Occupational health problems and adverse patient reactions in orthodontics

Abstract

The purpose of the present investigation was to study the nature and frequency of adverse reactions to materials and procedures among orthodontists and their patients. A questionnaire about this topic was mailed to practicing members of the Norwegian Orthodontic Society, of which 137 (about 75%) responded together with 127 chairside assistants. About half of the orthodontic personnel had experienced adverse reactions. The majority of the problems were dermatoses, comprising dryness, redness, itching, thickening, reduced tactile sensitivity, fissuring, soreness/desquamation and pain of hands and fingers. The residual were respiratory reactions, eye reactions or reactions of a general nature. Many of the dermatoses were of moderate severity, attributed to (seasonal) air/ventilation associated problems. Other frequent causes were hand washing procedures, work involving composites and acrylics (orthodontists), or work involving model materials, alcoholic disinfectants, latex gloves, alignates etc. (assistants). For both groups the most severe dermatological reactions were associated with unspecified allergies, acrylics and composites. Non-dermatological reactions also reflected the different working pattern and exposure to materials in orthodontics; acrylic monomer topping the list. The orthodontists had observed 425 patients with dermal reactions and 67 patients with intraoral/systemic reactions, indicating a prevalence of about 1 per cent. Dermal reactions included redness, eczema, itching and fissuring in facial, neck or perioral areas, mostly attributed to metallic parts of extraoral appliances, with some exceptions (elastics, neck pillows, head caps). Intraoral reactions consisted of redness, soreness and swelling of the oral mucosa, gingiva and/or lips and were associated with metal brackets, labial wires, bonding procedures or acrylic appliances.

Biocompatibility of alloys used in orthodontics evaluated by cell culture tests

“…1 In some instances one might suspect that the appliances or their corrosive products cause local tissue damage, which clinically cannot be distinguished from gingivitis of bacterial etiology. The most common metals used in orthodontics are of a composition similar to 18/8 (18% chromium and 8% nickel) stainless steel.…”

A Severe Reaction to Ni-Containing Orthodontic Appliances

“…[11][12][13] It is estimated that 4.5% to 28.5% of the population have hypersensitivity to nickel. 11,[14][15][16] Females have been reported to have a much higher prevalence than males, at 10 to 1.…”

In vitro cytotoxic effects of orthodontic appliances

“…1,2 Biocompatibility means that the tissues of the patient who comes into contact with the materials do not suffer from any toxic, irritating, inflammatory, allergic, mutagenic, or carcinogenetic action. [3][4][5][6] In the field of dentistry, orthodontics is the branch in which the problem of biocompatibility is most felt, since the patients are young and, therefore, more susceptible to develop inflammatory reactions, as well as because of the use of alloys with possible toxic effects. 7,8 Historically, precious metal alloys were the first to be used.…”