Allergic reaction from dental bonding material through nitrile gloves: Clinical case study and glove permeability testing

Abstract

Objective: This study examines monomer permeation of commercial dental adhesive through nitrile-based gloves, and correlates findings with clinical case studies of dental students having localized skin eruptions following resin placement on a gloved hand to manipulate composite.Methods: Three dental students self-reported presenting itchy, red skin lesions underneath the area where they placed uncured adhesive resin on a nitrile-gloved hand. Histories and cursory examinations were performed in the Department of Dermatology at The Medical College of Georgia. Infrared spectroscopic methods were used to determine permeation times of known monomer components of commercial adhesive material used through nitrile glove. Monomer permeation times were correlated with the time when the commercial adhesive first applied and penetrated through the glove.Results: Assessment by the dermatologist concluded that the reporting students had occupational contact dermatitis resulting from components of the adhesive permeating through the barrier glove. Permeation times of neat monomer components of the adhesive resin varied over a wide range, with lower molecular weight showing faster pass-through times. Spectroscopic interpretation indicated that the probable causative agent for the student's skin reaction was 2-hydroxyethyl methacrylate (HEMA).Conclusions: Probable correlation of the observed skin reaction sites was made with diffusion of HEMA in the uncured dental adhesive formulation through nitrile glove material.Clinical Significance: All measures to prevent skin contact with uncured methacrylate-based resin components should be taken, including avoidance of resin permeation through a gloved hand. Sensitization to one type of methacrylate can result in sensitization to other types of resins within this family, significantly impacting the careers of both dental auxiliaries as well as clinicians. K E Y W O R D Sallergy, dental adhesive, glove permeability, methacrylate, occupational contact dermatitis

A case of allergic contact dermatitis to dental bonding materials, masked by the use of gloves

“…Despite the anatomical site of contact dermatitis, the bonding agents are often not suspected as a source of contact allergy because of the misconception regarding the protective effect of gloves. However, different studies have demonstrated the inadequacy of natural rubber latex and nitrile gloves in protecting against acrylate induced contact allergy 8,9 . We suggest that the information about the contents of sensitizing acrylates in denture fixation products should be highlighted to create awareness of the presence of these compounds.…”

“…However, different studies have demonstrated the inadequacy of natural rubber latex and nitrile gloves in protecting against acrylate induced contact allergy. 8,9 We suggest that the information about the contents of sensitizing acrylates in denture fixation products should be highlighted to create awareness of the presence of these compounds. These products should also display a mandatory a hazard statement, in accordance with the Globally Harmonized System/Classification, Labelling and Packaging regulations.…”

Methacrylate perspective in current dental practice

“…Unfortunately medical‐grade dental gloves have been demonstrated to offer little protective capability with methacrylate materials. Reports identifying the permeability of dental gloves to methacrylates was evident in the early 1980s 74 and has been a subject of continued interest over the years 39,74,79‐92 . Maekelae et al 79 in 1999 found that a mixture of 50% (w/w) HEMA and TEGDMA had breakthrough leakage to the skin in 10 minutes with both natural rubber and PVS glove materials.…”

“…The best protection was afforded by a neoprene glove that resisted HEMA permeation for 97 minutes 82 . In 2020 Saranez et al 92 reported using infrared spectroscopy reported that a nitrile glove resisted HEMA penetration for approximately 6 minutes, while TEGDMA and GDMA passed through the nitrile material in approximately 12 and 43 minutes, respectively. A further complication reported by Phalen and Wong is that glove materials may also lose any protective ability due to microscopic glove breakdown due to functional forces created during movement 84 .…”

“…For adhesives, adopting a unit‐dose application method has promise. As previously discussed, dental gloves have been shown to offer little prevention from methacrylate materials 39,79‐92 and it is prudent to change gloves frequently with some researchers suggest that double‐gloving may offer some slight additional short‐term benefit 39,85 . Furthermore, it has been suggested that neoprene gloves can offer the most protection but may present dexterity difficulties 82 .…”