When metals compete: a case of copper-deficiency myeloneuropathy and anemia

Abstract

Change to a low-zinc denture cream and oral copper replacement.

Zinc-containing denture adhesive: a potential source of excess zinc resulting in copper deficiency myelopathy

“…1). 1,11 Zinc excess can occur with parenteral feeding, 1 use of supplements 6,11 and accidental ingestion of zinc-containing denture adhesive. 1,2 Our patient reported using dentures for the past seven to eight years and in the past four years had noticed a deterioration in the fit of the dentures.…”

“…2 Although the patient did admit to swallowing some of 'swayback' for many years, 6 but has only recently been recognised in humans, and even more recently the role of zinc containing adhesives has been described in several case reports. 1,2 While evidence remains at case report level and without being able to exactly determine the amount of ingested denture adhesive/absorbed zinc, the relationship between copper deficient myelopathy and zinc-containing denture adhesive remains a hypothesis. However, our patient's zinc levels improved on cessation of zinc-containing denture cream and extensive investigation ruled out other possible sources.…”

“…1,2,8,11 Prevention is therefore essential and dentists have an important role in educating patients about denture adhesive use. Dentists are well placed to identify patients who may be using zinccontaining denture adhesives to excess and who have anaemia or neurological symptoms affecting balance and walking.…”

“…However, there have been a number of recent reports of copper deficiency myelopathy and anaemia. 1,5,6 These have highlighted the critical role of copper in a wide range of physiological processes from ATP production and cell maintenance to erythropoeisis and myelin synthesis. 1,3,4,7 Neutropenia, anaemia and neurological symptoms seem to be the most common manifestations of copper deficiency 1,8,9 and perhaps reflect the higher metabolic activity of the nervous system and bone marrow.…”

“…1,2 As this condition is preventable but largely untreatable, dentists are well placed to detect denture adhesive overuse in patients with neurological symptoms and anaemia, and prompt further investigation.…”