Transcript Slide 1

Materials Reactivity Testing
Clifford Consulting & Research, Inc.
Prepared for The IAOMT-UK Seminar
13-14 November 2004
London
The Nature Of The Problem....
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“The safety of dental materials has historically been assumed.
Indeed, many materials have been classified by the FDA as ‘nonsignificant risk devices’. The testing is often superficial, with most
interest directed toward physical performance of the material.
When a biological response is considered, the reaction
anticipated is usually acute toxicity.”
Schultz, et.al., Oral Health, page 7, 1997
How Materials Are Usually Selected....
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Will it stay put and wear well?
Is it hard or time-consuming to use?
Does it make the mouth sore?
Does it look good?
Has the ADA approved it?
Who else is using it?
How expensive is it?
About Thresholds....
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Reactivity requires acquisition of one or more thresholds
Compensatory mechanisms may mask some reactivities
Symptoms and loss of function do not follow a linear pathway
Reducing body burden may permit limited use of toxics
Sporadic symptoms may indicate loads at threshold boundary
How Do Reactivity Issues Arise?
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Corrosion by-products
Out gassing and off-loading
Improper mixing
Incomplete curing
Dissimilarity in alloys and mixed etiologies
Diet
Microbial presence
Corrosion Activity And Absorption
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Corrosive effects of pH and osmolality
Disruption of normal osmotic gradient
Available binding sites and physiology modification
Entrance through both soft and hard tissues
Dissimilarity throughout the oral cavity
Tissue-Based Conversions
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Oral cavity fluids
Periodontal violations
Cellular secretions and modifications
Blood
Mucous membranes
Physical swallowing
Microbial Conversions
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Direct microbial physiology
Microbial waste products
Altered physiology
Competitive binding of nutrients
Mixed microbial etiology
Contribution of gut flora
Galvanic Generation
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Dissimilar alloys and other components
Local circuits within a restorative mass
Circuits within the same tooth and between adjacent teeth
Long-range circuits throughout the body
Chemistry alterations due to pH, osmolality, and microbes
Electron sumping via the vascular bed
Tissue violation due to burns and necrosis
Electromotive table
Mechanical Irritation
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Surface violations due to friction and pressure
Interference with circulatory activity
Direct blood contact
Chemotactic and electro tactic attraction of leucocytes
Adjuvant Amplified Actions
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Increased irritability of weak antigens
Piggy-backed reactions with established allergens
Mixed microbial synergism and altered terrain
Abnormal attraction of leucocytic action
Physical Symptomology Of Reactivity
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● Discolorations and tattoos
● Mechanical site irritations
● Infection patterns - perio
● Tremor and motor control problems
● Sweats and abnormal temperature excursions
● Numbness, tingling and asymmetric muscle and sensory
control
● Increasing unexplained fatigue
Physical Symptomology Of Reactivity
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Chronic gastrointestinal and digestive problems
Bowel dysfunction and unexplained eliminatory excursions
Persistent unusual taste sensations
Sudden frequent urination
Persistent headache and regional neuralgia
Sleep pattern disturbances
Itching, tight or irritated skin
Physical Symptomology Of Reactivity
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Upper torso regional angina and chest pain
Severe excursion of irritability and mood
Frequent non-focused depression
Decreasing cognitive function
Frequent severe tinitis
Frequent irrational fear
Bruxing
Clinical Detection Of Reactivity
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General physical symptoms in the surrounding tissues
Specific antibodies to restorative components
Leucocyte counts <5000 and >7000
Depressed oxygen saturation via co-oximetry
Increased hemoglobin subspecies (met-, sulf- and carboxy-)
Triglyceride elevation with relatively normal cholesterol
Moderate hypoglycemia (60-70 mg/dl)
Clinical Detection of Reactivity
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Irregular BUN and uric acid
Abnormal LDH subspecies
Creatinine clearance impairment
Non-responsive chronic infections
Marked blood pressure excursions
Marked pulse variations
Endocrine dysfunction
Approaches To Reactivity Detection
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Review of patient history and questionnaire
Patch, pellet and injection provocative challenges
Inhalation and sublingual challenges
Electro dermal evaluation
Kiniesiologic determination
Approaches To Reactivity Detection
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Active challenge of lymphocytes (ELISA, MELISA, viability)
Apoptosis challenges
Necrosis evaluation
Cytotoxic testing
Passive specific antibody detection
Strengths In Antibody Detection Methods
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Detectable even after toxic substance exits the body
Repeatable and demonstrable
Classical laboratory methodology
Irritant concentration independent
Irritant source independent
Findings have broad-spectrum applicability
Specimen is storable when necessary
Weaknesses Of Antibody Detection
Method
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Qualitative findings only
No degree-of-reactivity data
Cross-reactions possible
False positives
False negatives
Reduced value with universal reactors
Antibody Data Application
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Antibody reaction for entire chemical group or family
One set of findings applicable to many products
After-the-fact evaluations
Irritant source independent
Useful beyond simple dental materials screening
Who Should Consider Being Tested....
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Patients with known materials-related problems
Immunocompromised and autoimmune-positive patients
Endocrine, hepatic and renal compromised patients
Severe allergy patients
Universal reactor / environmentally ill patients
High cost, complex restoration projects
Galvanically active patients
Patients seeking peace of mind
Blood Drawing
Shipment Of Specimen
Test Tray Preparation
Patient Specimen Dispensing
Data Processing And Reporting
Test Reporting
Getting Materials Into The System
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MSDS and Product Insert Sheet
Research / Technical department at the manufacturer
510-K filing data with the US FDA / European equivalents
Research literature
Dental product databases sponsored by associations
Physical testing
And While We’re At It.....
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Metal-free dentistry
Aluminum in restoratives
Gutta percha
Estrogen mimicry
Non-precious alloys
How much metal is required to be a factor
Metal-Free Dentistry
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● Basic chemistry requires that anions be balanced with cations
● Nearly all cations are metals
● Issue of Content vs. Form
● Dissociability / Ionizability
● Binding to ligands, amino acids, proteins, polysaccharides and
adipose tissues
● Some metals accumulate, others readily pass on
Aluminum In Restoratives
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● Aluminosilicate, alumina and aluminum oxide have half-life on
the order of 109 - 1011 years under oral cavity conditions
● Forms found in glass and sand
● Human skeleton is 2.0% - 2.5% Aluminosilicate, normally,
naturally and routinely
● Sometimes disguised as ‘quartz’, ‘mica’ or ‘feldspar’
● Dissociable aluminum is a grave cause for concern
Gutta Percha
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● Common vs. Synthetic / Purified
● Gutta percha sold and marketed through reputable North
American and West European supply sources within the past 1520 years is of the synthetic or semi-synthetic or purified variety
● Cheap dentistry is cheap for a reason
Estrogen Mimicry
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● Bis-Phenol-A and certain other organic compounds can mimic
the binding qualities and stimulatory functions of estrogen, and
may be carcinogenic
● Uncured or incompletely cured monomer may be an issue
● Component mixing needs to be carefully executed
● Do not take short cuts with curing process
● Cleanliness is next to Godliness
Non-Precious Alloys
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● Nickel is wonderful in structural steel and certain stainless
applications - Keep it out of the body and in the building
● Chromium in the penta- or hexa-valent state is a disaster
● Cadmium will do anything mercury, arsenic and lead can do it’s just a little slower
● Hiding metal alloy under porcelain or ceramic is about as
isolating as coating mercury with saliva
● NEVER, NEVER, NEVER USE MERCURY AND GOLD IN THE
SAME MOUTH - Never!
The Future...