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Dental gold and contact allergy
Malmö högskola, Faculty of Odontology (OD).ORCID iD: 0000-0003-1049-6567
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Guld har i många år använts som rekonstruktionsmaterial vid bettrehabilitering. Mer än 50% av Sveriges vuxna befolkning har kronor och/eller broar framställda i guldlegering och guld används också till stift i rotfyllda tänder, på vilka sedan kronor kan fästas. Guld har länge betraktats vara inert, dvs. ej kunna ge några reaktioner vid användning i kroppen, men på senare år har en ökad frekvens av kontaktallergi mot guld kunnat konstateras. Kontaktallergi är en typ av allergi, som vid upprepad kontakt med ämnet kan ge patienten en reaktion i hud och slemhinna. När det gäller guld kan kontaktallergi uppstå t.ex. under guldringar, av örhänge eller av halsband. När man utreder patienter för kontaktallergi mot guld – s.k. lapptestning, fäster man en häfta med guldsaltet guldnatriumtiosulfat (GSTS) på ryggen i 48 timmar. Patienten tar efter dessa två dygn bort testlappen och 3–4 samt 7 dagar efter exponeringen värderas den eventuellt uppkomna reaktionen av en hudläkare. Reaktionerna kan klassas som ospecifika irritationsreaktioner, negativa reaktioner, tveksamma reak-tioner och allergiska (positiva) reaktioner av eksemtyp. 1991 började man i Malmö rutinmässigt använda GSTS vid lapptestning av kontaktallergi mot guld, och då kunde konstateras att 10 % av de testade uppvisade kontaktallergi mot guld. Man har också visat att ett positivt lapptest är en manifestation av kontaktallergi. GSTS är, efter nickelsulfat, det näst vanligaste allergenet, som ger positiv hudreaktion vid rutintestning av eksempatienter. Detta tillsammans med en enkätstudie, som indikerade att kontaktallergi för guld var överrepresenterat hos patienter som hade guld i munnen, utgör bakgrunden till detta avhandlingsprojekt. I det första delarbetet studerades om dentalt guld (kronor, broar, inlägg) kunde sättas i samband med kontaktallergi för guld. Patienterna som ingick i studien var patienter som skulle testas eftersom de hade eksem. Resultaten visade att de patienter som vid tandläkarundersökning visat sig ha guld i munnen också i större utsträckning hade kontaktallergi för guld vid lapptestning. Symtom i munnen eller tecken på munslemhinnereaktioner kunde dock inte sättas i samband med dentalt guld eller positivt lapptest för guld. Däremot kunde det konstateras att de som hade mycket guld i munnen i större utsträckning hade kontaktallergi mot guld. I delarbete två studerades guldhalten i blodet hos samma patientpopulation. Det kunde konstateras att de patienter som hade dentalt guld hade förhöjda värden av guld i blod. I tredje delarbetet undersöktes mängden guld i blod efter att patienterna fått guldinlägg, vilket motsvarar en krona men med en fyllnings utsträckning. Patienterna hade mer guld i blodet efter att inläggen satts in jämfört med mängden guld i blod innan inläggen sattes fast. Fortfarande 15 år efter att inläggen sattes in hade patienterna förhöjda värden av guld i blod, vilket måste tolkas som en kontinuerlig frisättning av guld från dentalt guld till blod. Förhöjda värden av guld i blod har visat sig ha betydelse för hudens reaktion i kontakt med guld. Huruvida det föreligger ett samband mellan dentalt guld, kontaktallergi mot guld och munslemhinnelesioner, är inte väl utrett. Dock har studier på patienter med oral lichen indikerat att dessa patienter skulle kunna vara allergiska mot guld, men även mot andra tandvårdsmaterial. I fjärde delarbetet undersöktes därför patienter med oral lichen, med avseende på kontaktallergi mot guld i jämförelse med kontrollpatienter, vilka var remitterade till Yrkes- och miljödermatologiska avdelningen, Hudkliniken i Malmö, för misstanke om allergiskt kontakteksem. I denna studie kunde man finna en numerär skillnad avseende kontaktallergi för guld men inte någon statistisk skillnad mellan grupperna. Det är därför av vikt att i fortsatta studier, med större undersökningsmaterial, försöka utröna om det finns ett statistiskt säkert samband mellan oral lichen och kontaktallergi mot guld eller andra tandvårdsmaterial eftersom dessa patienter kan uppleva perioder med stora besvär, vilka kan försvåra både födointag och upprätthållande av en adekvat munhygien.

Place, publisher, year, edition, pages
Malmö University, Department of Prosthetic dentistry , 2009. , p. 112
Series
Swedish Dental Journal : Supplement, ISSN 0348-6672 ; 200
Keywords [en]
contact dermatitis, gold alloys/adverse effects, inlays
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-7686Local ID: 9919ISBN: 9171043063 (print)OAI: oai:DiVA.org:mau-7686DiVA, id: diva2:1404626
Note

Paper IV in dissertation as manuscript

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-19Bibliographically approved
List of papers
1. Contact allergy to gold is correlated to dental gold.
Open this publication in new window or tab >>Contact allergy to gold is correlated to dental gold.
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2002 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 82, no 1, p. 41-4Article in journal (Refereed) Published
Abstract [en]

Questionnaire studies have indicated that patients with dental gold will more frequently have contact allergy to gold. This study aimed at investigating the relationship between contact allergy to gold and the presence and amount of dental gold alloys. A total of 102 patients were referred for patch testing because of suspicion of contact allergy. Patch tests were performed with gold sodium thiosulphate 2% and 5%. The patients underwent an oral clinical and radiological examination. Contact allergy to gold was recorded in 30.4% of the patients, and of these 74.2% had dental gold (p=0.009). A significant correlation was found between the amount of gold surfaces and contact allergy to gold (p=0.008), but there was no statistical relationship to oral lesions. It is concluded that there is a positive relationship between contact allergy to gold and presence and amount of dental gold alloys.

Place, publisher, year, edition, pages
Acta Dermato-Venereologica, 2002
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-36979 (URN)10.1080/000155502753600876 (DOI)000175356800010 ()12013197 (PubMedID)2-s2.0-0036234493 (Scopus ID)
Available from: 2020-11-26 Created: 2020-11-26 Last updated: 2024-05-22Bibliographically approved
2. Gold concentration in blood in relation to the number of gold restorations and contact allergy to gold.
Open this publication in new window or tab >>Gold concentration in blood in relation to the number of gold restorations and contact allergy to gold.
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2002 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 60, no 5, p. 301-5Article in journal (Refereed) Published
Abstract [en]

Previous studies have demonstrated an association between gold allergy and the presence of dental gold restorations. The aim of the present study was to investigate the relationship between the concentration of gold in blood (B-Au) and the number of tooth surfaces with gold alloys in subjects with and without contact allergy to gold. In 80 patients referred for patch testing because of eczematous disease, blood samples were taken and analyzed for B-Au using inductively coupled plasma mass spectrometry. The detection limit for the Au determination was 0.04 microg/L. In addition, a dentist made a clinical and radiological examination of the patients and registered the number of dental gold surfaces. Patients with dental gold restorations had a statistically significantly higher B-Au in Mann-Whitney U test (P = 0.025), (range < 0.04-1.07 microg/L) than patients without (range < 0.04-0.15 microg/L). Furthermore, a positive correlation was found between B-Au and the number of dental gold surfaces (P < 0.01). There was no statistically significant difference in B-Au between persons with and without contact allergy to gold. The study thus indicates that gold is released from dental restorations and taken tip into the circulation.

Place, publisher, year, edition, pages
Taylor & Francis, 2002
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-36980 (URN)10.1080/00016350260248283 (DOI)000178268700008 ()12418721 (PubMedID)
Available from: 2020-11-26 Created: 2020-11-26 Last updated: 2024-02-05Bibliographically approved
3. Levels of gold in plasma after dental gold inlay insertion.
Open this publication in new window or tab >>Levels of gold in plasma after dental gold inlay insertion.
2007 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 65, no 6, p. 331-334Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Several studies have reported increased levels of gold (Au) in the blood of patients with dental gold restorations. This study analyzed gold levels in blood plasma before dental gold inlay insertion, 0-12 months after, and 15 years after. MATERIAL AND METHODS: Plasma samples from 9 patients were taken before and 0-10 months after gold inlay insertion. Fifteen years after gold inlay insertion, further blood samples taken from 8 of these patients were analyzed for gold using inductively coupled plasma mass spectrometry. An oral examination was also carried out before and 15 years after gold inlay insertion. RESULTS: Gold levels in plasma were significantly higher 0-12 months after gold inlay insertion than before treatment (p=0.008). No significant difference in gold plasma levels was found between 0-12 months after and 15 years after insertion (p=0.109), although there was a significant correlation between the number of gold alloy surfaces and the amount of gold in plasma 15 years after insertion (p=0.028). CONCLUSIONS: This study supports a dose-related release of gold into plasma from dental gold restorations, a release that appears to be stable over time.

National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15740 (URN)10.1080/00016350701721772 (DOI)000251547900004 ()17952707 (PubMedID)2-s2.0-37048999746 (Scopus ID)5461 (Local ID)5461 (Archive number)5461 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
4. Contact Allergy to Gold in Patients with Oral Lichen Lesions
Open this publication in new window or tab >>Contact Allergy to Gold in Patients with Oral Lichen Lesions
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2012 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 92, no 2Article in journal (Refereed)
Abstract [en]

The aetiology of oral lichen lesions is obscure. In this study the frequency of contact allergy to gold in 83 patients with oral lichen lesions was compared with that in two control groups, comprising 319 age- and gender-matched patients with dermatitis selected from files and 83 clinically examined dermatitis patients. All patients were tested epicutaneously with gold sodium thiosulphate. The two control groups tested were under examination for a tentative diagnosis of allergic dermatitis not related to oral problems. The frequency of contact allergy to gold was 28.9% in the patients with oral lichen lesions, 18.2% in patients selected from files, and 22.9% in the clinically examined control patients. The difference in frequency between patients with oral lichen lesions and those taken from files was statistically significant.

Place, publisher, year, edition, pages
Scandinavian University Press, 2012
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15445 (URN)10.2340/00015555-1247 (DOI)000301823400005 ()22170162 (PubMedID)2-s2.0-84859591272 (Scopus ID)15606 (Local ID)15606 (Archive number)15606 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved

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Ahlgren, Camilla

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