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Dentists’ concern over gold allergy

By Anne Sarzin

The Dean of Sydney University’s Dentistry Faculty, Professor
Iven Klineberg, says the dental profession is increasingly
concerned over allergic reactions to dental materials, especially
gold fillings.

Professor Klineberg, who was President of the Third
International Symposium on Titanium in Dentistry held in Leura
recently, said his overseas colleagues had presented major
research into allergies to metals, including gold.

Professor Arnie Hensten-Pettersen of the Scandinavian Institute
of Dental Materials, revealed that gold can cause inflammation of
the mouth tissues and severe dermatological reactions, such as

Although skin tests can determine whether a patient has a gold
allergy, patch testing is expensive and can cause allergies in
three to five per cent of people tested.

“Who would have thought gold was likely to be an
allergy-inducing metal,” Professor Klineberg said. “We always
thought gold was the blandest of metals.”

The problem of dental gold causing allergies surfaced in
Scandinavia. Patients reported a burning mouth syndrome, and
generalised rashes, and many allergy cases have been documented
in southern Sweden.

Sophisticated dental research techniques can identify the causes
of allergies. “We now recognise metal allergies,” Professor
Klineberg said. “Alloys, particularly involving titanium and
nickel, are still used for implant purposes and the consequences
may be allergies and other bodily reactions.”

Dr Toshiko Mori,the head of the Dentistry Faculty’s Biomaterials
Research Unit, who organised the Symposium, said that allergies
might result from “bad” gold or gold alloys rather than pure

Most metals used in dentistry-mercury, silver, tin, copper,
nickel, cobalt, chromium, palladium, indium, gallium, manganese
and aluminium-have been implicated in allergy reactions.

Patients susceptible to allergies often experienced reactions to
more than one metal. The handling, processing and polishing of
dental devices could further contaminate materials, provoking
more serious allergies.

Professor Klineberg said even an “exquisitely” biocompatible
metal, such as titanium, could be corrupted by handling.

Allergic reactions to nickel, used in orthodontics as a
component of titanium wires, were more common in people with
pierced ears, nose or other pierced body parts. Patients with
developed local and systemic allergic reactions to nickel rings
were especially susceptible to dental crowns and bridges
containing nickel.

Headgear appliances with nickel-based wires that touch the lips
could trigger allergic reactions, especially in young patients.

Dr Mori said that nickel was used as an alloy in dentistry for
its memory capability or “shaped memory”, which metals such as
titanium did not have on their own. When titanium nickel
orthodontic wires were placed in the mouth, body temperature
enabled the metal to recover its original shape.

“The problems of the alloys are now becoming more obvious,” she
said. “We must develop better materials that are kinder to the
body. We must pursue improved biocompatible materials. Higher
strengths of pure titanium are preferable to using dangerous
alloys. Allergic reactions are very distressing for the patient.”

Professor Ken Anusavice of Florida University said dentists were
concerned about the release of irons from the metals in the
mouth. "Materials are evolving so fast that laboratory testing to
ensure their safety has not proceeded at the same pace,"he said.

The Fourth International Symposium will be held in Geneva,
Switzerland, in 1998 and the President-elect, Professor
Jean-Marc Meyer of Geneva University will promote the
international collaboration that was the cornerstone of the Leura
Symposium .

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