• Users Online: 337
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2021  |  Volume : 11  |  Issue : 3  |  Page : 217-219

Importance of determining and establishing latex allergy in orthodontic patients

Department of Preventive Dental Science, Al Farabi College of Dentistry and Nursing, Riyadh, Saudi Arabia

Date of Submission01-Dec-2020
Date of Acceptance14-Apr-2021
Date of Web Publication04-Sep-2021

Correspondence Address:
Dilshad Umar
Al Farabi College of Dentistry and Nursing, Riyadh
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aihb.aihb_141_20

Rights and Permissions

Introduction: The current study was commended with the aim of assessing the incidence of latex allergy in orthodontic patients. Materials and Methods: Silver-coloured orthodontic elastomeric ligatures (modular) from six different manufacturers were selected for the cytotoxicity study, being one of natural latex, two of latex-free and three containing polyurethane. The samples were divided into 6 groups of 15 elastics each. The cytotoxicity of these orthodontic elastics was determined through the dye-uptake technique, which is based on the neutral red absorption by living cells. Different periods of time were considered: 1, 2, 3, 7 and 28 days. Results: Among all the respondents to the survey, 7.5% showed positive change after wearing elastics. Most of the positive changes were seen in females Conclusion: Safe orthodontics practice is dependent upon recognising patients with allergy along with awareness of etiologic materials.

Keywords: Allergic reactions, elastomers, tensile strength, latex, silicone elastomers, orthodontic material, patch test

How to cite this article:
Umar D, Alrashidi HA, Alnazer HA, Arnous WA. Importance of determining and establishing latex allergy in orthodontic patients. Adv Hum Biol 2021;11:217-9

How to cite this URL:
Umar D, Alrashidi HA, Alnazer HA, Arnous WA. Importance of determining and establishing latex allergy in orthodontic patients. Adv Hum Biol [serial online] 2021 [cited 2021 Oct 26];11:217-9. Available from: https://www.aihbonline.com/text.asp?2021/11/3/217/325573

  Introduction Top

There is increasing concern in relation to the biocompatibility of materials used in the field of dentistry; this may be because of a real rise in the incidence of allergic reactions against the materials or due to a rise in awareness of antagonistic reactions to these materials.[1],[2],[3] In subjects undergoing fixed orthodontic therapy, allergy is possible visible because of numerous reasons and these include nickel allergy, allergy to the acrylic resins and latex products.[4] Harmless and efficacious therapy is dependent largely upon recognising subjects with allergy admixed with awareness of materials which can possibly cause them. The appliances used in orthodontic practices are composed of latex which is routinely employed in elastics and other materials. Latex is the organic raw material for natural rubber products.[5],[6],[7] Its proteins and polypeptides, but not its polymer backbone (cis-1, 4-polyisoprene), are antigens. The remaining chemicals derived from the rubber built-up procedure resulted in irritation and contact dermatitis, which are focal, uncomfortable and distorting. Allergy occurring because of latex proteins results in immediate hypersensitivity responses, swelling and stomatitis, erythematous oral lesions, respiratory reactions and even anaphylactic shock in severe cases.[8],[9],[10] Incidence of latex allergy is approximately 3% to 17% of the cases. Since latex allergy is predominant among occupationally exposed subjects, the requirement for non-latex replacements is rising. Few laboratory researches were carried out for evaluating the behaviour of non-latex elastics in comparison to latex elastics.[4],[6],[9],[11],[12],[13] Majority of the researchers demonstrated a marked reduction in the strength levels of these elastics within the first 24 h, demonstrating the non-latex elastics limitation in upholding a continuous force for an extended period.[4],[6],[11],[12] Manufacturers have additional chemical materials to delay these effects and stretch the longevity of these elastomers.[2] Nevertheless, in the oral cavity, the features of elastics substances are affected by physical, chemical and biological factors, few of them connected to functional activities, salivary alterations and nutrition habits.[3],[14] Non-latex elastics also must be tested in the oral environment and to our knowledge, just one clinical study[15] was reported in the literature.[3],[16]

Hence, under the inference of the above-documented data, the current study was commended with the aim of assessing the incidence of latex allergy in orthodontic patients.

  Materials and Methods Top

The current study was commended with the aim of assessing the incidence of latex allergy in orthodontic patients. For the present study, six different silver-coloured orthodontic elastomeric ligatures were employed:

  • Natural latex (one)
  • Latex-free (two)
  • Polyurethane (three).

All the specimens were randomly and broadly categorised into six study groups, with 15 elastic in each group. After removing the powder coating, washing of the elastics was done for 15 s. Time before carrying out the testing procedure, sterilisation of elastomeric ligatures was done for exposure to ultraviolet light for half an hour.[12],[13] The cell culture model used was the monolayer containing L929 mouse fibroblast cells and cell culture incubate at 37 degrees for 48 h. The positive and negative controls were incubated in Eagles' minimum essential medium for 1, 2, 3, 7 and 28 days. Determination of the cytotoxicity was done through the dye-uptake technique.[14] Repetition of the tests was done thrice. All the results were recorded in a Microsoft excel sheet and were analysed by SPSS Software IBM, Chicago, Illinois, USA.

  Results Top

While comparing the cellular viability among the Groups CC, A, G, TP and U at 2 and 28 days or among Groups CC, A, TP and U at 7 days or between Groups CC and U at 3 days, non-significant results were obtained. There were decrease viable cells in Groups M and Te at 1 and 2 days compared to the other experimental periods. At 24 h, the percentage of viable cells varied from 94.6% in Group U with the latex-free elastomeric ligatures to 76.1% in Group M polyurethane elastomeric ligatures. The percentage of viable cells increased slightly over the following 24 h in all Groups, continued to increase in Groups M, Te, TP and U between days 2 and 28. Among all the respondents to the survey, 7.5% showed positive change after wearing elastics. Most of the positive changes were seen in females [Table 1].
Table 1: The percentage of viable cells among different elastomeric ligatures over the time

Click here to view

  Discussion Top

In the present-day orthodontic practices, orthodontic elastics are still important significant expedients, extensively employed in dental practice, since they present numerous varieties of uses in relation to the direction of force applied to the teeth to be moved, consequently assisting in the correction of several malocclusions.[1] Originally, these elastics were made up of natural rubber (latex) and employed for years and decades by the ancient Inca and Mayan civilisations.[2] They are still widely used today,[3],[4] mostly due to high flexibility and cheap cost.[5] Nonetheless, in the early eighties, allergic reactions to latex became more predominant and enhanced documentation.[6],[7] With the target of sustaining the mechanical qualities of the elastics without resulting in allergic reactions in subjects having hypersensitivity to latex, orthodontic rubber elastics based on synthetic rubber (non-latex) have been employed more routinely.[8],[9],[10]

Hence, it is authoritative to assess the mechanical properties of above-mentioned dental materials. Few laboratory analysis has demonstrated a marked decrease in the strength levels of these elastics within the first 24 h, showing the non-latex elastics limitation in maintaining a constant force for an extended period.[4],[6],[11],[12],[13] For decreasing the effects, few chemical modulations have been done by different manufacturers, which have resulted in the extension of the lifetime of these elastomers.[2] Within the oral cavity, the parameters of elastics materials are altered by physical, chemical and biological features, few of them connected to functional accomplishments, salivary alterations and nutrition practices.[3],[11] Non-latex elastics also must be tested in the oral environment and to our knowledge, just one clinical study[11] was reported in the literature. Dead or damaged cells cannot incorporate vital stain, thus not being recognised on optical reading. Therefore, spectrophotometry does not allow dead cells to be distinguished from the damaged ones.[14],[15],[16]

Filon FL et al., in previous research, assessed the prevalence of latex-related clinical manifestations in healthcare workers. An evaluation of a total of 1040 healthcare workers was analysed, which were exposed to latex allergen for latex-related symptoms and sensitisation. The evaluation was carried out by means of a pre-framed questionnaire and different antigen-antibody analysis admixed with clinical examination. A second assessment was also conducted. They observed Glove-related manifestations in approximately 22% of the nurses, the majority being mild dermatitis: Approximately 3½% of patients complained of contact urticaria and a little more than 2% complained of asthma and/or rhinitis. These symptoms were significantly related to skin prick tests positive to latex. Simple measures such as the avoidance of unnecessary glove use, the use of non-powdered latex gloves by all workers and use of non-latex gloves by sensitised subjects can stop the progression of latex symptoms and can avoid new cases of sensitisation.[17]

  Conclusion Top

Safe orthodontics practice is dependent upon recognising patients with allergies along with awareness of etiologic materials. A thorough history, with distinctive consideration to prior allergic reactions, is the main prognostic factor to avoid allergic reactions during orthodontic therapy.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Poley GE Jr., Slater JE. Latex allergy. J Allergy Clin Immunol 2000;105:1054-62.  Back to cited text no. 1
Bakula A, Lugović-Mihić L, Situm M, Turcin J, Sinković A. Contact allergy in the mouth: Diversity of clinical presentations and diagnosis of common allergens relevant to dental practice. Acta Clin Croat 2011;50:553-61.  Back to cited text no. 2
Stenman E, Bergman M. Hypersensitivity reactions to dental materials in a referred group of patients. Scand J Dent Res 1989;97:76-83.  Back to cited text no. 3
Hensten-Pettersen A, Jacobsen N. Disintegration of orthodontic appliances in vivo. In: Eliades G, Eliades T, Brantley WA, Watts DC, editors. In vivo Aging of Dental Biomaterials. Chicago: Quintessence; 2003, p. 290-296.  Back to cited text no. 4
Lowey MN. Allergic contact dermatitis associated with the use of an Interlandi headgear in a patient with a history of atopy. Br Dent J 1993;175:67-72.  Back to cited text no. 5
Hwang CJ, Cha JY. Mechanical and biological comparison of latex and silicone rubber bands. Am J Orthod Dentofacial Orthop 2003;124:379-86.  Back to cited text no. 6
Lessa FC, Aranha AM, Hebling J, Costa CA. Cytotoxic effects of white-MTA and MTA-bio cements on odontoblast-like cells (MDPC-23). Braz Dent J 2010;21:24-31.  Back to cited text no. 7
Miranda RB, Fidel SR, Boller MA. L929 cell response to root perforation repair cements: An in vitro cytotoxicity assay. Braz Dent J 2009;20:22-6.  Back to cited text no. 8
Schedle A, Samorapoompichit P, Rausch-Fan XH, Franz A, Füreder W, Sperr WR, et al. Response of L-929 fibroblasts, human gingival fibroblasts, and human tissue mast cells to various metal cations. J Dent Res 1995;74:1513-20.  Back to cited text no. 9
Franz A, König F, Skolka A, Sperr W, Bauer P, Lucas T, et al. Cytotoxicity of resin composites as a function of interface area. Dent Mater 2007;23:1438-46.  Back to cited text no. 10
Schmalz G. Use of cell cultures for toxicity testing of dental materials--advantages and limitations. J Dent 1994;22 Suppl 2:S6-11.  Back to cited text no. 11
Dos Santos RL, Pithon MM, Da Silva Mendes G, Romanos MT, De Oliveira Ruellas AC. Cytotoxicity of intermaxillary orthodontic elastics of different colors: An in vitro study. J Appl Oral Sci 2009;17:326-9.  Back to cited text no. 12
dos Santos RL, Pithon MM, Martins FO, Romanos MT, de Oliveira Ruellas AC. Evaluation of the cytotoxicity of latex and non-latex orthodontic separating elastics. Orthod Craniofac Res 2010;13:28-33.  Back to cited text no. 13
De Genova DC, McInnes-Ledoux P, Weinberg R, Shaye R. Force degradation of orthodontic elastomeric chains--a product comparison study. Am J Orthod 1985;87:377-84.  Back to cited text no. 14
Pithon MM, Mendes JL, da Silva CA, Dos Santos RL, Coqueiro RD. Force decay of latex and non-latex intermaxillary elastics: A clinical study. Eur J Orthod 2016;38:39-43.  Back to cited text no. 15
Qodcieh SM, Al-Khateeb SN, Jaradat ZW, Abu Alhaija ES. Force degradation of orthodontic latex elastics: An in vivo study. Am J Orthod Dentofacial Orthop 2017;151:507-12.  Back to cited text no. 16
Filon FL, Radman G. Latex allergy: A follow up study of 1040 healthcare workers. Occup Environ Med 2006;63:121-5.  Back to cited text no. 17


  [Table 1]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Materials and Me...
Article Tables

 Article Access Statistics
    PDF Downloaded52    
    Comments [Add]    

Recommend this journal