Walton Orthodontics Offers Teeth Whitening Special Value
Thats right, Teeth Whitening for a short time only! Walton Orthodontics is offering a Teeth Whitening system for only $195. That includes both upper and lower arches. It also includes the Teeth Whitening trays.
We will schedule you to come into our Alpharetta Office for teeth impressions from which we will fabricate your custom teeth whitening bleaching trays. We use only the finest take-home Teeth Whitening system: Nite White® from Discus Dental. To take advantage of this Special Offer mention the code "Smile" to our receptionist or enter it in the form after clicking the '5 Smiling Faces' image below.
Read more on Atlanta-Alpharetta Teeth Whitening-Bleaching $195…
An Evidenced Based Article
Do Braces Cause An Increased Sensitivity to Nickel?
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The popularity of body piercing in today's generation of orthodontic aged patients can mean that many of these patients may have already been sensitized to nickel by the time they see an orthodontist. Though, body piercing is not the subject of this article, it must be noted that that much of the metal used in jewelry contains nickel. You might ask, "what does nickel have to do with orthodontics?" Nickel is a metallic element used in many of the "high tech", ultra-flexible wires, auxiliaries, and stainless steel appliances used in orthodontic practice today, including the braces themselves. Nickel is known to cause more cases of allergic contact dermatitis than all other metals combined.[1] Most cases of nickel contact dermatitis are the result of direct contact from jewelry, clothes, watches, and glasses. Nickel is present in a large number of commonly used objects and can therefore cause contact dermatitis.
There has been a lot of research done on nickel hypersensitivity over the years. A Recent study in the American Journal of Orthodontics & Dentofacial Orthopedics set out to determine the prevalence of nickel hypersensitivity in orthodontic patients and compare it with the prevalence in the general population. A meta-analysis was performed on all previous valid studies to come up with a consensus view or recommendation.
How Does Nickel Cause Allergic Reactions?
Allergic reactions occur when the immune system reacts adversely to a foreign substance (antigen). Nickel induces a contact dermatitis, which is a Type IV delayed hypersensitivity immune response.[2] There are 2 phases to this process. The sensitization phase occurs the instant the allergen (nickel) enters the body and causes a response. The elicitation phase occurs after the body is re-exposed to the antigen (nickel) a second time which causes the appearance of the full clinical manifestations. The initial exposure usually does not elicit symptoms, but subsequent contact with the antigen is usually enough to cause a more visible reaction.
Occurrence of Nickel Allergy: Who Is At Risk? What are the Symptoms?
The percentage of nickel in orthodontic appliances ranges from 8% (in stainless steel) to more than 50% (in nickel-titanium alloys).[3-5] Estimates are that 4.5% to 28.5% of the total population are sensitized to nickel.[6-9] Nickel hypersensitivity is more prevalent in females than in males by a factor of 10 to 1. [6]This disproportionate hypersensitivity in females is thought to be related to their more frequent exposure to and contact with detergents, jewelry, earrings, and other metal objects such as watches, metal buttons, and buckles. For males, nickel hypersensitivity is related more to occupational exposure for example in industries where nickel is used as a raw material.[7,10,11]
Another study reported that oral contact with nickel in normal, non-sensitized individuals may actually cause those individuals to become more resistant to nickel allergy.[12]Sensitization to nickel is thought to be increased by mechanical irritation, skin maceration, or oral mucosal injury, all of which can occur in orthodontic practice.
Symptoms of nickel allergy include development of an allergic dermatitis and/or lesions of contact stomatitis which can be highly variable in nature and at times barely visible.[13] Itching is not usually a common symptom and outside the mouth reactions (most commonly associated with headgear wear) are more common than inside the mouth reactions.
Diagnosis of Nickel Allergy
Nickel hypersensitivity induced contact dermatitis is confirmed through the use of a patch test in which small amounts of allergens are applied to the skin for a period of time. The dermatologist then measures the intensity of the skin's reaction. A patch test score of +4 (the most severe of reactions) is characterized by the presence of erythema, edema, papules, and vesicles at the test site while a score of +2 presents in only erythema which is a much less intense allergic response. An erythematous allergic reaction is depicted below.
Correct diagnosis of nickel hypersensitivity is important. The following patient medical history would suggest a diagnosis of nickel allergy:
- a previous allergic response after wearing earrings or other metal item
- appearance of allergy symptoms following insertion of orthodontic components containing nickel
- extra-oral (outside the mouth) rash adjacent to headgear arms
It is very important to eliminate lesions associated with other causes:
- herpetic stomatitis
- candidiasis
- ulcers due to mechanical irritation
- allergies to other materials such as acrylic
Recommendations For Nickel Sensitive Patients
As mentioned previously, many orthodontic components contain nickel alloys. Stainless steel contains approximately 8% nickel, while nickel titanium archwires contain approximately 50% or more nickel. It is important to note that most research has determined that all intra-oral orthodontic components made of stainless steel are safe to use in nickel hypersensitive patients because the molecular structure of stainless steel prevents the release of nickel and renders it
unreactive.[14] However, a nickel-free alternative to stainless steel brackets are available in the following forms:
- ceramic brackets
- polycarbonate or plastic brackets
- titanium brackets
- gold-plated brackets
Stainless steel orthodontic archwires are also considered safe in nickel sensitive patients. On the other hand, many high technology ultra-flexible nickel-titanium wires used in orthodontics today should be avoided in nickel sensitive patients. Alternate wires such as twist-o-flex, TMA, pure titanium, and gold-plated can be used without risk.
If a patient experiences a positive nickel sensitivity (positive patch test) reaction during orthodontic treatment it is recommended that all intraoral and/or extraoral appliances (braces) containing nickel be removed until the adverse reaction subsides. Once the lesions have healed, nickel-free appliances can be placed.
Conclusion
The popularity of body piercing in the teenage population will no doubt cause the sensitization of more orthodontic aged patients to the effects of nickel allergy in the coming years. Severe intra-oral reactions of nickel allergy are very rare, however, extra-oral reactions are more common. In the final analysis, research has concluded that orthodontic treatment is not associated with an increased occurrence of nickel sensitivity unless patients had his or her ears pierced.
Walton Orthodontics – Alpharetta Orthodontist
Please let us know if you have any questions by clicking the link above.
References
1 Fisher AA. Contact dermatitis. Philadelphia: Lea & Febiger; 1973; pd. 2.
2 Aaolu G, Arun T, Izgü B, Yarat A. Nickel and chromium levels in the saliva and serum of patients with fixed orthodontic appliances. Angle Orthod 2001; 71: 375–79.
3. Park HY, Shearer TR. In vitro release of nickel and chromium from stimulated orthodontic appliances. Am J Orthod. 1983; 84:156–159.
4. Brantley WA. Orthodontic wires. In: Brantley WA, Eliades T, eds. Orthodontic Materials: Scientific and Clinical Aspects. Stuttgart, Germany: Thieme; 2001: 77–103.
5. Eliades T, Athanasiou AE. In vivo aging of orthodontic alloys: implications for corrosion potential, nickel release, and biocompatibility. Angle Orthod. 2002; 72:222–237.
6. Peltonen L. Nickel sensitivity in the general population. Contact Dermat. 1979; 5:27–32.
7. Blanco-Dalmau L, Carrasquillo-Alberty H, Silva-Parra J. A study of nickel allergy. J Prosthet Dent. 1984; 52:116–119.
8. Janson GRP, Dainesi EA, Pereira ACJ, Pinzan A. Clinical evaluation of nickel hypersensitivity reaction in patients under orthodontic treatment. Ortodontia. 1994; 27:31–37.
9. Schäfer T, Böhler E, Ruhdorfer S, Weigl L, Wessner D, Filipiak B, Wichmann HE, Ring J. Epidemiology of contact allergy in adults. Allergy. 2001; 56:1192–1196.
10. Wilkinson JD, Rycroft RJG. Contact dermatitis. In: Champion RH, Burton JL, Ebling FJG. Textbook of Dermatology. 5th ed. Oxford: Blackwell Scientific Publications; 1992: 648– 729.
11. Gawkrodger DJ, Vestry JP, Wong WK, Buxton PK. Contact clinic survey of nickel-sensitive subjects. Contact Dermat. 1986; 14:165–169.
12 Vreeburg K J, de Groot K, von Bloomberg M, Scheper R. Induction of immunological tolerance by oral administration of nickel and chromium. J Dent Res 1984; 63: 124–8.
13. North American Contact Dermatitis Group. Epidemiology of contact dermatitis. Arch Dermatol. 1973; 108:537
14. Toms AP. The corrosion of orthodontic wire. Eur J Orthod. 1988; 10:87–97.
Evidenced Based Article
This article is a summary of the latest research presented in the Journal of the American Dental Association (JADA) and a report published by the ADA Council on Scientific Affairscontaining recommendations for treatment of dental patients who are taking oral bisphosphonates.
What is Osteoporosis?
Osteoporosis (os-tee-oh-puh-roh-sis) is a disorder of the skeletal system which severely weakens bones and significantly increases the chance of bone fractures, especially of the hip, spine and wrist. Bone density is decreased by osteoporosis. A person's bone density is determined by several factors including heredity, hormones, lifestyle, diet, physical activity and certain medications. Also, bone density and bone strength is usually decreased as people age.
Approximately 10 million Americans are affected by osteoporosis, of those, 8 million are women. An additional 34 million are at risk of developing the condition. More women are affected by this disease than cancer, stroke or heart disease combined. Certain prescription drugs called "oral bisphosphonates" (bis-fos-foh-nates) are used to treat these patients including well known brand name medications such as Fosamax, Actonel, and Boniva.[1] The table below lists brand name, manufacturer and generic name for both oral and intravenous bisphosphonates. (Click on table to enlarge)
Osteoporosis And Bone Fractures: Who Is At Risk?
Bone fractures as a result of osteoporosis are serious. Fractures of the spinal column and hip can be life-threatening and are the most common problems associated with osteoporosis.[2] An average of 24 percent of patients 50 years and older with hip fractures die within one year of their injury as reported by National Osteoporosis Foundation. The foudation also reports that 1 in 2 women and 1 in 4 men over the age of 50 will have an osteoporosis-related fracture in their lifetime. Of the patients that experience a hip fracture, 1 in 5 will end up in a nursing home and only 15 percent of these patients are able to walk across a room without help six months after. The risk of hip fractures in women is equal to their combined risk of developing breast and ovarian cancers.[1]
Estimates are that bisphosphonates (alendronate) can reduces the risk of hip fractures in patients with osteoporosis by 40 percent. Therefore, this drug could possibly prevent more than 100,000 hip fractures and thousands of deaths each year[3] Obviously, there are risks associated osteoporosis and the benefits of oral bisphosphonate therapy are well documented, patients should never stop taking these medications without thoroughly discussing the benefits and risks with their physician, dentist or othodontist.
Bisphosphonates And Osteonecrosis Of The Jaws
Complications of the jaw have been linked to the use of bisphosphonates in the scientific literature.[4-7] These drugs have been associated with the development of osteonecrosis of the jaws (ONJ) which is a serious, but uncommon, c
ondition that causes significant destruction of the jawbones. Osteonecrosis is caused by reduction, obstruction or inhibition of the local blood supply to the bone causing it to die or undergo necrosis. Many patients who take bisphosphonates to treat or prevent osteoporosis have become confused and alarmed by news reports of these associated problems. The majority of reported Bisphosphonate Associated Osteonecrosis (BON) of the jaws cases have occurred in patients with cancer who receive therapy with intravenous bisphosphonates, which absorb differently from oral bisphosphonates. It is important to note, that even though the risk for developing BON remains uncertain, the current scientific literature on cases reported so far, "…a patient's risk for developing BON is minute with oral bisphosphonate therapy as compared to intravenous bisphosphonate therapy in cancer patients." [8]
Other Risk Factors and Clinical Symptoms
BON can occur spontaneously, but is more commonly associated with the following medical and dental conditions:
- Invasive dental procedures or conditions that increase the risk of for bone trauma like dental extractions.[6-7]
- Patients 65 years and older
- Periodontists (Gum Disease)
- Corticosteroid use for chronic conditions
- Prolonged use of bisphosphonates (more than 2 years)
- Smoking
- Diabetes
Clinical Appearance And Symptoms Of Osteonecrosis Of The Jaws
You should tell your dentist immediately if you have any of the following symptoms, now or in the months following treatment:
- Feeling of numbness, heaviness or other sensations in your jaw
- Pain in your jaw
- Swelling of your jaw
- Loose teeth
- Drainage
- Exposed bone (See image above)
Should I stop taking the oral bisphosphonates?
The benefits of bisphosphonates for the treatment of osteoporosis and its complications are well documented. Research has not shown that stopping use of these drugs will decrease your risk for developing osteonecrosis. You should talk with your physician if you have any questions.
General Recommendations
Routine dental treatment should not generally be modified because of the use of oral biphosphonates (Consult your physician and dentist).
Routine dental examinations are a must. Patients who are prescribed oral bisphosphonates and are not receiving regular dental care would likely benefit from a comprehensive oral examination before or early during their bisphosphonate therapy.
All patients taking oral biphosphonates should be informed that:
- Oral bisphosphonate use places them at very low risk for developing BON. The actual incidence is unknown with estimates ranging from zero to 1 one in 2,260 cases for oral bisphosphonate users. The low risk for developing BON may be minimized but not eliminated.
- An oral health program consisting of sound oral hygiene practices and regular dental care may be the optimal approach for lowering the risk for developing BON.
- There is no validated diagnostic technique currently available to determine if patients are at increased risk for developing BON.
- Discontinuing bisphosphonate therapy may not eliminate any risk for developing BON.
Orthodontics
Although there are no documented studies examining the effects of bisphosphonates on orthodontic treatment, some case studies have witnessed inhibited tooth movement in patients taking bisphosphonates.[9-10]
Walton Orthodontics – Alpharetta Orthodontics
Alpharetta, GA
References
1National Osteoporosis Foundation. Osteoporosis Fast Facts. Available at: http://www.nof.org/osteoporosis/diseasefacts.htm . Accessed Mar 27, 2007.
2Riggs BL, Melton LJ 3rd. The worldwide problem of osteoporosis: insights afforded by epidemiology.Bone. 1995 Nov;17(5 Suppl):505S-511S.
3 Nguyen ND, Eisman JA, Nguyen TV. Anti-hip fracture efficacy of biophosphonates: a Bayesian analysis of clinical trials. J Bone Miner Res. 2006 Feb;21(2):340-9.
4 Migliorati CA, Casiglia J, Epstein J, Jacobsen PL, Siegel MA, Woo S-K. Managing the care of patients with bisphosphonate-associated osteonecrosis. JADA 2005;136:1658-68.
5 Marx RE. Pamidronate (Aredia) and zoledronic acid (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115-7.
6 Migliorati CA. Bisphosphonates and oral cavity avascular bone necrosis. J Clin Oncol 2003;21:4253-4.
7 Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: A review of 63 cases. J Oral Maxillofac Surg 2004;62:527-34.
8 Dental Management of Patients Receiving Oral Bisphosphonate Therapy―Expert Panel Recommendations:Report of the Council on Scientific Affairs; American Dental Association;July, 2008
9 Schwartz JE. Ask us: Some drugs affect tooth movement. Am J Orthod Dentofacial Orthop 2005;127:644.
10 Rinchuse DJ, Rinchuse DJ, Sosovicka MF, Robison JM, Pendleton R. Orthodontic treatment of patients using bisphosphonates: A report of 2 cases. Am J Orthod Dentofacial Orthop 2007;131:321-6.
