OCCUPATIONAL CONTACT DERMATITIS AMONGST DENTISTS AND DENTAL TECHNICIANS

Prevalence of Occupational Contact Dermatitis Among Dental Personnel Using the Nordic Occupational Skin Questionnaire-2002: A Prospective Cross-Sectional Study

BACKGROUND

Occupational skin disease (OSD), such as contact dermatitis, is widespread among dental professionals; however, reports regarding its prevalence have inconsistent findings and methodology. Therefore, we conducted a cross-sectional survey using a self-reported questionnaire to estimate the prevalence of work-related and occupational exposure-induced skin diseases.

METHODOLOGY

A self-administered questionnaire, based on the validated Nordic Occupational Skin Questionnaire-2002, was distributed to 15 dental clinics in Israel in the first half of 2022. The questionnaire included questions about the occupation, exposure, and history of atopic disease, dry skin, and hand/arm and wrist eczema, as well as participant demographics.

RESULTS

Overall, 312 dental professionals completed the questionnaires. Response rate was 80%. The lifetime prevalence of self-reported skin symptoms was 19.23%. Significant risk factors included exposure to metal objects, odds ratio (OR): 2.43, 95% confidence interval (CI): [1.02, 5.78]; p < .05, dry skin (OR: 3.54, 95% CI: [1.93, 6.5]; p < .001), itching when sweating (OR: 2.89, 95% CI: [1.39, 6]; p < .05), contact urticaria (OR: 10.67, 95% CI: [4.46, 25.49]; p < .001), hay fever (OR: 2.25, 95% CI: [1.14, 4.42]; p < .05), allergic symptoms (OR; 2.33, 95% CI: [1.18, 4.58]; p < .05), and asthma (OR: 4.8, 95% CI: [2.17, 10.36]; p < .001).

CONCLUSIONS

This is the first study to use the NOSQ-2002 among dental professionals. Our study provides a better understanding of the prevalence and consequences of OSDs among dental personnel by utilizing the validated tool NOSQ-2002.

Frequency and clinical relevance of contact allergy in dental patients

BACKGROUND

While many studies have reported on occupational allergic contact dermatitis amongst dental personnel, studies on the relevance of patch testing in dental patients are scarce.

OBJECTIVES

To determine the frequency and clinical relevance of contact allergy in patients with intra- and perioral complaints.

METHODS

A total of 360 patients with intra- and perioral complaints suspected of having a contact allergy were patch-tested with the dental allergen series, European Baseline Series, and extended Amsterdam Baseline Series at Amsterdam University Medical Centers between January 2015 and November 2021.

RESULTS

A total of 285 patients (79.2%) had a positive patch test reaction for either one (18.6%) or multiple allergens (60.6%). Sodium tetrachloropalladate was the most sensitising allergen with 98 patients (27.2%) testing positive, followed by nickel sulphate (23.3%), methylisothiazolinone (15.6%), and fragrance mix I (14.2%). Clinical relevance was found in 68 of 208 patients (32.7%), with patients having one (15.4%) or multiple (17.3%) patch test reactions clinically relevant to their (peri)oral complaints.

CONCLUSIONS

Clinically relevant patch test reactions were frequently seen in dental patients. Although this study provides us with a better understanding on the frequency and clinical relevance of contact allergy in dental patients, further studies are needed to confirm our results.

Dermatological conditions associated with dental professionals in Saudi Arabia

Background

Dental professionals and students are commonly exposed to occupation-related skin lesions, characterized as contact dermatitis (like allergic and irritant contact dermatitis, contact urticaria), that are commonly observed on hands and fingers. The present study evaluated the prevalence of skin lesions, knowledge about risk factors, and prevention of dermatological lesions among dental students and dental professionals.

Methods

The present observational study was carried out on 100 study subjects, including dental students and staff, using a self-administered and structured questionnaire to assess demographic variables, awareness information, and knowledge about work-related skin lesions. The data was subjected to statistical analysis using IBM's Statical Package for the Social Sciences (SPSS) version 20.

Results

Sixty percent of the total number of subjects were dental students and 40% were dentists. 56.8% of the subjects were female and 43.2% were male, with a maximum of 0-5 years of practice/experience. The most common symptoms of skin lesions were itching and erythema, especially on the hands and fingers. Only 15.6% had their treatment done by dermatologists, and 7% underwent skin prick tests. Latex allergy was most familiar with feature of facial edema. The use of hand sanitizers, soaps, and protective cream was limited among the subjects.

Conclusion

There was a lack of awareness among both the dentists and students regarding work-related skin lesions and getting them treated by dermatologists at the earliest, though the dentists' level of knowledge was better than that of the students. Thus, various educational programs on dermatological lesions should be implemented so that dental professionals and students take necessary precautions and seek treatment for skin disorders.

Allergic contact dermatitis caused by 2-hydroxyethyl methacrylate and ethyl cyanoacrylate contained in cosmetic glues among hairdressers and beauticians who perform nail treatments and eyelash extension as well as hair extension applications: a systematic review

Current cosmetic regulations primarily focus on protecting consumers, not the professional user who is subjected to a partly different, and certainly more intense exposure to hazardous substances. Against this background, the present systematic review aims to compile and appraise evidence regarding skin toxicity of 2-hydroxyethyl methacrylate (HEMA; CAS no. 212-782-2) and ethyl cyanoacrylate (ECA; CAS no. 7085-85-0) contained in cosmetic glues used among hairdressers and beauticians who perform nail treatments and eyelash extension as well as hair extension applications. This systematic review followed the PRISMA 2020 recommendations for reporting systematic reviews and meta-analysis. In total, 6 publications from 6 countries were eligible for this systematic review. Meta-analysis revealed that hairdressers and beauticians have a 9-fold increased risk of developing contact allergy to HEMA compared to controls who are not hairdressers and beauticians. Results for ECA are lacking. The present systematic review clearly shows that - regarding contact allergy to acrylates - it is not appropriate to apply risk assessment for consumers to hairdressers and beauticians who occupationally handle cosmetic glues. The regulations in existence do not adequately address occupational risks for hairdressers and beauticians connected with the use of acrylate-containing cosmetic substances and need reconsideration. This article is protected by copyright. All rights reserved.

Indoor Air Pollution with Fine Particles and Implications for Workers’ Health in Dental Offices: A Brief Review

(1) Background: Indoor air pollution can affect the well-being and health of humans. Sources of indoor pollution with particulate matter (PM) are outdoor particles and indoor causes, such as construction materials, the use of cleaning products, air fresheners, heating, cooking, and smoking activities. In 2017, according to the Global Burden of Disease study, 1.6 million people died prematurely because of indoor air pollution. The health effects of outdoor exposure to PM have been the subject of both research and regulatory action, and indoor exposure to fine particles is gaining more and more attention as a potential source of adverse health effects. Moreover, in critical situations such as the current pandemic crisis, to protect the health of the population, patients, and staff in all areas of society (particularly in indoor environments, where there are vulnerable groups, such as people who have pre-existing lung conditions, patients, elderly people, and healthcare professionals such as dental practitioners), there is an urgent need to improve long- and short-term health. Exposure to aerosols and splatter contaminated with bacteria, viruses, and blood produced during dental procedures performed on patients rarely leads to the transmission of infectious agents between patients and dental health care staff if infection prevention procedures are strictly followed. On the other hand, in the current circumstances of the pandemic crisis, dental practitioners could have an occupational risk of acquiring coronavirus disease as they may treat asymptomatic and minimally symptomatic patients. Consequently, an increased risk of SARS-CoV-2 infection could occur in dental offices, both for staff that provide dental healthcare and for other patients, considering that many dental procedures produce droplets and dental aerosols, which carry an infectious virus such as SARS-CoV-2. (2) Types of studies reviewed and applied methodology: The current work provides a critical review and evaluation, as well as perspectives concerning previous studies on health risks of indoor exposure to PM in dental offices. The authors reviewed representative dental medicine literature focused on sources of indoor PM10 and PM2.5 (particles for which the aerodynamic diameter size is respectively less than 10 and 2.5 μm) in indoor spaces (paying specific attention to dental offices) and their characteristics and toxicological effects in indoor microenvironments. The authors also reviewed representative studies on relations between the indoor air quality and harmful effects, as well as studies on possible indoor viral infections acquired through airborne and droplet transmission. The method employed for the research illustrated in the current paper involved a desk study of documents and records relating to occupational health problems among dental health care providers. In this way, it obtained background information on both the main potential hazards in dentistry and infection risks from aerosol transmission within dental offices. Reviewing this kind of information, especially that relating to bioaerosols, is critical for minimizing the risk to dental staff and patients, particularly when new recommendations for COVID-19 risk reduction for the dental health professional community and patients attending dental clinics are strongly needed. (3) Results: The investigated studies and reports obtained from the medical literature showed that, even if there are a wide number of studies on indoor human exposure to fine particles and health effects, more deep research and specific studies on indoor air pollution with fine particles and implications for workers’ health in dental offices are needed. As dental practices are at a higher risk for hazardous indoor air because of exposure to chemicals and microbes, the occupational exposures and diseases must be addressed, with special attention being paid to the dental staff. The literature also documents that exposure to fine particles in dental offices can be minimized by putting prevention into practice (personal protection barriers such as masks, gloves, and safety eyeglasses) and also keeping indoor air clean (e.g., high-volume evacuation, the use of an air-room-cleaning system with high-efficiency particulate filters, and regularly maintaining the air-conditioning and ventilation systems). These kinds of considerations are extremely important as the impact of indoor pollution on human health is no longer an individual issue, with its connections representing a future part of sustainability which is currently being redefined. These kinds of considerations are extremely important, and the authors believe that a better situation in dentistry needs to be developed, with researchers in materials and dental health trying to understand and explain the impact of indoor pollution on human health.

Respiratory symptoms of exposure to substances in the workplace among Bulgarian dentists

OBJECTIVES

Dentists are exposed to a variety of airborne chemicals that can act as irritants and sensitizers and may give rise to work-related respiratory symptoms. The aim of this study was to estimate the prevalence of respiratory symptoms of exposure to substances in the workplace and associated risk factors in Bulgarian dentists.

METHODS

A cross-sectional study was performed among Bulgarian dentists by using a self-report questionnaire. A direct acyclic graph (DAG) was elaborated to illustrate the direct and indirect causal pathways between exposure to irritants and/or allergens from dental environment and work-related respiratory symptoms among dentists. Multiple logistic regression analysis was conducted in order to investigate the relationship between sex, work experience, daily exposure to chemicals from dental environment, history of atopic disorder and work-related respiratory symptoms.

RESULTS

A total of 4675 dentists completed the questionnaire (response rate 48.1%). The prevalence of self-reported work-related respiratory symptoms was 20.7%. The most common repeated causes of respiratory reactions were disinfectants (65.7%) and materials based on acrylic resins (29.7%). Factors associated with work-related respiratory symptoms are personal history of asthma (odds ratio (OR) 2.50, 95% confidence interval [CI]: 1.71-3.64), work experience >20 years (OR 2.17, 95% CI: 1.74-2.70) and female gender (OR 2.14, 95% CI: 1.81-2.56).

CONCLUSION

Work-related respiratory symptoms are frequent among dentists and indicate a need for efforts to establish effective programmes and techniques of reducing or eliminating direct exposure to airborne chemicals in the dental environment.

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.

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.

Analysis of Dental Professionals' and Dental Students' Care for their Skin

Objectives

To determine prevalence of undesirable, work-related skin lesions and their localizations in dental professionals and students, and to collect data about diagnostic procedures they undergo and skin care they take when these lesions occur.

Subjects and methods

Our research included 444 respondents (dentists, dental assistants, dental technicians, dental students) who filled out a questionnaire. They were asked to specify if they had observed any lesions on their skin and where; if they had undergone any treatments and in what way; if they had undergone any allergy tests; and if they had taken any protective measures.

Results

Of all the respondents that took part in the survey, 249 (56.1%) reported undesirable skin reactions commonly on their hands and fingers (96%). Before our survey, only 15% of them had seen a dermatologist, while 33% had undergone allergy tests (without a dermatologists’ clinical examination). Also, 45% of them sometimes used soaps for sensitive skin and the majority (61%) of them used protective hand creams 1-2 times per day.

Conclusion

Although a large number of dental professionals and students have noticed work-related skin lesions, only some of them sought dermatologists’ professional help and most of them did not take care of their skin adequately when those lesions occurred. According to the results of this study, it is necessary to take additional preventive measures to increase dental professionals’ and students’ awareness of occupational dermatoses and adequate skin care.

Skin reactions to latex in dental professionals - first Croatian data

Purpose. To determine the prevalence of undesirable skin reactions to latex in dental professionals and students of the School of Dental Medicine in Zagreb, Croatia. Methods. Our research included 444 participants, of which 200 agreed to undergo a skin prick test (SPT). All participants answered a questionnaire in which we asked about incidence of skin lesions, duration of occupational exposure to latex, localization of skin lesions and symptoms. Statistical analysis of the questionnaire and test results was then carried out. Results. Of the total 444 participants surveyed, 249 (56.1%) reported lesions on their skin (professionals 64.8%, students 6.1-58.5%). From the questionnaire, 239 (96.0%) respondents reported lesions on the hands and fingers, mostly in the form of erythema (37.0%) and occasional dryness of skin (29.0%). Positive SPT results were found in 14 (7.0%) out of the 200 respondents who underwent the test. Conclusions. While a large number of subjects (56.1%) reported skin lesions when using latex products at their workplace, the SPT test was positive only in 7.0%. The results show that the prevalence of self-reported skin lesions was significantly related to the length of occupational exposure, with a substantial effect size (p < 0.001; V = 0.334).