title: In vivo effects of dental casting alloys.
abstract: OBJECTIVE
  Corrosion products of different metallic alloys used in prosthetic dentistry often cause the development of a bluish-grey pigmentation of gingiva and oral mucosa. The aim of this study was to determine the content of metals in metallic pigmentations and evaluate the immune response to metals found in the oral cavity.
  
  
  METHODS
  The local tissue reactions were investigated clinically by electron microscopy and by energy dispersive x-ray microanalysis. An extensive anamnesis of the patients was recorded as well as earlier contacts with health care institutions. The immunological response to metallic components of dental alloys was evaluated in 34 patients by MELISA, a modified test for lymphocyte proliferation. In addition, cytokines in culture media were determined in 10 persons by the Human Inflammation Antibody Array.
  
  
  RESULTS
  Dense particles containing metals were found in the matrix among collagen fibrils and in close proximity of the lamina basalis of the gingival epithelium. Particles were also localized intracellularly in fibroblasts, macrophages, and endothelial cells. Metallic depositions consisted predominantly of silver accompanied by selenium and sulphur. Twenty five out of 34 patients revealed high lymphocyte reactivity (positive MELISA test) to one or more metal components of dental restorations. A correlation between the positivity in MELISA test and number of dental alloys in the oral cavity was also found. Twenty MELISA positive patients suffered from serious health problems (various allergies, autoimmune diseases, Parkinson's syndrome etc.). Nickel and inorganic mercury were the most common sensitizers in vitro. The cytokine assay revealed that mercury chloride activated predominantly TH2 lymphocytes, while nickel chloride activated mainly TH1 lymphocytes.
  
  
  CONCLUSIONS
  Metallic pigmentations in the oral cavity demonstrate a corrosion process and may pose a risk in immunologically susceptible patients.
authors.affiliation: Institute of Dental Research, 1st Medical Faculty, Charles University, General Faculty Hospital, Prague, Czech Republic. ZVenclikova@seznam.cz
authors.forename: Zora
authors.initials: Z
authors.lastname: Venclíková
authors.forename: Oldrich
authors.initials: O
authors.lastname: Benada
authors.forename: Jirina
authors.initials: J
authors.lastname: Bártová
authors.forename: Ludĕk
authors.initials: L
authors.lastname: Joska
authors.forename: Lubor
authors.initials: L
authors.lastname: Mrklas
authors.forename: Jarmila
authors.initials: J
authors.lastname: Procházková
authors.forename: Vera
authors.initials: V
authors.lastname: Stejskal
authors.forename: Stĕpán
authors.initials: S
authors.lastname: Podzimek
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003343:Corrosion; D003722:Dental Alloys / Q000009:adverse effects*; D004577:Electron Probe Microanalysis; D005260:Female; D005881:Gingiva / Q000187:drug effects / Q000473:pathology*; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology; D008213:Lymphocyte Activation; D008297:Male; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D009061:Mouth Mucosa / Q000187:drug effects / Q000473:pathology*; D010859:Pigmentation Disorders / Q000209:etiology*
chemical_list: D003722:Dental Alloys; D008670:Metals