Following the diagnosis in the previous scenario, what is the appropriate next step?

Correct answer: C. Determine the alloy composition from the laboratory and remake the framework in a different alloy

• A. A topical steroid suppresses the inflammatory response while leaving the patient in continuous contact with the allergen. It treats the sign and perpetuates the cause, and sensitisation typically deepens with continued exposure.
• B. Reducing wearing time reduces exposure but does not eliminate it. In a true contact allergy the response tends to intensify with repeated exposure rather than habituate.
• C. CORRECT. The management of a contact allergy is removal of the allergen. That means contacting the laboratory to establish exactly what alloy was used, confirming the responsible element through patch testing, and remaking the framework in a material the patient tolerates — commercially pure titanium, a titanium alloy, or a high-noble gold alloy, all of which are markedly less allergenic than nickel-chromium.
• D. Polishing addresses mechanical irritation, not immunological sensitisation. The allergen is in the bulk of the alloy, and a smoother surface still releases the same ions.

Note: Base metal alloys (nickel-chromium, cobalt-chromium) are inexpensive, strong and stiff, which is why they dominate RPD frameworks — but nickel is the most common contact allergen in the general population, with a substantially higher prevalence in women. Ask about jewellery and watch-strap reactions during history taking, before you prescribe the framework.