Frequently Asked Questions: Parents Of Orthodontic Patients (tm) Part 4
Contents: Other Questions and Concerns Regarding Children and Dental Braces
- Special concerns the allergic child
- Special concerns for children with spina bifida
- "Recycling" of orthodontic materials from one persons mouth to another persons mouth
- All about: allergies to orthodontic wires
- allergies to orthodontic rubber bands
- sterilization of orthodontic products
- TMJ damage during orthodontic procedured
- Any concern about dental x-rays
- My child has lots of allergies. Is there any
special concerns when the child comes in for orthodontic treatment?
There are always special concerns with an allergic child, so you will need to discuss your child's allergies with your orthodontist. The child can be allergic to something in the orthodontist's office, or allergic to the orthodontic materials.
There are two kinds of allergies to orthodontic products: allergies to nickel chrome and copper and allergies to latex. Allergies to nickel, chromium, or copper tend to be fairly common, but generally not very serious. Latex allergy seems to be less common but can be life threatening. Further details about latex allergy, and nickel, chrome and copper allergy are given later in this document. If you are worried about allergic reactions your orthodontist can provide your child with latex, nickel, chrome and copper free orthodontic materials.
- My child has Spina Bifida. Is there
anything to fear?
Spina Bifida patients are especially vulnerable to class I latex allergy. Be sure to inform your orthodontist that your child has spina bifida before your child starts orthodontic treatment.
- I have heard that some orthodontists take
orthodontic materials out of one patients mouth and then "recycle"
the orthodontic materials to another patient's mouth.
How prevalent is "recycling" of orthodontic materials and is it
Reuse of orthodontic products is a continuing problem. It has been estimated that as many as one US orthodontist in three "recycles" some of their materials from one patients mouth to the next patients mouth. Brackets are removed from one patients mouth, sent out for cleaning and then bonded in another patients mouth.
At present there are no standards for the sterilization of brackets and no data to indicate whether "recycled" brackets are safe; a recent study of other dental materials and instruments indicates that some common sterilization procedures do not kill the AID's virus. Further a study from the University of Iowa indicates that "recycled" brackets do not meet the manufactures original specifications. Still, there are no governmental guidelines which prevent the use of "recycled" orthodontic materials in the US. European standard xxx precludes the use of recycled orthodontic materials in Europe, however.
- What can I do to prevent my child from getting orthodontic
materials which have been previously in someone elses mouth?
Talk to your orthodontist about your concerns. Most orthodontists will not use "recycled" materials (materials that have already been used in a previous patient's mouth) without your consent. Read carefully any consent forms that your orthodontist asks you to sign. If your orthodontist discloses that he uses recycled materials, he is usually not saying that he is recycling paper. Instead he is probably "recycling" orthodontic materials from one patients mouth to the next. In such a case, you need to be especially sure that your child is getting materials that are fresh and clean.
Also, be very careful with "managed care" plans. Many managed care plans are priced low assuming that the orthodontist will not have to buy any new orthodontic materials for your child. Instead, it is assumed that the orthodontist will reuse materials that he has taken out of another patient's mouth. If you have a "managed care" dental plan, talk very carefully with the plan administrator to make sure that the plan specify that the orthodontist use only fresh materials in your child's mouth.
If you cannot convince your plan administrator to pay for fresh materials for your child, then talk to your orthodontist about you paying for your orthodontic materials yourself. Some orthodontists will allow you to do that. As a worst case, ask your orthodontist if he would be willing to order new materials and charge them to your credit card.
- I have heard about allergies to nickel,
chromium and copper? How common are these allergies, what are the
symptoms, and how serious are they?
Nickel, copper and chromium allergy occurs in 1-3% of all orthodontic patients. The symptoms are generally an inflammation of the mouth, and possibly inflammation at points where metal such as a watchband comes in contact with your child's skin.
It has been found that patients sometimes develop sensitivity to nickel, chrome or copper during the orthodontic treatments. Fortunately, a recent article, Contact Dermatitis 30(1994) 210. suggests that the effects are largely reversed when the orthodontist switches to nickel, copper or chrome free materials. If you are concerned about nickel, chrome or copper allergies, talk to your orthodontist.
- I have heard about latex allergy? How common
is it, and do I have anything to fear?
There are two kinds of latex allergies, a so called class IV allergy, which is not very serious, and a so called class I allergy, which can be life threatening. The class VI allergy causes a slight inflammation of the patients mouth, but it goes away after the latex is removed. Class IV latex allergy is fairly common, affecting perhaps 1% of the orthodontic patients.
The Class I allergy is much more insidious. Class I latex allergy is quite similar to penicillin allergy. A person might be exposed to latex and have no symptoms for years. Then the person might break out in a rash. Thereafter, the patient is permanently sensitive to latex. He or she might break into hives when exposed to a rubber glove or a condom. We have even heard of a case develop a severe case of latex allergy where a patient cannot walk into a hospital or doctors office without having a severe anaphylactic reaction.
Further information about latex allergy can be found at the University of Chicago medical information site.
The estimates of how common Class I latex allergies are varies considerably. We have seen estimates as high as a class I latex reaction in one a thousand patients, with about one in 40,000 have a life threatening reaction. Other workers have given much lower estimates. Some orthodontists have reported that they have never seen a case of class I latex allergy in 20 years of practice. Our best estimate is that latex allergy is very rare in orthodontic patients. However, there is a slim possibility that your child will have a class I allergic reaction to the latex in orthodontic rubber bands.
- What are the symptoms of Class I latex allergy
There can be several different symptoms. Some patients with class I latex allergy develop hives and/or swelling in their face and hands perhaps 20 to 50 minutes after being exposed to latex. Other patients have difficulty breathing. Occasionally, there are no visible symptoms. IF YOUR CHILD BREAKS OUT INTO HIVES SOON AFTER CHANGING THEIR ORTHODONTIC RUBBER BANDS, OR IF THE CHILD DEVELOPS SWELLING IN THEIR HANDS OR FACE, OR IF THE CHILD HAS DIFFICULTY BREATHING, TAKE THE CHILD DIRECTLY TO AN URGENT CARE FACILITY OR A HOSPITAL EMERGENCY ROOM.
DO NOT WAIT HOPING THAT THE SYMPTOMS WILL GO AWAY.
- What can I do to avoid latex allergy?
Ask your orthodontist to use only Latex free materials.
- Are there any concerns about sterilization
of orthodontic materials?
Orthodontic materials can be sterilized in dry heat sterilizers, autoclaves, or a solution called "glutaraldehyde". A recent study shows that when used properly, dry heat sterilizers and autoclaves kill all known infectious agents. However, the glutaraldehyde solution does not always kill the Aids virus. The chances of your child catching Aids in the orthodontist's office are slim. Still, we recommend that you make sure that your orthodontist is using a dry heat sterilizer or autoclave on all of the orthodontist's instruments and orthodontic materials.
You do also have to be concerned whether the orthodontist is following the correct infection control protocols. The orthodontist should change gloves before examining every patient. The orthodontist's assistant should change their gloves too. Washing gloves is not good enough.
- Is there any chance that my child will develop
a temporomandibular joint (TMJ) problem from orthodontic treatment.
Yes and No. One of the first steps in standard orthodontic treatment is to take x-rays of your child's temporomandibular joint (the joint where your child's jaw connects to their skull) to screen for TMJ problems. If the initial screen does not reveal any weaknesses, then the orthodontist will proceed as normal. If any weaknesses are seen in the TMJ screening, the orthodontist will modify his treatment plan to make sure that no damage is done to your child's temporomandibular joint.
I am not aware of a single example where a TMJ problem developed during orthodontic treatment after all of the proper TMJ screening was done.
Unfortunately, some insurance companies and managed care plans are now refusing to pay for TMJ screening as part of orthodontic treatment. If the orthodontist does not do the TMJ screening, there is a small chance that your child will develop a TMJ problem during orthodontic treatment.
- It seems like my child is getting a lot of x-rays
during their treatment. Are all of those xrays needed?
Well, we think so. You orthodontist does xrays to make sure that his treatment plan is going to work properly and that you child will not develop any jaw or gum problems later on. The panoromic x-ray and the cepaholometric x-rays allow to look for weaknesses in the jaw or any shallow roots, so that you child can avoid a painful TMJ problem or other difficulty later on. The bitewing xrays look for caries (cavaties). If you child has a cavity under his or her braces, the cavity will grow during orthodontic treatment, and your child may get a tooth ache.
We would never have our treatment done by an orthodontist who does not do the xrays. It is just looking for trouble to avoid them.
- Is there anything which can be done to minimize the x-ray
People sell xray shields to help minimize the xray exposure. The precision xray shield attaches to the orthodontists xray machine, and collimates the xrays so the xrays shine on on your childs teeth gums and cheeks and not elsewhere on their face. If you are concerned about this, talk to your orthodontist about using a xray shield.
The American Association of Pediatric Dentistry maintains a page on X-ray use and safety. Please check out their site for further information.