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Meek B, Bridges JW, Fasey A, Sauer UG. Evidential requirements for the regulatory hazard and risk assessment of respiratory sensitisers: methyl methacrylate as an example. Arch Toxicol 2023; 97:931-946. [PMID: 36797432 PMCID: PMC10025211 DOI: 10.1007/s00204-023-03448-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/17/2023] [Indexed: 02/18/2023]
Abstract
This review addresses the need for a framework to increase the consistency, objectivity and transparency in the regulatory assessment of respiratory sensitisers and associated uncertainties. Principal issues are considered and illustrated through a case study (with methyl methacrylate). In the absence of test methods validated for regulatory use, formal documentation of the weight-of-evidence for hazard classification both at the level of integration of individual studies within lines of evidence and across a broad range of data streams was agreed to be critical for such a framework. An integrated approach is proposed to include not only occupational studies and clinical evidence for the regulatory assessment of respiratory sensitisers, but also information on structure and physical and chemical factors, predictive approaches such as structure activity analysis and in vitro and in vivo mechanistic and toxicokinetic findings. A weight-of-evidence protocol, incorporating integration of these sources of data based on predefined considerations, would contribute to transparency and consistency in the outcome of the assessment. In those cases where a decision may need to be taken on the basis of occupational findings alone, conclusions should be based on transparent weighting of relevant data on the observed prevalence of occupational asthma in various studies taking into account all relevant information including the range and nature of workplace exposures to the substance of interest, co-exposure to other chemicals and study quality.
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Affiliation(s)
| | - James W Bridges
- Emeritus Professor, University of Surrey, Guildford, Surrey, UK
| | | | - Ursula G Sauer
- Scientific Consultancy-Animal Welfare, Hallstattfeld 16, 85579, Neubiberg, Germany.
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Occupational Contact Dermatitis in Dental Personnel: A Retrospective Analysis of the North American Contact Dermatitis Group Data, 2001 to 2018. Dermatitis 2022; 33:80-90. [PMID: 35029351 DOI: 10.1097/der.0000000000000847] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dental personnel are at risk of developing occupational contact dermatitis. OBJECTIVES The aims of the study were to determine prevalence of occupational contact dermatitis in dental personnel referred for patch testing and to characterize relevant allergens and sources. METHODS The study used a retrospective, cross-sectional analysis of the North American Contact Dermatitis Group (NACDG) data, 2001-2018. RESULTS Of 41,109 patients, 585 (1.4%) were dental personnel. Dental personnel were significantly more likely than nondental personnel to be female (75.7% vs 67.4%, P < 0.0001), have occupationally related dermatitis (35.7% vs 11.5%, P < 0.0001), and/or have primary hand involvement (48.6% vs 22.5%, P < 0.0001). More than one quarter of dental personnel (62/585, 27.7%) had 1 or more occupationally related allergic patch test reaction(s). There were 249 occupationally related reactions to NACDG screening allergens, most commonly glutaraldehyde (18.1%), thiuram mix (16.1%), and carba mix (14.1%). The most common sources of NACDG screening allergens were gloves (30.7%), dental materials (26.6%), and sterilizing solutions (13.1%). Seventy-three dental personnel (12.5%) had 1 or more positive patch test reactions to occupationally related allergen(s)/substances not on the screening series. Occupationally related irritant contact dermatitis was identified in 22.2% (n = 130) of dental personnel, most commonly to nonskin soaps/detergents/disinfectants (32.0%). CONCLUSIONS Occupational contact dermatitis is common in dental personnel referred for patch testing. Comprehensive testing beyond screening series is important in these patients.
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Isaksson M, Rustemeyer T, Antelmi A. Contact Allergy to Dental Materials and Implants. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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4
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Bishop S, Roberts H. Methacrylate perspective in current dental practice. J ESTHET RESTOR DENT 2020; 32:673-680. [PMID: 32744420 DOI: 10.1111/jerd.12633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/10/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To provide a current perspective concerning dental personnel sensitivity to methacrylate materials. OVERVIEW Methacrylate related sensitivity and allergies are currently beyond traditional thoughts concerning denture base resins and methyl methacrylate provisional materials. Methacrylates are now ubiquitous in current dental practice and dental personnel should be aware that dental adhesives contain potent sensitizers that may also cross-sensitize individuals to other methacrylates not experienced. The growing sensitivity to 2-hydroxyethyl methacrylate (HEMA) has been described to be epidemic in nature due to the artificial nail industry with dental patients and dental personnel may be more susceptible to dental methacrylate sensitization. While contact dermatitis remains the most prevalent methacrylate-related clinical presentation, respiratory complications and asthma are increasing associated with methacrylate exposure. While additional personal protective equipment (PPE) is thought to be first protective choice, the National Institute for Occupational Safety and Health (NIOSH) considers PPE overall largely ineffective and should be considered only as a last resort. CONCLUSION Dental personnel need to be more aware of methacrylate sources and use workplace control measures to limit methacrylate exposures to both dental personnel and patients. CLINICAL SIGNIFICANCE Sensitivity to methacrylate materials is a growing dental workplace major concern and dental personnel should be aware of both the methacrylate content of current materials and the products that contain ingredients with the most sensitization potential.
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Affiliation(s)
- Susan Bishop
- Division of Restorative Dentistry, University of Kentucky College of Dentistry, Lexin1gton, Kentucky, USA
| | - Howard Roberts
- Director of Graduate Studies, University of Kentucky College of Dentistry, Lexington, Kentucky, USA.,USAF Postgraduate Dental College, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Alizadehgharib S, Östberg AK, Dahlstrand Rudin A, Dahlgren U, Christenson K. The effects of the dental methacrylates TEGDMA, Bis-GMA, and UDMA on neutrophils in vitro. Clin Exp Dent Res 2020; 6:439-447. [PMID: 32543782 PMCID: PMC7453771 DOI: 10.1002/cre2.296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 12/30/2022] Open
Abstract
Objectives The prevalent usage of methacrylates in modern dentistry demands good knowledge of their biological impacts. While there have been several studies demonstrating the effects of different methacrylic monomers on mononuclear white blood cells, very little is known about the effects caused by these monomers on neutrophilic granulocytes. The objective of this study was to add novel knowledge about how neutrophils are affected by exposure to triethylene glycol dimethacrylate (TEGDMA), urethane dimethacrylate (UDMA), and bisphenol A glycol dimethacrylate (Bis‐GMA) alone or in combinations. Materials and Methods Isolated neutrophils were cultured in the presence or absence of methacrylates. The IL‐8 release was measured using a DuoSet ELISA development kit. Apoptosis and necrosis were analyzed using flow cytometry. The formation of neutrophil extracellular traps (NETs) was investigated using Sytox green DNA staining combined with microscopically examination of released DNA and myeloperoxidase (MPO). Results The release of IL‐8 was significantly increased after exposure to TEGDMA, Bis‐GMA, UDMA, or TEGDMA in combination with Bis‐GMA or UDMA compared to the unstimulated controls. Exposure to TEGDMA, UDMA, and Bis‐GMA for 24 hr separately or in combination did not affect apoptosis or necrosis of the exposed neutrophils. NET structures were formed by neutrophils after exposure to the different combinations of the methacrylates. Conclusion The combination of TEGDMA and Bis‐GMA had a synergistic proinflammatory effect on neutrophils by increasing the release of IL‐8 and the formation of NET structures. The changes in the normal functions of neutrophils caused by methacrylate exposure may lead to altered inflammatory response and relate to previously reported adverse immune reactions caused by these substances.
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Affiliation(s)
- Sara Alizadehgharib
- Department of Oral Microbiology and Immunology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann-Karin Östberg
- Department of Oral Microbiology and Immunology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Agnes Dahlstrand Rudin
- Department of Oral Microbiology and Immunology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Dahlgren
- Department of Oral Microbiology and Immunology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Christenson
- Department of Oral Microbiology and Immunology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Dental Materials and Implants. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_39-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Isaksson M, Rustemeyer T, Antelmi A. Contact Allergy to Dental Materials and Implants. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_39-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Quaade AS, Hald M, Johansen JD. Allergic contact stomatitis caused by (meth)acrylates in an occlusal splint. Contact Dermatitis 2019; 82:112-114. [PMID: 31515815 DOI: 10.1111/cod.13397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Anna S Quaade
- National Allergy Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Marianne Hald
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jeanne D Johansen
- National Allergy Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Lyapina M, Dencheva M, Krasteva A, Cekova M, Deliverska M, Vodenicharov V, Markov D, Mitova Y, Kisselova A. Contact sensitization to metals in dental exposures in Bulgaria. BIOTECHNOL BIOTEC EQ 2018. [DOI: 10.1080/13102818.2018.1450163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Maya Lyapina
- Medical College “Iordanka Filaretova”, Medical University of Sofia, Sofia, Bulgaria
| | - Maria Dencheva
- Department of Image and Oral Diagnostic, Faculty of Dental Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Assya Krasteva
- Department of Image and Oral Diagnostic, Faculty of Dental Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Mariana Cekova
- Department of Image and Oral Diagnostic, Faculty of Dental Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Mariela Deliverska
- Department of Medical Ethics and Law, Faculty of Public Health, Medical University of Sofia, Sofia, Bulgaria
| | - Vlayko Vodenicharov
- Department of Hygiene, Medical Ecology and Nutrition, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Daniel Markov
- Department of Image and Oral Diagnostic, Faculty of Dental Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Yordanka Mitova
- Department of Epidemiology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Angelina Kisselova
- Department of Image and Oral Diagnostic, Faculty of Dental Medicine, Medical University of Sofia, Sofia, Bulgaria
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Bogen KT, Garry MR. Risks of Allergic Contact Dermatitis Elicited by Nickel, Chromium, and Organic Sensitizers: Quantitative Models Based on Clinical Patch Test Data. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2018; 38:1036-1051. [PMID: 29023909 DOI: 10.1111/risa.12902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 06/30/2017] [Accepted: 08/14/2017] [Indexed: 06/07/2023]
Abstract
Risks of allergic contact dermatitis (ACD) from consumer products intended for extended (nonpiercing) dermal contact are regulated by E.U. Directive EN 1811 that limits released Ni to a weekly equivalent dermal load of ≤0.5 μg/cm2 . Similar approaches for thousands of known organic sensitizers are hampered by inability to quantify respective ACD-elicitation risk levels. To help address this gap, normalized values of cumulative risk for eliciting a positive ("≥+") clinical patch test response reported in 12 studies for a total of n = 625 Ni-sensitized patients were modeled in relation to observed ACD-eliciting Ni loads, yielding an approximate lognormal (LN) distribution with a geometric mean and standard deviation of GMNi = 15 μg/cm2 and GSDNi = 8.0, respectively. Such data for five sensitizers (including formaldehyde and 2-hydroxyethyl methacrylate) were also ∼LN distributed, but with a common GSD value equal to GSDNi and with heterogeneous sensitizer-specific GM values each defining a respective ACD-eliciting potency GMNi /GM relative to Ni. Such potencies were also estimated for nine (meth)acrylates by applying this general LN ACD-elicitation risk model to respective sets of fewer data. ACD-elicitation risk patterns observed for Cr(VI) (n = 417) and Cr(III) (n = 78) were fit to mixed-LN models in which ∼30% and ∼40% of the most sensitive responders, respectively, were estimated to exhibit a LN response also governed by GSDNi . The observed common LN-response shape parameter GSDNi may reflect a common underlying ACD mechanism and suggests a common interim approach to quantitative ACD-elicitation risk assessment based on available clinical data.
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Alizadehgharib S, Östberg AK, Dahlgren U. Triethylene glycol dimethacrylate: adjuvant properties and effect on cytokine production. ACTA BIOMATERIALIA ODONTOLOGICA SCANDINAVICA 2017; 4:1-9. [PMID: 29230430 PMCID: PMC5717717 DOI: 10.1080/23337931.2017.1409075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/20/2017] [Indexed: 11/16/2022]
Abstract
Objective: Leakage of monomers from dental fillings due to incomplete curing is very common. The objective of the present study was to examine the cytokine profile in cells exposed to triethyleneglycol dimethacrylate (TEGDMA) and the adjuvant properties of TEGDMA. Materials and methods: Human peripheral blood mononuclear cells were exposed to TEGDMA (500 and 1000 μM) for 24 h in vitro. Bio-Plex Pro™ assays were used for analysis and detection of cytokines. In vivo, BALB/c mice were immunized subcutaneously in the base of the tail with TEGDMA in combination with ovalbumin (OVA). Results: The cytokine levels of IL-8, IL-18, GRO-α and MCP-1 were significantly increased for both concentrations. IL-1β, IL-6 and TNF-α was only significantly increased in cultures exposed to 500 μM TEGDMA. The concentration of TNF-α was significantly decreased in cultures exposed to 1000 μM TEGDMA. Animals immunized with OVA co-administrated with TEGDMA had a significantly higher IgE and IgG anti-OVA antibody levels in blood than animals immunized with OVA only. Conclusions: TEGDMA affects production of proinflammatory cytokines IL-1β, IL-6, IL-8, IL-18 and TNF-α. This inflammatogenic capacity renders TEGDMAs adjuvant properties, which may interfere with the homeostasis between the immune system and the indigenous microflora in the oral cavity.
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Affiliation(s)
- Sara Alizadehgharib
- Department of Oral Microbiology and Immunology, University of Gothenburg, The Sahlgrenska Academy, Institute of OdontologyGothenburgSweden
| | - Anna-Karin Östberg
- Department of Oral Microbiology and Immunology, University of Gothenburg, The Sahlgrenska Academy, Institute of OdontologyGothenburgSweden
| | - Ulf Dahlgren
- Department of Oral Microbiology and Immunology, University of Gothenburg, The Sahlgrenska Academy, Institute of OdontologyGothenburgSweden
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Kansu G, Kalyoncuoğlu T, Uyar P, Uzun E. Cell death induced by eluates from hypoallergenic denture base acrylic resins in NIH-3T3 fibroblast cells. J Dent Sci 2014. [DOI: 10.1016/j.jds.2013.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Rai R, Dinakar D, Kurian SS, Bindoo YA. Investigation of contact allergy to dental materials by patch testing. Indian Dermatol Online J 2014; 5:282-6. [PMID: 25165644 PMCID: PMC4144212 DOI: 10.4103/2229-5178.137778] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Dental products are widely used by patients and dental personnel alike and may cause problems for both. Dental materials could cause contact allergy with varying manifestations such as burning, pain, stomatitis, cheilitis, ulcers, lichenoid reactions localized to the oral mucosa in patients, and hand dermatitis in dental personnel. Patch testing with the dental series comprising commonly used materials can be used to detect contact allergies to dental materials. AIM This study aimed to identify contact allergy among patients who have oral mucosal lesions after dental treatment and among dental personnel who came in contact with these materials. MATERIALS AND METHODS Twenty patients who had undergone dental procedures with symptoms of oral lichen planus, oral stomatitis, burning mouth, and recurrent aphthosis, were included in the study. Dental personnel with history of hand dermatitis were also included in the study. Patch testing was performed using Chemotechnique Dental Series and results interpreted as recommended by the International Contact Dermatitis Research Group (ICDRG). RESULTS Out of 13 patients who had undergone dental treatment/with oral symptoms, six patients with stomatitis, lichenoid lesions, and oral ulcers showed positive patch tests to a variety of dental materials, seven patients with ulcers had negative patch tests, seven dental personnel with hand dermatitis showed multiple allergies to various dental materials, and most had multiple positivities. CONCLUSION The patch test is a useful, simple, noninvasive method to detect contact allergies among patients and among dental personnel dealing with these products. Long term studies are necessary to establish the relevance of these positive patch tests by eliminating the allergic substances, identifying clinical improvement, and substituting with nonallergenic materials.
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Affiliation(s)
- Reena Rai
- Department of Dermatology, PSG Institute of Medical Science & Research, Coimbatore, Tamil Nadu, India
| | - Devina Dinakar
- Department of Prosthodontia, Ramakrishna Dental College, Coimbatore, Tamil Nadu, India
| | - Swetha S Kurian
- Department of Dermatology, PSG Institute of Medical Science & Research, Coimbatore, Tamil Nadu, India
| | - Y A Bindoo
- Department of Prosthodontia, Ramakrishna Dental College, Coimbatore, Tamil Nadu, India
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Kimber I, Pemberton MA. Assessment of the skin sensitising potency of the lower alkyl methacrylate esters. Regul Toxicol Pharmacol 2014; 70:24-36. [PMID: 24956587 DOI: 10.1016/j.yrtph.2014.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/11/2014] [Accepted: 06/15/2014] [Indexed: 01/08/2023]
Abstract
There is continued interest in, and imperatives for, the classification of contact allergens according to their relative skin sensitising potency. However, achieving that end can prove problematic, not least when there is an apparent lack of concordance between experimental assessments of potency and the prevalence allergic contact dermatitis as judged by clinical experience. For the purpose of exploring this issue, and illustrating the important considerations that are required to reach sound judgements about potency categorisation, the lower alkyl methacrylate esters (LAM) have been employed here as a case study. Although the sensitising potential of methyl methacrylate (MMA) has been reviewed previously, there is available new information that is relevant for assessment of skin sensitising potency. Moreover, for the purposes of this article, analyses have been extended to include also other LAM for which relevant data are available: ethyl methacrylate (EMA), n-butyl methacrylate (nBMA), isobutyl methacrylate (iBMA), and 2-ethylhexyl methacrylate (EHMA). In addressing the skin sensitising activity of these chemicals and in drawing conclusions regarding relative potency, a number of sources of information has been considered, including estimates of potency derived from local lymph node assay (LLNA) data, the results of guinea pig assays, and data derived from in silico methods and from recently developed in vitro approaches. Moreover, clinical experience of skin sensitisation of humans by LAM has also been evaluated. The conclusion drawn is that MMA and other LAM are contact allergens, but that none of these chemicals has any more than weak skin sensitising potency. We have also explored here the possible bases for this modest sensitising activity. Finally, the nature of exposure to LAM has been reviewed briefly and on the basis of that information, together with an understanding of skin sensitising potency, a risk assessment has been prepared.
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Affiliation(s)
- Ian Kimber
- Faculty of Life Sciences, University of Manchester, Manchester, UK
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Ramos L, Cabral R, Gonçalo M. Allergic contact dermatitis caused by acrylates and methacrylates - a 7-year study. Contact Dermatitis 2014; 71:102-7. [DOI: 10.1111/cod.12266] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 04/25/2014] [Accepted: 04/29/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Leonor Ramos
- Dermatology Department; Centro Hospitalar e Universitário de Coimbra; 3000 Coimbra Portugal
| | - Rita Cabral
- Dermatology Department; Centro Hospitalar e Universitário de Coimbra; 3000 Coimbra Portugal
| | - Margarida Gonçalo
- Dermatology Department; Centro Hospitalar e Universitário de Coimbra; 3000 Coimbra Portugal
- Faculty of Medicine, University of Coimbra; 3000 Coimbra Portugal
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Kocak O, Gul U. Patch test results of the dental personnel with contact dermatitis. Cutan Ocul Toxicol 2014; 33:299-302. [DOI: 10.3109/15569527.2013.866132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kolle SN, Basketter DA, Casati S, Stokes WS, Strickland J, van Ravenzwaay B, Vohr HW, Landsiedel R. Performance standards and alternative assays: practical insights from skin sensitization. Regul Toxicol Pharmacol 2012; 65:278-85. [PMID: 23279805 DOI: 10.1016/j.yrtph.2012.12.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/10/2012] [Accepted: 12/20/2012] [Indexed: 11/17/2022]
Abstract
To encourage the development and validation of alternative toxicity test methods, the effort required for validation of test methods proposed for regulatory purposes should be minimized. Performance standards (PS) facilitate efficient validation by requiring limited testing. Based on the validated method, PS define accuracy and reliability values that must be met by the new similar test method. The OECD adopted internationally harmonized PS for evaluating new endpoint versions of the local lymph node assay (LLNA). However, in the process of evaluating a lymph node cell count alternative (LNCC), simultaneous conduct of the regulatory LLNA showed that this standard test may not always perform in perfect accord with its own PS. The LNCC results were similar to the concurrent LLNA. Discrepancies between PS, LLNA and LNCC were largely associated with "borderline" substances and the variability of both endpoints. Two key lessons were learned: firstly, the understandable focus on substances close to the hazard classification borderline are more likely to emphasise issues of biological variability, which should be taken into account during the evaluation of results; secondly, variability in the results for the standard assay should be considered when selecting reference chemicals for PS.
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Affiliation(s)
- Susanne N Kolle
- BASF SE, Experimental Toxicology and Ecology, Ludwigshafen, Germany.
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Hunasehally RYP, Hughes TM, Stone NM. Atypical pattern of (meth)acrylate allergic contact dermatitis in dental professionals. Br Dent J 2012; 213:223-4. [DOI: 10.1038/sj.bdj.2012.776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2012] [Indexed: 11/09/2022]
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Burrow MF. Clinical evaluation of non-carious cervical lesion restorations using a HEMA-free adhesive: three-year results. Aust Dent J 2011; 56:401-5. [DOI: 10.1111/j.1834-7819.2011.01370.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
INTRODUCTION Dental professionals may be at increased risk of developing occupational allergic diseases specially to methacrylates that can permeate protective disposable gloves. CASE REPORT We presented a case of occupational allergic contact dermatitis in a 28-year-old dental technician. The patient had complained of itching and cracking of fingers for 6 months. The dermatitis improved over weekends. Skin erythema and scaling were present with primarily involvement of the fingertips. Patch testing with dental series gave positive vesicular reaction to methyl methacrylate. Follow-up after 6 months of allergen avoidance showed a complete regression of dermatitis. CONCLUSION Methacrylates serve as bases for acrylic resins which are used in prosthetics. Methyl methacrylate as a small molecular acrylate can permeate thin protective disposable gloves. Using adequate personal protective equipment, like nitrile rubber gloves, is the most important preventive measure in this occupation. Health practitioners should recognize possible occupational hazards in dentistry and implement appropriate preventive measures to protect health of workers.
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Andersson J, Dahlgren U. 2-Hydroxyethyl methacrylate (HEMA) promotes IgG but not IgM antibody production in vivo in mice. Eur J Oral Sci 2011; 119:305-9. [DOI: 10.1111/j.1600-0722.2011.00836.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Tillberg A, Stenberg B, Berglund A. Reactions to resin-based dental materials in patientsâtype, time to onset, duration, and consequence of the reaction. Contact Dermatitis 2009; 61:313-9. [DOI: 10.1111/j.1600-0536.2009.01590.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Aalto-Korte K, Jungewelter S, Henriks-Eckerman ML, Kuuliala O, Jolanki R. Contact allergy to epoxy (meth)acrylates. Contact Dermatitis 2009; 61:9-21. [DOI: 10.1111/j.1600-0536.2009.01574.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Liljelind IE, Hagenbjörk-Gustafsson A, Nilsson LO. Potential dermal exposure to methyl methacrylate among dental technicians; variability and determinants in a field study. ACTA ACUST UNITED AC 2009; 11:160-5. [DOI: 10.1039/b810355k] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Warshaw EM, Schram SE, Maibach HI, Belsito DV, Marks JG, Fowler JF, Rietschel RL, Taylor JS, Mathias TC, DeLeo VA, Zug KA, Sasseville D, Storrs FJ, Pratt MD. Occupation-Related Contact Dermatitis in North American Health Care Workers Referred for Patch Testing: Cross-Sectional Data, 1998 to 2004. Dermatitis 2008. [DOI: 10.2310/6620.2008.07059] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Joska L, Poddana M, Leitner J. Corrosion behavior of palladium–silver–copper alloys in model saliva. Dent Mater 2008; 24:1009-16. [DOI: 10.1016/j.dental.2007.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Revised: 11/27/2006] [Accepted: 11/21/2007] [Indexed: 10/22/2022]
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Aalto-Korte K, Alanko K, Kuuliala O, Jolanki R. Methacrylate and acrylate allergy in dental personnel. Contact Dermatitis 2008; 57:324-30. [PMID: 17937748 DOI: 10.1111/j.1600-0536.2007.01237.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Methacrylates are important allergens in dentistry. OBJECTIVE The study aimed to analyse patch test reactivity to 36 acrylic monomers in dental personnel in relation to exposure. METHODS We reviewed the test files at the Finnish Institute of Occupational Health from 1994 to 2006 for allergic reactions to acrylic monomers in dental personnel and analysed the clinical records of the sensitized patients. RESULTS 32 patients had allergic reactions to acrylic monomers: 15 dental nurses, 9 dentists, and 8 dental technicians. The dentists and dental nurses were most commonly exposed to 2-hydroxyethyl methacrylate (2-HEMA), triethyleneglycol dimethacrylate (TREGDMA), and 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]propane (bis-GMA). 8 dentists and 12 dental nurses were allergic to 2-HEMA. The remaining dentist was positive to bis-GMA and other epoxy acrylates. The remaining 3 dental nurses reacted to diethyleneglycol diacrylate (DEGDA) or triethyleneglycol diacrylate (TREGDA), but not to monofunctional and multifunctional methacrylates. Our dental technicians were mainly exposed and sensitized to methyl methacrylate (MMA) and ethyleneglycol dimethacrylate (EGDMA). 1 technician reacted only to 2-HEMA, and another to ethyl methacrylate (EMA) and ethyl acrylate (EA). CONCLUSIONS 2-HEMA was the most important allergen in dentists and dental nurses, and MMA and EGDMA in dental technicians. Reactions to bis-GMA, DEGDA, TREGDA, EMA and EA were relevant in some patients.
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Affiliation(s)
- Kristiina Aalto-Korte
- Finnish Institute of Occupational Health, Control of Hypersensitivity Diseases, Helsinki, Finland.
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Isaksson M, Zimerson E, Svedman C. Occupational airborne allergic contact dermatitis from methacrylates in a dental nurse. Contact Dermatitis 2007; 57:371-5. [DOI: 10.1111/j.1600-0536.2007.01244.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jaakkola MS, Leino T, Tammilehto L, Ylöstalo P, Kuosma E, Alanko K. Respiratory effects of exposure to methacrylates among dental assistants. Allergy 2007; 62:648-54. [PMID: 17508969 DOI: 10.1111/j.1398-9995.2007.01379.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Case reports of occupational asthma in dental personnel have been published, but there is little data on the risk of respiratory disorders related to occupational exposure to methacrylates in dental assistants. The objective of this study was to investigate the relation of exposure to methacrylates to occurrence of respiratory symptoms and diseases among dental assistants. METHODS A cross-sectional study of female dental assistants from the membership register of the Finnish Association of Dental Hygienists and Assistants was conducted in the Helsinki metropolitan area. A CATI was carried out to collect information on health and exposures. A total of 799 dental assistants participated (response rate 87%). RESULTS Daily use of methacrylates was related to a significantly increased risk of adult-onset asthma (adjusted OR 2.65, 95% CI 1.14-7.24), nasal symptoms (1.37, 1.02-1.84), and work-related cough or phlegm (1.69, 1.08-2.71). Nasal symptoms showed a dose-response relation with increasing years of exposure to methacrylates, and those with >10 years of exposure had also increased risk of hoarseness, dyspnoea, and wheezing with dyspnoea. Dental assistants with a history of atopic diseases were particularly susceptible to exposure to methacrylates, the adjusted OR for adult asthma being in this group 4.18 (95% CI 1.02-28.55) and for nasal symptoms 2.11 (1.08-4.19). CONCLUSIONS This study provides new evidence that the risk of adult-onset asthma, nasal symptoms and other respiratory symptoms increase significantly with daily use of methacrylates in dental assistants' work. The results suggest that exposure to methacrylates poses an important occupational hazard for dental assistants.
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Affiliation(s)
- M S Jaakkola
- Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
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Goon ATJ, Isaksson M, Zimerson E, Goh CL, Bruze M. Contact allergy to (meth)acrylates in the dental series in southern Sweden: simultaneous positive patch test reaction patterns and possible screening allergens. Contact Dermatitis 2006; 55:219-26. [PMID: 16958920 DOI: 10.1111/j.1600-0536.2006.00922.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Contact allergy to dental allergens is a well-studied subject, more so among dental professionals than dental patients. 1632 subjects had been patch tested to either the dental patient series or dental personnel series at the department of Occupational and Environmental Dermatology, Malmö, Sweden. Positive patch tests to (meth)acrylate allergens were seen in 2.3% (30/1322) of the dental patients and 5.8% (18/310) of the dental personnel. The most common allergen for both groups was 2-hydroxyethyl methacrylate (2-HEMA), followed by ethyleneglycol dimethacrylate (EGDMA), triethyleneglycol dimethacrylate, and methyl methacrylate. 47 (29 dental patients and 18 dental personnel) out of these 48 had positive patch tests to 2-HEMA. All 30 subjects who had a positive reaction to EGDMA had a simultaneous positive reaction to 2-HEMA. One dental patient reacted only to 2,2-bis[4-(2-hydroxy-3-methacryloxypropoxy) phenyl]propane (bis-GMA). From our data, screening for (meth)acrylate contact allergy with 2-HEMA alone would have picked up 96.7% (29/30) of our (meth)acrylate-allergic dental patients and 100% (18/18) of our (meth)acrylate-allergic dental personnel. The addition of bis-GMA in dental patients would increase the pick-up rate to 100%.
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Affiliation(s)
- Anthony T J Goon
- Department of Occupational and Environmental Dermatology, Lund University, Malmö University Hospital, Malmö, Sweden.
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34
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Rycroft RJ, Frosch PJ. Occupational Contact Dermatitis. Contact Dermatitis 2006. [DOI: 10.1007/3-540-31301-x_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Konradsson K, Claesson R, van Dijken JWV. Mutans streptococci and lactobacilli in plaque on a leucite-reinforced dental ceramic and on a calcium aluminate cement. Clin Oral Investig 2006; 10:175-80. [PMID: 16642391 DOI: 10.1007/s00784-006-0045-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 03/28/2006] [Indexed: 11/26/2022]
Abstract
In this in vivo study, the proportions of mutans streptococci and lactobacilli in plaque were examined (1) on proximal surfaces of bonded, leucite-reinforced ceramic crowns and (2) on class V restorations of calcium aluminate cement (CAC). The examined proportions were intraindividually compared with those of resin composite and enamel. Mutans streptococci and lactobacilli in samples from plaque that was accumulated for 10 days on the following surfaces were determined by cultivation on blood agar plates and species-selective plates: (1) proximal leucite-reinforced ceramic crown, class II composite and enamel (n=11); and (2) class V restoration of CAC and composite, and enamel (n=17). Mutans streptococci and lactobacilli in the samples were distributed in three groups: 0, >0-1, and >1% of total bacteria. The surfaces with detected mutans streptococci were similarly distributed between the materials and enamel. The highest proportion of mutans streptococci and lactobacilli were observed on ceramic followed by composite and enamel. A higher proportion of lactobacilli, but not of mutans streptococci, was detected on enamel compared to CAC and composite. However, no significant differences were found between the surfaces. Conclusively, the materials investigated did not show different relative proportions of mutans streptococci and lactobacilli in plaque, compared to enamel.
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Affiliation(s)
- Katarina Konradsson
- Department of Odontology, Dental Hygienist Education, Dental School, Umeå University, 901 87, Umeå, Sweden.
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Abstract
With almost 65 million women in the workforce, their representation in various occupational sectors is crucial, as is their health and safety. Female-dominated occupations in health care and cosmetology along with their potential cutaneous exposures are reviewed. Proper evaluation and management are necessary to minimize the disability that can result from these illnesses.
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Affiliation(s)
- Antoine Amado
- Department of Dermatology, Desk A-61, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Mutluay MM, Ruyter IE. Evaluation of adhesion of chairside hard relining materials to denture base polymers. J Prosthet Dent 2005; 94:445-52. [PMID: 16275305 DOI: 10.1016/j.prosdent.2005.08.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STATEMENT OF PROBLEM Removable denture bases are made of modified poly(methyl methacrylate) (PMMA), which has reliable bond strength with resins containing methyl methacrylate (MMA). However, some hard relining materials with different chemical compositions have been reported to have less than adequate bond strength to PMMA denture base polymers. PURPOSE This in vitro study evaluated the initial bonding properties of chairside hard relining materials to different removable denture base polymers, as well as the structure of the interface. MATERIAL AND METHODS The tensile strength (MPa) of adhesion of 8 chairside hard relining materials (Original Truliner, GC Reline Hard, Ufigel Hard, Triad Reline, New Truliner, Light Liner, Astron LC Hard, and Flexacryl Hard) was tested against 3 denture base polymers (Ivocap Plus, Paladon 65, and Palapress Vario). Dumbbell-shaped specimens with a 6-mm diameter of bonding surface were used for tensile testing of bond strength (n=5). An MMA containing hard relining material (Original Truliner) was used as a control. Tensile strength of the bond was calculated using the bonding area and maximum force under tension. Statistical analyses of data were conducted with 2-way analysis of variance (alpha=.05). The influence of the bonding agents and the relining materials on the PMMA denture base surface layer and its structure were investigated. The depths of the swollen layers were measured with a transmission light microscope. Fracture surfaces after testing were also visually evaluated. Chemical analyses of all materials prior to testing were performed using high-performance liquid chromatography. RESULTS Significant differences were found among tensile bond strengths of chairside hard relining materials to PMMA denture base polymers forming 3 different groups (P<.001). No significant difference among different denture base polymers was found with regard to tensile strength of adhesion (P=.918), but the interaction term between hard relining material and denture base polymer was found to be significant (P<.001). The tensile bond strength of the relining materials and denture base polymers was found to range from 8% to 60% of the strength of the PMMA denture base polymers. CONCLUSION The chemical composition of the bonding agents and the relining materials and their combinations affected the depth of the swollen layers of the denture base polymers and the tensile strength of adhesion.
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Abstract
Patients undergoing dental treatment can be exposed to a wide range of potential allergens, but adverse events seem infrequent. Patients with symptoms or signs of stomatitis, burning, tingling, cheilitis, oral lichenoid lesions, lip and facial swelling may relate their problems to dental treatment or to the use of dental products. Investigation for immediate type or delayed type hypersensitivity is indicated using patch testing, prick testing and blood tests for allergen-specific IgE. The main allergic reactions found in patients include contact allergy to metals, cosmetics, food additives, flavours and acrylates, and immediate type allergy to latex. Adverse reactions following the administration of local anaesthetics are seen in about 0.5% of cases, but immediate type allergy to these agents is rare. In dental staff, occupationally related problems are common and usually take the form of hand or facial dermatitis or respiratory disease. The most common allergic reactions in dental staff are immediate type allergy to latex, and contact allergy to rubber additives, fragrances, acrylates and formaldehyde. Occupational irritant problems causing hand dermatitis are probably more common in dental personnel than is dermatitis caused by contact allergy. Patch testing and tests for immediate type allergy are useful investigative methods in the investigation of patients who present with oral or facial symptoms possibly related to dental treatments and are also beneficial in dental personnel who present with hand or facial dermatitis or respiratory symptoms.
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Affiliation(s)
- D J Gawkrodger
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
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Sandberg E, Bergenholtz G, Kahu H, Dahlgren UI. Low HEMA conjugation induces high autoantibody titer in mice. J Dent Res 2005; 84:537-41. [PMID: 15914591 DOI: 10.1177/154405910508400610] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
2-hydroxyethylmethacrylate (HEMA) is a known causal agent of hypersensitivity to resin composites. We have reported that immunization with HEMA conjugated to mouse serum albumin (MSA) induces an autoantibody response in mice. In this study, we investigated both the activity and the avidity of autoantibodies induced by immunization with various HEMA conjugations to MSA. Female Balb/c mice were given MSA carrying 3, 7, 15, or 22 HEMA molecules. Antigen-specific IgG and IgE antibodies were determined by ELISA, and average antibody avidity by thiocyanate dissociation. Immunization with MSA carrying the lowest number of HEMA molecules induced a significantly higher IgG and IgE anti-MSA autoantibody response, with significantly higher IgG antibody avidity, than did the more heavily conjugated preparations. The results suggest that the lower the degree of HEMA conjugation to self-protein, the higher the risk for autoantibody production to the carrier protein. These findings suggest a mechanism of potential relevance in humans.
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Affiliation(s)
- E Sandberg
- Section for Oral Immunology, Faculty of Medicine, The Sahlgrenska Academy, Göteborg University, Box 450, SE 405 30 Göteborg, Sweden.
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Van Landuyt KL, De Munck J, Snauwaert J, Coutinho E, Poitevin A, Yoshida Y, Inoue S, Peumans M, Suzuki K, Lambrechts P, Van Meerbeek B. Monomer-solvent phase separation in one-step self-etch adhesives. J Dent Res 2005; 84:183-8. [PMID: 15668338 DOI: 10.1177/154405910508400214] [Citation(s) in RCA: 264] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
One-step adhesives bond less effectively to enamel/dentin than do their multi-step versions. To investigate whether this might be due to phase separation between adhesive ingredients, we characterized the interaction of 5 experimental and 3 commercial self-etch adhesives with dentin using transmission electron microscopy. All adhesives were examined for homogeneity by light microscopy. Bonding effectiveness to dentin was determined with the use of a micro-tensile bond-strength protocol. The lower bond strength of the one-step adhesives was associated with light-microscopic observation of multiple droplets that disappeared slowly. Interfacial analysis confirmed the entrapment of droplets within the adhesive layer. The prompt disappearance of droplets upon application of a small amount of HEMA (2-hydroxyethyl methacrylate) or a HEMA-containing bonding agent, as well as the absence of droplets at the interface of all HEMA-containing adhesives, strongly suggests that the adhesive monomers separate from water upon evaporation of ethanol/acetone. Upon polymerization, the droplets become entrapped within the adhesive, potentially jeopardizing bond durability. This can be avoided by strong air-drying of the adhesive, thereby removing interfacial water and thus improving bonding effectiveness.
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Affiliation(s)
- K L Van Landuyt
- Leuven BIOMAT Research Cluster, Department of Conservative Dentistry, School of Dentistry, Oral Pathology and Maxillo-Facial Surgery, Catholic University of Leuven, Kapucijnenvoer 7, B-3000 Leuven, Belgium
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Abstract
BACKGROUND Allergies to natural rubber latex (NRL) were unknown in dentistry until 1987. That changed with the publication of a report documenting NRL-based anaphylaxis in a dental worker. This case and others prompted regulatory and manufacturing changes in rubber products and increased awareness throughout the profession. However, other common dental chemicals cause allergic reactions and irritation and often are handled with insufficient precautions. Although recognition of NRL allergy has improved, awareness of other potential allergens and irritants in dentistry still is limited. OVERVIEW Recent research indicates that the prevalence of NRL protein allergy may be decreasing. In contrast, occupation-related dermatoses associated with other dental products may be more common. Encounters with bonding agents, disinfectants, rubber, metals and detergents can cause occupation-based irritant contact dermatitis and allergic contact dermatitis. These conditions may be found in more than one-quarter of dental and medical personnel. Therefore, dental-specific information about the recognition and management of allergic and irritant reactions is needed. CONCLUSIONS AND CLINICAL IMPLICATIONS The prevalence of occupation-related dermatitis may be increasing in dentistry. Reducing exposure to potential irritants and allergens and educating personnel about proper skin care are essential to reversing this trend.
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Abstract
PURPOSE OF REVIEW Dental professionals and their physicians frequently do not recognize, accurately diagnose or appropriately manage occupational allergies. Dental allergen identification, diagnostics and practical avoidance strategies are summarized in this review. RECENT FINDINGS Methacrylates, natural rubber latex proteins, rubber glove allergens, and glutaraldehyde are the predominant allergens in dentistry. Reactions range from cell-mediated contact allergy to urticaria and occupational asthma. SUMMARY Despite recent advances in allergen characterization and increased awareness of selected allergens, treatment of occupational allergies can be improved. Better information and improved cooperation between dental workers and their clinicians is needed.
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Liljelind IE, Eriksson KA, Nilsson LO, Jonsson IBM, Burstrom YI. A method for measuring the potential dermal exposure to methyl methacrylate during two different dental technical work tasks. ACTA ACUST UNITED AC 2005; 7:519-23. [PMID: 15877176 DOI: 10.1039/b415207g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Dental technicians are exposed on a daily basis to undiluted methyl methacrylate (MMA) when performing various routine tasks. Although the clinical effects of this chemical have been known for decades, no previous studies have been performed to estimate the potential dermal exposure to it. In this study we describe a patch-sampling technique to intercept the MMA that would otherwise have contaminated the skin on different parts of the hand and lower arm. Two different work tasks, making an orthodontic splint and denture preparation, were both performed under simulated workplace conditions twice by two recent graduated dental technicians. Air measurements were collected simultaneously. The results indicate that the exposure patterns associated with producing an orthodontic splint and denture preparation differed. We found work task-dependent differences in the amounts of MMA collected at the different parts of each hand, and differences between the right and left hands. There was also an interaction between hand and work task, especially for the right hand. The air measurements were positively correlated with the dermal exposure. This study highlights the importance of using a measurement strategy that takes the variability within the hand/arm body parts into account when measuring potential exposure during these kinds of work tasks. In order to establish future dermal exposure limits, more workplace and experimental studies are required.
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Affiliation(s)
- Ingrid E Liljelind
- Occupational Medicine, Department of Public Health and Clinical Medicine, Umea University, S-901 87, Umea, Sweden.
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Kawahara T, Nomura Y, Tanaka N, Teshima W, Okazaki M, Shintani H. Leachability of plasticizer and residual monomer from commercial temporary restorative resins. J Dent 2004; 32:277-83. [PMID: 15053910 DOI: 10.1016/j.jdent.2003.12.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2003] [Revised: 12/10/2003] [Accepted: 12/12/2003] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study was performed to determine the compositions of commercial temporary restorative resins and to evaluate the leachability of plasticizer and residual monomer from them. METHODS The chemicals in four commercial temporary restorative resins (Dura Seal, Fit Seal, Plast Seal Quick, and Poly Seal) were detected by GCMS and HPLC. The amounts of plasticizers and residual monomers that leached from cured resin samples immersed in ethanol for 1 h to 14 d were determined by HPLC. RESULTS Phthalate esters used as plasticizers contained 40-55 wt% either di-n-butyl phthalate (DBP) or butyl phthalyl butyl glycolate. The resin monomer included methyl methacrylate (MMA) or a mixture of MMA and 2-hydroxyethyl methacrylate (HEMA); 1,3-butanediol dimethacrylate was added as a cross-linking agent. Each resin contained 40-60 wt% monomer. The amounts of phthalate esters leached increased with immersion time up to 7 d, reaching 120-190 microg/mg, and did not change subsequently. The residual monomers leached gradually for up to 3d and did not change subsequently. The amount of leached residual monomer (MMA, HEMA) was 20-90 microg/mg after 3d storage. More than 50% of the leachable plasticizers and monomers were eluted from the cured resins within 24 and 3 h, respectively. CONCLUSIONS The amounts of leached plasticizers and residual monomers were extremely large compared with the concentrations of endocrine disrupters and their potentially genotoxic effects. Therefore, it is very important to evaluate the leachability of these compounds from temporary restorative resins.
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Affiliation(s)
- T Kawahara
- Department of Operative Dentistry, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
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Lönnroth EC, Eystein Ruyter I. Resistance of medical gloves to permeation by methyl methacrylate (MMA), ethylene glycol dimethacrylate (EGDMA), and 1,4-butanediol dimethacrylate (1,4-BDMA). INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2003; 9:289-99. [PMID: 14577946 DOI: 10.1080/10803548.2003.11076569] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Gloves afford hand protection by minimizing skin contact. The effectiveness of medical gloves to protect against permeation of the monomers, methyl methacrylate (MMA), ethylene glycol dimethacrylate (EGDMA), and 1,4-butanediol dimethacrylate (1,4-BDMA), was assessed focusing on permeation rates and degradation of glove materials caused by monomer contact. Fifteen different brands of gloves were tested using a European Standard procedure. Surface images of glove materials before and after exposure to the monomer mixture were obtained using a scanning electron microscope. The standard is not applicable as the only method for estimating the safety of gloves, but it is useful as guideline together with the cumulative permeation of acrylic monomers. Monomer contact on the outside resulted in substantial swelling of most glove materials, and structure changes of the inside surface.
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Menni S, Lodi A, Coassini A, Boccardi D, Rossini P, Crosti C. Unusual widespread vesicular eruption related to dental composite resin sensitization. Contact Dermatitis 2003; 48:174. [PMID: 12755744 DOI: 10.1034/j.1600-0536.2003.00014.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- S Menni
- Clinica Dermatologica IV-Università degli Studi di Milano-Ospedale S Paolo, Milan, Italy.
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Hamann CP, Rodgers PA, Sullivan K. Allergic contact dermatitis in dental professionals: effective diagnosis and treatment. J Am Dent Assoc 2003; 134:185-94. [PMID: 12636122 DOI: 10.14219/jada.archive.2003.0132] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Like other health care workers, dental professionals are at risk of developing allergic contact dermatitis, or ACD, after exposure to allergenic chemicals. Common allergens include antimicrobials, preservatives, rubber additives and methacrylates. CASE DESCRIPTION The authors describe an orthodontic assistant with severe skin disease, whose symptoms included redness, cracking and bleeding that persisted for 10 years. The patient had previously received an incomplete diagnosis. After performing patch testing, assessing symptoms and evaluating the patient's medical history, the authors diagnosed ACD resulting from exposure to several dental allergens. The patient received appropriate treatment and counseling to better manage her allergies; this resulted in resolution of all symptoms and averted permanent occupational disability. CLINICAL IMPLICATIONS Not all skin reactions are related to gloves or natural rubber latex. Dental professionals should be aware of common chemical allergens, symptoms of ACD and the appropriate treatment of occupational skin disease.
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Hamann C, Rodgers PA, Alenius H, Halsey JF, Sullivan K. Cross-reactivity between gutta-percha and natural rubber latex: assumptions vs. reality. J Am Dent Assoc 2002; 133:1357-67. [PMID: 12403538 DOI: 10.14219/jada.archive.2002.0051] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Immunological cross-reactivity between gutta-percha and natural rubber latex, or NRL, has not been demonstrated clearly despite recent concerns and several suspected cases reported in the literature. METHODS The authors analyzed aqueous extracts of commercial gutta-percha points and raw gutta-percha samples for cross-reactivity to NRL by radioallergosorbent test, or RAST, inhibition; immunoblot inhibition; direct enzyme-linked immunosorbent assay, or ELISA; and ELISA inhibition using sera from NRL-allergic people as the source of anti-NRL immunoglobulin E, or IgE, antibodies. To confirm in vitro results, the authors conducted skin prick testing, or SPT, on a patient with type I NRL allergy using aqueous extracts from raw gutta-percha, ammoniated gutta-percha and gutta-percha points. RESULTS Aqueous extracts from commercial gutta-percha points did not cross-react to NRL in RAST inhibition or immunoblot inhibition, ELISA or ELISA inhibition assays. However, three of 13 sera from subjects with type I NRL allergy exhibited IgE binding to raw gutta-percha extracts in direct ELISA. Moreover, in ELISA inhibition, the binding of IgE to raw gutta-percha extracts was inhibited in a dose-dependent manner by raw NRL and vice versa. SPT results from a subject with type I NRL allergy were positive for NRL and raw gutta-percha extracts but negative for gutta-percha point extracts. CONCLUSIONS The authors found no detectable cross-reactivity between NRL and commercial gutta-percha points. However, their ELISA and SPT results demonstrated that some allergenic cross-reactivity exists between raw gutta-percha and raw NRL. CLINICAL IMPLICATIONS Gutta-percha alone is not likely to induce symptoms in patients with type I NRL allergy. However, other materials used in obturating root canals may be irritating and potentially allergenic in patients with pre-existing allergies.
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