Five hundred patients reporting on adverse effects from dental materials: Frequencies,complaints, symptoms,allergies

Objective

Information on patients with real or claimed adverse reactions towards dental materials in large patient cohorts is rare. Therefore, the aim of the present study was to investigate patients reporting on complaints and symptoms to dental materials over a 16-year period.

Biological interactions of dental cast alloys with oral tissues.

OBJECTIVE: All dental cast alloys release metal ions into the oral environment which have the potential to interact with the oral tissues. Amount and type of metal elements released are varying and not directly related to the composition of the alloy. The aim of the present literature survey was to describe the interactions of dental cast alloys with living tissues and to relate them to clinically adverse local reactions of the oral tissues. RESULTS: Interactions of dental cast alloys with the oral tissues take place by different mechanisms; e.g. bacterial adherence promotion, toxic and subtoxic effects and allergy. Whereas bacterial adhesion promotion may be counteracted by adequate oral hygiene measures, the other mechanisms may lead to clinically adverse local reactions due to the metal present. However, the number of cases, where such a relation can be safely diagnosed, is small. Safe ground is felt with proven allergies. The comparatively high allergy rate towards nickel should be the impetus to replace those alloys whenever there is a suitable alternative. Medical and dental impairments as well as general medication may lead to symptoms allegedly attributed to metal restorations. CONCLUSIONS AND SIGNIFICANCE: Patients relating oral symptoms to metal restorations should be subjected to a thorough dental and general medical examination in order to exclude non-material related diseases being the cause for their complaints/symptoms. These cases are a challenge for the collaboration between the medical and dental professions.     

Relationship between oral symptoms, salivary function, smoking habits and general health in patients with complaints related to dental restorative materials

Eighty consecutive patients, referred to the Department of Prosthetic Dentistry, Public Dental Service, Stockholm, for examination of complaints related to dental restorative materials or for supposed adverse effects from mercury released from dental amalgams were investigated. Clinical examination as well as battery of laboratory tests were performed. Statistical correlations were found between subjective and objective oral symptoms and lowered pH-values in stimulated saliva (p less than 0.001) as well as between objective oral symptoms only and lowered pH-values in stimulated saliva (p less than 0.001), which indicate salivary tests to be a useful tool when examining this type of patients.     

Non-allergy-related dental and orofacial findings in 625 patients reporting on adverse effects from dental materials

ObjectiveIn a cohort of 500 patients complaining about adverse effects from dental materials, allergies were found to be contributing to the patients’ subjective complaints in only about 14% of the cases. Therefore, the aim of this retrospective study was to investigate an enlarged cohort of 625 patients reporting on adverse effects from dental materials on non-allergy-related dental or orofacial findings with relevance for their subjective complaints.Methods625 patients visiting a specialized consultation on suspected adverse effects from dental materials were characterized regarding age and sex distribution, subjective complaints, allergies, and dental and orofacial findings with relevance for their subjective complaints.ResultsThis cohort comprised about 81% females and the median age was 58 years. The most often reported subjective complaints were burning mouth (43.8%), taste disorders (28.8%) and dry mouth (22.7%). Allergies toward dental materials were found in 12.3%. In 28.0% of the patients, no dental or orofacial findings with relevance for the subjective complaints expressed by the patients could be found. 19.8% of the patients exhibited relevant functional symptoms, 16.2% relevant orofacial diseases, 15.2% relevant mechanical irritations, 10.1% or 9.4% relevant tooth-related or plaque-related symptoms, respectively, 9.4% hyposalivation, and in 7.2% relevant manufacturing faults were found.SignificanceIn patients complaining about adverse effects from dental materials, a wide variety of dental or orofacial findings need to be considered despite allergies, although a quarter of the patients did not present any relevant dental or orofacial finding. Therefore, specialized consultations and close collaboration with experts from other fields are eligible.     

The rate of appearance intraoral pain and discomfort caused byCandida

Patients sometimes complain of pains and/or discomfort in the tongue or oral mucosa, even though they are diagnosed to have no abnormalities at dental and prosthetic examinations and maintain good health. It is extremely difficult to identify the exact cause of pain in these patients, who have only the complaint of subjective symptoms, without any symptoms such as rubber or swelling. Such pains and discomfort might beCandida. However, reports of the rate of appearance were rare. In the present study, we examined patients with primary complaints of intraoral pain and discomfort thought to be caused byCandida at their first visit to our clinic during the period between March and June 1994, out of 173 geriatric patients. The age of 173 patients was ranging from 65 to 91 years of age with an average of 75 years of age. Among 173 patients, there were 13 patients (7.5%) with a primary complaint of pain in oral mucosa, and the pain of 9 patients (5.2%) out of these 13 were diagnosed to be caused byCandida. In these 9 patients, 7 (4.0%) had objective symptoms, but 2 (1.2%) did not. Their primary complaint was improved by treatment with an antifungal agent.     

口腔内金属修复物的成分分析

目的：测定口腔内金属修复物的成分，确定使用的合金种类，以使牙科金属过敏患者避免再次使用此种合金。方法：用细砂纸及圆锥形抛光磨头，采取微量口腔内金属修复物，通过EDXRF(荧光X线分析仪)测定所含金属成分，确定合金种类。结果：14例可疑牙科金属过敏患者中，牙科金属修复物120个，按照检出频度的高低．排在前10位的金属元素分别是Ag、Cu、Au、Pd、Zn、Sn、Co、Cr、In和Mo。Au-Ag-Pd合金的使用频度为65％，Ag-Sn-Hg合金为2.5％，Ag合金为5.4％，Au合金为14.6％，Ni-Cr、Co-Cr合金为10.1％，其他2.4％。2种以上异种合金共存同一口腔环境中的患者12例,5种合金同时存在者1例。含Hg的银汞合金的使用频度为2.5％，与10年前的使用频度16％相比下降明显。Ni、Cr、Co的使用频度未见明显改变。结论：被疑牙科金属过敏的患者中，异种金属同存的现象严重，提示在口腔科临床工作中，尽量避免使用异种金属及含Hg和Ni等易诱发过敏的金属合金。     

Reporting on adverse reactions to dental materials--intraoral observations at a clinical follow-up

OBJECTIVES: A national reporting system designed to monitor adverse reactions to dental materials was established in Norway in 1993. The activities have also included clinical examination of patients with suspected reactions to dental materials. The ongoing activities are coordinated by the Dental Biomaterials Adverse Reaction Unit at the University of Bergen. The reporting procedure is based on voluntary spontaneous reporting by dentists and physicians. The reports could be based on subjective symptoms or objective findings, or both. The aim of the present study was to compare reported objective intraoral findings with those found during examination at the unit. METHODS: Reported reactions were compared with clinical findings obtained following dental and medical examination at the unit. From 1993 to 1999, a total of 899 reports were received while 253 patients were referred and examined at the unit. RESULTS: The reports on patients who were examined at the unit involved mainly reactions related to amalgam fillings (84%), metals in fixed dentures (11%), resin-based materials and cements (4%), materials used in removable dentures (2%), and endodontic materials (2%). Edema, lichenoid reactions, ulcers/vesicles, erythema, and atrophy were found in 80 patients during the examination at the unit. For 35 of these patients, the intraoral findings at the unit were also given in the reports. For another 45 patients, objective intraoral signs of reactions were found upon examination at the unit, but these findings had not been reported. CONCLUSION: A spontaneous reporting system is a cost-effective method for monitoring intraoral reactions associated with dental materials. Considering the increasing number and complexity of these materials, there appears to be a need for continuous validation of reports by a speciality unit. In order to receive more accurate information about the adverse reactions, it would be advisable that the reporting forms include more detailed guidance regarding signs of reactions that practitioners should be on the look out for and consider.     

A follow-up study of patients with subjective symptoms related to dental materials

OBJECTIVES: The extent to which substances released from dental materials cause adverse health effects and whether removal of dental materials results in improvement of health is a matter of dispute. The aim of the study was to investigate changes in the intensity of subjective symptoms after replacement of dental materials in patients referred for adverse reactions related to dental materials, and to compare the profiles of symptoms with those found in the general population. METHODS: Information was obtained from 142 patients referred to the Dental Biomaterials Adverse Reaction Unit in Bergen, Norway. At the time of examination, all patients completed a questionnaire regarding a range of subjective symptoms. A follow-up questionnaire was sent to all patients 1 to 2 years later. Similar questionnaires were sent to a reference group of 800 persons drawn from the general population. RESULTS: The follow-up questionnaires were completed and returned by 84 patients, and 441 persons in the reference group. The patient group presented higher symptom indices than the reference group (P<0.001). Generally, there was some decrease in the intensity of different symptoms in patients who had replaced dental materials. The decrease was evident regarding intraoral symptoms (P=0.022) and total symptom index (P=0.041). The group of patients who had replaced materials still had significantly higher symptom indices than those of the reference group. Patients who had not replaced dental materials did not present any reduction in symptom indices. CONCLUSION: The pattern of symptoms was similar for the groups investigated. At the group level, the intensity of local and some general subjective symptoms was reduced after replacement of the materials, but not to the level found in the general population.     

Orthodontic treatment possibilities of allergic patients

During the past two decades the incidence of allergies against dental materials has been rising. The most common allergens are nickel, mercury, benzoxyl-peroxide, formaldehyde, MMA, HEMA, EGDMA and TEGDMA. Contact allergy develops in predisposed individuals as a consequence of environmental exposures to allergens. Although the relatively high frequency of contact allergies in children is well documented, its importance during orthodontic treatments is still often underestimated. The most common metal to cause dental allergic reactions is nickel. Nickel-containing metal alloys, such as nickel-titanium, are widely used in orthodontics because of their favorable physical properties. Coated wires (epoxi coating, teflon, etc.) are not only more aesthetic, but can play a role in the orthodontic treatment of patients with nickel allergy. In our case report we present two patients with nickel allergy, and their treatment with alternative orthodontic appliances. During the orthodontic treatment our patients did not have any objective or subjective allergy-related symptoms.     

Tongue piercing and associated oral and dental complications

The insertion of metal objects into intraoral and perioral sites is growing in popularity. However, there are numerous oral and dental complications associated with tongue piercing. Fifteen patients with tongue piercings (pierced in the body of the tongue, anterior to the lingual frenum) attending the dental office of the authors, with and without complaints, were clinically and radiographically examined. The most common dental problem registered was chipping of teeth. Furthermore, two cracked teeth and four teeth with cusp fractures were also seen. One case of selective dental abrasion was registered. Trauma to the lingual anterior gingiva was the most common gingival problem. A salivary flow stimulating effect was only reported by 2 of the 15 individuals. None of the patients complained of interference with speech, mastication and swallowing. One case of galvanic currents produced by the appliance was registered. On the basis of the registered data, we concluded that patients need to be better informed of the potential complications associated with tongue and oral piercings, and that the dental profession can serve this role.     

Tongue piercing and associated oral and dental complications

Abstract – The insertion of metal objects into intraoral and perioral sites is growing in popularity. However, there are numerous oral and dental complications associated with tongue piercing. Fifteen patients with tongue piercings (pierced in the body of the tongue, anterior to the lingual frenum) attending the dental office of the authors, with and without complaints, were clinically and radiographically examined. The most common dental problem registered was chipping of teeth. Furthermore, two cracked teeth and four teeth with cusp fractures were also seen. One case of selective dental abrasion was registered. Trauma to the lingual anterior gingiva was the most common gingival problem. A salivary flow stimulating effect was only reported by 2 of the 15 individuals. None of the patients complained of interference with speech, mastication and swallowing. One case of galvanic currents produced by the appliance was registered. On the basis of the registered data, we concluded that patients need to be better informed of the potential complications associated with tongue and oral piercings, and that the dental profession can serve this role.     

Results obtained from patients referred for the investigation of complaints related to oral galvanism

One hundred consecutive patients, 74 women and 26 men, aged between 18 and 83 years (mean = 54.8 years), referred with complaints related to oral galvanism were investigated and treated and the treatment results were evaluated after 2-3 years. Forty of the patients reported facial pain, pain from the teeth, temporomandibular joints (TMJ) and masticatory muscles and TMJ clicking and locking and 26 reported headache. Smarting in the oral mucosa, smarting of the tongue and xerostomia were reported by 26, 21 and 24 patients, respectively, and 30 patients reported an unpleasant taste, a metallic taste or a battery taste. The same patient often reported several symptoms. The patients also reported various general symptoms, above all joint symptoms, pain in the back, neck and shoulders and general muscular pain but also tiredness, weakness, difficulty in concentrating, depression and insomnia. After clinical and radiological examination, salivary tests, determination of the maximum galvanic current at metallic contacts and screening for contact allergy to dental materials, various oral diagnoses could be established. Most of the patients exhibited functional disturbances of the masticatory system, periodontitis, smarting of the oral mucosa, xerostomia, pulpitis and pulpal necrosis and mucosal lesions. The medical illnesses the patients reported themselves to be suffering from or had been treated for included cardiovascular disorders, high and low blood pressure, asthma, rheumatic disorders, diabetes, pernicious anaemia, gastritis and peptic ulcer. Seventy-six patients took drugs regularly. In most cases there were several oral, dental and medical explanations for the symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)     

Impression materials: a comparative review of impression materials most commonly used in restorative dentistry

Impression materials are used to record intraoral structures for the fabrication of definitive restorations. Accurate impressions are necessary for construction of any dental prosthesis. The relationship between static and mobile oral structures must be reproduced accurately for an optimum cast. The more common types of impressions are used for fabricating diagnostic and master casts. Accurate impressions depend on identifying the applications that do or do not fit each material's characteristics. Materials used without adequate knowledge of their characteristics can impair a successful outcome. Often, the choice of impression materials depends on the subjective choice of the operator based on personal preferences and past experience with particular materials.     

Four years of clinical experience with an adverse reaction unit for dental biomaterials

OBJECTIVES: We describe the function of, and results from, the Norwegian National Dental Biomaterials Adverse Reaction Unit after 4 years of activity from 1993 to 1997. METHODS: During this period of time, 296 patients were examined at the unit, which is located at the Dental School, University of Bergen. The most prevalent age group was 40-49 years, and 70% were women. Dental amalgam was the primary reason for referral to the unit for nearly 85% of the patients, followed by metals in crowns and bridges (11%). Materials in removable dentures, resin-based filling materials and cements, endodontic materials, and others, including temporary materials, were also involved. Nearly all (96%) patients reported general subjective symptoms, such as muscle and joint pain, fatigue, and memory problems. Complaints involving the orofacial region (lips, face, temporomandibular joint) and intraoral subjective symptoms were also common. RESULTS: Of the patients who were patch tested with substances in dental materials, 23% were positive to gold, 28% to nickel, 14% to cobalt, 9% to palladium, 6% to mercury, and 8% to one or more components of resin-based materials. Mercury concentrations in blood and urine were statistically higher in the patients with amalgam fillings compared with those without. CONCLUSIONS: Generally, we could not establish a straightforward cause-and-effect relationship between the presence of dental biomaterials and general symptoms. Twenty patients were advised to replace restorative materials because of contact lesions. Another 20 patients were recommended replacement of materials because of allergy verified with positive patch tests. The complex nature of most of the reactions requires a multidisciplinary approach to the care taking of patients who are concerned about reactions from dental materials, particularly amalgam.     

Oral allergies to dental materials

Oral allergies represent a pathological entity not well known nor diagnosed by dental health professionals. The purpose of this work is to present an information relative to the multidisciplinary steps to be done to solve allergy problems.Three clinical examples of contact oral allergies (to mercury, or gold, or metacrylates) are presented, as to illustrate signs and symptoms of an oral allergy to the more frequent dental materials implied.We discuss the problem of oral allergies from what is known from the scientific literature.We stress the importance of a multidisciplinary approach to take into account patients with an oral allergy, with participation of specialists from dental and dermatologic fields.     

Clinical evaluation of patients referred with symptoms related to oral galvanism

Sixty-eight consecutive patients (9 males, 59 females) referred for symptoms alleged to be caused by oral galvanism were investigated according to a standardized examination program including clinical examination, epicutaneous patch test with dental materials, haematologic screening, salivary test, calculation of currents created at metallic contacts between restorative materials and testing of electrical taste thresholds. No clinical entity could be identified but recognized clinical conditions that could possibly explain the complaints for which the patients were referred were prevalent. The most common symptoms reported were a smarting sensation in the mouth (71%) and different distant symptoms (47%). As regards oral signs, some of them showed similar prevalences as have been found in a general Swedish population. The main exception was changes at the apex of the tongue - found in 15%. Allergic skin reactions to dental materials were found among 25% of the patients. Mean values of blood and saliva parameters did not differ from what is considered normal. The distribution of currents created by contacting dental metallic restorations showed no deviation from the corresponding currents calculated in a control group. The median value for lowest electrical taste threshold in the group of referred patients was significantly lower than in a control group.     

Prosthodontic biomaterials and adverse reactions: a critical review of the clinical and research literature

Prosthodontic biomaterials include impression materials, luting cements, and restorative materials. They consist of metals and alloys ceramics, and polymer materials and are retained in patients for <60 min or for decades. Oral release of compounds from biomaterials occurs, and adverse reactions may follow dental treatment. Especially in allergically vulnerable patients contact allergy may occur. There are reports from many different countries on contact allergy from gold/palladium alloys, components from polymer-based materials, chromium/cobalt alloys, and nickel. Notifications on adverse reactions in Norway, Sweden, and England are handled by a registry in which patient reactions and occupational exposure are recorded. Data from The Adverse Reaction Unit in Bergen and Ume? have been a most valuable basis in extending knowledge in a field of current interest in dentistry. A review of the clinical and research literature relating to prosthodontic biomaterials and adverse reactions shows that reliable methods seem necessary to expose the frequency of adverse reactions in general dentistry, including prosthodontic treatment.     

Effect of Pilocarpine on impaired salivary secretion in patients with Sjögren's syndrome

The aim of this study was to analyze resting whole saliva (RWS) and stimulated whole saliva (SWS) flow rates before and after administration of Pilocarpine in secondary Sj?gren's Syndrome patients. Fifty-one patients (49 women, 2 men, mean age 61 years, range 38-85), all with a resting saliva < or =0.1 ml/min, participated. Volumes of RWS and SWS collected over periods of 15 and 5 min, respectively, using standardized protocols were measured and the same procedure was repeated after oral administration of Pilocarpine (0.7 mg per 10 kg body weight). The sample was then divided into two groups, according to those in whom Pilocarpine stimulation had caused RWS flow to reach >0.1 ml/min (responders) and those who remained at values < or =0.1 ml/min (non-responders). All participants completed a questionnaire related to general and oral health status, as well as their subjective intraoral complaints before and after administration of Pilocarpine. Thirteen patients (25%) were classified as non-responders and the remaining 38 (75%) as responders. No statistically significant differences between the non-responders and responders were detected as regards general health parameters or intake of medicines with anticholinergic affect. As regards intraoral subjective complaints, no difference between the groups was found before Pilocarpine administration. After administration of Pilocarpine, complaints were significantly fewer among the responders (p<0.01). Both groups exhibited a significant decrease of intraoral symptoms after administration of Pilocarpine (responders P<0.001 and non-responders P<0.05) compared to baseline. For the whole group, more severe intraoral complaints were significantly associated with a lower SWS (P<0.05), but not a RWS, rate at baseline. It is concluded that a subgroup of Sj?gren patients do not respond to Pilocarpine stimulation. The clinical implications of this finding need further investigation.     

Contact allergy to dental materials in patients with orofacial complaints

Two groups of individuals were patch tested for frequencies of contact allergy to dental materials. The patient group with orofacial and distant symptoms and complaints referred to the Department of Prosthetic Dentistry were compared with an age-sex matched control group of individuals referred to the Department of Dermatology. The results did not show any differences in patch test reactions between the patient and control groups. The study did not prove any obvious associations between the patients' symptoms or objective findings and the patch test results.     

Formation of mucogingival defects associated with intraoral and perioral piercing: case reports

BACKGROUND: The authors provide clinical findings in five patients wearing oral jewelry to illustrate the risks of experiencing periodontal injury associated with body piercing involving intraoral and perioral sites. They also present a literature review of other adverse dental and medical consequences attributed to oral piercing. CASE DESCRIPTIONS: Five young adult patients with tongue and lip piercing sought dental care. Each patient exhibited some degree of gingival recession and mucogingival defects in proximity of their oral jewelry. Three of these patients had probing depths ranging from 5 to 8 millimeters in the affected areas. CLINICAL IMPLICATIONS: Intraoral and perioral jewelry may be associated with the development of significant mucogingival deformities. Because severe attachment loss can develop even when gingival recession is minimal, it is critical that patients with oral piercing routinely undergo comprehensive periodontal assessment. The authors urge clinicians to educate patients about the potential risks regarding the practice of oral piercing.