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Chemical and Biocompatibility Risks in Orthodontic Biomaterials: A Bioethical and Toxicological Narrative Review
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Braces, aligners, and other orthodontic devices can shed small amounts of metals (like nickel and chromium), chemicals like BPA, and even tiny plastic particles into your mouth over time, this review pulls together existing research on what we know about these exposures. The good news is current levels appear to stay below concerning thresholds, but scientists still don't fully understand the long-term, cumulative effects, which matters especially since most orthodontic patients are kids and teens who rely on parents and dentists to weigh these risks for them.
Fixed and removable orthodontic appliances place metallic and polymeric biomaterials in prolonged contact with the oral environment. These materials are not chemically inert. Metal alloys corrode and release nickel, chromium, and other ions. Resin adhesives and thermoplastic aligners can leach bisphenol A, methacrylate monomers, and other additives. Elastomeric ligatures degrade and release plasticizers and trace metals. Recent work has also identified microplastic and nanoplastic shedding from orthodontic polymers. This narrative review summarizes current evidence on the chemical composition, release pathways, and biological effects of common orthodontic materials. It also discusses how salivary pH, fluoride exposure, and biofilm accumulation influence chemical release, and it outlines practical measures that can reduce patient exposure. Because much of this treatment is delivered to children and adolescents who cannot independently weigh longterm chemical risk, the review also considers the bioethical dimensions of material-related chemical exposure. Specifically, it examines how the principles of autonomy, beneficence, nonmaleficence, and justice apply to informed consent, material selection, and professional transparency about evidence gaps. Overall, most reported exposure levels remain below recognized toxicological thresholds. However, long-term, cumulative, and individual-level risks are not yet fully characterized, and this uncertainty itself carries ethical weight for how orthodontists communicate risk and select materials. Further clinical, analytical, and ethics-oriented research is warranted.
More Papers Like This
Chemical and Biocompatibility Risks in Orthodontic Biomaterials: A Bioethical and Toxicological Narrative Review
AI summary Read the abstract
Braces, retainers, and clear aligners can release tiny amounts of metals (like nickel and chromium), plastic-related chemicals (like BPA), and even microplastics into your mouth over time, this review pulls together existing research on the topic. The good news: current exposure levels are generally below levels considered harmful, but scientists still don't fully understand the long-term effects of this slow, steady exposure, especially since many patients are kids and teens who don't get much say in choosing their treatment materials. The takeaway is less "be alarmed" and more "the science isn't finished yet," so orthodontists should be upfront with patients and families
Chemical leaching and microplastics from clear aligner materials: Current evidence and future perspectives
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This review found that orthodontic clear aligners can release microplastics and chemicals like BPA into the mouth during normal use. While most products meet current safety standards, the combination of mechanical wear, saliva, and temperature changes in the mouth accelerates material breakdown, making dental appliances an underrecognized source of daily microplastic exposure.
The Microplastic Footprint of Orthodontics
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This review pulls together existing research showing that orthodontic devices like clear aligners, retainers, and tooth-colored fillings can shed tiny plastic particles—known as microplastics and nanoplastics—into your mouth over time. While scientists are still studying exactly how these particles affect our health, the paper suggests practical steps dentists can take to reduce this plastic exposure, which matters since millions of people wear these devices for months or years at a time.
Microplastics and orthodontic aligners: The concerns arising from the modernization of practice through polymers and plastics
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This review highlights that clear plastic orthodontic aligners release microplastics and the chemical BPA (bisphenol A) during normal use in the mouth. The released particles can be swallowed and potentially affect the gut, respiratory system, cardiovascular system, and brain. The authors urge the orthodontic field to prioritize patient safety and develop materials that minimize microplastic release from dental devices.
Biocompatibility and Safety of Orthodontic Clear Aligners and Thermoplastic Retainers: A Systematic In Vitro Review (2015–2025)
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This systematic review examined whether orthodontic clear aligners and retainers release harmful chemicals or microplastics in the mouth. While most products met safety standards, some materials did release detectable levels of bisphenol A and other chemicals, especially during initial wear and after aging, raising questions about long-term oral exposure.
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