Epidemiologic study on occupational allergy in the dental clinic

Prevalence of occupationally related hand dermatitis in dental workers

Occupationally related hand dermatitis has been attributed to frequent hand-washing, exposure to possible sensitizers and latex glove use. The authors conducted a study to determine the prevalence of occupationally related hand dermatitis in dental personnel. They found that 75 (19.2 percent) of 390 subjects self-reported they had a positive history of hand dermatitis. Further testing of 53 of these subjects indicated that only 9.4 percent reacted to the 45 allergens tested, and 3.8 percent had an allergy to latex.

Occupational risks in dentistry: comforts and concerns

Dentistry has been portrayed as a high-risk profession in recent reports. A look at several areas of concern, however, shows that the field is no more hazardous than any other profession--and less than most.

Casting alloys: side-effects

Side-effects from dental materials are a minor problem, but should be recognized. In recent questionnaire surveys about side-effects, the incidence was estimated to be 1:300 in periodontics and 1:2600 in pedodontics. None of these reactions was related to dental casting alloys. In prosthodontics, the incidence was calculated to be about 1:400, and about 27% were related to base-metal alloys for removable partial dentures (cobalt, chromium, nickel) and to noble/gold-based alloys for porcelain-fused-to-metal restorations. The complaints consisted of intra-oral reactions (such as redness, swelling, and pain of the oral mucosa and lips), oral/gingival lichenoid reactions, and a few instances of systemic reactions. In orthodontics, the incidence was 1:100, and most reactions (85%) were related to metal parts of the extra-oral anchorage devices. Even though the extensive use of base-metal alloys has been of major concern to the dental profession, relatively few case reports substantiate this concern. Allergy to gold-based dental restorations has been more commonly reported. Palladium-based alloys have been associated with several cases of stomatitis and oral lichenoid reactions. Palladium allergy seems to occur mainly in patients who are very sensitive to nickel. All casting alloys, except titanium, seem to have a potential for eliciting adverse reactions in individual hypersensitive patients. Tolerance induction may be a possible benefit of the use of intra-orally placed alloys. In non-sensitized individuals, oral antigenic contacts to nickel and chromium may induce tolerance rather than sensitization. A variety of systemic diseases and reactions has been claimed to be caused by dental materials. The claims are generally poorly documented.

Burning mouth syndrome: a possible etiologic role for local contact hypersensitivity

BACKGROUND

The pathogenesis of the burning mouth syndrome (BMS) is not yet understood. Apart from psychologic factors, several etiologic "somatic" factors have been reported.

OBJECTIVE

In 22 patients (19 women, 3 men, mean age 56 years) classified with BMS, clinical and laboratory investigations were performed, with particular emphasis on the role of contact hypersensitivity. Twenty of the 22 patients wore a complete or partial denture.

METHODS

Besides clinical and laboratory investigations patch testing was performed with a standard routine series and a standardized denture-dental (acrylate and metal) series.

RESULTS

Folate, iron, pyridoxine deficiency, and Candida infections were found, but correction of the deficiency or treatment of the infection was of no benefit. Contact allergy to allergens used in the production of acrylate-based dentures was observed in six (27%) of the cases (all wore a denture); positive reactions were seen to N,N,-dimethyl-4-toluidine (3 cases), to 4-tolyldiethanolamine (2 cases), to benzoylperoxide (2 cases), and to oligotriacrylate (1 case). In six cases (27%) a possible relevant sensitization was seen to dental metals and in particular to gold chloride (four cases).

CONCLUSION

The possible role of local hypersensitivity reactions to denture or dental components as etiologic factors in BMS must be considered.