Allergies in Orthodontics;
Two key allergic reactions have been described in the literature. Type I hypersensitivity reactions and a delayed hypersensitivity reaction (Type IV) Orthodontic staff should be trained in how to deal with an anaphylactic shock.
Nickel
Orthodontists are sometimes required to treat patients with an allergy to nickel and nickel is present in a number of orthodontic materials, notably nickel titanium (Ni–Ti) archwires.. The immune response to nickel is usually a type IV cell mediated delayed hypersensitivity reaction. Oral clinical signs and symptoms of nickel allergy can include the following: a burning sensation, gingival hyperplasia, angular chelitis, labial desquamation, erythema multiforme, periodontitis, stomatitis with mild to severe erythema, loss of taste or metallic taste, numbness, soreness of the side of the tongue.
Orthodontic considerations in patients with a nickel allergy
· .Patients with a defined history of atopic dermatitis to nickel containing metals is treated with caution and closely monitored during orthodontic treatment
· If the allergic reaction continues, all SS arch wires and brackets is removed. If the allergic reaction is severe the patient is referred to a physician.
· Alternative nickel free bracket materials include ceramic, polycarbonate, titanium and gold. Fixed appliances may be substituted with plastic aligners in selected cases.
· In patients with diagnosed nickel hypersensitivity and where intra-oral signs and symptoms are present the orthodontist should replace Ni-Ti arch wires with one of the following:
Stainless steel arch wires with a low nickel content;
- titanium molybdenum alloy (TMA) which is nickel free
- fibre reinforced composite wires
- pure titanium or gold plated wires
Latex allergy
The increase in allergic reactions to natural rubber latex over the past two decades has been accredited to the increased use of latex based gloves and universal precautions. Disposable medical gloves, particularly powdered gloves are the main reservoir of latex allergens. Orthodontic elastics used to apply intermaxillary forces are another potential source of the latex protein. Both type I and type IV hypersensitivity reactions can occur.
Orthodontic considerations in patients with latex allergy
· If a reaction to latex is suspected, patient is referred to an allergist, clinical immunologist or dermatologist for testing
· Post-diagnosis-The orthodontic team including radiographers must be aware of the implication of treating latex allergy patients
· The goal is to significantly reduce exposure to patients routinely. This can be done by cleaning the surgery more frequently with a protein wash, cleaning or changing the air filter more regularly
· Latex free goods are stored in a ‘latex-screened’ area to avoid prior contamination with latex products
· Patients with a diagnosed allergy can be offered early morning appointments to reduce the exposure to airborne latex particle
· The diagnosed patient is monitored for signs of adverse reactions. If present, emergency services are activated immediately
· The emergency drugs and resuscitation equipment should be free from latex
Latex free orthodontic materials
· There are a number of latex free alternatives to commonly used orthodontic materials. Natural rubber latex is found in gloves, elastics, separators, elastomeric modules, elastomeric power chain, polishing rubber cups, band removers and masks with latex ties
· Synthetic non-latex gloves made from nitrile, polychloroprene, elastyren and vinyl, are readily available for clinical use
· Elastomeric separators can be replaced with self-locking separating springs.
· Manufacturers can provide alternatives such as latex free power chain, ligature chain, rotation wedges, headgear components, and masks. It is wise to check with retailers that the product they are marketing is latex free
