Nickel has been indicated as a biological sensitizer and being capable of initiating short and long term reactions (Type IV immune response). However, research and case studies in the literature are rare to non-existent to identify case studies that indicated any physiologic response of such magnitude as to be life threatening and require emergency room assistance. The credibility of the timeline as presented by the mother included a scenario from the time of orthodon-tic bracket placement to the squad run to the hospital. Photographs were taken of the face and torso both dorsal and ventral that provided evidence of the sever-ity of the cutaneous changes of her son. The use of a Naranjo nomogram test 19 was applied to the information gained about the patient. The scor-ing was a plus 7 score indicating strong probability of the metal brackets as the initiator of the allergic response. This indicates a strong causal relationship of the indictment of nickel as the sensitizer. The pictures that were taken at the hospital of their child were time stamped and accepted as strong evidence as to the credibility of the description of the allergy response. 3. Saglam AM, Baysal V, Ceylan AM. Nickel and cobalt hypersensitiv-ity reaction before and after orthodontic therapy in children. J Contemp Dent Pract. 2004 Nov 15;5(4):79-90. PMID: 15558093 4. Rahilly G, Price N.J Nickel allergy and orthodontics Orthod. 2003 Jun;30(2):171-4. 5. Nickel hypersensitivity reaction before, during, and after orthodontic therapy. Janson GR, Dainesi EA, Consolaro A, Wood-side DG, de Freitas MR.Am J Orthod Dentofacial Orthop. 1998 Jun;113(6):655-60. 6. Jensen CS, Lisby S, Baadsgaard 0, Byrialsen K, Menne Release of nickel ions from stainless steel alloys used in dental braces and their patch test reactivity in nickel-sensitive individuals. T.Contact Dermatitis. 2003 Jun;48{6):300-4. 7. Noble J, Ahing SI,Raraiskos NE, Wiltshire WA.Nickel allergy and orthodontics, a review and report of two cases. Br Dent J. 2008 Mar 22;204(6):297-300. Review. 8. Kolokitha OE, Chatzistavrou E.A severe reaction to ni-containing orthodontic appliances. Angle Orthod. 2009 Jan;79(1):186-92. 9. Petoumenou E, Arndt M, Keilig L, Reimann S, Hoederath H, Eliades T, Jager A, Bourauel C.Nickel concentration in the saliva of patients with nickel-titanium orthodontic appliances. Am J Orthod Dentofacial Orthop. 2009 Jan; 135(1 ):59-65. 10. Ehrnrooth M, Kerosuo H.,Face and neck dermatitis from a stain-less steel orthodontic appliance. Angle Orthod. 2009 Nov;79(6):1194-6. 11. Kuhta M, Paulin D, Slaj M, Varga S, Lapter-Varga M, Slaj M.Type of archwire and level of acidity: effects on the release of metal ions from orthodontic appliances. Angle Orthod. 2009 Jan;79(1):102-10. 12. Pantuzo MC, Zen6bio EG, de Andrade Marigo H, Zen6bio MA. Hypersensitivity to conventional and to nickel-free orthodontic brackets. , Orthodontic treatment possibilities of allergic patients, Braz Oral Res. 2007 Oct-Dec;21(4):298-302. 13. Pazzini CA, Pereira LJ, Marques LS, Generoso R, de Oliveira G Jr.Allergy to nickel in orthodontic patients: clinical and histopathologic evaluation. Gen Dent. 2010 Jan-Feb;58(1):58-61. Review. 14. Thompson A. An overview of nickel-titanium alloys used in dentistry. Int Endod J. 2000 JuI;33(4):297-310. Review. 15. Kerosuo H, Kanerva L.Systemic ,Contact dermatitis caused by nickel in a stainless steel orthodontic appliance.Contact Dermati-tis. 1997 Feb;36(2):112-3. 16. Al-VVaheidi EM.Allergic reaction to nickel orthodontic wires: a case report. Quintessence Int. 1995 Jun;26(6):385-7. 17. Dunlap CL, Vincent SK, Barker BF.Allergic reaction to orthodontic wire: report of case. J Am Dent Assoc. 1989 Apr;118(4):449-50. 18. Jensen CS, Lisby S, Baadsgaard 0, Byrialsen K, Menne T.Release of nickel ions from stainless steel alloys used in dental braces and their patch test reactivity in nickel-sensitive individuals. Contact Dermatitis. 2003 Jun;48(6):300-4. 19. Naranjo et.al. Clin Pharmocol Ther. 1981 Aug;30(2):239-45 20. Fisher AA. Contact dermatitis. Philadelphia: Lea & Febiger; pd 2 CONCLUSION This case study of an unusual allergy response to nickel content in orthodontic appliances presents a strong reason why the health history is so important. Additional questioning of the patient or the family about allergies may elicit additional information not recorded in the health history. This is a step not to be overlooked. There are a number of biological and histological sensitizers that can cause short and long term reactions (Type IV immune response). Nickel is a metal (atomic weight number 28) that has sometimes been indicated as a foreign substance to the body that can cause allergic reactions. It is important to be aware of the substances used in orthodontics that can cause allergic responses. The health history is a very important part of regis-tration of a dental patient. The materials used in orthodontic treatment can be suspect. A comprehensive evaluation of each patient can be of significance and its importance can’t be overlooked. The response of this patient to nickel hypersensitiv-ity 20 has altered our office protocol in how we regard the patient’s medical history. We are more aggressive in exploring each patient and the family background with regard to allergies and past allergic responses. REFERENCES 1. Park HY, Schearer TR. In vitro release of nickel and chromium from stimulated orthodontic appliances. Am J Orthod. 1983; 84:156-159 2. Current Products and Practice, Nickel allergy and orthodontics, Rahilly, G. Price, N. Journal of Orthodontics, Vol. 30, 2003, 171-174 38 Winter 2016 JAOS
Journal of the American Orthodontic Society Winter 2016: Page 38
