Russell Jaffe MD, PhD; Hona Kandi MS, CNHP; Jayashree Mani MS, CCN
Introduction
In the 21st century, we are exposed to many novel substances daily through our environment, food, products, and treatments. Each person possesses unique sensitivities that can affect us differently and to varying degrees clinically. Certain substances and their byproducts can be toxic or immunotoxin. This too often leads to serious chronic, autoimmune, or inflammatory repair deficient conditions. It’s important to note that while certain items are always toxic, immune responses are individual and these can vary over months. This article highlights why testing for dental and orthopedic materials is essential before selecting materials and which methodology is the most clinically complete.
Every person’s physiology responds differently and what may work effectively for one may not be the most appropriate course of action for another. Therefore, it is imperative to conduct a thorough evaluation of each patient on a case-by-case basis and carry out comprehensive testing to determine the optimal treatment plan. Utilizing a delayed hypersensitivity procedure helps identify potential allergic reactions or adverse responses to these materials, allowing practitioners to select suitable alternatives and minimize the risk of complications.
The Lymphocyte Response Assay (LRA) is a comprehensive clinical test that provides information on antibodies, immune complexes, and T-cell responses. This information guides the dentist or clinician to make the right decisions with their patient’s care whether it’s recovery after a dental procedure, or during wound healing after a hip replacement. The LRA Dental and Orthopedic Reactivity Testing is an assessment that helps dentists and physicians (and surgeons) identify any sensitivities or allergies their patients may have before selecting non-reactive materials for dental and orthopedic treatments.
LRA Cell Culture Tests Are Better
Other procedures do exist for dental and orthopedic materials. They however usually claim to identify potential harm from dental materials on the immune system through serum antibody measurement. Often, these serology IgG antibody assays are performed to detect immunoglobulin G (IgG). This has the advantage of examining the system’s immunologic memory. Our estimate is that 80+% of IgG antibodies are helpful and that less than 20% are harmful. But more importantly, tests that do not distinguish helpful from harmful results are of limited predictive significance at best. Importantly, these tests are unable to detect all three delayed hypersensitivity pathways (type II, type III, and type IV). (Figure 1). In addition to these tests not being able to distinguish between symptom-provoking (harmful) reactive substances and protective (helpful) antibodies, there is no direct T cell lymphocytic reaction. Ex-vivo testing allows for examining lymphocytes while they are still present in the bloodstream and exposed to foreign agents, providing more precise and targeted information.
Common Dental Materials Overview
Dental practice relies on a combination of common features and materials to ensure better oral health and aesthetics.
Dental crowns: often crafted from materials like porcelain, ceramic, or metal alloys, serve to restore damaged or decayed teeth. Porcelain and ceramic crowns are mainly used to mimic natural tooth appearance, making them popular for visible areas.
Dental fillings: Used to fill cavities. Commonly utilize materials such as composite resin or dental amalgam (mercury and silver). Composite resin, tooth-colored and versatile, blends seamlessly with natural teeth, is used often for its aesthetically pleasing look compared to traditional silver amalgam fillings.
Tooth replacements: Dental implants have become a standard solution for tooth replacement. Typically made of titanium, these implants provide a sturdy foundation for prosthetic teeth. The biocompatibility of titanium ensures integration with the jawbone, offering a durable and long-lasting option. These days, many biological dentists are veering to zirconia as a material of choice for dental crowns and bridges because of its durability, biocompatibility, and aesthetic appeal.
Orthodontic treatments: Often involve braces, traditionally made of stainless steel, which correct misalignments over time. However, advancements have introduced clear aligners (e.g., Invisalign®) made of transparent materials like thermoplastic polyurethane/copolyester because of its discreet alternative for teeth straightening.
Dental sealants: Usually composed of resin, provide a protective barrier against cavities on the chewing surfaces of molars. They work by sealing pits and fissures in the surfaces of teeth.
The choice of dental materials should be based on factors such as the patient’s oral health and specific needs. Also, it is critical to ensure that there are no immune sensitivities or reactivity to the item(s) being used that can interfere with wound healing and clinical success.
Common Orthopedic Materials Overview
Implants and fixation devices: The orthopedic field utilizes a range of features and materials to treat musculoskeletal problems to improve mobility and reduce pain. Joint replacement surgeries rely heavily on orthopedic implants, usually composed of titanium or other metal alloys. These materials are selected for their robustness, biocompatibility with living tissue, and rust resistance, guaranteeing that the implant remains stable and long-lasting within the human body.
Orthopedic fixation devices, including screws, plates, and rods, are usually made of stainless steel or titanium. Surgeons often have the option to choose between stainless steel and titanium plates. In medical settings, these materials provide the strength to support fractured bones during healing. Stainless steel is renowned for its durability, while titanium offers a combination of stability and a reduced risk of complications. In joint replacement surgeries, metals like titanium, chromium, and nickel are commonly used to ensure durability, strength, and resistance to corrosion.
Orthopedic prosthetics. Advancements have led to the use of high-density and metal. Polyethylene is commonly used in joint components because it has low friction and thus replicates natural joint movement. Metal alloys, such as cobalt chromium, are widely used bearing surfaces in metal-on-polyethylene applications for orthopedic surgery. Cobalt chrome is commonly used in orthopedic implants such as joint replacements and bone plates. It is also frequently used as a bearing surface in metal on polyethylene applications. Additionally, ceramics are also commonly used in arthroplasty, particularly for hip replacements. Ceramics have hardness and wear resistance, making them suitable for articulating surfaces in joint replacements. In hip and knee replacements, ceramics components are often used for the prosthetic joints’ femoral head or articulating surfaces.
Testing for sensitivity to orthopedic materials assures better patient safety and success of orthopedic procedures. Individuals may have varying reactions to materials used in implants, and testing helps identify potential sensitivities and allergies before surgery.
Both dental and orthopedic materials have modernized. The array of choices has no doubt helped considerably in better outcomes. As mentioned earlier, dental crowns use materials ranging from gold and nickel to titanium, zirconia(zirconium), and porcelain alloys. Mouth guards are manufactured using materials like silicone and polyethylene. Sutures made of materials like nickel and ceramic, and titanium alloys are often used in dental and orthopedic procedures due to their biocompatibility. Stainless steel or nickel-titanium alloys are widely used for structural support in surgical mesh and stents.
This abundant choice makes it even more critical that we choose the right type of material for the person not just based on literature but based on what the body says.
Certain Chemicals May Pose Short-Term and Long-Term Issues to the Body
For instance:
- Mercury is associated with delayed hypersensitivity reactions, especially in the context of dental amalgam fillings. Delayed hypersensitivity reactions involve the immune system’s delayed response to perceived threats, leading to inflammation (repair deficit) and symptoms that may be delayed.
- Some orthopedic implants contain nickel or other toxic minerals as catalysts that can cause allergic reactions in susceptible individuals. This may lead to skin irritation or more severe complications.
- Using titanium in implants or dental materials can cause delayed sensitivity reactions in some individuals. As titanium particles wear and tear, they can be released and lead to an immune response, increasing the risk of developing hypersensitivity. The same is the case for zirconia (zirconium dioxide) which often may be the material of choice for implants and crowns but may not be the best choice for a particular individual.
- Gold is often used in dental work such as crowns, bridges, or implants. Benign as it may be for most individuals, some may be sensitive to gold on the surface which can promote inflammation and irritation. This, in turn, may lead to symptoms such as generalized redness, swelling, or chronic health conditions.
Dr. Walter Jesse Clifford and CMRT
Walter Clifford, the inventor of Clifford Materials Reactivity Testing (CMRT), developed a screening system to identify potentially harmful materials that contain substances that may cause an immune reaction in patients. The CMRT test checked for antibodies the immune system produces when it encounters toxic or irritating substances using a classic serum ELISA IgG test. With Dr Clifford’s passing, the ELISA/ACT Biotechnologies laboratory took over this testing and in 2023 revalidated this testing – moving it over to the LRA platform.
LRA by ELISA/ACT™ tests assess reactions of lymphocytes exposed in the lab to different substances but are different by design. Through the technology breakthrough involved in the LRA by ELISA/ACT methodology, it is possible to allow living white cells to react in the laboratory just as they do in the body. This determines true delayed allergy/hypersensitivity based on the body’s long-lived memory-carrying white blood cells. LRA by ELISA/ACT tests are also unique in that all 3 delayed hypersensitivity pathways are measured on the same specimen and at the same time. The clinical results have more true positives, and few false negative reactions confirmed in multiple successful community-based controlled outcome studies. Functional tests such as lymphocyte response assays (LRAs) do not suffer the methodologic limitation of serology or antibody tests and have been developed to overcome these limitations.
LRA tests are functional, predictive and evidence based.
By testing the lymphocytic reactions, it is possible to accurately assess the burden on immune defense and repair systems. The LRA by ELISA/ACT functional tests have a 97+% accuracy (<3% variance) rate substantially better than non-functional IgG testing and other automated cytotoxic, particle size procedures.
This technique has been in use since 1984 to test over 500 items, including foods, toxic metals, chemicals, additives, and preservatives and more. Now for the first time this cell culture is now available to accurately assess compatibility to 25000+ dental and orthopedic materials by assessing 46 antigens (Table 1).
Table 1. LRA Dental and Orthopedic Antigens
| Acetates | Aluminum | Antimony | Arsenic |
| Barium | Benzil | Benzylkonium Chloride | Beryllium Salts |
| Bismuth Salt | Cadmium | Cellulose | Cerium Salts |
| Chromium Salts | Cobalt Salts | Formaldehyde | Gallium Salts |
| Gold | Iron Salts | Lanthanum | Lead |
| Mercury | Metabisulfite | Methyl Paraben | Nickel |
| O-Phosphoric Acid | Phenol | Polyethers | Polyethimines |
| Polyvinyls | Propionates | Phthalates | Rubidium Salts |
| Ruthenium | Scandium | Silicates | Silver |
| Sodium Fluoride | Sorbates | Thallium | Thimerosal |
| Tin | Titanium | Toluene | Xylene |
| Zinc | Zirconia |
For successful repair and prompt wound healing from any procedure, doing the LRA dental and orthopedic tests are smarter choices.
You are and become what you eat, drink, think and do.
The LRA Dental and Orthopedic tests can be done on their own or in conjunction with any other standard LRA panel(s). Health issues often come in groups and if there is an underlying autoimmune condition, this is the recommended testing and approach for complete immune enhancement. Clinical reports indicate that in all autoimmune conditions, identifying and substituting each of the specific foreign invaders known generally as antigens that wear down the immune defense and repair system.
If requested, a Health Appraisal Questionnaire (HAQ) may be included with the specimen. This incorporates the LRA results with the lifestyle questionnaire and provides meaningful suggestions about eating, hydrating, supplementation, and supporting mental and physical activities.
Primary proactive predictive personalized prevention practices and protocols deserve to be part of today’s first line comprehensive care. LRA for Dental and Orthopedic compatibility tests are the ideal choice for improved wound healing, compatibility, with materials used during procedures and optimum recovery.
References
- Coombs, PR and Gell, PG. (1968) Classification of Allergic Reactions Responsible for Clinical Hypersensitivity and Disease. In: Gell, R.R., Ed., Clinical Aspects of Immunology, Oxford University Press, Oxford, 575-596.
- Hodsdon W, Zwickey H. NMJ Original Research: Reproducibility and Reliability of Two Food Allergy Testing Methods, Nat Med J, 2010; 2(3): 8-13.
- Jaffe R, Improved Immune Function Using Specific Nutrient Supplementation and ELISA/ACT “Immunologic Fingerprint” to detect Late Phase Responses –Ex Vivo. J Am Coll Nutr,1989; 8(5): 424.
- Deuster PA, Jaffe R. A Novel Treatment for fibromyalgia improves Clinical Outcomes in a Community Based Study. J Musculo Pain, 1998; 6:133-149.
- Jaffe R, Mani J, DeVane J, Mani H. Tolerance loss in diabetics: Association with foreign antigen exposure. Diabetic Medicine, 2006; 23(8): 924-925.
- AE Lynch and R Jaffe, “Lymphocyte Response Assay: Report on Precision of Novel Cell Culture Test, Experimental Biology,” Poster presented at the American Society for Investigative Pathology conference, San Diego, CA, 2016.
- Apscott DC, Wottowa C. Orthopedic Implant Materials. [Updated 2023 Jul 25]. In: StatPearls Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560505/
- Dental Mercury: Why We All Don’t Get Sick in the Same Way.” IAOMT, 13 Jan. 2023, iaomt.org/resources/dental-mercury-facts/dental-mercury-amalgam-side-effects/.
Useful Links
https://www.betterlabtestsnow.com/product/lra-dental-orthopedic-materials-bundle/
Published February 24, 2024
About the Authors
Russell Jaffe, MD, PhD, received his AB, MD (with senior thesis honors), and PhD (In biochemistry and physiology) from Boston University. Dr. Jaffe served his medical internship at University Hospital and was awarded the US Public Health Service Officer Commission, assigned to the Clinical Center of the National Institutes of Health in June 1973. While at the Clinical Center, Dr. Jaffe served his residency in clinical pathology. He is board certified in clinical and subspecialty certified in chemical pathology. Dr. Jaffe remained on the permanent senior staff of the NIH Clinical Pathology Department, where he continued method innovation and was active in collaborative research with the Laboratory of Experimental Atherosclerosis (of the Heart, Lung, and Blood Institute). Concurrently, Dr. Jaffe’s interests in the mechanisms of health and the evoking of human healing responses led him to apprentice in such healing arts as acupuncture; mindfulness; massage; music, art, and color therapy; and a variety of eclectic therapeutic approaches.
In addition, Dr. Jaffe performed innovative studies of platelet function and blood clotting in relation to the origins of coronary artery and cardiovascular diseases.
Among the tests that he developed are the early colon cancer-screening test using occult blood detection not interfered with by vitamin C consumption, as well as a variety of tests related to the blood clotting and immune defense and repair systems. Dr. Jaffe developed the first method of measuring cell-mediated immunity using a modified ELISA system in a lymphocyte mitogenesis/blastogenesis brief cell culture known as lymphocyte response assays (LRA). This LRA by ELISA/ACT provides an “immunologic fingerprint” of items to which the body is reactive or tolerant.
Dr. Jaffe has contributed over 100 symposium-invited talks, scientific articles, or book chapters. He received the J. D. Lane award for original research from the USPHS, the Merck Sharp and Dohme Excellence in Research Award, and in 2002 the International Research Scientist of the Year, among other recognitions for his investigations. Dr. Jaffe is a fellow of the Health Studies Collegium and director of ELISA/ACT Biotechnologies LLC and PERQUE LLC in Ashburn, Virginia. He may be reached at 800-525- 7372 ext. 5101, and rjaffe@ELISAACT.com or rjaffe@PERQUE.com.
Jayashree Mani, MS, CCN, is a clinical nutritionist with over 20 years’ experience in providing nutritional counseling and education to patients and physicians in various medical environments. Her focus over the past 10 years has been on the functional use of lymphocyte cell response assays in clinical management of various autoimmune conditions, including fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome. Developing nutritional protocols involving the Alkaline Way and specific nutritional supplementation, her work also includes specific emphasis on diabetes and metabolic syndrome and its management. She has coauthored chapters on these topics and published scientific articles describing these comprehensive approaches as well. She may be contacted at PERQUE Integrative Health/ELISA/ACT Biotechnologies; 800-525-7372 or 703-840-4427; jmani@PERQUE.com or jmani@elisaact.com
Hona Kandi is a highly experienced natural health practitioner and nutritionist with over three years of experience working in integrative health and wellness settings. Her focus is on providing nutritional support for immune robustness using Lymphocyte Response Assays and plans. As a clinical educator, Hona helps her community to lead healthier lifestyles by considering all aspects of their health history, including food, stress, environmental toxicity, and hormone imbalances. She looks at the body as a whole and creates personalized plans that involve the Alkaline Way/Nature’s pHarmacy principles and comprehensive nutritional supplementation. Hona has also co-authored case studies and highlighted this comprehensive approach to wellness at conferences. She can be reached at PERQUE Integrative Health/ ELISA/ACT Biotechnologies at hkandi@elisaact.com or call 800-553-5472 ext. 3320.