Dental Technicians' Pneumoconiosis

Knowledge and awareness on pneumoconiosis among dental technicians and senior dental technology students in Saudi Arabia

Dental technicians' pneumoconiosis is a condition that causes interstitial inflammation and fibrosis as a result of complex drug exposure. Therefore, it is of interest to assess and evaluate the knowledge and awareness about pneumoconiosis and other respiratory disorders among dental technicians and dental technology students in Saudi Arabia. A cross sectional survey was conducted on convenient sample of 300 senior dental technician students and dental technicians from Saudi Arabia and informed consent was obtained. The participants were approached through online questionnaire using Google forms. Questions were related to the socio-demographic data, knowledge and awareness of the students and the practicing dental technicians and their willingness to learn about pneumoconiosis. Final year undergraduate, interns and Dental technicians were included, undergraduate students without practical knowledge and experience and participants with history of respiratory disease were excluded from the study. Questions were assessed by face validity. The data was analyzed using Statistical Package for Social Sciences software. Descriptive statistics was calculated. 34.8% of the study group were not aware of the term and don't know about the etiology of pneumoconiosis. Pearson correlation was significant in terms of awareness difference between males and females and females had less awareness compared to males.

Pathological Comparison of Rat Pulmonary Models Induced by Silica Nanoparticles and Indium-Tin Oxide Nanoparticles

Purpose

The objective of this study was to evaluate and compare the histopathological implications of silica nanoparticles (Nano-SiO₂) and indium-tin oxide nanoparticles (Nano-ITO), in vivo.

Methods

Male Sprague-Dawley rats were exposed to Nano-SiO₂ (50 mg/kg) and Nano-ITO (6 mg/kg) by a single intratracheal instillation, respectively. Broncho-alveolar lavage fluid (BALF) and lung tissue were obtained at 7, 14, 28, and 56 days post exposure for analysis of BALF inflammatory factors, total protein, and for lung tissue pathology. Histopathological and ultrastructural change in lungs were investigated by hematoxylin and eosin, Masson’s trichrome, sirius red staining, periodic acid Schiff stain, and transmission electron microscopy. The expression of SP-A, collagen type I and III in lung tissue was determined by immunohistochemistry and ELISA.

Results

The rats in both models exhibited obvious collagen fibrosis and the severity of the lung injury increased with time after exposure to respective dosage increased. Several parameters of pulmonary inflammation and fibrosis significantly increased in both groups, which was reflected by increased LDH activity, total proteins, TNF-α, and IL-6 levels in BALF, and confirmed by histopathological examination. The results also showed that the two models exhibited different features. Exposure to Nano-ITO caused persistent chronic lung inflammation, illustrated by the infiltration of a large amount of enlarged and foamy macrophages and neutrophils into the lung parenchyma. In Nano-SiO₂ exposed rat lung tissue, granulomatous inflammation was most prominent followed by progressive and massive fibrotic nodules. Compared with the Nano-SiO₂ rats, Nano-ITO exposed rats exhibited significantly severe pulmonary alveolar proteinosis (PAP) pathological changes, lower fibrosis, and higher levels of inflammatory biomarkers. However, Nano-SiO₂ exposed rats had greater fibrosis pathological changes and more severe granulomas than Nano-ITO exposed rats.

Conclusion

This study suggests that the Nano-SiO₂-induced model has greater value in research into granulomas and fibrosis, while the Nano-ITO-induced model has greater repeatability in area of PAP.

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.

Early signs of pneumoconiosis in a dental technician in Italy: a case report

BACKGROUND

Dental technicians are at high risk of pneumoconiosis, usually driven by inhalation of mixed dusts, including metals. An etiological diagnosis is not easy to be performed, particularly in advanced stages.

CASE PRESENTATION

We describe the case of an early pneumoconiosis occurring in a 47-year-old dental technician who developed respiratory symptoms shortly after beginning work. She described the work environment as dusty and lacking relevant primary prevention tools. A chest CT showed multiple peripheral pseudonodular lesions in both lower lobes; bronchoalveolar lavage and bronchial aspirate evidenced numerous macrophages with reflective metal bodies included into the cytoplasm, that at scanning electron microscopy coupled to Energy Dispersive X-Ray Analysis resulted Zirconium and Aluminum, whereas Tungsten (W) was localized outside cells. End of shift urinary concentrations of W were substantially raised as compared to pre-shift (1.1 vs. 0.2 µg/L).

CONCLUSIONS

We concluded for diagnosis of early work-related pneumoconiosis due to abnormal occupational exposure to metals. The case demonstrates the need also for dental professionals to comply with industrial hygiene standards and to be monitored by occupational health physicians.

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.

Assessment of occupational exposure to fine particulate matter in dental prosthesis laboratories in Kocaeli, Turkey

Dental prosthesis laboratories (DPLs) are among the workplaces where predominantly manual production takes place. In such working environments, during the manual manufacturing process, which involves fine smoothing and polishing of dental prostheses, fine particulate matter is released into the ambient air. In this study, the particulate matter (PM) concentrations and elemental content of the fine particles in the working ambient air were identified in six DPLs in Kocaeli, Turkey. PM_2.5 mass concentrations, measured in all the DPLs, ranged between 80.8 and 1645 μg/m³ (mean 414 ± 406). As a result of the analyses performed with an ICP-MS device (Perkin Elmer Elan®DRC-e), trace elements of Be, Cd, Hg, and, notably, Co, Cr, Mo, and Ni were found. The researchers calculated the excess lifetime cancer risks and total hazard indexes. The average total cancer risk for all the DPLs was 8 × 10^-3, which is higher than the acceptable limit of 1.0 × 10^-6, and the total hazard index was 187, which is greater than the acceptable limit of 1.0. Considering these high-level risks, the study concluded that there is a need for new production methods, and strict application of occupational health and safety measures, to reduce the fine particle exposure of the workers in the laboratories. In addition, there are prescribed limit values for particulate matter only for respirable particles in working environments. The establishment of limit values, especially for PM_2.5 concentrations, is important for the protection of the health of the employees.

Pulmonary Alterations Among Workers in a Dental Prosthesis Laboratory: Exploring High Dust Concentrations and Novel Findings of Bacterial Genera in the Workplace to Achieve Improved Control

OBJECTIVE

To evaluate the pulmonary alterations in workers from a dental prosthesis laboratory and explore dust and bacterial dissemination generated in the laboratory.

METHODS

Spirometry and computerized axial tomography were performed on 67 workers. Dust in workplace air was determined using the filtration-gravimetric method, and bacterial detection was explored using 16S rDNA gene sequencing.

RESULTS

Pulmonary alterations were detected in 37% of the workers. Airborne dust concentrations were determined to be higher than the maximum permissible exposure limit, and bacterial detection analysis revealed 23 bacterial genera. The most frequently detected bacterial genus was Sphingomonas sp., which has been described as microbiota associated with disease of the oral cavity.

CONCLUSIONS

The results of this study highlight the importance of the implementation of biosecurity measures, improvement of ventilation systems, and routine disinfection of dental impressions.

Upregulated has-miR-4516 as a potential biomarker for early diagnosis of dust-induced pulmonary fibrosis in patients with pneumoconiosis

Background: Pulmonary fibrosis (PF) is a representative pathological change in patients with pneumoconiosis; however, due to the absence of reliable and early biomarkers, microRNAs have recently emerged as potential candidates for identification. Objectives: The aim of our study was to discover the potential of PF-specific circulating microRNAs as early biomarkers among patients with pneumoconiosis. Methods: Four dust-exposed patients with PF and four matched healthy individuals (not exposed to dust) were recruited for the study. microRNA profiling was identified by micro-array and bioinformatics methods. Gene Ontology (GO) analysis was used to identify the potential biological or molecular processes modulated by these miRNAs. Kyoto Encyclopedia of Genes and Genomes pathway (KEGG) analysis was used to identify the potentially involved signaling pathways. miRNA-mRNA-binding network analysis was employed to identify genes potentially targeted by the miRNAs. Results: 1079 miRNAs were discovered, of which 406 were up-regulated and 117 were down-regulated in PF patients. 32 miRNAs were up-regulated by >4-fold and 17 miRNAs were down-regulated by >0.5 fold. GO analysis identified the biological processes affected by anatomical structure development, hemophilic cell adhesion and cell-cell adhesion via plasma membrane proteins. Target prediction software showed that serum has-miR-4516 targeted genes encoding basonuclin2, inhibitors of growth family member 4, the potassium voltage-gated channel, and "sha-1-related subfamily member 1" proteins. qRT-PCR revealed that has-miR-4516 was a potential biomarker of PF progression in patients with pneumoconiosis. Conclusions: Our findings suggest that the level of serum miR-4516 may be a potential biomarker for early diagnosis of PF in patients with pneumoconiosis. This is a pilot work that paves the way for a further functional study of the underlying regulatory mechanisms.