Allergic contact dermatitis due to para-tertiary-butylcatechol in a resin operator

Para-tertiary-butylcatechol (PTBC) is a rare but potent contact allergen. This is a report of occupational allergic contact dermatitis to PTBC in a resin operator.

Simultaneous p-tert-butylphenol-formaldehyde resin and p-tert-butylcatechol contact allergies in man and sensitizing capacities of p-tert-butylphenol and p-tert-butylcatechol in guinea pigs

In patients who are hypersensitive to p-tert-butylphenol-formaldehyde resin (PTBP-F-R), it is necessary, for diagnostic, therapeutic, and preventive reasons, to know the identity of the primary sensitizing substances, their sensitizing capacities, and their crossreaction patterns. The aims of this study were to investigate the presence of a simultaneous p-tert-butylcatechol (PTBC) contact allergy in individuals who were hypersensitive to PTBP-F-R, to investigate the sensitizing capacity of PTBC and p-tert-butylphenol (PTBP) in guinea pigs, and to study any crossreaction patterns. In 294 dermatitis patients tested with PTBP-F-R and PTBC, there was a statistically significant over-representation of simultaneous test reactions. Use of the guinea pig maximization test demonstrated that PTBC is a strong sensitizer giving crossreactions to PTBP. PTBP, however, failed to induce sensitization.

Development of gingivitis around aged restorations of resin-modified glass ionomer cement, polyacid-modified resin composite (compomer) and resin composite

Resin-modified glass ionomer cements (RMGIC) and polyacid-modified resin composites (PMC, compomers) are two recently introduced material groups supposed to replace traditional cements in operative dentistry. The new restoratives release initially fluoride in different relatively high concentrations, which decrease gradually during the first weeks in vivo. Earlier studies showed a stronger subclinical inflammatory reaction around different conventional tooth colored restorative materials than around intact enamel. The aim of this study was to compare intra-individually the initiation of gingival inflammation around, aged RMGIC, PMC and resin composite restorations. Subgingivally located Class III restorations were placed in 17 patients. Each patient received one of each of the experimental materials. All patients were placed on an oral hygiene regime 1-year after finishing of the restorations. Gingivitis was induced during a one-week period without oral hygiene. The gingival condition was assessed by sampling of gingival crevicular fluid (GCF), registration of the amount of bacterial plaque and by registration of bleeding after gentle probing of the entrance of the gingival sulcus (SBI) on the experimental filling- and control-enamel surfaces at days 0 and 7. No differences were seen in plaque and gingival index scores between the materials at both days. The GCF increased significantly for all surfaces during the experimental gingivitis period. At day 7 significantly lower GCF was sampled around the enamel surfaces. In conclusion, the differences between the materials did not result in measurable differences concerning clinical or subclinical signs of gingivitis.

Contact allergy to the monomers of p-tert-butylphenol-formaldehyde resin in the guinea pig

In patients hypersensitive to p-tert-butylphenol-formaldehyde resin (PTBP-F-R), and butylphenol derivatives therein, it is for diagnostic, therapeutic and preventive reasons necessary to know the identity of the primary sensitizing substances, their sensitizing capacities as well as their cross-reaction patterns. The monomers in PTBP-F-R, 2-methylol p-tert-butylphenol (2-MPTBP) and 2,6-dimethylol p-tert-butylphenol (2,6-MPTBP), have been shown to be contact sensitizers in man. The aim of this study was to investigate the sensitizing capacities of the monomers and establish cross-reacting patterns in the guinea pig with the guinea pig maximization test. 2,6-MPTBP was shown to be a strong sensitizer while it was indicated that 2-MPTBP was a sensitizer. Animals sensitized to 2,6-MPTBP showed cross-reactions to 2-MPTBP and p-tert-butylcatechol. No cross-reactions were shown to p-tert-butylphenol, tert-butyl 4-hydroxyanisole (BHA) and 3,5-di-tert-butyl 4-hydroxytoluene (BHT).

Postoperative dental bleaching: effect of microleakage on Class V tooth colored restorative materials

The effect of 3 percent, 11 percent, and 16 percent carbamide peroxide bleaching solutions and 35 percent hydrogen peroxide bleaching gel on microleakage of Class V composite resins, resin modified glass ionomer cements, and compomer restorative materials together with corresponding (if indicated) fourth/fifth generation bonding agents was evaluated using previously extracted human teeth. Five groups of Class V cavity preparations were placed in enamel of the facial surfaces of 200 teeth. Groups A through D included 40 restorations each (4 different restorative materials and their accompanying bonding agent multiplied by 10 teeth) treated with 3 percent, 11 percent, and 16 percent carbamide peroxide bleach and 35 percent hydrogen peroxide bleach. Group E included 40 restorations without treatment of bleach and stood as the control. The restorative materials included were: Fuji II LC resin modified glass ionomer cement, Helioprogress composite resin/-Heliobond adhesive system, Aelitefil composite resin/Allbond 2 adhesive and Dyract compomer material/Prime & Bond adhesive system. Bleaching agents included were Rembrandt 3 percent peroxide gel, Perfecta 16 percent carbamide peroxide gel, White & Brite 11 percent carbamide peroxide solution and Superoxyl 35 percent hydrogen peroxide gel. All teeth were thermally stressed for 100 cycles and microleakage were assessed by dye penetration. The results were tabulated using Analysis of Variance (ANOVA) testing procedures. The Aelitefil composite resin material behaved the least favorably (relative to microleakage) compared to the other materials when exposed to various concentrations of dental bleaching agents.

Adverse health reactions in skin, eyes, and respiratory tract among dental personnel in Sweden

Dental personnel manually handle products that contain monomers. Several studies have documented adverse health effects after exposure to such products. Gloves made of vinyl or latex are easily penetrated by monomers. Ordinary glasses, or visors, do not protect against vapour from polymer products. Dental face masks filter out about 40% of respirable particles. To survey the prevalence of asthma, atopic dermatitis, conjunctivitis, hay fever/rhinitis, and hand eczema among dental personnel, a questionnaire was distributed to all dental teams in Northern Sweden. Referents were researchers, teachers, and secretaries from the same geographical area. The response rate was 76% for dental teams, and 66% for referents. The results show a significantly higher prevalence of conjunctivitis, and atopic dermatitis among dentists, both male and female. Hypersensitivity to dental materials was reported by significantly more dental personnel than by referents.

Skin and mucosal reactions associated with dental materials

The selection of dental materials for specific treatment purposes is primarily based on their physical properties. The composition of materials available indicates that there is the potential for adverse biological effects. The amounts of substances released are usually too low to cause any overt systemic toxic effects. However, many of the chemicals used in dentistry are irritating and may cause local damage. Also, in reactions mediated via the amplifying mechanisms of the immune system, small amounts may lead to clinical manifestations of allergic contact dermatitis and urticaria. A special problem in the diagnosis of adverse events occurs when intraoral exposure leads to generalized urticarial reactions. Due to a low level of suspicion, extraoral reactions are rarely associated with dental treatment modalities. Occupational dermatoses represent a serious problem, especially the development of an allergy to constituents of the resin-based filling materials and adhesives. The monomers of resin-based materials are volatile and penetrate latex and vinyl gloves easily. Allergic contact dermatitis related to resin-based materials may be occupationally disabling.

[Cutaneous sarcoidosis secondary to inhalation of wall insulating material particles]

BACKGROUND

Sarcoidosis is a systemic disease defined by multiple granulomas. We report a case of sarcoidosis which occur concomitantly or secondary to foreign body granuloma of the lung.

CASE REPORT

A 50-year-old women presented with Lofgren syndrome, subcutaneous granulomatous nodular lesions on the arms and legs. Computed tomography revealed a foreign body granuloma of the lung centered on particles of mural isolation material that the patient had inhaled accidentally. Analysis of the foreign body particles showed non crystalline silica, calcite monohydrate and phenol resin.

DISCUSSION

Recent studies support the hypothesis that sarcoidosis is an antigen-driven disease involving pulmonary T-cell activation. The antigen-mediated reaction may be caused by infectious agents, particularly mycobacteria, occupational and environmental agents (beryllium) or as in our observation following inhalation of mural isolation material particles.

[Sodium polystyrene sulfonate (Resonium A) as possible cause of rectal blood loss]

A 67-year-old man underwent laparotomy for a ruptured aneurysm of the abdominal aorta. Postoperatively he was treated with haemodialysis because of perioperatively developed acute renal failure. Hyperkalaemia was temporarily treated with sodium polystyrene sulfonate (Resonium A) after which he lost blood per rectum. A hemicolectomy was necessary because of intractable blood loss due to ulceration of the colon. This complication is related to uraemia and the use of sodium polystyrene sulfonate with or without sorbitol.

Evaluation of genotoxic potential of styrene in furniture workers using unsaturated polyester resins

Styrene is a widely used chemical, mostly in making synthetic rubber, resins, polyesters, plastics and insulators. Increasing attention has been focused on this compound since experiments using cytogenetic end-points have implicated styrene as a potential carcinogen and mutagen. In order to perform biological monitoring of genotoxic exposure to styrene monomer, we evaluated the urinary thioether (UT) excretion, and sister chromatid exchanges (SCEs) and micronuclei (MN) in peripheral lymphocytes from 53 furniture workers employed in small workplaces where polyester resin lamination processings were done and from 41 matched control subjects. The mean air concentration of styrene in the breathing zone of workers was 30.3 ppm. As a metabolic marker for styrene exposure, mandelic acid + phenylglyoxylic acid was measured in the urine and the mean value was 207 mg/g creatinine. The mean +/- SD value of UT excretions of workers was 4.43 +/- 3.42 mmol SH-/mol creatinine and also mean UT for controls was found to be a 2.75 +/- 1.78 mmol SH-/mol creatinine. The mean +/- SD/cell values of SCE frequency in peripheral lymphocytes from the workers and controls were 6.20 +/- 1.56 and 5.23 +/- 1.23, respectively. The mean +/- SD frequencies (%o) of MN in the exposed and control groups were 1.98 +/- 0.50 and 2.09 +/- 0.35, respectively. Significant effects of work-related exposure were detected in the UT excretion and SCEs analyzed in peripheral blood lymphocytes (p < 0.05 and p < 0.01, respectively). The MN frequency in lymphocytes from the styrene-exposed group did not differ from that in the controls (p > 0.05). Effect of smoking, age and duration of exposure on the genotoxicity parameters analyzed were also evaluated. In conclusion, although our data do not demonstrate a dose-response relationship, they do suggest that styrene exposure was evident and that this styrene exposure may contribute to the observed genotoxic damage in furniture workers.

Prevalence and distribution of dental restorative materials in US Air Force veterans

OBJECTIVES

Millions of restorative procedures are performed annually in the United States, yet very little is known about their distribution in the general population. With increasing concern about potential adverse health effects of some restorative materials, a better understanding of the extent of exposure to these materials in the population is important. The purpose of this study is to report the prevalence, patterns, and distribution of dental restorative materials in a population of male veterans.

METHODS

This collaborative study with the US Air Force examined 1,166 male veterans to assess exposure to dental amalgam and other restorative materials. An inventory of dental materials in the study population was obtained through oral examinations. Dental materials were classified into five categories: (1) amalgam; (2) resin; (3) porcelain, cement, or temporary, including ionomer (PCT); (4) cast gold alloys/direct filling gold; and (5) other metals (OM). The mean age of the study participants was 52.9 years. Over 94 percent of the study participants were dentate.

RESULTS

The study participants averaged 45.8 restored/replaced surfaces. Restored/replaced surfaces increased with age while the number of teeth decreased with age. The most frequently used restorative material was amalgam, averaging 19.89 surfaces per subject, followed by PCT (9.38), resins (8.99), OM (5.52), and gold (4.91). The distributions of restorative materials varied by age, arch type, and location in the mouth.

CONCLUSION

The study population experienced substantial exposure to dental materials.

Self-reported occupational dermatological reactions among Danish dentists

The aims of the study were to investigate the causes and prevalences of occupational dermatological reactions among Danish dentists. Questionnaires and telephone interviews with Danish dentists revealed that 37.8% reported skin reactions. In 27.2% of the cases the reactions were related to occupation, occurring with a point prevalence of 9.6%, and with a 1-yr period prevalence of 21.4%. The main causes were hand washing/soaps, latex gloves and (di)methacrylate-containing materials occurring at point prevalences of 7.1%, 1.3% and 1.7%, respectively. In addition, several other causes were reported, each occurring at relatively low frequency. Diagnosed allergic latex eczema was reported by 0.6%, but the frequency might be more than 2%, estimated on basis of reported symptoms. Allergic eczema caused by (di)methacrylate-containing materials was diagnosed among 0.7%, but estimated by the description of symptoms to be nearly 2%. The results urge for developing safer materials for dental use.

Bioavailability of components of resin-based materials which are applied to teeth

Chemical components of many materials used in dental practice can move into the local biophase, where they can have beneficial or adverse effects. The strongest indirect evidence that components of resin-based materials used in dentistry can move into the biophase are the many reports of allergic dermatitis in dental personnel. Direct measurement of component release has shown that triethylene glycol dimethacrylate (TEGDMA), hydroxyethyl methacrylate (HEMA), and, in the case of some orthodontic cements, bis-glycidyl methacrylate and benzoyl peroxide can move into an aqueous medium from a range of resin-based materials which are applied to teeth as part of oral care. In the case of resin composite restorations, HEMA and TEGDMA are available in microgram quantities via the salivary surface in the minutes and hours after clinical placement and via dentin and pulp in the hours and days after placement. Fortunately, moderate thickness of dentin protects pulp tissue against local toxicity. There are no data which suggest that systemic toxicity is a risk with any of these materials. There are some case reports of allergic responses to the monomers in patients, but the incidence of such responses appears at present to be much lower than that in dental personnel.

Sensitization to para-tertiary-butylphenolformaldehyde resin

BACKGROUND

Phenolformaldehyde resins, especially the para-tertiary-butylphenolformaldehyde resin (PTBP-FR), are widely used in industry and in numerous materials of everyday use, such as glues, adhesives, or inks. They can cause many occupational and nonoccupational cases of dermatitis.

PATIENTS AND METHODS

Forty-one patients with positive patch test results to PTBP-FR were selected for this study. They were patch-tested with a series of chemically related compounds and cross-reactions were noted.

RESULTS

Phenolformaldehyde resin (PF-R) was frequently positive (65.8%), whereas other compounds gave a much smaller number of positive results. Cases of occupational exposure (24.4%), location of the dermatitis (hands were involved in 46.3% of cases), and possible sources of exposure (shoes were the responsible agent in 12.2% of cases) were evaluated.

CONCLUSIONS

Phenolformaldehyde resins are an important cause of contact dermatitis and must be studied chemically and clinically to improve the prognosis of sensitized patients.