Occupation-related allergies in dentistry

Effect of Various Airborne Particle Abrasion Conditions on Bonding between Polyether-Ether-Ketone (PEEK) and Dental Resin Cement

The effects of alumina particle size and jet pressure on the bond strength of polyetheretherketone (PEEK) were examined to determine the airborne particle abrasion parameters with minimal effects on PEEK and to achieve optimal bond strength, as a reference for future clinical use. An alumina particle with four particle sizes and three jet pressures was used to air-abrade PEEK. Surface roughness (R_a), morphology, chemical structure, and wettability were analyzed using a stylus profilometer, scanning electron microscope, X-ray diffractometer, and contact angle analyzer, respectively. The shear bond strength (SBS) of PEEK and dental resin cement was analyzed using a universal testing machine (n = 10). The failure modes and debonded fracture surfaces were observed using optical microscopy. Airborne particle abrasion increased the R_a and hydrophobicity of PEEK and deposited alumina residues. The SBS generally decreased after thermal cycling. A large particle size damaged the PEEK surface. The effects of different particle sizes and jet pressures on the SBS were only significant in certain groups. Adhesive failure was the main mode for all groups. Within the limitations of this study, 110 μm grain-sized alumina particles combined with a jet pressure of 2 bar prevented damage to PEEK, providing sufficient SBS and bonding durability between PEEK and dental resin cement.

The Use of Acrylate Polymers in Dentistry

The manuscript aimed to review the types of acrylate polymers used in dentistry, as well as their chemical, physical, mechanical, and biological properties. Regarding their consistency and purpose, dental acrylate polymers are divided into hard (brittle), which includes acrylates for the production of plate denture bases, obturator prostheses, epitheses and maxillofacial prostheses, their repairs and lining, and soft (flexible), which are used for lining denture bases in special indications. Concerning the composition and method of polymerization initiation, polymers for the production of denture bases are divided into four types: heat-, cold-, light-, and microwave-polymerized. CAD/CAM acrylate dentures are made from factory blocks of dental acrylates and show optimal mechanical and physical properties, undoubtedly better monomer polymerization and thus biocompatibility, and stability of the shape and colour of the base and dentures. Regardless of the number of advantages that these polymers have to offer, they also exhibit certain disadvantages. Technological development enables the enhancement of all acrylate properties to respond better to the demands of the profession. Special attention should be paid to improving the biological characteristics of acrylate polymers, due to reported adverse reactions of patients and dental staff to potentially toxic substances released during their preparation and use.

[Allergic reactions to bioimplants]

BACKGROUND

Bioimplants are used in a variety of ways in otorhinolaryngology, most commonly in facial reconstructive surgery, cochlear implants (CI), bone-anchored hearing aids, and partial/total ossicular replacement prostheses (PORP/TORP), but also for tympanic drainage, laryngeal cannula, voice prostheses after laryngectomy, etc., and in otorhinolaryngology-related procedures as dental implants in dentistry.

METHODS

A literature search was performed to analyze the immunology of allergic reactions to bioimplants and to determine the available evidence by searching Medline, PubMed, and national and international study and guideline registries and the Cochrane Library. Human studies published in the period up to and including 12/2021 were considered.

RESULTS

Based on the international literature and previous experience, a review of allergies to bioimplants in otolaryngology is presented.

CONCLUSION

Otorhinolaryngologists should always consider the possibility of allergic reactions when inserting allogeneic materials, particularly, but not only, when using bioimplants.

Occupational Contact Dermatitis in Dental Personnel: A Retrospective Analysis of the North American Contact Dermatitis Group Data, 2001 to 2018

BACKGROUND

Dental personnel are at risk of developing occupational contact dermatitis.

OBJECTIVES

The aims of the study were to determine prevalence of occupational contact dermatitis in dental personnel referred for patch testing and to characterize relevant allergens and sources.

METHODS

The study used a retrospective, cross-sectional analysis of the North American Contact Dermatitis Group (NACDG) data, 2001-2018.

RESULTS

Of 41,109 patients, 585 (1.4%) were dental personnel. Dental personnel were significantly more likely than nondental personnel to be female (75.7% vs 67.4%, P < 0.0001), have occupationally related dermatitis (35.7% vs 11.5%, P < 0.0001), and/or have primary hand involvement (48.6% vs 22.5%, P < 0.0001). More than one quarter of dental personnel (62/585, 27.7%) had 1 or more occupationally related allergic patch test reaction(s). There were 249 occupationally related reactions to NACDG screening allergens, most commonly glutaraldehyde (18.1%), thiuram mix (16.1%), and carba mix (14.1%). The most common sources of NACDG screening allergens were gloves (30.7%), dental materials (26.6%), and sterilizing solutions (13.1%). Seventy-three dental personnel (12.5%) had 1 or more positive patch test reactions to occupationally related allergen(s)/substances not on the screening series. Occupationally related irritant contact dermatitis was identified in 22.2% (n = 130) of dental personnel, most commonly to nonskin soaps/detergents/disinfectants (32.0%).

CONCLUSIONS

Occupational contact dermatitis is common in dental personnel referred for patch testing. Comprehensive testing beyond screening series is important in these patients.

Recent update on potential cytotoxicity, biocompatibility and preventive measures of biomaterials used in dentistry

Dental treatment is provided for a wide variety of oral health problems like dental caries, periodontal diseases, periapical infections, replacement of missing teeth and orthodontic problems. Various biomaterials, like composite resins, amalgam, glass ionomer cement, acrylic resins, metal alloys, impression materials, bone grafts, membranes, local anaesthetics, etc., are used for dental applications. The physical and chemical characteristics of these materials influence the outcome of dental treatment. It also impacts on the biological, allergic and toxic potential of biomaterials. With innovations in science and their positive results, there is also a need for awareness about the biological risks of these biomaterials. The aim of dental treatment is to have effective, yet safe, and long-lasting results for the benefit of patients. For this, it is important to have a thorough understanding of biomaterials and their effects on local and systemic health. Materials used in dentistry undergo a series of analyses before their oral applications. To the best of our knowledge, this is the first and original review that discusses the reasons for and studies on the toxicity of commonly used biomaterials for applications in dentistry. It will help clinicians to formulate a methodical approach for the selection of dental biomaterials, thus providing an awareness for forecasting their risk of toxic reactions.

Methacrylate perspective in current dental practice

OBJECTIVE

To provide a current perspective concerning dental personnel sensitivity to methacrylate materials.

OVERVIEW

Methacrylate related sensitivity and allergies are currently beyond traditional thoughts concerning denture base resins and methyl methacrylate provisional materials. Methacrylates are now ubiquitous in current dental practice and dental personnel should be aware that dental adhesives contain potent sensitizers that may also cross-sensitize individuals to other methacrylates not experienced. The growing sensitivity to 2-hydroxyethyl methacrylate (HEMA) has been described to be epidemic in nature due to the artificial nail industry with dental patients and dental personnel may be more susceptible to dental methacrylate sensitization. While contact dermatitis remains the most prevalent methacrylate-related clinical presentation, respiratory complications and asthma are increasing associated with methacrylate exposure. While additional personal protective equipment (PPE) is thought to be first protective choice, the National Institute for Occupational Safety and Health (NIOSH) considers PPE overall largely ineffective and should be considered only as a last resort.

CONCLUSION

Dental personnel need to be more aware of methacrylate sources and use workplace control measures to limit methacrylate exposures to both dental personnel and patients.

CLINICAL SIGNIFICANCE

Sensitivity to methacrylate materials is a growing dental workplace major concern and dental personnel should be aware of both the methacrylate content of current materials and the products that contain ingredients with the most sensitization potential.

Finite-element analysis and optimization of the mechanical properties of polyetheretherketone (PEEK) clasps for removable partial dentures

PURPOSE

Polyetheretherketone (PEEK), a high-strength, aesthetic, and non-allergic thermoplastic polymer, recently became a candidate for replacing metallic components in dental prosthesis. However, as PEEK is flexible, the need for retention presents a key challenge in terms of its clinical application. In this study, clasps prepared using PEEK were optimized and evaluated to provide the mechanical properties required by dentures.

METHODS

Seventy-two three-dimensional rod-shape models, based on four thickness/width ratios, three base widths, and six taper ratios were created. These models were analyzed using finite-element methods to determine which modified clasp arm shape provided the most appropriate mechanical properties. Three shape-optimized PEEK specimens and one standard-shape Co-Cr alloy specimen were then fabricated. Constant-displacement fatigue testing was performed to calculate load values and deformations after ten years of clinical use.

RESULTS

Shape optimization indicated a maximum stress concentration that was consistently located at the base of the specimen, a correlation between mean load values and thickness that was greater than that with the width, and a correlation between taper ratio and mean load values. Fatigue testing showed that although PEEK exhibited significantly lower average load values than the Co-Cr alloy, these were sufficient for clinical use. All specimens exhibited significant deformation during the first period of cycling; however, there was no significant difference in the deformation between the two materials after fatigue testing.

CONCLUSIONS

PEEK exerts fewer stresses on abutments compared to standard-alloy clasps, provides adequate retention, and satisfy aesthetic demands, indicating that PEEK presents a promising alternative to conventional metal clasps.

Skin reactions among Bulgarian dental students: A self-report questionnaire survey

BACKGROUND

Dental students are at high risk of developing adverse skin reactions following practical work during the dentistry degree program. They encounter multiple irritants and allergens that may cause skin reactions on exposed parts of the body, notably the hands.

OBJECTIVES

To estimate the prevalence of skin reactions related to the pre-clinical and clinical training courses of the dentistry program and associated risk factors in Bulgarian dental students.

METHOD

A cross-sectional study was performed using a self-report questionnaire.

RESULTS

A total of 467 dental students completed the questionnaire (response 51.8%). The prevalence of self-reported skin symptoms was 21.2%. According to logistic regression analysis, the most important risk factors for work-related skin symptoms were a personal history of atopic dermatitis (odds ratio [OR] 3.92, 95% confidence interval [CI]: 1.99-7.72), allergic rhinoconjunctivitis and/or asthma (OR 1.94, 95%CI: 1.03-3.68), personal history of contact allergy (OR 2.19, 95%CI: 1.06-4.55), and hand washing >16 times a day (OR 2.42, 95%CI: 1.06-5.52).

CONCLUSIONS

The results of this study suggest that work-related skin symptoms are frequent among dental students and indicate the need to establish effective primary preventive programs for occupational skin disorders at a national level.

Airborne exposure to gaseous and particle-associated organic substances in resin-based dental materials during restorative procedures

Dental composite dust has been shown to act as a vehicle for methacrylates in vivo/in vitro. The objective of this study was to assess airborne exposure of dental personnel to gaseous and particle-associated organic constituents from resin-based dental materials in a simulated clinic. Sampling of total aerosol fractions and gaseous substances was performed by dental students carrying particle filters and gas sorbents attached to a personal pump during preclinical restorative procedures in phantom models (n = 13). Water from the phantoms was sampled. Organic substances were extracted from the sampled water, particle filters, and gas sorbents. Qualitative and quantitative analyses were performed by gas chromatography-mass spectrometry (GC-MS) and ultra-high-performance liquid chromatography-mass spectrometry (UHPLC-MS). The methacrylates 2-hydroxyethyl methacrylate (HEMA) and triethylene glycol dimethacrylate (TEGDMA) and the additives camphorquinone (CQ), butylated hydroxytoluene (BHT), and ethyl 4-(dimethylamino)benzoate (DMABEE), were quantified in the gas and particle fractions sampled. A positive-control experiment was conducted. No methacrylates were detected in the gas or particle fractions sampled, whereas strong signals for methacrylates were detected in the positive controls, matching the analysis of the uncured material. In addition, TEGDMA and DMABEE were quantified in the sampled water. Airborne exposure to constituents in resin-based dental materials was below the detection limit. However, the extent of exposure is probably dependent on the procedure, preventive measures, and type of materials used.

Fatigue resistance of yttria-stabilized tetragonal zirconia polycrystal clasps for removable partial dentures

With the rapid development of computer-aided design/computer-aided manufacturing (CAD/CAM) systems, the application of zirconia in removable partial dentures is expected to expand. Clasps composed of zirconia should improve esthetics without inducing the risk of metal allergy. The aim of this study was to examine the fatigue resistance of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) clasps for removable partial dentures. Yttria-stabilized tetragonal zirconia polycrystal and cobalt-chromium (Co-Cr) alloy were prepared using CAD/CAM systems. Specimens were either of the semicircular type or of the flat type, with cross-sectional areas of taper ratios of 0.50, 0.75, and 1.00. All specimens were tested using the cantilever test and the constant displacement fatigue test, and data were analyzed using ANOVA. During the cantilever test, the maximum displacement prior to fracture was greater than the required undercut, and the semicircular-type specimen exhibited a higher fracture load than the flat type. None of the specimens displayed permanent deformation and showed almost the same degree of deformation after fatigue testing. A lower taper ratio was associated with lower average load values and greater displacement. Within the limitations of this study, it was possible to conclude that Y-TZP provides the required undercut and adequate retentive force for removable partial denture clasps. Additionally, Y-TZP and Co-Cr alloy had almost the same degree of deformation even after the simulated lifespan of removable partial dentures.

Glove-Related Allergic Contact Dermatitis

Hand dermatitis is a common condition with a lifetime prevalence of 20%. Glove allergic contact dermatitis (ACD) is a very important dermatitis affecting health care workers, hairdressers, cleaning personnel, kitchen workers, craftsmen, construction workers, laboratory workers, and homemakers. Occupationally related cases may be severe and can result in significant disability. Glove ACD is most commonly due to exposure to rubber accelerators, which are compounds that are added to rubber during production to increase strength and durability. Given the known allergic potential of these compounds, glove manufacturing companies have reformulated gloves leading to the introduction of new rubber allergens. In this review, we will discuss risk factors for glove ACD, both common and uncommon allergens in gloves, common contact allergens that permeate gloves, and patch testing to help uncover the inciting allergen(s).

Assessment of risk factors and preventive measures and their relations to work-related musculoskeletal pain among dentists

BACKGROUND

Dentists have a high prevalence of musculoskeletal (MS) pain, which is the most common symptom associated with work-related musculoskeletal disorders (WMSDs). To overcome this problem, identification of the risk factors and preventive measures for MS pain are of paramount importance to dentists in order to improve their quality of life and work.

OBJECTIVES

The aims of this study were to recognize the risk factors for MS pain and their impact on dental work, as well as to identify preventive measures of MS pain among dentists.

METHODS

Self-reporting questionnaire consisting of 78 questions was exclusively developed for the study and sent to 500 working active dentists in Serbia.

RESULTS

Response rate was 71.2% (356 dentists). The prevalence of MS pain was 82.6% among dentists. The main risk factors for MS pain were advanced age, female dentists, presence of chronic diseases, long working hours, and high frequency of treated patients. The most effective preventive measures in preventing MS pain were massage treatments and physical activities. Followed by use of ergonomically designed equipment, correct and dynamic working positions, and an adequate workflow organization.

CONCLUSION

The risk factors for MS pain and their impact on dental work should widely be disseminated among dentists. Importantly, proper implementation in everyday life of adequate preventive measures is essential for preventing MS pain and development of WMSDs.

Allergy to Surgical Implants

Surgical implants have a wide array of therapeutic uses, most commonly in joint replacements, but also in repair of pes excavatum and spinal disorders, in cardiac devices (stents, patches, pacers, valves), in gynecological implants, and in dentistry. Many of the metals used are immunologically active, as are the methacrylates and epoxies used in conjunction with several of these devices. Allergic responses to surgical components can present atypically as failure of the device, with nonspecific symptoms of localized pain, swelling, warmth, loosening, instability, itching, or burning; localized rash is infrequent. Identification of the specific metal and cement components used in a particular implant can be difficult, but is crucial to guide testing and interpretation of results. Nickel, cobalt, and chromium remain the most common metals implicated in implant failure due to metal sensitization; methacrylate-based cements are also important contributors. This review will provide a guide on how to assess and interpret the clinical history, identify the components used in surgery, test for sensitization, and provide advice on possible solutions. Data on the pathways of metal-induced immune stimulation are included. In this setting, the allergist, the dermatologist, or both have the potential to significantly improve surgical outcomes and patient care.

Allergic Reactions to Dental Materials-A Systematic Review

INTRODUCTION

Utility of various dental materials ranging from diagnosis to rehabilitation for the management of oral diseases are not devoid of posing a potential risk of inducing allergic reactions to the patient, technician and dentist. This review aims to develop a systematic approach for the selection and monitoring of dental materials available in the market thereby giving an insight to predict their risk of inducing allergic reactions.

MATERIALS AND METHODS

Our data included 71 relevant articles which included 60 case reports, 8 prospective studies and 3 retrospective studies. The source of these articles was Pub Med search done with the following terms: allergies to impression materials, sodium hypochlorite, Ledermix paste, zinc oxide eugenol, formaldehyde, Latex gloves, Methyl methacrylate, fissure sealant, composites, mercury, Nickel-chromium, Titanium, polishing paste and local anaesthesia. All the relevant articles and their references were analysed. The clinical manifestations of allergy to different dental materials based on different case reports were reviewed.

RESULTS

After reviewing the literature, we found that the dental material reported to cause most adverse reactions in patients is amalgam and the incidence of oral lichenoid reactions adjacent to amalgam restorations occur more often than other dental materials.

CONCLUSION

The most common allergic reactions in dental staff are allergies to latex, acrylates and formaldehyde. While polymethylmethacrylates and latex trigger delayed hypersensitivity reactions, sodium metabisulphite and nickel cause immediate reactions. Over the last few years, due to the rise in number of patients with allergies from different materials, the practicing dentists should have knowledge about documented allergies to known materials and thus avoid such allergic manifestations in the dental clinic.

Identification and practical management of latex allergy in occupational settings

Allergy to natural rubber latex (NRL) from Hevea brasiliensis is a relevant occupational health hazard. The use of gloves and products manufactured with latex and environmental allergen exposure in the work environment are risks factors for the development of occupational allergy among different job categories. Healthcare workers have been the most commonly affected, but other professions with exposure to latex products such as hairdressers, cleaners, food handlers and those making natural rubber latex (NRL) products are also at risk of developing occupational allergy. Clinical manifestations of IgE-mediated latex allergy can range from troublesome skin disorders to life-threatening systemic reactions. It is very important to identify the occupational allergic diseases in their early stages in order to implement avoidance strategies. For this purpose, the interventions for prevention should emphasize the importance of latex allergy awareness and surveillance among exposed workforces.

Bonding of acrylic denture teeth to MMA/PMMA and light-curing denture base materials: the role of conditioning liquids

OBJECTIVES

The connection between resin denture teeth and the denture base is essential for the integrity of partial and full dentures. The aim of the present study was to analyse the bond strength of acrylic denture teeth to two light curing denture base materials compared to the gold-standard (MMA/PMMA) using different conditioning liquids.

METHODS

The ridge laps of 220 identical denture teeth were ground and pre-treated using different conditioning liquids (MMA, an experimental conditioning liquid as well as the two commercially available liquids Palabond and Versyo.bond). The denture base materials (PalaXpress, Versyo.com, Eclipse) were applied using a split mould to obtain tensile bond strength specimens of identical shape. Ten specimens per test group were either stored in water for 24h or thermocycled (5000×, 5-55°C) prior to tensile bond strength testing (cross-head speed 10mm/min). Data was subjected to parametric statistics (α=0.05).

RESULTS

The three-way ANOVA revealed a significant influence of the material, pre-treatment as well as the storage. PalaXpress showed the highest bond strength (24.3MPa) of all materials tested after TC, whereas the use of MMA led to the most constant results. Lower values were recorded for Versyo.com (17.5MPa) and Eclipse (10.4MPa) bonded with Versyo.bond.

CONCLUSIONS

The results indicate that MMA/PMMA based denture base resins provide reliable and durable bond strength to acrylic denture teeth. Using light-curing denture base materials requires the application of appropriate conditioning liquids to obtain acceptable bond strength. The use of MMA affects bond strength to light-curing denture base materials.

CLINICAL SIGNIFICANCE

The pre-treatment of denture teeth is critical regarding their bond-strength to denture base materials and in turn for the integrity of removable full and partial dentures. Light-curing denture base resins are more sensitive to the correct tooth pre-treatment compared to conventional MMA/PMMA materials, requiring specific conditioning liquids.

Latex gloves allergy in dental workers, Iran

Dermal-respiratory reactions to latex glove is a common problem and sometimes life threatening. Some of the health related past histories such as hand dermatitis, atopy and food allergy increase the probability of these reaction. The purpose of this study was to evaluate reactions to latex gloves amongst dental workers in military dental health centers. In this cross-sectional descriptive survey, dental workers with minimum three months length of employment and most often use of latex gloves were asked to fill standard questionnaire regarding latex related clinical manifestation and personal medical history and predisposing factors. Those with clinical problems did Skin Prick Test (SPT). In this study 330 personnel were assessed. The mean age and length of employment was 31.6 and 8 years, respectively. The most occupation was dentistry. A total of 232 subjects (70.3%) reported latex gloves-allergic symptoms. 72 (21.8%) of persons have history of atopy and food allergy was seen in 114 (34.5%). 63 (19.1%) of subjects reported history of hand dermatitis. All of these had positive regression with allergic responses. Among 73 (34%) symptom positives, 28 (38%) had positive result of SPT. In this survey, the prevalence of allergic reactions is higher than similar studies, which may be due to type of gloves, lack of preemployment assessments and other factors. Because of relationship between allergic reactions to latex gloves and some medical histories, it seems to be necessary for preemployment evaluation and periodic health surveillance of dental workers.

Self-reported occupational health issues among Lithuanian dentists

This article describes the second phase of a large study of Lithuanian dentists' health, and focuses on self-reported physical health complaints, general health state and associations between the two. In 2006, a postal questionnaire survey of all (N=2,449) licensed dentists registered with the Lithuanian Dental Association was conducted, obtaining a response rate of 68.2%. Fatigue (94.7%) and back pain (91.0%) were the most prevalent physical complaints reported, and they were also the most likely to become chronic among all physical disorders. Hypertension, joint diseases and allergy were the most prevalent diagnosed and treated diseases during the previous 12 months. Only half of the surveyed Lithuanian dentists (50.4%) rated their health as satisfactory. Logistic regression revealed that fatigue (Odds Ratio: 0.52; 95%CI: 0.29-0.94), headache (OR: 0.62; 95%CI: 0.42-0.90), hand problems (OR: 0.62; 95%CI: 0.44-0.87), chest pain (OR: 0.51; 95%CI: 0.40-0.64) and musculoskeletal complaints (OR: 0.41; 95%CI: 0.28-0.60) had a significant negative impact on dentists' self-reported general health. Overall, this study suggests that Lithuanian dentists do experience a certain amount of occupationally-related health problems. It is therefore important to increase health knowledge on occupational hazards and also to emphasize the importance of early diagnosis and treatment for these disorders in Lithuania, as elsewhere.

Do adverse effects of dental materials exist? What are the consequences, and how can they be diagnosed and treated?

OBJECTIVES

All dental biomaterials release substances into the oral environment to a varying degree. Various preclinical biocompatibility test systems have been introduced, aiming at an evaluation of the potential risks of dental materials. Potential pathogenic effects of released substances from dental materials have been demonstrated. For the biocompatibility of a biomaterial, it is not only important that minimal diffusable substances are released when it is in body contact--the material must also fulfill the function for which it has been designed. This is also very much dependent on the material properties and its handling properties. The aim of this review was to generate an overview of the present status concerning adverse reactions among patients and personnel.

MATERIALS AND METHODS

A systematic review was performed using a defined search strategy in order to evaluate all MEDLINE-literature published between 1996 and 2006.

RESULTS

The compilation of the literature available has revealed that the majority of studies have been carried out on patients compared with personnel. Adverse reactions towards dental materials do occur, but the prevalence and incidence are difficult to obtain. The results were essentially based on cohort studies. Clinical trials, especially randomized-controlled trials, are in the minority of all studies investigated, with the exception of composite and bonding studies, where clinical trials, but not randomized-controlled trials, represent the majority of studies. Patients and personnel were treated separately in the manuscript. Amalgam studies show the lowest degree of verified material-related diagnosis. Even if objective symptoms related to adverse reactions with polymer resin-based materials have been reported, postoperative sensitivity dominates reports concerning composites/bondings. Verified occupational effects among dental personnel show a low frequency of allergy/toxic reactions. Irritative hand eczema seemed to be more common than in the general population.

CONCLUSIONS

Patient- and personnel-related studies are of variable quality and can be improved. There is a need for a better description of the content of materials. A registry for adverse effects of dental materials would be useful to detect the occurrence of low-incidence events.