position of the metal retractors used. This was associated with a lichenoid buccal reaction adjacent to the dental amalgam. Subsequent to these oral and facial reactions, several different dental prostheses were used, including gold, but she continued to have similar allergic reactions. She had no previous dermatological history. She underwent patch testing to the European standard series, dental series, rubber series and latex. After 4 days, there were strong reactions to 1% cobalt chloride, 5% nickel sulfate, 2% copper sulfate and 2% palladium chloride. Weak reactions were seen to 5% mercury and 0.5% gold sodium thiosulfate. All other patch tests, including latex rubber and acrylic filling materials (methyl hydroquinone), were negative.