Adverse reactions to protective gloves used in the dental profession: experience of the UK Adverse Reaction Reporting Project

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 safety and biocompatibility of direct aesthetic restorative materials

Restorative dental materials are among the most important medical devices in terms of the numbers of patients who benefit and the technical sophistication of the products. Many though contain toxic or noxious substances, including potentially sensitising resin monomers, photoinitiators, acidic polymers and glass or ceramic filler particles. Despite this, dental materials are among the safest medical devices in use today, with very few reports of adverse reactions or injuries among both patients or the dental team. This paper considers the potential for adverse reactions to dental materials, current evidence for harm and finally examines the reasons why in real-world clinical use the likelihood of an adverse event is extremely low. Medical devices regulations, responsible manufacture and clinical vigilance all appear to play important roles in ensuring that dental materials do not cause or present a risk to patients. While this excellent in-practice safety record is welcome, there is now increasing interest in the 'macro' scale biocompatibility of dental materials and their packaging in the environment, subjects that have been relatively neglected until recently. It was concluded that this should be a priority for future research and development and support is needed from governments alongside the manufacturing industry and the profession.

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.

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

Objectives

To evaluate the current routine use of latex gloves and latex containing dental dam in UK general dental practice.

Methods

A questionnaire was disseminated to 89 general dental practitioners (GDPs) in June 2017. The survey concerned their current, routine use of latex gloves and latex-containing dental dam in general dental practice. In addition, monthly sales figures of gloves classified by material, were obtained from a UK dental supply company, for 2015–2017.

Results

The questionnaire response rate was 84 (94%), of whom 90% reported using non-latex (non-sterile examination) gloves for their routine dentistry. The majority were using nitrile gloves. All GDPs surveyed would use examination gloves for routine extractions, and 76% would use examination gloves for surgical extractions. The majority (75%) reported using non-latex dental dam. Sales of nitrile gloves were significantly higher than for latex gloves, with a continuing trend in the reduction in volume of sales of latex gloves.

Conclusion

The majority of GDP's now routinely use non-latex containing gloves and dental dam in their clinical dentistry. Nitrile gloves are predominantly used. Examination gloves are used for straightforward extractions, with many practitioners also using them for minor oral surgery. Sales of latex containing gloves are continuing to decrease.

Clinical significance

The routine use of latex-containing products in UK dental practice is low and likely to reduce further, with on-going benefit for the dental practitioner, latex allergic patients and prevalence of latex allergy in the general population.

Key determinants of health and wellbeing of dentists within the UK: a rapid review of over two decades of research

Aim To review the key determinants of health and wellbeing among dentists working in the UK.Methods Rapid review of the literature (1996-2018) across seven health and social science databases through OVID and the Cochrane Library, professional and health system sources. Records were screened according to agreed inclusion and exclusion criteria by title, abstract and full text. Data extraction and qualitative synthesis of the included studies were performed. Quality assessments for risk of bias were made using a mixed methods appraisal tool.Results Thirty-eight studies met the criteria for inclusion. Fourteen were assessed as high, 22 as medium and two of low quality, most involving cross-sectional research in the form of questionnaire surveys. Whereas overall, the health and wellbeing of dentists within the UK is reported as 'good', recently published evidence suggests a less positive view may be emerging. The health and wellbeing of dentists is associated with a wide range of factors: personal, professional career, relationships, job specification, workplace and system. Emerging evidence suggests additional concerns about the regulation of dentistry. Workplace characteristics were most often explored among researchers and reported as being a key issue.Conclusion Evidence highlights multiple determinants of health and wellbeing, most notably related to workplace characteristics; however, while there is a relative lack of well-founded prospective research investigating the nature and direction of the relationships and comparison across UK health systems, there is increasing evidence of health and wellbeing concerns that require further investigation.

Occupational health problems in modern dentistry: a review

Despite numerous technical advances in recent years, many occupational health problems still persist in modern dentistry. These include percutaneous exposure incidents (PEI); exposure to infectious diseases (including bioaerosols), radiation, dental materials, and noise; musculoskeletal disorders; dermatitis and respiratory disorders; eye injuries; and psychological problems. PEI remain a particular concern, as there is an almost constant risk of exposure to serious infectious agents. Strategies to minimise PEI and their consequences should continue to be employed, including sound infection control practices, continuing education and hepatitis B immunisation. As part of any infection control protocols, dentists should continue to utilise personal protective measures and appropriate sterilisation or other high-level disinfection techniques. Aside from biological hazards, dentists continue to suffer a high prevalence of musculoskeletal disorders (MSD), especially of the back, neck and shoulders. To fully understand the nature of these problems, further studies are needed to identify causative factors and other correlates of MSD. Continuing education and investigation of appropriate interventions to help reduce the prevalence of MSD and contact dermatitis are also needed. For these reasons, it is therefore important that dentists remain constantly informed regarding up-to-date measures on how to deal with newer technologies and dental materials.

Do adverse effects of dental materials exist? What are the consequences, and how can they be diagnosed and treated?

OBJECTIVES

All dental biomaterials release substances into the oral environment to a varying degree. Various preclinical biocompatibility test systems have been introduced, aiming at an evaluation of the potential risks of dental materials. Potential pathogenic effects of released substances from dental materials have been demonstrated. For the biocompatibility of a biomaterial, it is not only important that minimal diffusable substances are released when it is in body contact--the material must also fulfill the function for which it has been designed. This is also very much dependent on the material properties and its handling properties. The aim of this review was to generate an overview of the present status concerning adverse reactions among patients and personnel.

MATERIALS AND METHODS

A systematic review was performed using a defined search strategy in order to evaluate all MEDLINE-literature published between 1996 and 2006.

RESULTS

The compilation of the literature available has revealed that the majority of studies have been carried out on patients compared with personnel. Adverse reactions towards dental materials do occur, but the prevalence and incidence are difficult to obtain. The results were essentially based on cohort studies. Clinical trials, especially randomized-controlled trials, are in the minority of all studies investigated, with the exception of composite and bonding studies, where clinical trials, but not randomized-controlled trials, represent the majority of studies. Patients and personnel were treated separately in the manuscript. Amalgam studies show the lowest degree of verified material-related diagnosis. Even if objective symptoms related to adverse reactions with polymer resin-based materials have been reported, postoperative sensitivity dominates reports concerning composites/bondings. Verified occupational effects among dental personnel show a low frequency of allergy/toxic reactions. Irritative hand eczema seemed to be more common than in the general population.

CONCLUSIONS

Patient- and personnel-related studies are of variable quality and can be improved. There is a need for a better description of the content of materials. A registry for adverse effects of dental materials would be useful to detect the occurrence of low-incidence events.

Prevalence of hand dermatoses related to latex exposure amongst dentists in Queensland, Australia

OBJECTIVES

To investigate the epidemiology of hand dermatoses symptoms and allergies, particularly those that suggested possible latex allergy.

METHODS

In 2004, a self-reporting questionnaire was mailed to a random sample of 400 dentists from the Queensland Branch of the Australian Dental Association.

RESULTS

A total of 285 questionnaires (73.1%) were completed and returned. Of the respondents, 73.3% were male and 26.7% female, with a mean age of 45.2 years (SD = 11.9 years) of whom 89.1% were general dentists, the remainder being specialists. Almost one third (29.1%) had experienced symptoms of hand dermatoses at some stage during the previous 12 months, with 15.1% experiencing symptoms during the previous three weeks. The most common symptom or sign was dry and cracked hands or fingers (22.5%). Only 2.1% of dentists had been medically diagnosed with latex allergy. The most common symptom or sign following the use of latex products was dermatitis (11.2%).

CONCLUSIONS

Overall, this study showed that occupational dermatoses constitute a major occupational health problem among dentists in Queensland, Australia. Symptoms appear to be reported at a similar prevalence to other studies in developed countries. The identification of atopic dermatitis as a significant risk factor again stresses the importance of allergic disease and its relationship with occupational skin conditions. Although reducing exposure to potential allergens and irritants is an important minimisation strategy, further research is needed to identify occupational and non-occupational factors associated with occupational dermatoses in dental personnel.

Investigation of reactions to dental materials

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.

An overview of the current status of national reporting systems for adverse reactions to dental materials

OBJECTIVES

Since all dental materials pose a potential risk to patients and members of the dental team, the post-market monitoring of adverse reactions caused by dental materials should be considered essential. This article reviews the current status of post-market monitoring of adverse reactions to dental materials and highlights some of the issues that arise in trying to establish an evidence base on the characteristics of adverse reactions to dental materials.

METHODS

Norway, Sweden and more recently the UK have sought to monitor adverse reactions to dental materials systematically and proactively in an effort to add to the evidence base on the safety of dental materials. Their experiences in undertaking post-market surveillance have been combined in preparing this article.

RESULTS

To date the Norwegian, Swedish and the UK projects has received 1268 reports over 11 years, 848 reports over 5.5 years and 1117 reports over 3 years, respectively, relating to adverse reactions seen or experienced by dental personnel and patients. Presently, there are no harmonized criteria for what can be classified as an adverse reaction related to dental materials. Under reporting is a recognised problem and lack of awareness and lack of clarity as to what constitutes an adverse reaction may be contributory factors. A pro-active reporting system takes a considerable time to become established, but can generate a lot of potentially useful information.

CONCLUSIONS

There is a need to raise the awareness among dental professionals of the potential for adverse reactions due to dental materials and to develop an internationally accepted system of data gathering that can produce the evidence that reflect the extent, severity and incidence of adverse reactions to dental materials.

The national survey of adverse reactions to dental materials in the UK: a preliminary study by the UK Adverse Reactions Reporting Project

OBJECTIVE

Dental treatment involves the use of a wide range of materials. Many of the dental materials or their components pose a potential risk to the patient and member of the dental team. Pre-market biocompatibility testing cannot guarantee absolute safety, making monitoring of materials likely to cause an adverse reaction essential. The prevalence of adverse reactions to dental materials amongst dental patients and staff has not been systematically monitored in the UK. This project aims to develop a systematic approach to the evaluation and monitoring of the extent and severity of adverse reactions to dental materials in the UK.

METHOD

Through the distribution of reporting forms to dental surgeries and laboratories in the UK, the ARRP has received 1,075 complete reports relating to adverse reactions seen or experienced by dental staff and patients.

RESULTS

The main findings were that different materials cause adverse reactions to different groups of people. The largest proportion of patient related adverse reactions were reported to be due to metals (n = 175). These were mainly amalgam associated oral lichenoid reactions (n = 124). Dental technicians reported acrylic resin as the causal factor of hand dermatitis in 61% (44 out of a total 72) of cases reported. Finally, dental surgery staff reported gloves as causing hand dermatitis in 75% of cases (398 out of a total 531).

CONCLUSIONS

Different dental materials affect different person groups depending on their exposure to the material. Dental staff are most at risk from an adverse reaction to latex gloves, whereas most reported reactions for patients were due to metals. For dental technicians the biggest danger of an adverse reaction was from acrylic resins. There is a need to continue to raise the awareness among dental professionals of the existence of the Adverse Reactions Reporting Project so as to overcome problems of under-reporting.