title: Allergies induced by orthodontic alloys: incidence and impact on treatment. Results of a survey in private orthodontic offices in the Federal State of Hesse, Germany.
abstract: BACKGROUND
  The incidence of allergies in general is on the increase. An allergic reaction can also occur during any dental and orthodontic treatment. However, the allergic potential of orthodontic appliances is frequently overestimated.
  
  
  METHODS
  The incidence of suspected allergic reactions during fixed appliance therapy in 68 orthodontic offices in the German State of Hesse was determined by questionnaire at approximately 0.3% of the 60,000 patients covered.
  
  
  RESULTS
  More extraoral (45%) than intraoral (17%) skin changes were registered, with both intraoral and extraoral changes being observed in 38%. In 53% of the affected cases the therapy was adapted to nickel-free materials, whereas it was continued as planned after a brief recovery period in 33%. The treatment was discontinued in 14% of the affected patients, corresponding to one in every 3150. The individual tolerance can often be tested by inserting one bracket or one band. In addition, early orthodontic treatment seems to promote a certain immune tolerance, especially towards extraoral nickel contacts. However, if a patient is known to have a nickel allergy, materials containing nickel should be renounced on principle in the orthodontic appliances.
  
  
  CONCLUSIONS
  Skin changes occurring in the course of orthodontic treatment should be examined and verified if necessary by a dermatologist. Gold plating and other coatings (titanium nitride) of the metal elements even encourage corrosion after a brief protection period. Soldering should be avoided.
authors.affiliation: Department of Orthodontics, University of Frankfurt am Main, Germany. g.schuster@em.uni-frankfurt.de
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schuster
authors.forename: Ralf
authors.initials: R
authors.lastname: Reichle
authors.forename: Radha Ranei
authors.initials: RR
authors.lastname: Bauer
authors.forename: Peter M
authors.initials: PM
authors.lastname: Schopf
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D003430:Cross-Sectional Studies; D003722:Dental Alloys / Q000009:adverse effects*; D017449:Dermatitis, Allergic Contact / Q000453:epidemiology* / Q000276:immunology; D005148:Facial Dermatoses / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D005858:Germany; D006306:Health Surveys; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology* / Q000276:immunology; D007108:Immune Tolerance / Q000276:immunology; D015994:Incidence; D008297:Male; D009532:Nickel / Q000009:adverse effects* / Q000276:immunology; D009967:Orthodontic Appliances / Q000009:adverse effects*; D012306:Risk; D013280:Stomatitis / Q000453:epidemiology* / Q000276:immunology
chemical_list: D003722:Dental Alloys; D009532:Nickel