Metal hypersensitivity in the context of connective tissue disease – An opportunity for practice prevention

Highlights: • Metal implants are association with metal hypersensitivity reactions of the skin. • American Contact Dermatitis Society endorses nickel allergy testing. • Metal dental appliances may trigger cutaneous reactions. • Alternative include stainless steel, fiber composite, plastic, and resin-coated. • Alternatives may improve symptoms of fibromyalgia and connective tissue disease. Metal hypersensitivity reactions (MHR) are not associated with metal containing orthodontic implants unless there is a positive history of dermatitis from a high nickel-release item (piercing post, earring, watch). We wish to present this letter to highlight evidence surrounding orthodontic-related nickel hypersensitivity and to bring to the readers attention current American Contact Dermatitis Society (ACDS) guidelines that endorse the importance of addressing metal hypersensitivity reactions in the setting of implantable dental devices.