How to make sure your orthodontists knows the symptoms of metals allergies and how to treat allergic patients.

Your child could be allergic to their braces

Many people do not know it, but your child could be allergic to their braces. A study of patients with pierced ears, published in the AJO (an orthodontic journal) said that 30% of the patients tested had some allergy to some component in their braces. A recent Swedish study in the Journal of Contact Dermatitis (a medical journal) put the incidence at 40%. Most reactions are minor. Inflammation around the appliance. Skin rashes. The symptoms usually go away when the allergin is removed. However the symptoms are annoying.

The one major exception is a latex allergy. Latex allergy is a progressive allergy. It gets worse with repeated exposure, and can lead to potentially fatal, anaphylactic reactions.

If you are worried about allergies, you should discuss your concerns with your orthodontist before you begin treatment. It is important that your orthodontist know the symptoms of metal allergies and know how to treat them. Your orthodontist should be able to recommend allergy testing and answer your questions about allergies. His staff should also be trained to recognize the symptoms of metals allergies. If your orthodontist cannot answer your questions, find another orthodontist.

Symptoms Of Metals Allergies

According to Dr Joseph Fowler “Dental patients sensitive to the metals of the prostheses in their mouths may develop three types of reactions: oral lesions like lichen planus, oral symptoms such as burning mouth syndrome that have non-specific lesions or no lesions, or systemic reactions such as a dermatitis. Other non-specific reactions including fatigue, headache and malaise have also been reported. ”

Allergic reactions are detected by the staff in the orthodontic office so it is important that the staff knows what to look for.

It is normal for your mouth to be sore when your braces are tightened. However, if the soreness lasts more than 2 days, you are likely to be allergic to something in your braces.

Another symptom is a rash around a watch or bracelet, or elsewhere around your body.

Metal’s allergies can also cause chronic fatigue syndrome, so if you suddenly get tired after getting braces, suspect a metals allergy.

Latex allergy is more insidious. There are usually only minor reactions. Perhaps a skin rash or a sore mouth. Then the allergy gets worse. If you suspect that you might have a latex allergy, be sure to tell your orthodontist.

Allergy testing

If you are unsure about allergies, then I recommend that you undergo allergy testing before you start orthodontic treatment. Your orthodontists should be able to recommend appropriate tests. I recommend that susceptible patients be tested for allergies to metals: nickel, chromium, cobalt, silver, gold. Also test for methylmethacrylate and cyanoacrylate (glues used to bond brackets) and 2-hydroxyethyl methacrylate and ethylene glycol dimethacrylate (components in retainers).

Years ago people always did the testing with a patch test. Now there is a newer blood test, called the “lymphocyte transformation test” which is more accurate, but more expensive than the patch test.

According to the Swedish study, many patients develop metals allergies after treatment, so I recommend that you get tested a year into treatment to see if you have developed an allergy to your braces.

Wilson’s Disease A Potential Fatal Reaction To Braces

There is one other aspect of this which I hesitate to bring up, but there is a rare condition called Wilson’s disease, which could cause a fatal reaction to certain orthodontic wires. Wilson’s disease is a defect in copper metabolism which can cause liver damage or death. It is relatively rare. It has been estimated that only 1 child in 30,000 has it, but still if it is your child it is pretty serious. You child might need a liver transplant and could die if the disease is not treated. For more information about Wilson’s Disease see the The Wilson’s Disease Association or The United States National Institute of Health

Most orthodontic companies avoid the use of copper in their products because of the possible fatal reactions. However, copper does work better in certain wires, and as a braze in brackets so some companies still use it. The companies claim that there is no copper released from the wires, so it is safe.

When I was in the orthodontic business, someone asked me to sell wires with copper. However, when we tested them we found that there was leaching of copper during toothbrushing and in orange juice. Therefore I never sold wires with copper.

Unfortunately, many orthodontists do not know about Wilson’s disease or potentially fatal reactions to copper, and so they still use wires with copper. My advice is to ask the orthodontist about copper, and tell him that to not use copper wires on your child.

What Should a patient or a parent do?

There are a few thing that a patient or parent can do to avoid possible allergic reactions:

  • Discuss your allergic concerns with your orthodontist. He should be able to tell you about the risks and what to look for to see if your child is allergic to his or her braces.
  • Consider allergy testing if you have an allergic child
  • Keep on the lookout for allergic reactions: a sore mouth, oral lesions, skin rashes, and general fatigue

Whatever happens, be sure to talk it over with your orthodontist.

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