title: Nickel allergy associated with a transpalatal arch appliance.
abstract: OBJECTIVE
  The purpose of this article was to present a case in which nickel sensitivity of the oral mucosa was demonstrated during the use of a transpalatal arch appliance (TPA).
  
  
  METHODS
  An 11-year 8-month old post-menarchal female presented for orthodontic treatment with Class III buccal segments and bilateral open bite. The treatment plan consisted of placing a rapid palatal expansion appliance (RPE) and a TPA with soldered lateral tongue cribs, in order to eliminate her tongue thrusting habit. 8 months into treatment, the gingiva of the right posterior segment began to hypertrophy, particularly around the bands of the right first molar and premolar. A patch test of 5% nickel sulfate indicated a positive reaction to nickel. The treatment was finished without the use of nickel titanium wires and the mucosa reaction resolved. The patient had had her ear pierced at age 2 days old, which was 11 years before orthodontic treatment was initiated. The literature shows that this exposure may have been the sensitizing event.
  
  
  CONCLUSIONS
  While the nickel sensitive patient may not present an extreme medical risk, the orthodontist must be aware of the problem and the likelihood of treating patients with this condition. It appears that the reaction may vary from patient to patient. The practitioner should possess a basic understanding of the occurrence rate, sex predilection, and signs and symptoms of allergy to nickel, and should be familiar with the best possible alternative modes of treatment, to provide the safest, most effective care possible in these cases. Practitioners should be aware that symptoms of nickel allergy may closely mimic those of typical gingival changes during orthodontic treatment of circumpubertal children.
authors.affiliation: Department of Orthodontics, University of Oklahoma College of Dentistry, Oklahoma City, OK, USA. amy-counts@ouhsc.edu
authors.forename: Amy L
authors.initials: AL
authors.lastname: Counts
authors.forename: Marlo A
authors.initials: MA
authors.lastname: Miller
authors.forename: Milan L
authors.initials: ML
authors.lastname: Khakhria
authors.forename: Steven
authors.initials: S
authors.lastname: Strange
mesh_terms: D002648:Child; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis*; D005260:Female; D005886:Gingival Hypertrophy / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D008313:Malocclusion, Angle Class III / Q000628:therapy*; D009532:Nickel / Q000009:adverse effects*; D024343:Open Bite / Q000628:therapy*; D009967:Orthodontic Appliances; D010155:Palatal Expansion Technique / Q000295:instrumentation*; D012307:Risk Factors; D013280:Stomatitis / Q000139:chemically induced*; D014025:Titanium / Q000009:adverse effects
chemical_list: C040654:titanium nickelide; D009532:Nickel; D014025:Titanium