Prevalence of type I natural rubber latex allergy among dental hygienists.

PURPOSE: Oral health care professionals have been shown to be at risk for developing a type I allergy to natural rubber latex (NRL). The objective of this study was to assess the prevalence of this allergy in dental hygienists. METHODS: Participants attending the 2000-2002 American Dental Hygienists' Association (ADHA) national meetings were screened for type I allergies to NRL using skin prick testing, symptom assessment, and health history. Participants were classified as positive for a type I NRL allergy based on their positive skin prick reactions to standardized NRL solutions. Risk factors and symptom assessments were based on a self-reported health history. RESULTS: Of the 582 ADHA participants who completed the screening and health history questionnaire, 4.8% (n=28) screened positive for a type I allergy to NRL (SPT-positive). These SPT-positive participants were significantly more likely to report an allergy to cross-reacting foods, plants, molds, and pollens, and to report reactions to rubber products. Participants screened SPT-positive were also significantly more likely to report a history of hives and respiratory symptoms after contact with natural rubber. CONCLUSION: Based on skin prick testing, the prevalence of a type I allergy to NRL in dental hygienists appears similar to that reported for other oral health care professionals and is greater than the general population. Educating dental hygienists about type I NRL allergy may help reduce prevalence and improve its management.

Occupation-related allergies in dentistry.

BACKGROUND: Allergies to natural rubber latex (NRL) were unknown in dentistry until 1987. That changed with the publication of a report documenting NRL-based anaphylaxis in a dental worker. This case and others prompted regulatory and manufacturing changes in rubber products and increased awareness throughout the profession. However, other common dental chemicals cause allergic reactions and irritation and often are handled with insufficient precautions. Although recognition of NRL allergy has improved, awareness of other potential allergens and irritants in dentistry still is limited. OVERVIEW: Recent research indicates that the prevalence of NRL protein allergy may be decreasing. In contrast, occupation-related dermatoses associated with other dental products may be more common. Encounters with bonding agents, disinfectants, rubber, metals and detergents can cause occupation-based irritant contact dermatitis and allergic contact dermatitis. These conditions may be found in more than one-quarter of dental and medical personnel. Therefore, dental-specific information about the recognition and management of allergic and irritant reactions is needed. CONCLUSIONS AND CLINICAL IMPLICATIONS: The prevalence of occupation-related dermatitis may be increasing in dentistry. Reducing exposure to potential irritants and allergens and educating personnel about proper skin care are essential to reversing this trend.

Prevalence of upper extremity symptoms and disorders among dental and dental hygiene students.

CONTEXT: Upper extremity musculoskeletal disorders are common among dental professionals. The natural history of these disorders is not well-understood. These disorders are more common in older workers, but the prevalence among younger workers has not been well-studied. OBJECTIVE: The objective of this study was to determine if dental/dental hygiene students had a similar prevalence of upper extremity musculoskeletal disorders compared to age-matched clerical workers. We hypothesize students will have a lower prevalence of upper extremity musculoskeletal disorders compared to clerical workers. DESIGN: This was a cross-sectional design. SETTING: Dental and dental hygiene students from three schools were compared to clerical workers from three locations (an insurance company and two data processing plants). SUBJECTS: There were 343 dental and dental hygiene students and 164 age-matched clerical workers. MAIN OUTCOME MEASURES: Regional discomfort was the primary outcome. The secondary health outcomes were diagnoses of carpal tunnel syndrome and upper extremity tendinitis. RESULTS: Clerical workers had a higher prevalence of hand symptoms (62 percent vs. 20 percent), elbow symptoms (34 percent vs. 6 percent) and shoulder/neck symptoms (48 percent vs. 16 percent) and a higher prevalence of carpal tunnel syndrome (2.5 percent vs. .6 percent) and upper extremity tendinitis (12 percent vs. 5 percent). The clerical workers were more obese, smoked more, exercised less frequently, and had lower educational levels and less control of their work environment. CONCLUSIONS: Dental and dental hygiene students have a very low prevalence of upper extremity musculoskeletal disorders. A longitudinal study is necessary to evaluate ergonomic and personal risk factors.

Occupational allergens in dentistry.

PURPOSE OF REVIEW: Dental professionals and their physicians frequently do not recognize, accurately diagnose or appropriately manage occupational allergies. Dental allergen identification, diagnostics and practical avoidance strategies are summarized in this review. RECENT FINDINGS: Methacrylates, natural rubber latex proteins, rubber glove allergens, and glutaraldehyde are the predominant allergens in dentistry. Reactions range from cell-mediated contact allergy to urticaria and occupational asthma. SUMMARY: Despite recent advances in allergen characterization and increased awareness of selected allergens, treatment of occupational allergies can be improved. Better information and improved cooperation between dental workers and their clinicians is needed.

Allergic contact dermatitis in dental professionals: effective diagnosis and treatment.

BACKGROUND: Like other health care workers, dental professionals are at risk of developing allergic contact dermatitis, or ACD, after exposure to allergenic chemicals. Common allergens include antimicrobials, preservatives, rubber additives and methacrylates. CASE DESCRIPTION: The authors describe an orthodontic assistant with severe skin disease, whose symptoms included redness, cracking and bleeding that persisted for 10 years. The patient had previously received an incomplete diagnosis. After performing patch testing, assessing symptoms and evaluating the patient's medical history, the authors diagnosed ACD resulting from exposure to several dental allergens. The patient received appropriate treatment and counseling to better manage her allergies; this resulted in resolution of all symptoms and averted permanent occupational disability. CLINICAL IMPLICATIONS: Not all skin reactions are related to gloves or natural rubber latex. Dental professionals should be aware of common chemical allergens, symptoms of ACD and the appropriate treatment of occupational skin disease.

Developmental expression of heme oxygenase in the rat lung.

Heme oxygenase (HO), the rate-limiting enzyme in the formation of bilirubin, is expressed in the lung and may serve as an antioxidant. This enzyme results in the formation of antioxidant bile pigments and the degradation of pro-oxidant heme. We wanted to evaluate the differences in expression of HO-1, the inducible form, and HO-2, the constitutive isoenzyme, during lung maturation and document whether lung HO expression was similar to that of other antioxidant enzymes. Lung total HO activity and HO-1 and HO-2 proteins as well as HO-1 and HO-2 mRNA were evaluated in animals from 16 d of gestation (e(16.5)) to 2 mo of age. Heme content was also evaluated because heme is the substrate of the reaction. HO-1 mRNA was maximal at e(19.5) and e(20.5), whereas HO-2 mRNA was not changed throughout maturation. Lung HO-1 protein was highest on the first days of life and lowest in adults, whereas HO-2 protein was maximally expressed at postnatal d 5 and then declined to reach adult values. As to HO activity, there was a prenatal peak at e(20.5), a second lesser peak at d 5, and thereafter a decline to adult values. Lung heme content was inversely correlated with HO activity or protein as the highest heme values were seen in adults with the lowest HO activity. In response to hyperoxia, HO-1 mRNA was induced only in the adult lungs. A better understanding of the maturational regulation of lung HO will define a role for HO in newborns at risk for oxygen toxicity.

Cross-reactivity between gutta-percha and natural rubber latex: assumptions vs. reality.

BACKGROUND: Immunological cross-reactivity between gutta-percha and natural rubber latex, or NRL, has not been demonstrated clearly despite recent concerns and several suspected cases reported in the literature. METHODS: The authors analyzed aqueous extracts of commercial gutta-percha points and raw gutta-percha samples for cross-reactivity to NRL by radioallergosorbent test, or RAST, inhibition; immunoblot inhibition; direct enzyme-linked immunosorbent assay, or ELISA; and ELISA inhibition using sera from NRL-allergic people as the source of anti-NRL immunoglobulin E, or IgE, antibodies. To confirm in vitro results, the authors conducted skin prick testing, or SPT, on a patient with type I NRL allergy using aqueous extracts from raw gutta-percha, ammoniated gutta-percha and gutta-percha points. RESULTS: Aqueous extracts from commercial gutta-percha points did not cross-react to NRL in RAST inhibition or immunoblot inhibition, ELISA or ELISA inhibition assays. However, three of 13 sera from subjects with type I NRL allergy exhibited IgE binding to raw gutta-percha extracts in direct ELISA. Moreover, in ELISA inhibition, the binding of IgE to raw gutta-percha extracts was inhibited in a dose-dependent manner by raw NRL and vice versa. SPT results from a subject with type I NRL allergy were positive for NRL and raw gutta-percha extracts but negative for gutta-percha point extracts. CONCLUSIONS: The authors found no detectable cross-reactivity between NRL and commercial gutta-percha points. However, their ELISA and SPT results demonstrated that some allergenic cross-reactivity exists between raw gutta-percha and raw NRL. CLINICAL IMPLICATIONS: Gutta-percha alone is not likely to induce symptoms in patients with type I NRL allergy. However, other materials used in obturating root canals may be irritating and potentially allergenic in patients with pre-existing allergies.

Prevalence of carpal tunnel syndrome and upper extremity tendinitis among dental hygienists.

PURPOSE: This study was undertaken to determine the prevalence of carpal tunnel syndrome (CTS) and upper extremity (UE) tendinitis among dental hygienists. METHODS: In a cross-sectional study dental hygienists (n = 305) were screened using sensory nerve conduction, a focused physical examination of the UE, and a symptom questionnaire. CTS was diagnosed if the subject had slowing of the median nerve at the wrist and symptoms of numbness, tingling of pain in the median distribution. Localized tendinitis of the UE was diagnosed if the subject had focal symptoms and associated findings on physical examination. RESULTS: Three percent of the participating dental hygienists were diagnosed with CTS. Thirteen were diagnosed with shoulder tendinitis, while 6% had a tendinitis of the elbow and 7% had tendinitis of the hand or wrist. Twenty-eight percent had a diagnosis of some UE tendinitis or CTS. CONCLUSIONS: The prevalence of hand and finger symptoms in the dominant hand among dental hygienists in this study was high, but the prevalence for CTS was nearly the same as the general population. There was a high rate of UE tendinitis noted within this population.

Management of dental patients with allergies to natural rubber latex.

Reports of serious allergic reaction to natural rubber latex (NRL) are not uncommon in dentistry. The prevalence of Type I allergies in high-risk patient groups can range as high as 17% for health care professionals and over 50% in patients with spina bifida. A Type IV allergy to NRL chemical additives, also known as allergic contact dermatitis, is common in health care professions. To safeguard patients and coworkers, dentists must learn to recognize patients and workers at risk for NRL allergies, identify the associated symptoms, implement preventive measures, and encourage thorough diagnostics and management. This article reviews the latest advances in NRL allergies, particularly as they apply in dentistry.