Palladium in dental alloys – the dermatologists’responsibility to warn?

Abstract

Palladium is increasingly used in industry, but also in fine jewelry and in dentistry. Thus, palladium-silver alloys comprise a substantial part of the noble metal ceramic alloy sales in Western countries. The increased use of this metal seems, however, to be paralleled by a rise in the number of reports of palladium allergy. Recently a European study reported a sensitization rate of 2.8%. In Austria, where palladium has started to displace amalgam in dental fillings because of concerns about mercury toxicity, and gold due to price factors, we have found a sensitization rate of 8.3% in unselected eczema patients. Despite the current lack of clear clinical relevance of this finding, these numbers should motivate us to question this substance as "the alloy of the future".

Comparative corrosion study of Ag-Pd and Co-Cr alloys used in dental applications

“…This concern stems from reports of frequent incidence of 'Pd-allergy' (BGA 1993). The element Pd is a known sensitizer with its sensitization rate in the range of 2-18% (Aberer et al 1993;Cai et al 1995;Wataha and Haks 1996). Thus, it is not surprising that its presence in a dental alloy can trigger adverse biological reactions.…”

Palladium alloys for biomedical devices

“…Concerns about allergy to Pd alloys emerged several years after the introduction of Pd-based alloys to dentists in the early 1970s [41]; this topic has been reviewed by several authors [1,4,5,42,43]. Many reports of allergy to Pd alloys were case studies where oral mucositis, urticaria, swelling, redness, burning or other symptoms were observed post-insertion of Pd alloys for dental prostheses [41,[44][45][46][47][48]. Patients often tested positive for hypersensitivity to Pd or Ni (see discussion later) and often experienced resolution of symptoms after the prostheses were removed and replaced with non-metallic alternatives.…”

“…However, prevalence of allergy in the general population is unclear because most studies have evaluated populations that had some other immunological sign or symptom. For example, patients who have eczema [41], a history of allergic reaction [49], Ni allergy or allergy to other metals [50,52] or who work in metal refineries [51,53] have been used as cohorts for assessing allergy to Pd ions. A more recent retrospective study used a cohort of dental patients who had received a metallic prosthesis, and found the prevalence of PdCl 2 sensitivity to be 3.8%, based on a patch test [54].…”

Kwaliteit van restauratiematerialen vanuit een gezondheidsperspectief belicht

“…Zo werd een hoge sensitatiegraad op palladium (8,3%) gevonden in at random geselecteerde eczeempatie¨nten (Aberer et al, 1993). Hoewel hiermee niet direct een causaal verband kon worden aangetoond, was het wel aanleiding om de toekomst van tandheelkundige palladium-zilverlegeringen ter discussie te stellen.…”