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Certified Prosthetist Jerald J.
Since palladium-containing dental alloys have been identified as a possible source of sensitization, protection of the public from related adverse effects may be achieved either by limiting the use of certain alloys or by using alloys with minimal release of palladium.
A study (see Table 30 in section 8.1.4 below) that found no visible clinical evidence of allergic stomatitis after contact with a pure palladium foil in patients allergic to nickel sulfate did find effects when the oral mucosa was examined immunohistologically. There were increases in the number of suppressor/cytotoxic T-lymphocytes in the connective tissue and a non-significant decrease in Langerhans cells in the epithelium adjacent to the palladium foil in a subgroup of 6 of 15 patients (van Loon et al., 1988).
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The influence of a silver-palladium alloy (no composition reported) on humoral immunity was investigated in 22 persons with a normal medical history. Slight, but not significant, changes in serum IgA, IgG and IgM levels were seen 5-7 days (22 patients) and 20 days (5 patients) after placement of the new alloy restoration in five patients (Vitsentzos et al., 1988).
Recently, responses to palladium of lymphocytes from palladium-sensitized patients were measured by means of a modified lymphocyte transformation test, the so-called memory lymphocyte immunostimulation assay (MELISA). The study in Table 27 (Stejskal et al., 1994) indicated that palladium induced strong lymphocyte proliferation responses in patients with oral or systemic symptoms, but not in a similarly exposed unaffected person. However, the low specificity of this assay suggests that it is not useful for diagnosis of contact allergy to the metals gold, palladium and nickel, since a large number of false-positive results will be obtained (Cederbrant et al., 1997). Possibly, hypersensitivity is linked to certain genotypes, as suspected from studies with other metals (Stejskal et al., 1994; Eneström & Hultman, 1995).
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No clear clinical effects on oral mucosa were found in 72 patients who wore partial dentures of palladium-copper-indium alloys (Pd73, Cu14, In5) for a period of up to 48 months (Augthun & Spiekermann, 1994), although this alloy showed a relatively low corrosion resistance (see chapter 5). Fourteen patients reported a metallic taste or "battery feeling" in the mouth. Another study noted slight or moderate reactions of the mucosa adjacent to prostheses consisting of palladium-type alloys in less than 20% of the 39 patients examined (Mjör & Christensen, 1993).
Possible side-effects of treating various kinds of tumours, e.g., prostate cancer, with 103Pd needles (in use since about 1987; see chapter 3) may refer to general symptoms of therapeutic (radioactive) irradiation and are not discussed in the context of this document. Altogether, there were no palladium-related complications reported that might preclude the use of 103Pd needles in cancer radiotherapy (e.g., Sharkey et al., 1998; Finger et al., 1999).
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Several explanations for the weak reactivity towards metallic palladium in contrast to the reactivity to palladium(II) chloride have been suggested: there could be an additive effect of allergens (palladium and nickel) in tests with palladium(II) chloride containing traces of nickel contaminants (Todd & Burrows, 1992) or a mechanism of sensitization that requires the formation of either ions (Augthun et al., 1990) or specific complexes between ions and skin proteins (Santucci et al., 1995). Differences in the ionic charge (thus leading to different reactivity) may also play a role (De Fine Olivarius & Menné, 1992; Santucci et al., 1995). For example, (PdCl4)2- seems to be less reactive than palladium(II) chloride (Santucci et al., 1995). The extent of release of palladium ions from foils onto skin is currently the most favoured explanation for the rates of sensitivity reported (Flint, 1998). However, the discordances are not yet fully understood.
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Several studies investigated the allergic potential of metallic palladium (pure or in mixture). As can be seen from Table 28, the epicutaneous or epimucosal tests performed resulted in only few positive reactions. Interestingly, many patients sensitive to palladium(II) chloride did not react to the applied metallic palladium. On the other hand, reactivity to metallic palladium was not necessarily connected with positive palladium(II) chloride patch test results.
Environmental Health Criteria 226
According to Tomilets et al. (1980), palladium (and platinum) salts were shown to possess both histamine-releasing and histamine-binding properties. The latter effect might be one of the possible mechanisms of the antitumour effect of palladium as well as platinum salts, since histamine binding in tumour cells is suggested to suppress their proliferation.
World Health Organization Geneva, 2002
In addition to case reports, there are numerous studies reporting the frequency of palladium allergy, as determined in special groups (with and without clinical symptoms) by means of patch test reactions to palladium(II) chloride. The frequency of sensitivity in apparently dentistry-related groups ranged from 3 to 36% (van Loon et al., 1986; Gailhofer & Ludvan, 1990; Koch & Bahmer, 1995, 1999; Tibbling et al., 1995; Marcusson, 1996; Richter & Geier, 1996; Schaffran et al., 1999), which was similar to the wide range found with eczema patients (see also Table 30 in section 8.1.4 below).
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