Increase in occupational skin diseases of dental personnel

Abstract

Occupational diseases of dentists and dental nurses were compiled from the Finnish Register of Occupational Diseases. The cases were recorded during 3 3-year observation periods, namely 1982-1984, 1986-1988, and 1992-1994 (i.e., 9 observation years). The relative risk of developing occupational allergic contact dermatitis in different occupations was calculated from the statistics of the years 1986-1991, and was expressed as the age-standardized rate ratio (SRR). During the 9 observation years, the majority of registered occupational diseases of dentists and dental nurses were skin diseases (221/312; 70.8%), followed by occupational repetitive strain injuries (61/312; 19.6%) and occupational respiratory diseases (20/312; 6.4%). The incidence rate (IR) for allergic contact dermatoses/10,000 workers (contact urticaria included) increased from 26 (95% confidence interval (CI) 16-40) in 1982-1984 to 79 (95%, CI 64-97) in 1992-1994. The IR/10,000 of allergic contact dermatoses increased especially for dentists, from 5.4 (95% CI 0.7-19) in 1982 to 67 (95% CI 45-95) in 1992-1994. The increase of the IR/10,000 dental nurses was smaller: from 43 (95%, CI 26-66) in 1982-1984 to 87 (95% CI 67-111) in 1992-1994. There was no increase in the IR/10,000 cases of irritant dermatoses. The most common causes of allergic contact dermatitis were plastics, disinfectants and antimicrobials, rubber chemicals, and mercury/mercury salts. The most common causes of irritant contact dermatitis were detergents, wet and dirty work, plastic chemicals and antimicrobials. Currently, Finnish dentists have the highest risk and dental nurses have the 4th highest risk of any occupation for developing occupational allergic contact dermatitis: the risk was 6.4-fold (SRR 6.4) in dentists and 6.1-fold in dental nurses, as compared to the general working population. It is evident that safer acrylics and protective gloves, better product declarations and material safety data sheets, as well as more information about protective measures, including non-touch working techniques, are needed.

Allergic contact dermatitis in dentistry

“…Over a 9‐year observation period of dentists in Finland selected from 1982 to 1994, the incidence rate of allergic skin disease (hence excluding irritant dermatitis) increased three‐fold. 6 Similar increases have been observed in Germany. 7 Increased exposure to rubber glove chemicals and greater use of acrylics in dental restoration are thought to be partly responsible for the observed increased rate of sensitization in dentists.…”

“… 14,15 On the other hand, using skin prick tests on 2166 Finnish dental workers, type I hypersensitivity to natural rubber latex (NRL) proteins was found in 6.2%. 16 Kanerva and co‐workers confirmed an increase in incidence of contact urticaria due to latex in the period 1982–1994, 6 most likely due to the reasons discussed. An increase in incidence of type IV allergy to rubber chemicals has not been reported, but such a finding would not be unexpected given their increased usage over the last decade.…”

“…Acrylics are gradually replacing amalgam use in restorative dental work, more so in Europe than in USA or Australia and, for this reason, the incidence of ACD to acrylics in dental personnel is increasing. 6 …”

“…In Europe, however, the use of metals in restorative work is gradually being replaced by plastics. 6 Metals are also used in orthodontic prostheses, cements and components of dentures, bridges and bands. Gold is used less than previously for restorations.…”

The Prevalence of Latex Gloves – Related Complaints Among Dental Student

“…They penetrate through latex gloves within minutes of exposure and can cause sensitivity (7). We did not find positive patch tests to substances relevant to work-place exposure (disinfectants or acrylates), although they are important contact allergens in dental work (4).…”