A patient develops a contact allergic reaction (Type IV hypersensitivity) to their metal RPD framework a few days after delivery. What is the MOST appropriate immediate management step?

Correct answer: A. Ask the dental laboratory what alloy composition was used in the framework

• A. CORRECT. The first step is to identify the specific metal alloy used. Contact allergy in RPD frameworks is typically caused by nickel, cobalt, or chromium in base metal alloys. Knowing the exact alloy composition allows the dentist to: (1) perform patch testing for specific metals, (2) guide material substitution (e.g., switch to a cobalt-free or nickel-free alloy or titanium), and (3) counsel the patient appropriately.
• B. Systemic corticosteroids may be needed for severe reactions but should not be the first step before identifying the causative allergen.
• C. Allergy referral may be appropriate but should be accompanied by the specific alloy data from the lab — a referral without this information is incomplete.
• D. Replacing with a different metal without knowing the alloy composition risks using another allergenic metal. Informed substitution requires knowing what caused the reaction first.