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Chemical and Biocompatibility Risks in Orthodontic Biomaterials: A Bioethical and Toxicological Narrative Review
Summary
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.