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.
Section snippets
Dental care worker susceptibility
A person's susceptibility to allergens or irritants can play a role in the development of type I NRL protein allergy, ACD or ICD.7, 28 The presence of existing allergies, contact dermatitis, eczema and poor skin condition may suggest an increased overall susceptibility for allergies.6, 7 A person's age and sex can suggest increased allergen exposure, which affects his or her risk of developing ICD and ACD.25, 29 Understanding daily activities, the frequency of wet work and potential contact
THE DIAGNOSIS
Making an accurate diagnosis can be challenging and depends on accurate interpretation of symptoms and tests (Figure 1). Sadly, health care workers have reported having skin dermatoses for an average of three years before locating a physician with sufficient skill and experience.5, 49 Experienced dermatologists or allergists—and sometimes both—are required; allergists are likely to test for a type I NRL protein allergy, while dermatologists commonly test for ACD.50, 51, 52
EDUCATION: THE ULTIMATE KEY
Healthy, intact skin is the quintessential barrier to pathogen transmission. Therefore, dental professionals should receive instruction about basic skin biology and proper hand hygiene, as well as guidance on the appropriate use of hand care products. The 2003 infection control guidelines for dental care workers published by the Centers for Disease Control and Prevention60 emphasizes these issues. Opportunities for training exist at dental schools, in continuing education courses and through
MANAGEMENT
In dental care workers with occupation-based allergies, management of the allergy is based on avoidance of the allergen. This is accomplished effectively through judicious use of alternative products and by isolating workers from exposure to the allergen. This paradigm generally applies to both type I NRL protein allergy and ACD resulting from exposure to chemical allergens, as well as to substances that may be skin irritants. Essentially, dental care workers must mitigate the opportunity for
SUMMARY
Dental and medical workers frequently report symptoms of occupational dermatoses. However, most are not caused by the widely publicized latex allergy. On the basis of current study data, it is more likely that dental professionals experience ACD resulting from exposure to one or more of the allergens in the dental office, such as methacrylates, glutaraldehyde and rubber processing chemicals.19, 20, 21, 23 There also may be an equal or greater number of people with ICD reactions to these
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Practical Science is prepared in cooperation with the ADA Council on Scientific Affairs, the Division of Science, and The Journal of the American Dental Association. The mission of Practical Science is to spotlight scientific knowledge about the issues and challenges facing today's practicing dentists.
Dr. DePaola is a professor, Department of Diagnostic Sciences and Pathology, Baltimore College of Dental Surgery, Dental School, University of Maryland-Baltimore.
