Latex and synthetic rubber glove usage in UK general dental practice: changing trends

Latex Allergy in Children

Notwithstanding the efforts made in the last decades to mitigate the consequences of natural rubber latex allergy, this disease continues to be a major health problem, especially in developing countries. The categories of patients with greater and frequent exposure to latex (such as health care professionals and, in the pediatric field, subjects who undergo repeated surgery, e.g., those suffering from spina bifida and urogenital malformations) have an increased risk of developing sensitization and allergy to latex. Herein we provide an overview of the current knowledge and practical recommendations with a focus on epidemiology, diagnostics, and management (including both prevention and therapy) in order to guide a correct recognition and containment of this potentially fatal condition.

Comparative Assessment of Hypersensitivity Reactions on Use of Latex and Nitrile Gloves Among General Dental Practitioners: A Cross-Sectional Study

Background  Latex gloves are used more frequently by dental, medical, and other health workers and their allergy has also increased as a result, dentists are frequently exposed to latex or nitrile gloves for extended periods. This prolonged exposure often leads to local symptoms such as itching and erythema rashes. However, some dentists experience more severe systemic reactions, including swelling, wheezing, breathlessness, and even an increase in blood pressure. Latex gloves have recently been replaced with nitrile gloves, powder-free latex gloves, and other preventive measures to avoid allergies. Latex allergies are more common than nitrile allergies, as they are hypoallergic with properties such as tear-resistant and provide an equivalent level of defense against various dental materials and procedures. Women experience more allergic reactions than men. Not only are dentists exposed to this allergy but the patient can also be exposed during the procedure. This study aimed to assess hypersensitive reactions to the use of latex and nitrile gloves among general dentist practitioners and dental students. Methods A cross-sectional study was conducted in Wardha, Maharashtra, India, to evaluate allergic reactions to latex and nitrile gloves among general dental practitioners and dental students at college. A questionnaire-based study was conducted with a sample size of 356. The self-administered survey inquiries about glove compliance, the time they wear the gloves, regular glove use, and problems related to latex or nitrile contact. In addition, dentists and dental students' personal histories of allergies to medications, dental materials, disinfectants, or other chemicals were noted, as well as signs and symptoms they experienced from prolonged contact with gloves. Result The total number of responses collected was 356. The investigated dentists were 274 and 82 were students, out of which 122 (34.3%) were male and 234 (65.7%) were female. Responses showed that 224 (62.92%) used latex gloves, and 132 (37.08%) used nitrile gloves. Among 356 participants 175 showed symptoms by the use of both latex and nitrile gloves, out of which 85.14% showed allergy to latex and 14.85% to nitrile gloves. All 175 individuals showed type IV hypersensitivity, and none of them showed type I. Conclusion Latex gloves are not the only option for dentists who experience itching when wearing gloves; they can also use powered-free latex gloves and nitrile gloves or take precautions such as not using oil-based cream, washing their hands, or taking pharmaceuticals such as cetirizine, pheniramine maleate, etc. However, when symptoms worsen and include erythema, swelling, wheezing, and in some cases, anaphylactic shock may occur they tend to use alternative gloves.

The chemicals between us-First results of the cluster analyses on anatomy embalming procedures in the German-speaking countries

Hands-on courses utilizing preserved human tissues for educational training offer an important pathway to acquire basic anatomical knowledge. Owing to the reevaluation of formaldehyde limits by the European Commission, a joint approach was chosen by the German-speaking anatomies in Europe (Germany, Austria, Switzerland) to find commonalities among embalming protocols and infrastructure. A survey comprising 537 items was circulated to all anatomies in German-speaking Europe. Clusters were established for "ethanol"-, formaldehyde-based ("FA"), and "other" embalming procedures, depending on the chemicals considered the most relevant for each protocol. The logistical framework, volumes of chemicals, and infrastructure were found to be highly diverse between the groups and protocols. Formaldehyde quantities deployed per annum were three-fold higher in the "FA" (223 L/a) compared to the "ethanol" (71.0 L/a) group, but not for "other" (97.8 L/a), though the volumes injected per body were similar. "FA" was strongly related to table-borne air ventilation and total fixative volumes ≤1000 L. "Ethanol" was strongly related to total fixative volumes >1000 L, ceiling- and floor-borne air ventilation, and explosion-proof facilities. Air ventilation was found to be installed symmetrically in the mortuary and dissection facilities. Certain predictors exist for the interplay between the embalming used in a given infrastructure and technical measures. The here-established cluster analysis may serve as decision supportive tool when considering altering embalming protocols or establishing joint protocols between institutions, following a best practice approach to cater toward best-suited tissue characteristics for educational purposes, while simultaneously addressing future demands on exposure limits.

Secondary prevention of latex allergy

PURPOSE OF REVIEW

The present review addresses the secondary prevention in healthcare worker, healthcare setting, and in patients outside the healthcare setting.

RECENT FINDINGS

There is sufficient knowledge of the broad aetiology of latex allergy for secondary preventive programmes to be widely adopted. Currently, avoidance of latex-containing surgical products is mandatory in the care of sensitized patients. They should also have a list of occult sources of natural rubber latex exposure and cross-reacting fruits. During all health-care procedures latex allergic patients should be treated in a 'latex-free' environment. Specific sublingual immunotherapy has been suggested as a suitable therapeutic option. It can be offered, in addition to symptomatic treatment, to selected patients, when avoidance measures are not feasible or effective. The use of omalizumab could also be extended as an adjunct to latex immunotherapy.

SUMMARY

Despite of the progress made in the secondary prevention of latex allergy, the disease still continues to be a global health problem.

The use of latex and non-latex gloves and dental equipment in UK and Irish dental hospitals

Aim To identify glove usage within UK and Ireland dental hospitals as well as the use of latex- and non-latex-containing dental equipment.Method A self-completed questionnaire was disseminated to 16 dental hospitals in the summer of 2017. The survey concerned their current use of latex and non-latex gloves and dental equipment. In addition, information was sought regarding any problems associated with non-latex and latex gloves.Results The questionnaire response rate was 13/16 (81%), of which 100% reported the use of non-latex examination gloves. The majority were using nitrile gloves. Twelve of the 13 dental hospitals would use examination gloves for simple extractions and 11 would use sterile gloves for minor oral surgery. In ten hospitals (77%), the sterile gloves were always non-latex, and again, the majority were nitrile. Latex-containing dental equipment including orthodontic bands, prophylactic polishing cups and dental dam was still being used within some dental hospitals, but to a much lesser extent than non-latex.Conclusion All dental hospitals were using latex-free examination gloves and were showing a move towards latex-free dental equipment. This usage is comparable to what has been seen in general dental practice and follows the trend towards latex-free dentistry.

Emissions and toxic units of solvent, monomer and additive residues released to gaseous phase from latex balloons

This study describes the VOCs emissions from commercially available latex balloons. Nine compounds are determined to be emitted from 13 types of balloons of different colors and imprints in 30 and 60 °C. The average values of total volatile organic compounds (TVOCs) emitted from studied samples ranged from 0.054 up to 7.18 μg g^-1 and from 0.27 up to 36.11 μg g^-1 for 30 °C and 60 °C, respectively. The dataset is treated with principal component analysis (PCA) and multiple curve resolution (MCR) to characterize its internal patterns. Here two groups on compounds are recognized - the first one related to balloon material, the second one being emissions of compounds previously adsorbed on balloon material. The toxicity assessment of MCR modeled balloons' emissions was performed by toxic unit (TU) approach. The obtained TUs were summed to give toxicity emission assessment. The incorporation of TUs allows to identify the balloons with the most toxic emissions- imprinted ones in 60 °C. The compounds of the highest TUs are hexanal and benzene. FTIR analysis shows that all balloons are made of the same polymeric material - isoprene, so all differences in emissions are related to different additives like pigments, imprints or these responsible for opaqueness. Analyzing the obtained research results it was noticed that latex balloons might be considered as an important source of emission of aliphatic and monoaromatic hydrocarbons to the gaseous phase.

Latex Allergy: Current Status and Future Perspectives

Allergy to natural rubber latex (NRLA) from Hevea brasiliensis is a relevant public health issue, in particular in healthcare workers and groups at risk. Clinical manifestations of NRLA can range from mild skin disorders to life-threatening systemic reactions. Prevention measures remain the gold-standard treatment for patients suffering from NRLA, but the only etiological therapy able to influence the natural history of NRLA is specific desensitization. This review aims to underline the epidemiological, clinical and diagnostic aspects of NRLA, and carries out a complete and wide-ranging review of the current literature on NRLA management and immunotherapy.