Titanium: A New Allergen

Abstract

Buccal allergies represent a growing problem and often go undiagnosed by health professionals. There is an increase in the prevalence of oral allergies to dental materials, and especially to metals used in dental materials. Titanium, used in orthopaedic devices and oral implants, although considered an inert material, can actually induce toxicity or allergic type I or IV reactions. Cases of an allergy to titanium described in the literature reflect the difficulty in the diagnosis of this allergy. In case of a suspected contact allergy, epicutaneous patch tests can be done, which consist of applying the allergens which are to be tested to the patient’s back. These tests are known to have a diagnostic efficiency of 75% for metal allergy, and can therefore underdiagnose a titanium sensitization or allergy. Blood tests which can be used for the diagnosis of allergies are based on lymphoblastic transformation. They are more sensitive than patch tests, but sometimes lack specificity. The occurrence of an allergy to titanium could be responsible for successive unexplained cases of failure of dental implants in some patients (known as “cluster patients”). It has been reported that the risk of an allergy to titanium is increased in patients who are allergic to other metals. In these patients, an allergy evaluation is recommended, in order to exclude any problem with titanium dental implants.