[{"@context":"https:\/\/schema.org\/","@type":"Article","@id":"https:\/\/iaomt.org\/practical-guide-compatibility-testing-dental-materials\/#Article","mainEntityOfPage":"https:\/\/iaomt.org\/practical-guide-compatibility-testing-dental-materials\/","headline":"A practical guide to compatibility testing for dental materials.","name":"A practical guide to compatibility testing for dental materials.","description":"As biologically-minded dentists, we strive to achieve all the goals of modern dentistry while treading as lightly as possible on our patients\u2019 biological terrain. So while we work to maximize strength, durability, comfort and esthetics, we seek to minimize toxicity, immune reactivity, and galvanic stress. [See also the related article, “Oral Medicine, Dental Toxicology“] The  [...]","datePublished":"2014-01-02","dateModified":"2023-06-09","author":{"@type":"Person","@id":"https:\/\/iaomt.org\/author\/jessica\/#Person","name":"Webmaster","url":"https:\/\/iaomt.org\/author\/jessica\/","identifier":3,"image":{"@type":"ImageObject","@id":"https:\/\/iaomt.org\/wp-content\/litespeed\/avatar\/6aa2b98c8dd5e8c8b24956bfacd0d2ed.jpg?ver=1778617446","url":"https:\/\/iaomt.org\/wp-content\/litespeed\/avatar\/6aa2b98c8dd5e8c8b24956bfacd0d2ed.jpg?ver=1778617446","height":96,"width":96}},"publisher":{"@type":"Organization","name":"The International Academy of Oral Medicine & Toxicology","logo":{"@type":"ImageObject","@id":"https:\/\/iaomt.org\/wp-content\/uploads\/IAOMT-Schema-app-logo.jpg","url":"https:\/\/iaomt.org\/wp-content\/uploads\/IAOMT-Schema-app-logo.jpg","width":120,"height":60}},"image":{"@type":"ImageObject","@id":"http:\/\/iaomt.wpengine.com\/wp-content\/uploads\/19832583_s-150x150.jpg","url":"http:\/\/iaomt.wpengine.com\/wp-content\/uploads\/19832583_s-150x150.jpg","height":"150","width":"150"},"url":"https:\/\/iaomt.org\/practical-guide-compatibility-testing-dental-materials\/","video":{"@context":"http:\/\/schema.org\/","@type":"VideoObject","@id":"https:\/\/www.youtube.com\/watch?v=c9kj-XfVang#VideoObject","contentUrl":"https:\/\/www.youtube.com\/watch?v=c9kj-XfVang","name":"Dental Potato Clock: Dentists use metals for restoring teeth, but ignore their electrical effects","description":"Many dentists choose metals for restoring teeth based on their strength and durability, but ignore their electrical effects, as explained in this Dental Potato Clock example.\n\nhttps:\/\/thesmartchoice.com\/components-of-dental-materials\/","thumbnailUrl":["https:\/\/i.ytimg.com\/vi\/c9kj-XfVang\/default.jpg","https:\/\/i.ytimg.com\/vi\/c9kj-XfVang\/mqdefault.jpg","https:\/\/i.ytimg.com\/vi\/c9kj-XfVang\/hqdefault.jpg","https:\/\/i.ytimg.com\/vi\/c9kj-XfVang\/sddefault.jpg","https:\/\/i.ytimg.com\/vi\/c9kj-XfVang\/maxresdefault.jpg"],"uploadDate":"2014-10-02T21:34:29+00:00","duration":"PT4M","embedUrl":"https:\/\/www.youtube.com\/embed\/c9kj-XfVang","publisher":{"@type":"Organization","@id":"https:\/\/www.youtube.com\/channel\/UCo87raXcBdqq8w-1U_SFq-Q#Organization","url":"https:\/\/www.youtube.com\/channel\/UCo87raXcBdqq8w-1U_SFq-Q","name":"IAOMT - International Academy of Oral Medicine and Toxicology","description":"The IAOMT are the leaders in science-based biological dentistry. We are a trusted academy of allied professionals providing scientific resources to support new levels of integrity and safety in healthcare. The IAOMT has over 1100 members in North America and in 53 other countries.\n\nIAOMT - International Academy of Oral Medicine and Toxicology","logo":{"url":"https:\/\/yt3.ggpht.com\/ytc\/AIdro_nzSc6oo_WFPqLjLPnpIMQ7L0kTyl4YhHGpWDUlcjLRSc0=s800-c-k-c0x00ffffff-no-rj","width":800,"height":800,"@type":"ImageObject","@id":"https:\/\/www.youtube.com\/watch?v=c9kj-XfVang#VideoObject_publisher_logo_ImageObject"}},"potentialAction":{"@type":"SeekToAction","@id":"https:\/\/www.youtube.com\/watch?v=c9kj-XfVang#VideoObject_potentialAction","target":"https:\/\/www.youtube.com\/watch?v=c9kj-XfVang&t={seek_to_second_number}","startOffset-input":"required name=seek_to_second_number"},"interactionStatistic":[[{"@type":"InteractionCounter","@id":"https:\/\/www.youtube.com\/watch?v=c9kj-XfVang#VideoObject_interactionStatistic_WatchAction","interactionType":{"@type":"WatchAction"},"userInteractionCount":6819}],{"@type":"InteractionCounter","@id":"https:\/\/www.youtube.com\/watch?v=c9kj-XfVang#VideoObject_interactionStatistic_LikeAction","interactionType":{"@type":"LikeAction"},"userInteractionCount":74}]},"about":["Articles"],"wordCount":1847,"keywords":["Biological Dentistry"],"articleBody":"As biologically-minded dentists, we strive to achieve all the goals of modern dentistry while treading as lightly as possible on our patients\u2019 biological terrain. So while we work to maximize strength, durability, comfort and esthetics, we seek to minimize toxicity, immune reactivity, and galvanic stress.[See also the related article, “Oral Medicine, Dental Toxicology“]The restorative materials we use today have all been developed with \u201cmost people\u201d in mind. Most people can put up with a bit of toxicity, immune reactivity, and galvanic stress. However, there are outliers, and perhaps their numbers are growing, who can\u2019t stand up to those stresses as well as others. The prevalence of multiple chemical sensitivities (MCS) has been reported to be somewhere between 12 and 33% in the general population, with 2 to 6% having been actually diagnosed as such.There is a well-documented physiological basis for MCS. Genetic variations leave some people with low-functioning enzymes in critical detoxification pathways, such as methylation, phase-2 conjugation, reduction of oxidized glutathione, membrane transport, and others. The result is that they can’t excrete the chemicals they are exposed to effectively and essentially are poisoned. Some researchers have suggested that there are psychological components to the disease as well. Certainly the experience of MCS leads to fear of exposure in the hearts of these patients, including fear of dental materials.Moreover, there is a significant number of people who are overtly allergic or otherwise immunologically reactive to chemicals in their environment. This phenomenon ranges from true allergies to something akin to non-allergic food sensitivities. It results in a range of idiosyncratic, highly individual immune reactions in susceptible people.These people tend to know who they are, and they are immensely grateful when their dentist acknowledges the problem when prescribing dental materials. After all, people can manage food sensitivities by rotating their diet, but they can\u2019t rotate their permanently installed artificial dental fillings. By practicing individualized biocompatibility testing and making other common sense choices, we can (almost) always find a combination of professionally recognized restorative materials that will do the job. We can fix teeth and, at the same time, help our patients avoid toxicity, immune reactivity, and galvanic stress, and, just as important, provide them with peace of mind.At the same time, \u201cmost people\u201d benefit from the same level of care, even if they are not, or not aware of being, chemically sensitive. Bad actorsA few common dental materials are totally out of the pale and should never be used. Mercury amalgam \u2013 \u2018nuff said, but don\u2019t forget the importance of careful barrier techniques when removing them to protect patient, doctor, and staff from mercury exposure during the procedure.Nickel allergy is so prevalent in the population that its use in dentistry is outrageous. Unfortunately, due to a difference in immune response between skin and mucosa, the same nickel alloy that would make one\u2019s skin break out if used in an earring will not cause a rash in the mouth. So it\u2019s hard to point to an obvious problem with the stuff. But it does raise the total level of immune reactivity in the body and should not be used.This calls into question the safety of stainless steel crowns, especially the NiCro variety. Also, nickel and other non-precious metal alloys tend to contribute disproportionately to galvanic electricity in the mouth. Immune reactivityDental materials implanted in teeth present a systemic exposure, which implies the possibility of an immune response. Two clinical labs provide \u201cserum compatibility testing\u201d for dental materials, which involves testing blood serum for pre-existing antibodies to the more than 140 metals and chemicals that can be found in dental materials. Each chemical is graded according to whether it creates clumps in the serum or not. If it clumps, there\u2019s an antibody against it.\u00a0 If there\u2019s no clump, there\u2019s no antibody reacting.A computer program then reassembles those components into thousands of name-brand products. If there is a reactive chemical in the product, it is flagged and labeled as not acceptable. Both labs provide a booklet of results by product name and by category.The two labs are:Elisa\/Act Biotechnologies, www.elisaact.com, 800-553-5472 (temporarily unavailable till July 2023).Biocomp Laboratories, www.biocomplabs.com,\u00a0 800-331-2303Both labs have very informative websites and are willing to discuss their techniques and preferences. Serum compatibility routinesAfter deciding which lab you want to use, obtain test kits, or have them sent directly to the individual patient. Provide the patient with a prescription for a blood draw unless you do that yourself. The patient takes the kit to a nearby blood lab, such as Quest Diagnostics, Labcor, or a local hospital. The patient fills out the enclosed paperwork and includes a check. The blood lab draws one tube of blood, prepares frozen serum, and overnights the sample to the compatibility lab. It\u2019s best to draw the sample early in the week, so Biocomp or Clifford can receive it before the weekend. Both labs are quick at getting the results back to you.Clifford Consulting Lab will also maintain a list of your favorite materials, and the results for those will appear on the front page of the report.Who should get tested? Some of our members test all new patients, while others test only those with documented MCS problems. That\u2019s a clinical judgment call. Multiple lensesThe sicker or more sensitive the patient, the more reassurance they need about the safety of our materials. Frankly, the differences among most current composites are minimal, and it probably doesn\u2019t matter which you use for healthy patients. For the true MCS patient, or the suspected, or the nervous, there are more lenses that can be brought to bear on the compatibility question.If you have a list of acceptable materials from a Biocomp or ELISA test that fits into your range of clinical choices, you might give the patient a physical sample of the proposed filling or crown, etc., to take home and try for themselves, in a fully reversible fashion. Remind them that this material has passed the blood test, and tell them to hold it in the cheek for a few minutes or a few hours and see if a familiar reaction starts.\u00a0 Taping a sample to the skin can be a revealing test, but a blank control must accompany it.Some people subscribe to the more \u201cholistic\u201d methods, like muscle testing or electrodermal testing. The patient can take your physical sample to another practitioner, too, for this type of corroboration. (It helps if you know the other practitioner because, once in a while, dealing with someone who does not understand dentistry can lead to more confusion rather than more clarity.)To whatever extent there is a psychological component to chemical sensitivity, going through all these motions for compatibility testing will go a long way toward reassuring that sensitive patient and recruiting his or her belief system.In the end, you, as a licensed dentist, must decide your own comfort level and adjust your techniques accordingly. Problems with metalsMetals are much more allergenic than we typically give them credit for. Does anyone remember being told in dental school to ask patients, especially women, if their skin breaks out with jewelry? Very few patients ever report having been asked that by a dentist.It is more possible than ever to perform good dentistry without the use of any metals at all, but sometimes we still need them. Some metals, most notoriously nickel, will create contact dermatitis, or a skin rash, upon exposure, and these are easily discovered by history and by serum testing. Other metals, most notoriously titanium, will never make a skin rash but can lead to other manifestations of type IV delayed hypersensitivity, a much more insidious cause of malaise, and other vague, varied symptoms.For patients who you plan a metal-based prosthodontic procedure, especially if there is any history of metal sensitivity, the most revealing test is the Melisa test (www.melisa.org). This is the only test that will show titanium sensitivity. (Of those tested, only 4% have tested positive to titanium on Melisa.)Melisa is short for \u201cmemory lymphocyte activation,\u201d and it takes four to six tubes of blood to get enough cells. The cells are isolated and cultured with the suspected antigen and tritiated thymidine. Cell proliferation, uptake of radioactivity, and morphological changes are taken as evidence of reaction. The Melisa test was created by immunologist Vera Stejskal, PhD, of Sweden, who has been a frequent speaker at IAOMT meetings.Several labs worldwide perform this test and are listed on their website. One lab in North America performs Melisa: Pharmasan Laboratory, www.pharmasan.com, 715-294-1705. Avoiding oral galvanismAside from their power to provoke immune reactivity, metals are also electrically active. Oral galvanism has been talked about for over 100 years, but dentists ignore it and its implications.Remember the electromotive scale from inorganic chemistry? Remember the potato clock, where a copper nail and a zinc nail stuck in a potato make enough electricity to run a digital clock?Here are some representative voltage numbers (standard hydrogen electrode) for typical dental metals:This means that gold and titanium grouped together in electrolyte-like saliva have the potential to create a battery of over three volts! (This is very oversimplified, go ask a corrosion chemist!) But considering that the nervous system works on membrane potentials of 0.140 volts, electricity from dental metals that is conducted randomly or unpredictably through anatomical structures and spaces can overwhelm normal neuronal control. Often the manifestation is localized pain or inappropriately elevated muscle tone \u2013 as in jaw tension, TMJ, temporal headache, skin pallor due to low-level vasoconstriction, etc.Why do the best stories still come from the old student days? I was covering the ER oral surgery clinic one Sunday afternoon when a homeless, disoriented woman came in. Her complaint was that the aliens in flying saucers were sending poison rays into her face, and they were spreading down her arm. I figured there must be some reason she was in my clinic, so I looked in her mouth. She had the typical assortment of metal restorations,\u00a0 some non-precious crowns, some gold crowns, amalgam fillings, all topped by a cast metal partial denture. You could almost see sparks when she bit down. \u201cPoison rays from space!\u201d I had her remove the partial and bite. \u201cNo poison rays!\u201d Put the partial back in. \u201cPoison rays from space!\u201dAvoid poison rays from space. Don\u2019t be cavalier about mixing metals in people\u2019s mouths. The old standard in the gold days would have been to make all restorations in a person\u2019s mouth, including removable frameworks,\u00a0 from the same high noble alloy and not to mix metals at all. Now we can choose flexible nylon-based partial dentures, all-ceramic crowns and bridges, and even ceramic implants \u2013 all the contemporary non-metallic methods we are currently blessed with and all the ways we can do our jobs while walking more softly through our patients\u2019 lives. Steve Koral, DMD, MIAOMT"},{"@context":"https:\/\/schema.org\/","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"A practical guide to compatibility testing for dental materials.","item":"https:\/\/iaomt.org\/practical-guide-compatibility-testing-dental-materials\/#breadcrumbitem"}]}]