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Mandibular advancement devices (MADs) are used in the treatment of obstructive sleep apnea. A patient (woman in the 60-ies) was treated with a MAD (SomnoDent Fusion Flex; SomnoMed AG). She experienced reactions in form a burning sensation in the mouth, ulcers on the tongue and gingiva, and swelling of the tongue. The patient was examined by a physician who prescribed oral antihistamine (Zyrtec; cetirizine) and recommended the patient not to use the device. The symptoms disappeared after the use was terminated. Allergy test (patch test) with Dental Screening Series showed a strong positive reaction to methyl methacrylate, and clear reactions to ethylene glycol dimethacrylate (EGDMA) and 2-hydroxyethyl methacrylate (HEMA). A continuous release of methyl methacrylate from the MAD was detected after immersion in water. Methyl methacrylate is one of the main constituents of the SomnoDent device. The reaction was reported to the manufacturer of the device and to the Dental Biomaterials Adverse Reaction Unit. Even though the reaction was not life threatening or led to a serious deterioration in state of health, the reaction was reported to the National Competent Authority (the Norwegian Medicines Agency).

Reference:
Allergisk reaksjon i forbindelse med bruk av søvnapnéskinne
Hatleberg K, Svahn J, Lundekvam BF, Lundekvam Berge TL, Gjerde K, Kopperud HM, Vindenes H, Björkman L.
Nor Tannlegeforen Tid. 2021; 131: 276–9