Occupational Disease in Dentistry and Chronic Exposure to Trace Anesthetic Gases

Cohen, Ellis N.; Brown, Byron W.; Wu, Marion L.; Whitcher, Charles E.; Brodsky, Jay B.; Gift, Helen C.; Greenfield, W; Jones, Thomas W.; Driscoll, Edward J.

doi:10.14219/jada.archive.1980.0345

Cited by 285 publications

(54 citation statements)

References 16 publications

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“…A number of epidemiological studies has linked occupational exposure to nitrous oxide with spontaneous abortions, reduced rates of fertility and congenital abnormality. Both supportive and negative studies exist and there is much conflicting information surrounding the existence of the problem [10][11][12][13][14][15][16]. Again there is little recent work.…”

mentioning

confidence: 99%

The use of nitrous oxide in anaesthetic practice: a questionnaire survey

Henderson

Raj²,

Hall

2002

Anaesthesia

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SummaryWhere practicable, exposure to a hazardous substance should be eliminated or adequately controlled. A postal questionnaire survey was sent to 10% of consultants from the Association of Anaesthetists of Great Britain and Ireland, to identify the level of use of nitrous oxide in current anaesthetic practice and identify any change of practice over the last 5 years. Details of anaesthetic practice were requested in three areas: nitrous oxide usage, availability of medical air on anaesthetic machines and the use of total intravenous anaesthesia. Replies were received from 320 consultants (75%). Of these, 49% felt that, over the last 5 years, their use of nitrous oxide had decreased. Twenty per cent of anaesthetists felt that there should be some restriction in availability of nitrous oxide. Where medical air was available, 32% felt that they would use it frequently. A total of 263 (83%) stated that they use total intravenous anaesthesia to some extent. The results showed that, although 49% of consultant anaesthetists had reduced their use of nitrous oxide, this was due to medical considerations rather than concerns over health and pollution issues arising from the use of nitrous oxide. Studies have identified levels of pollution generated from the use of nitrous oxide in clinical procedures [1][2][3][4]. One of the contributing factors may be the lack of provision of medical air on the anaesthetic machine, and therefore the greater use of nitrous oxide as a carrier gas [5].There are potential health risks associated with occupational exposure to nitrous oxide. The problem of addiction has been reported [6,7]. Associated with this is the development of myeloneuropathy [8,9], but these problems have not been investigated recently. A number of epidemiological studies has linked occupational exposure to nitrous oxide with spontaneous abortions, reduced rates of fertility and congenital abnormality. Both supportive and negative studies exist and there is much conflicting information surrounding the existence of the problem [10][11][12][13][14][15][16]. Again there is little recent work.In the UK, the Control of Substances Hazardous to Health (COSHH) Regulations 1999 state that exposure to anaesthetic agents must be reduced to as low as is reasonably practicable. Where practicable, exposure to a hazardous substance should be eliminated or adequately controlled [17]. Nitrous oxide has an occupational exposure limit (OEL) of 100 parts per million (p.p.m.) over an 8-hr time weighted average (TWA). This is based on personal exposure. There are varying exposure limits across the world; in the USA the limit for nitrous oxide is as low as 25 p.p.m. and internationally, there is no agreed standard.With the recent increased provision of medical air on anaesthetic machines and greater interest in the use of total intravenous anaesthesia [18], it was decided to look at the usage of nitrous oxide in anaesthetic practice and try to assess whether its usage has increased, decreased or stayed the same over the past 5 years. The c...

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mentioning

confidence: 99%

The use of nitrous oxide in anaesthetic practice: a questionnaire survey

Henderson

Raj²,

Hall

2002

Anaesthesia

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“…10 Other studies suggest the incidence of congenital abnormalities and spontaneous abortion is slightly higher in the offspring of wives of exposed dentists, as well as reduced fertility in women occupationally exposed. 11,12 Studies have shown that adverse neurologic effects (e.g. numbness, tingling, weakness, audiovisual performance decrements) appear to increase in persons occupationally exposed to N 2 O, while other studies have not confirmed these findings.…”

Section: Nitrous Oxidementioning

confidence: 99%

Health hazard evaluation report: HETA-94-0227-2448, D. Kurtzman, DDS, Atlanta, Georgia.

1994

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“…6 Chronic exposure to low levels of nitrous oxide has been questioned as an occupational hazard for OR personnel. 7 The elimination of volatile agents may likewise have some advantages. None of the intravenous drugs has been shown to have organ toxicity while the volatile agents have been implicated in both hepatic and renal toxicity.…”

Section: Total Intravenous Anaesthesiamentioning

confidence: 99%

“…None of the intravenous drugs has been shown to have organ toxicity while the volatile agents have been implicated in both hepatic and renal toxicity. 7 The possibility of teratogenic, mutagenic or carcinogenic effects of trace concentrations of volatile agents becomes a non-issue. The necessity for accurately calibrated vaporizers is obviated, as is the use of mass spectrometry to monitor inspired and end-tidal anaesthetic concentrations.…”

Section: Total Intravenous Anaesthesiamentioning

confidence: 99%