Mixed-dust pneumoconiosis in a dental technician: a multidisciplinary diagnosis case report.

BACKGROUND: In dental laboratories, exposure to crystalline silica can occur during procedures that generate suspended mineral dusts, e.g. dispersion of mixing powders, removal of castings from molds grinding, polishing of castings and porcelain, and use of silica sand for blasting. There is also a large list of toxic agents (acrylic resins, polymeric materials, etc.) used to produce removable and fixed prostheses, but also impression materials and more. Using personal protective equipment and other aids reduces the exposure to these potentially harmful agents. CASE PRESENTATION: We report the case of a 42-year-old male dental technician who began to suffer from a dry cough and exertional dyspnea after approximately 15 years of work. The operations he conducted for his job resulted in the generation of crystalline silica, aluminum, chromium and titanium dust. The worker did not regularly wear personal protective equipment and some of the above operations were not carried out in closed circuit systems. The Chest X-ray showed diffused micronodules in the pulmonary interstitium of the upper-middle lobes, bilaterally, and a modest left basal pleural effusion. Simple spirometry showed small airway obstruction in its initial stage. High Resolution Computerized Tomography of the chest showed bilateral micronodulation of a miliariform type, with greater profusion to the upper lobes, also present in the visceral pleura, bilaterally. Histological examination showed aggregates of pigment-laden macrophages forming perivascular macules or arranged in a radial pattern around a core of sclerohyalinosis. Scanning Electron Microscopy and Energy Dispersive Spectrometry revealed several mineral particles, typically characterized by the presence of crystalline silica and metal aggregates. The environmental concentrations of total dust and its respirable fraction were all lower than the relative TLV-TWA-ACGIH, yet not negligible. CONCLUSIONS: The above findings and a multidisciplinary assessment led to the diagnosis of mixed dust pneumoconiosis s/q with 2/2 profusion of occupational origin. This diagnosis in a dental technician was supported for the first time in literature by environmental exposure analysis.

[From mandatory to participatory prevention: a model applied to the upholstered furniture industry]. / Dalla prevenzione imposta alla prevenzione partecipata: un modello applicativo nel comparto del mobile imbottito.

BACKGROUND: The Italian 2006-2008 National Health Plan emphasizes synergy and cooperation between the agencies formally involved in the prevention of occupational risks, in agreement with social partners. The so-called 'triangle of the sofa industry' is an interregional geographic area south-west of Bari, Italy. In 2003 this area produced 16% of the world-wide upholstered furniture output, with more than 500 plants of varying size. OBJECTIVE: The aim was to set up a network of communication and cooperation between the competent Agencies and Regions in order to address the rising trend of upper limb work-related musculoskeletal disorders. METHODS: The first step of the National Health Service Unit in Bari was to assess risk via a Ministerial research project and implement various information campaigns involving institutions, occupational physicians, private companies and public opinion. In a subsequent phase a synergy between the local Departmenst ofPrevention of the different Regions, the Italian Institute for Insurance Occupational Accidents and Disease (INAIL), the trade unions and the upholstered furniture industry Association was established. RESULTS AND CONCLUSIONS: New joint experimental projects (cutting tools, ergonomic table for assemblers, instruments for isokinetic evaluation) were launched together with training programmes for management, safety technicians and workers. This kind of 'participatory prevention' is more appropriate for the goal of a collaborative effort in order to assist the companies, which is a modern interpretation of the mission of public health prevention operators.