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Nickel allergy in a Swedish adolescent population and its relation to orthodontic treatment and lifestyle factors
Umeå University, Faculty of Medicine, Odontology.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Nickel stands out as the main cause of contact allergy in both children and adults, which has given rise to concern and the introduction of regulations by official bodies. Today´s youths are frequently exposed to body piercing and orthodontic treatment. Changes in youth lifestyle practices are also likely to influence nickel exposure and thus, the occurrence of nickel allergy. However, against patient and parental concern regarding nickel exposure to orthodontic appliances, often evoked by allergies following piercing, stand results from studies indicating that early orthodontic appliance treatment may reduce, rather than increase, prevalence of nickel allergy; a finding that has been suggested to result from tolerance induction by early exposure to nickel via the oral route.

The objective of the present thesis was to investigate the association between nickel allergy and exposure to different orthodontic appliances and lifestyle, in particular piercing, as well as to study nickel release from orthodontic appliances into the oral cavity. Furthermore, one objective was to establish baseline prevalence data of nickel allergy in a Swedish adolescent population.

Data was generated from a cross-sectional survey, in which about 6000 youths completed a questionnaire and almost 4500 of these were patch-tested for contact allergy. Information on exposure to orthodontic appliances was verified by dental records, whilst nickel content in saliva and dental biofilm was measured in a clinical study.

Questionnaire data demonstrated a reduced risk of nickel allergy when orthodontic treatment preceded piercing (OR 0.5; 95 % CI 0.3-0.8) and similar results were found for data verified from dental records, however statistical significance was lost when adjusting for background factors (OR 0.6, 95 % CI 0.4-1.0). Exposure to full fixed appliances with NiTi-containing alloys, as well as a pooled ‘high nickel-releasing’ appliance group prior to piercing correlated with a significantly reduced risk of nickel allergy and a trend towards a reduced risk with exposure duration. Nickel could also be found in significantly higher concentrations from dental plaque samples, but not saliva samples, in orthodontic patients who were well into treatment compared to patients who had not been exposed to orthodontic appliances. The effect was not found to be due to differences in estimated dietary nickel intake between the two groups.

Significantly more girls than boys (13.3 % versus 2.5 %) were found to be patch-test positive to nickel. Positive nickel tests were also most prevalent in occupational programmes and least prevalent in natural science programmes, indicating differences in lifestyle and exposure to nickel. Dropout from testing was handled using a missing-value analysis. This internal validation showed that our results overestimated the occurrence of nickel allergy to a minor degree. More girls than boys reported piercing, vegetarian/vegan diet, and smoking practices, whereas an interesting shift in tattooing prevalence was observed with a larger proportion of girls reporting this practice compared to boys. Sex, number of piercings, smoking and orthodontic appliance treatment prior to piercing were found to influence weighted risk estimates of nickel allergy.

To conclude, although orthodontic patients are exposed to nickel intraorally, we found no increased risk of sensitising adolescents to nickel by the use of oral orthodontic appliances. On the contrary, early orthodontic treatment preceding piercing reduced the risk of nickel allergy by a factor of 1.5-2.0. This reduced risk appears to be associated with estimated nickel release of the appliance and duration of treatment, in all supporting a hypothesised induction of immunological tolerance via oral administration of nickel. Our study also showed a strong association between lifestyle and nickel allergy. Although there have been changes in lifestyle over time, as indicated by the strong shift in tattooing practices, no large change in nickel allergy prevalence was found compared with previous Swedish data. Our data will serve as a baseline for future studies of the effect of nickel exposure regulations, such as the Nickel Directive, and for studies of lifestyle changes and their effects on nickel allergy.

Place, publisher, year, edition, pages
Umeå: Odontologi , 2008. , 89 p.
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 104
Keyword [en]
adolescent, dental plaque, lifestyle, nickel, oral, orthodontic treatment, patch test, questionnaire, sensitisation, tolerance
National Category
Dentistry
Identifiers
URN: urn:nbn:se:umu:diva-1639ISBN: 978-91-7264-552-3 (print)OAI: oai:DiVA.org:umu-1639DiVA: diva2:141647
Public defence
2008-05-22, Sal B, Tandläkarhögskolan,9tr., Tandläkarhögskolan i Umeå, 901 85 Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2008-05-06 Created: 2008-05-06 Last updated: 2009-04-22Bibliographically approved
List of papers
1. Nickel allergy: prevalence in a population of Swedish youths from patch test and questionnaire data
Open this publication in new window or tab >>Nickel allergy: prevalence in a population of Swedish youths from patch test and questionnaire data
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2008 (English)In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 58, no 2, 80-87 p.Article in journal (Refereed) Published
Abstract [en]

Background: The prevalence of body piercing and orthodontic treatment has increased during recent decades. Such changes in lifestyle may influence the occurrence of nickel allergy.

Objectives: The aim of this study was to describe the prevalence of nickel allergy in a Swedish youth population.

Methods: In a cross-sectional survey, 6095 adolescents answered a questionnaire on their lifestyle and medical history, and 4439 consented to patch testing for contact allergy. Patch test results were adjusted for dropouts by a missing value analysis.

Results: The prevalence of self-reported dermatitis from contact with metal items was 14.8%. Patch testing showed nickel sensitization in 9.9% of the subjects, and in significantly more girls than boys, 13.3% versus 2.5%, respectively. Taking the dropout into account, the estimated true prevalence of nickel sensitivity evaluated by test reading at D4 is 11.8% in girls and 1.6% in boys.

Conclusions: The prevalence of nickel sensitization was higher for girls and slightly lower for boys compared with previous Swedish data. Self-reported information on metal dermatitis as an estimate of nickel allergy has low validity. When possible, missing value analysis should be performed to account for dropouts.

Place, publisher, year, edition, pages
Copenhagen: Munksgaard, 2008
Keyword
adolescent, lifestyle, missing value analysis, orthodontic treatment, patch test, questionnaire
National Category
Dermatology and Venereal Diseases Respiratory Medicine and Allergy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-21766 (URN)10.1111/j.1600-0536.2007.01257.x (DOI)18186740 (PubMedID)
Available from: 2009-04-20 Created: 2009-04-20 Last updated: 2017-12-13Bibliographically approved
2. Nickel in dental plaque and saliva in patients with and without orthodontic appliances.
Open this publication in new window or tab >>Nickel in dental plaque and saliva in patients with and without orthodontic appliances.
2006 (English)In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 28, no 3, 292-297 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to compare the content of nickel in the saliva and dental biofilm in young patients with and without orthodontic appliances. The possible influence of a dietary intake of nickel on recorded nickel levels was examined. Nickel content in unstimulated whole saliva and in dental plaque of 24 boys and girls (mean age 14.8 years) with intraoral fixed orthodontic appliances was compared with 24 adolescents without such an appliance. Sample collection was set up to exclude nickel contamination. Diet intake was recorded for the preceding 48 hours to account for the influence of recent nickel content in food. Saliva and plaque were analysed for nickel content using an electrothermal atomic absorption spectrometric (ETAAS) method. The acidified saliva samples were analysed as Millipore-filtered saliva with filter-retained fractions and plaque following dissolution in acids. No significant difference in nickel content of filtered saliva was found between the test and the control samples (P = 0.607); the median values of nickel content were 0.005 and 0.004 mug/g saliva, respectively. On the other hand, a significant difference was found for the filter-retained fraction (P = 0.008); median values for nickel were 25.3 and 14.9 mug/g, respectively. A significant difference in nickel content between test and control samples was also found in plaque collected at various tooth sites (P = 0.001; median values 1.03 and 0.45 mug/g, respectively). A stronger difference was found when comparing plaque collected from metal-covered tooth surfaces than from enamel surfaces of orthodontic patients. No association could be found between calculated dietary intake of nickel and recorded nickel in the test and control samples. It is concluded that nickel release occurs into the dental plaque and components of saliva of orthodontic patients, a situation that may reflect time dependence of its release from orthodontic appliances into the oral cavity and an aggregation of nickel at plaque sites.

National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-22032 (URN)10.1093/ejo/cji091 (DOI)000238544400013 ()16415086 (PubMedID)
Available from: 2009-04-22 Created: 2009-04-22 Last updated: 2017-12-13Bibliographically approved
3. Nickel allergy in relation to piercing and orthodontic appliances: a population study
Open this publication in new window or tab >>Nickel allergy in relation to piercing and orthodontic appliances: a population study
2012 (English)In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 67, no 6, 342-350 p.Article in journal (Refereed) Published
Abstract [en]

Background. Studies have shown conflicting results on the association between nickel exposure from orthodontic appliances and nickel sensitization. Objectives & Method. In a cross-sectional study, we investigated the association between nickel sensitization and exposure to orthodontic appliances and piercings. 4376 adolescents were patch tested following a questionnaire asking for earlier piercing and orthodontic treatment. Exposure to orthodontic appliances was verified in dental records. Results. Questionnaire data demonstrated a reduced risk of nickel sensitization when orthodontic treatment preceded piercing (OR 0.46; CI 0.27–0.78). Data from dental records demonstrated similar results (OR 0.61, CI 0.36–1.02), but statistical significance was lost when adjusting for background factors. Exposure to full, fixed appliances with NiTi-containing alloys (OR 0.31, CI 0.10–0.98) as well as a pooled ‘high nickel-releasing’ appliance group (OR 0.56, CI 0.32–0.97) prior to piercing was associated with a significantly reduced risk of nickel sensitization. Conclusion. High nickel-containing orthodontic appliances preceding piercing reduces the risk of nickel sensitization by a factor 1.5–2. The risk reduction is associated with estimated nickel release of the appliance and length of treatment. Sex, age at piercing and number of piercings are also important risk indicators. Research on the role of dental materials in the development of immunological tolerance is needed.

Keyword
cross-sectional, dental braces, patch test, questionnaire, tolerance
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-3158 (URN)000311056000004 ()22631615 (PubMedID)
Available from: 2008-05-06 Created: 2008-05-06 Last updated: 2017-03-27
4. Lifestyle and nickel allergy in a Swedish adolescent population
Open this publication in new window or tab >>Lifestyle and nickel allergy in a Swedish adolescent population
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Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-3159 (URN)
Available from: 2008-05-06 Created: 2008-05-06 Last updated: 2010-01-13Bibliographically approved

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