Orthodontic Braces and Allergies
According to the current research evidences, the most common allergy reported in children is due to the nickel in orthodontic appliances. Moreover, the allergy is more common in women as compared to men, due to a sensitizing exposure to nickel in jewelry. Studies have proven that allergy can also be the etiological cause of hypodontia and high-risk factor for extensive root resorption development, during the ortho treatment.
Sometimes, orthodontists are required to treat patients with nickel allergy. It is a vast concern for them because majority of the dental appliances and materials are made using nickel. Nickel is used in super-elastic-nickel titanium arch wires that are used during the initial leveling and alignment of teeth. The concentration is 47 to 50 percent approximately. In addition to that, it is also a component of stainless steel, which is present in arch wires and brackets both, representing 8% of the alloy.
Extra oral orthodontic appliances such as head gears may also cause an allergic reaction due to nickel. The allergy and sensitization to nickel is a major concern in orthodontics, especially when it comes to nickel containing oral piercings and jewelry.
Response to Immunity
When the immune system responds to nickel, it usually type IV hypersensitivity, also known as contact dermatitis. It is T cell and monocytes/macrophages mediated and consists of two phases. The first phase is elicited after the nickel initially enters the body. It starts in the form of contact dermatitis or contact mucositis, which occurs due to constant re-exposure to nickel, developing over a period of days to three weeks. If nickel is leached from orthodontic appliances, it is type IV hypersensitivity.
How is it diagnosed?
The diagnosis of nickel allergy due to braces is more difficult as compared to problems on the skin. When the patient completes his questionnaire, the dentist will be aware whether he/she has an allergy to nickel or not. Moreover, the patient should be warned about it before the procedure. However, if a patient is unaware whether he has nickel allergy, it can be confirmed by taking a dermatologist consult.
Oral Signs and Symptoms
Following are the oral signs and symptoms of nickel allergy
• Gingival hyperplasia
• Burning sensation
• Angular cheilitis
• Labial desquamation
• Erythema multiforme
• Lateral soreness of the tongue
What is the treatment?
If intra oral signs and symptoms are seen, the arch wires should be removed immediately and replaced with stainless steel arch wires, which has a lower content of nickel or has titanium molybdenum alloy. Resin coated Ni-Ti wires are also one of the options.
In addition to that, if the allergy persists, all treatment should be stopped, and arch wires should be removed. For any severe reactions, the patient should consult a physician.
Other alternatives to nickel include
• polycarbonate brackets made from plastic polymers
• titanium brackets and gold brackets
At Comfortho we are very aware of this side effect and we have made a conscious choice to offer our customers the following types of brackets:
Plastic clear aligners, ceramic braces, titanium braces and golden braces.
Are you considering taking braces? Come and visit us to have an introductory talk with one of our specialists who would like to discuss your situation :).