Reactions to Acrylates in Dentistry and Related Factors - The First Croatian Survey Study on Reactions to Acrylates in Dentistry

Abstract

Objective

Our aim was to examine the potential impact of acrylate exposure and the influence of other associated factors on skin and mucosal changes/lesions among dental professionals and students.

Materials and Methods

In this cross-sectional field study, we used a questionaire to survey 136 participants—including dentists, dental technicians, nurses, assistants, and students—to assess skin conditions and the impact of acrylates on skin and mucosal disorders.

Results

A high prevalence of self-reported work-related skin changes in dentistry was recorded, affecting 65% of dental professionals/students, with the highest frequency among dental technicians (78%) and assistants (77%), followed by students (52%) and dentists (49%). Dental technicians were significantly more frequently in daily contact with acrylates (54%) than others (students 13%, dental assistants/nurses 19%) and had a markedly higher prevalence of skin lesions after contact with acrylates (71.7%). The most common manifestations were hand eczema/fissuring (29.4%), facial/neck eczema (14.7%) and periungual dermatitis (11.8%). Those who reported acrylates as an aggravating factor had significantly more facial/neck eczema (p=0.003). Other significant findings: contact with contact lenses and hearing aids was a predictor of periungual dermatitis (p=0.028); contact with artificial eyelashes and hair extensions was a predictor of mucosal symptoms (p=0.006); and the contact with diabetic devices, TENS/ECG electrodes, was more frequently associated with hand eczema/fissuring (p=0.026).

Conclusion

Skin lesions in dental professionals and students, particularly dental technicians, are shown to be linked to acrylate exposure in this first Croatian study. Consequently, the implementation of additional protective measures is highly recommended.

Introduction

Occupational exposure in healthcare may induce a range of adverse cutaneous reactions, predominantly affecting exposed areas such as the hands (hand dermatitis or eczema), as a consequence of repeated contact with various substances, which mostly manifest as contact dermatitis: non-allergic or irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD), each with a unique underlying pathogenesis (1-5). ICD and ACD are relatively common dermatoses, with the irritant form being more frequent than the allergic type (1, 3, 4). Among dental professionals and students, hand lesions/eczema are especially common in those with longer professional experience, more frequent glove changes and hand washing, as well as in those with allergies and atopy (5-10). Adverse reactions to acrylates are also possible in dental professionals and students, often manifesting as eczema with erythematous, dry, scaling, cracked and vesicular lesions (sometimes accompanied by itching), predominantly on the hands and face (11, 12). They can also manifest as pulpitis, nail dystrophy and sometimes even acute facial swelling. Therefore, reactions to acrylates usually include hand eczema as a manifestation of contact dermatitis (ICD and ACD), as well as nail changes (dystrophy, abnormal nail growth or discoloration such as leukoderma), periungual dermatitis, facial lesions or swelling or mucosal reactions (e.g. eyes, nasal passages or airways). Symptoms usually occur after direct contact with acrylates present in dental materials such as composite resins and denture bases. Accurate identification and diagnosis require a complete medical history and a detailed clinical examination (13).

Acrylates and methacrylates (MA) are plastic materials produced by the polymerization of monomers derived from acrylic or methacrylic acid, formed through the esterification of these acids (their reactivity varies depending on the type of acid used in the reaction) (11, 13). They serve as the basis for acrylic resins and, owing to their reactive double bonds, can readily polymerize—either spontaneously at room temperature or upon activation by heat or ultraviolet (UV) light—to form stable polymeric plastic structures (12, 14). The use of acrylates and methacrylates is widespread in dentistry, where they are components of denture bases, composite resins, dentin bonding agents, and glass ionomer materials (13, 15, 16). Historically, acrylate exposure occurred mainly in industrial production, specifically within the printing, painting, coating, and metallurgical sectors. However, the intensive use of acrylate and methacrylate compounds surged in the 1930s with the development of plastic materials like "organic glass," which quickly expanded into the aviation, paint, and ink industries (12, 17). Over time, other acrylates have come into use in paints, adhesives, composite resins used in dentistry, printing inks, artificial nails, and various medical devices, such as contact lenses, hearing aids, and bone cements for orthopedic endoprostheses (11).

In recent decades, an increase in reactions to (meth) acrylates has been observed within the cosmetic industry, where the primary sources of sensitization in cosmetics include artificial eyelashes, hair extensions, and artificial nails (12, 18-20). Due to the widespread availability and frequent use of artificial nails based on acrylates, methacrylates, or cyanoacrylates, adverse reactions are becoming increasingly common (12, 20, 21). Modern long-lasting nail polishes contain photo-bonded acrylates (the so-called “semi-permanent”, “permanent”, or “gel” nail polishes), composed of blends of acrylate monomers that are applied to the nail plate and polymerized under fluorescent, UV or light-emitting diode (LED) lamps which have gained popularity due to their low cost and ease of application (12, 18, 20). All types of artificial nails contain acrylates and can induce unwanted reactions in beauticians and their clients. Acrylates are also widely used in medical and dental applications, where adverse reactions (including allergic reactions) to acrylates present in bone cements for orthopedic endoprostheses, soft contact lenses, hearing aids, histological implant materials; wound dressings, surgical adhesives containing acrylates, etc. have been reported (12, 22). Taking all this into account, the aim of this study was to investigate the impact of exposure to acrylic and other related factors on the occurrence of skin and other manifestations or complaints in dentists and dental students.

Materials and Methods

This study was a cross-sectional field study conducted between January 2025 and July 2025 at the departments and teaching units of the School of Dental Medicine at the University of Zagreb. It was approved by the Ethics Committee of the School of Dental Medicine, University of Zagreb, at its 4th regular session held on January 15, 2025 (approval number: 05-PA-1-4/25). It was conducted in accordance with the principles outlined in the Declaration of Helsinki. Participation in the study was voluntary, and written informed consent was obtained from each participant before their inclusion. General objectives were to determine the prevalence of skin and mucosal lesions in relation to exposure to acrylates among dental professionals (dental technicians, dentists, and dental assistants/nurses) and dental students, and to determine the prevalence of self-reported occupationally related lesions. We also wanted to identify the associated factors that influence them (and their interrelationships), as well as the impact of acrylic nails and other acrylate-containing materials on the development of skin/mucosal lesions. Thus, the purpose of this study was to provide insight into the potential impact of acrylate exposure and other associated factors on skin and mucosal changes among dental professionals and students. This contributes to a better understanding of their interrelationship and serves as a basis for developing and implementing preventive measures.

Participants and data collection

A total of 136 participants between the ages of 20 and 61 (85% female, 15% male) were included in the study, comprising 46 dental technicians, 33 dentists, 26 dental assistants/nurses, and 31 dental students (the students had already been in contact with acrylates during their studies at the School of Dental Medicine). Participants had previously been in contact with acrylates over various periods of exposure, varying from 1 to 40 years. They provided written informed consent and met all inclusion and exclusion criteria. The inclusion criteria comprised being an adult, belonging to one of the defined target groups, expressing a voluntary willingness to participate, and signing an informed consent form. Exclusion criteria included individuals with diagnosed chronic non-eczematous skin diseases (e.g., psoriasis vulgaris) or systemic inflammatory conditions affecting the skin. Additionally, all individuals who were unable to understand the nature and purpose of the study or the content of the informed consent were excluded from participation.

This reasearch includes a questionnaire that assessed factors relevant to skin condition and the impact of acrylate exposure and associated factors on skin and other symptoms among dental professionals and students (Table 1), where we considered various factors associated with the occurrence of skin and other symptoms during exposure to acrylates in dentistry (23-25). Participants were asked to participate in this study and those who agreed to it received a questionnaire that included questions regarding their exposure to acrylates, potential skin and systemic reactions they had noticed, and the perceived relationship between them. Throughout the research, we were in contact with study participants and were ready for additional questions and clarifications.

Table 1. Survey questionnaire on reactions to acrylates among dental professionals and students.

Questionnaire items on acrylate exposure and associated symptoms No.	Questionnaire item	Response options
1.	Respondent's gender	A. Male B. Female
2.	Respondent's age	_____ years
3.	Occupation	A. Student B. Doctor of dental medicine/dentist C. Dental assistant D. Dental technician E. Nurse F. Other _____
4.	How many years have you worked in your current profession/performed this type of activity?	_____ years
5.	Do you notice any changes in your skin that you associate with your job? (multiple answers possible)	A. No B. Yes, only on hands (fist and fingers) C. Yes, on the head (face and neck) D. Yes, on other parts of the body that are covered with clothes E. Somewhere else, please specify where: _____
6.	Which symptoms do you have? (circle all symptoms)	A. I do not have any symptoms B. Occasional dryness of the skin C. Occasional reddness of the skin D. More extensive changes with blisters, papules, and skin cracking E. Some others, please specify which ones: _____
7.	How many times a year do these changes occur?	A. I have never noticed any changes B. They used to appear before, but now I no longer notice them C. 1-2 times a year D. 5-10 times a year E. More than 10 times a year F. They are constantly present
8.	Do you observe any factors that contribute to the worsening of these changes?	A. No B. I don't know C. Yes, specify which: _____
9.	How often do you use acrylic materials in your work/profession (i.e., come into contact with them)?	A. Daily B. Several times a week C. Several times a month D. Rarely E. Never
10.	Have you ever experienced an adverse reaction after contact with acrylic material?	A. Yes B. No
11.	Have you noticed any adverse reactions after exposure to acrylate-based products outside of work/profession/practice? (multiple answers possible)	A. No B. After using artistic/construction materials (paints, varnishes, resins) C. After using cosmetic products (makeup, nail glue, false eyelash glue) D. After the application of artificial nails (acrylate nails, gel nails, permanent nail polish)
12.	If you have noticed any adverse reactions after exposure to acrylate-based products (circle all symptoms).	A. No symptoms B. Occasional dryness C. Itching D. More extensive changes with blisters, papules, and skin cracking E. Some others, specify which ones: _____
13.	Have you ever sought treatment for these changes? If yes, please specify the type of treatment.	A. No B. Yes, self-treated: _____ C. Yes, treated by a general practitioner: _____ D. Yes, treated by a dermatologist:_____ E. Yes, allergy testing was performed (please specify): _____ and the test was positive/negative
15.	Do you engage in leisure-time activities that involve prolonged hand contact with liquids or substances/allergens that may cause adverse reactions?	A. Yes, specify which: _____ B. No
16.	Are you frequently exposed to any of the following substances? If yes, please circle all that apply.	A. Paints, adhesives, coatings, and printing inks B. Dental composite resins and bonding agents C. Artificial nails and long-lasting nail polish (e.g., semi-permanent nail polish, permanent nail polish, or gel nail polish) D. Artificial eyelashes, hair extensions E. Cosmetics containing acrylates F. Floor waxes and coatings G. Leather, textile, and paper products H. Soft contact lenses, hearing aids I. Wound dressings, surgical adhesives, histological preparations J. Medical devices for people with diabetes, electrodes for transcutaneous electrical nerve stimulation (TENS), electrocardiogram (adhesive layer of electrodes) K. Intradermal filler injections L. Production of plastic glass M. Bone cement for orthopedic endoprostheses
17.	Have you ever experienced, or are you currently experiencing, any symptoms potentially related to acrylate exposure? If so, please circle all that apply.	A. Hand skin inflamation with dryness (eczema), cracking of the fingertip skin (pulpitis), especially the first three fingers B. Skin inflammation (dermatitis) around the nails (periungual) C. Appearance of whitish depigmentation (leucoderma) on the fingertips D. Changes/damage (dystrophy) of the nails E. Skin inflammation with dryness (eczema): skin changes, rash of the face, neck, and eyelids F. Generalized skin inflamation (dermatitis) G. Mucosal symptoms (ocular, nasal, and respiratory) due to exposure to acrylates (e.g., methacrylates), including airway inflammation and impaired lung function H. Breathing problems, e.g., difficulty breathing, asthma, frequent respiratory tract infections, or rhinoconjunctivitis I. Allergic contact stomatitis

We invited participants to be tested to acrylates by patch test, and those who agreed were tested to methyl methacrylate 2.0% (MMA), 2-hydroxyethyl methacrylate 2.0% (HEMA), ethylene glycol dimethacrylate 2.0% (EGDMA), triethylene glycol dimethacrylate 2.0% (TREGDMA), and butanediol dimethacrylate 2.0% (BDDMA) by applying adhesive patches containing allergens to their upper arms. These allergens included allergen preparations and IQ Ultimate™ adhesive chambers obtained from Chemotechnique Diagnostics, Sweden. A positive reaction was defined according to the International Contact Dermatitis Research Group (ICDRG) criteria (26).

Statistical Analysis

The collected data were stored in a format suitable for further statistical processing (Excel database). For the analysis of proportions, such as the prevalence of skin lesions between occupational groups, the χ2 test was used, with the z-test for proportions applied as a post hoc test. For the analysis of variables measured on continuous scales, such as the hand eczema severity index between occupations, the Kruskal–Wallis test was used, followed by the Mann–Whitney post hoc test and the Bonferroni correction. The Mann–Whitney test was applied when comparing continuous variables between two groups. Effect size was quantified using the formula r = Z/√N for the Mann–Whitney test, ε2 = (H – k + 1)/(n – k) for the Kruskal–Wallis test, and Cramer’s V for the χ2 test. Cohen’s criteria were applied for interpretation: V = 0.25–0.3 indicated a small effect size, 0.3–0.5 a moderate effect, 0.5–0.7 a large effect, and >0.7 a very large effect. The squared value was used for interpreting ε2. All analyses were performed using the commercial software IBM SPSS Statistics, version 22.0 (IBM Corp., Armonk, NY, USA).

Results

The prevalence of cutaneous/mucosal changes (work-related symptoms) in relation to exposure to acrylates and other substances

Daily contact with acrylates was significantly more frequent among dental technicians (54%) compared to students (13%) and dental assistants/nurses (19%), while no significant difference was observed when compared to dentists (36%). The frequency of reactions following acrylate exposure differed significantly between occupational groups (p < 0.001; V = 0.421). Also, a markedly higher prevalence of skin lesions after contact with acrylates was observed in dental technicians (71.7%) compared to dental assistants (38.5%), dentists (24.2%), and students (25.8%). No significant differences were found among the latter three groups. Among the reported manifestations affecting the skin and other organ systems, only hand eczema and fingertip fissuring were significantly more common in dental technicians (50%) than in dentists (6%) (p < 0.001; V = 0.246). No association was found between the occurrence of skin lesions and the frequency of acrylate contact.

The prevalence of self-reported occupationally related skin lesions was 65%, and this difference was significant across occupations, with a small effect size (p = 0.009, V = –0.235). Dental technicians reported skin lesions significantly more frequently than dentists (78% vs. 49%), while no significant differences were observed compared with dental assistants (77%) and students (52%). The frequency of skin lesions on specific body sites is presented in Table 2. The overall prevalence of skin lesions was 63%, and it varied significantly between occupational groups (p = 0.006, V = –0.263), being markedly higher among technicians (80%) compared with students (48%) and dentists (49%). Table 3 presents the prevalence of self-reported worj-related skin lesions (localization, manifestations) by occupation in dental professionals and students.

Table 2. Prevalence of skin and other manifestations reported by dental professionals and students.

Variable (manifestation)	Occupation				Total N=136	p	V
	Student N=31	Doctor of dental medicine N=33	Dental assistant/nurse N=26	Dental technician N=46
Hand skin inflamation with dryness (eczema); fissuring of the skin on the fingers	8 (25.8%)a. b	2 (6.1%)b	7 (26.9%)a. b	23 (50%)a	40 (29.4%)	<0.001	0.246
Skin inflammation (dermatitis) around the nails (periungual)	3 (9.7%)	2 (6.1%)	5 (19.2%)	6 (13%)	16 (11.8%)	0.452	0.064
Depigmented patches on the skin on the fingertips/ (leukoderma)	0	0	1 (3.8%)	5 (10.9%)	6 (4.4%)	0.057	0.203
Nail dystrophy	0	1 (3.0%)	3 (11.5%)	6 (13%)	10 (7.4%)	0.101	0.189
Skin inflamation with dryness (eczema) of the face, neck, and eyelids	5 (16.1%)	4 (12.1%)	3 (11.5%)	8 (17.4%)	20 (14.7%)	0.874	0.021
Generalized skin inflamation (dermatitis) with dryness	1 (3.2%)	2 (6.1%)	3 (11.5%)	3 (6.5%)	9 (6.6%)	0.656	0.049
Mucosal symptoms (eyes, nose, respiratory tract)	1 (3.2%)	1 (3%)	2 (7.7%)	5 (10.9%)	9 (6.6%)	0.447	0.122
Allergic contact stomatitis	0	0	2 (7.7%)	3 (6.5%)	5 (3.7%)	0.197	0.145

p – level of significance based on the χ² test; V – effect size. Groups sharing the same superscript letter do not differ significantly according to the z-test for proportions.

Table 3. Prevalence of self-reported, occupationally related skin lesions (localization and symptoms) in dental professionals and students.

	Variable	Occupation				Total N=136	p	V
		Student N=31	Doctor of dental medicine N=33	Dental assistant/nurse N=26	Dental technician N=46
Localization of skin changes	Reported work-related localization of skin changes	16 (51.6%)a, b	16 (48.5%b	20 (76.9%)a, b	36 (78.3%)a	88 (64.7%)	0.009	0.235
	-skin changes on hands (palms and fingers)	14 (45.1%)a	15 (45.5%)a	17 (65.4%)a	34 (73.9%)a	80 (58.8%)	0.022	0.232
	-skin changes on head (face, neck)	2 (6.5%)a	2 (6.1%)a	7 (26.9%)a	11 (23.9%)a	22 (16.2%)	0.031	0.199
	-skin changes on non-exposed body areas	1 (3.2%)	1 (3%)	0	3 (6,55%	5 (3.7%)	0.525	0.059
Symptoms and manifestations	Reported work-related symptoms	15 (48.4%)a	16 (48.5%)a	18 (69.2%)a, b	37 (80.4%)b	86 (63.2%)	0.006	-0.263
	-occasional dryness	11 (35.5%)	13 (39.4%)	11 (42.3%)	29 (63%)	64 (47.1%)	0.060	0.2
	-occasional redness	13 (41.9%)a, b	11 (33.3%)b	11 (42.3%) a, b	30 (65.2%)a	65 (47.8%)	0.028	0.193
	-observed vesicles, papules, skin fissuring	4 (12.9%)	6 (18.2%)	7 (26.9%)	15 (32.6%)	32 (23.5%)	0.192	0.17

p – level of significance based on the χ2 test; V – effect size. Groups sharing the same superscript letter do not differ significantly according to the z-test for proportions.

Among the 53 participants tested by patch test to acrylates, two individuals were positive to MMA, two to HEMA, and two to EGDMA.

The most common manifestations of cutaneous and mucosal changes among participants and associated factors that influence them and their interrelationships

The most frequent manifestations were hand eczema and fingertip fissuring (29.4%), followed by eczema of the face, neck, and eyelids (14.7%) and periungual dermatitis (11.8%). The rarest manifestations included allergic contact stomatitis (3.7%) and leukoderma on the fingertips, as well as eczematous lesions around the nails (4.4%) (Table 4). The frequency of self-reported skin and mucosal changes among dental professionals and students is presented in Figures 1-3. Among our examinees, three participants reported frequent contact with acrylates as a factor exacerbating their skin lesions and all of them presented with eczema of the face, neck, and eyelids (p = 0.003; V = 0.362). No association was found between the occurrence of skin or mucosal changes and the frequency of acrylate contact. In addition, three participants identified frequent hand washing as an aggravating factor; however, hand washing was not associated with any specific manifestation.

Table 4. Frequency of self-reported skin and mucosal changes among dental professionals and students.

Frequency of skin and mucosal changes	Occupation				Total N=136	p	V
	Student N=31	Doctor of dental medicine N=33	Dental assistant/nurse N=26	Dental technician N=46
No changes observed so far	14 (45.2%)	14 (42.4%)	6 (23.1%)	10 (21.7%)	44 (32.4%)
Previously present, now absent	3 (9.7%)	2 (6.1%)	1 (3.8%)	4 (8.7%)	10 (7.4%)
1-2 times per year	8 (25.8%)	4 (12.1%)	5 (19.2%)	3 (6.5%)	20 (14.7%)
5-10 times per year	2 (6.5%)	2 (6.1%)	4 (15.4%)	8 (17.4%)	16 (11.8%)
Persistently present	4 (12.9%)	11 (33.3%)	10 (38.5)	21 (45.7%9	46 (33.8%)	0.063	0.223
Dichotomous ≤2 times er year	25 (80.6%)	20 (60.6%)	12 (46.2%)	17 (37%)	74 (54.4%)
≥5 times per year	6 (19.4%)a	13 (39.4%)ab	14 (53.8%)b	29 (63%)b	62 (45.6%)	0.001	0.337

p – level of significance based on the χ² test; V – effect size. Groups sharing the same superscript letter do not differ significantly according to the z-test for proportions.

Figure 1.

Frequency (temporal) of self-reported skin/mucosal changes among dental professionals and students

Figure 2.

Frequency (occurence) of self-reported work-related skin changes among dental professionals and students

Figure 3.

Frequency of self-reported work-related skin symptoms among dental professionals and students

Of other recorded factors, cold exposure was reported as an aggravating factor in 3 out of 136 participants (2%), disinfectants in 6 participants (4%), and protective gloves in 4 participants (3%) (cold exposure was not significantly associated with skin/mucosal changes, except in one participant who presented with eczema on the hands). Disinfectants were associated with leukoderma or eczema: 2/6 participants (33%) with these manifestations reported disinfectants as an aggravating factor, compared with 4/130 (3%) without such manifestations (half of them who cited disinfectants as an aggravating factor had hand eczema), and only one participant each reported a relationship with periungual dermatitis, nail dystrophy, or generalized dermatitis. Protective gloves use was mentioned as an aggravating factor for hand eczema by only one participant (no other manifestations were observed among those who cited gloves as an aggravating factor). Statistically, when all frequency categories were considered, the frequency of self-reported skin and mucosal changes did not differ significantly among dental professionals and students. However, when frequency was dichotomized into “rare” (<2 times per year) and “frequent” (>5 times per year), these changes were significantly more common among dental technicians and assistants than among students (p = 0.001; V = 0.337).

Assessment of the influence of acrylic nails and other acrylate-containing materials on the development of skin lesions among dental professionals and students

Participants most frequently reported contact with dental composite resins, as well as with artificial nails and permanent nail polish (Table 5). When analyzed by occupation, the only statistically significant difference was observed for contact with composite resins and adhesives, which was more common among dentists and students (79% and 77%, respectively) than among dental technicians and dental assistants/nurses (33% and 42% p < 0.001).

Table 5. Frequency of contact with acrylates (from various sources) and exposure to them among dental professionals and students.

Variable	Occupation				Total (N=136)	p	V
	Student (N=31)	Doctor of dental medicine (N=33)	Dental assistant/nurse (N=26)	Dental technician (N=46)
Frequent exposure to paints, adhesives, and inks	2 (6.5%)	3 (9.1%)	4 (15.4%)	5 (10.9%)	14 (10.3%)	0.731	0.098
Frequent exposure to composite resins and dental bonding agents	24 (77.4%) a	26 (78.8%) a	11 (42.3%) b	15 (32.6%) b	76 (55.9%)	<0.001	0.428
Frequent exposure to artificial nails and permanent nail polish	8 (25.8%)	10 (30.3%)	10 (38.5%)	9 (19.6%)	37 (27.2%)	0.36	0.154
Frequent exposure to artificial eyelashes or hair extensions	0	1 (3%)	1 (3.8%)	3 (6.5%)	5 (3.7%)	0.517	0.129
Frequent exposure to cosmetics containing acrylates	3 (9.7%)	1 (3%)	3 (11.5%)	2 (4.3%)	9 (6.6%)	0.465	0.137
Frequent exposure to floor waxes and coatings	0	0	1 (3.8%)	2 (4.3%)	3 (2.2%)	0.432	0.142
Frequent exposure to leather, textile, and paper products	3 (9.7%)	3 (9.1%)	5 (19.2%)	6 (13%)	17 (12.5%)	0.645	0.111
Frequent exposure to soft contact lenses and hearing aids	5 (16.1%)	4 (12.1%)	4 (15.4%)	2 (4.3%)	15 (11%)	0.326	0.159
Frequent exposure to bandages, surgical adhesives, and histological specimens	0	2 (6.1%)	3 (11.5%)	0	5 (3.7%)	0.046	0.243
Frequent exposure to medical devices for diabetics, TENS units, and electrocardiographic equipment	1 (3.2%)	0	3 (11.5%)	1 (2.2%)	5 (3.7%)	0.106	0.212
Frequent exposure to intradermal fillers	0	2 (6.1%)	0	0	2 (1.5%)	0.096	0.216
Frequent exposure in plastic glass manufacturing	0	0	0	0	0
Frequent exposure to bone cement used in orthopedic endoprostheses	0	1 (3%)	0	0	1 (0.7%)	0.37	0.152

In the analysis of the association between exposures and manifestations, hand eczema and fingertip fissuring were significantly more frequent among participants who reported contact with diabetic devices, TENS, or ECG electrodes than among those without such contact (10% vs. 1%; p = 0.026; V = 0.217). Mucosal symptoms (eyes, nose, respiratory tract) were more common in participants who had contact with artificial eyelashes and hair extensions compared to those who did not (22.2% vs. 2.4%; p = 0.035; V = 0.262). No significant associations were observed between other exposures and manifestations. Statistically, when controlling for the simultaneous effect of all exposures in multiple logistic regression analyses, wearing contact lenses and hearing aids was a significant predictor of periungual dermatitis, conferring a 5.3-fold higher likelihood of dermatitis (OR 5.3; 95% CI 1.2–23.2; p = 0.028). Contact with artificial eyelashes and hair extensions was a significant predictor of mucosal symptoms (eyes, nose, respiratory tract), conferring a 107.1-fold higher likelihood of such symptoms (OR 107.1; 95% CI 3.9–2936.3; p = 0.006). No significant predictors were identified for other manifestations.

Discussion

Our assessment of the prevalence of skin lesions and its association with acrylate exposure has revealed a significantly higher prevalence among dental technicians than other dental staff and students, where this relationship depends on multiple factors (frequent contact with acrylates, frequent hand washing, and exposure to cold, etc.). Thus, a markedly higher prevalence of skin lesions after contact with acrylates was recorded in dental technicians (71.7%) compared to dental assistants (38.5%), dentists (24.2%), and students (25.8%). Also, among our examinees, three participants reported frequent contacts with acrylates as a factor exacerbating their skin lesions, with an observed association between acrylates exposure and facial/neck/eyelid eczema. Consequently, the high prevalence of work-related skin lesions among our dental professionals and students (65%) underscores the clinical significance of occupational exposure to acrylates. Although the rate among dental students and dentists specifically was lower (49%–52%), it remains substantial. The most frequently reported manifestations in our examinees were hand eczema and cracking on finger skin (29.4%), eczema of the face/neck (14.7%) and periungual dermatitis (11.8%), which is generally in accordance with literature data.

The high incidence of adverse skin changes reported in dental staff and students exposed to acrylates aligns with data showing these materials are not entirely safe. For instance, components of acrylic resin used in denture bases can be released and absorbed through the oral mucosa, skin, gastrointestinal, or respiratory systems (27). The specific absorption mechanism would depend on the nature/chemical properties of the released elements. Adverse effects on skin and internal tissues may be caused by both toxic and immunological reactions. According to research data, the unbound MMA may be both an allergen and tissue irritant, e.g., certain amounts of residual MMA have been found in dentures that had been worn for decades. By hydrolyzing MMA, methacrylic acid, which is cytotoxic, is formed. According to previous research results, potentially toxic effects of acrylic materials, including those in dentistry, are associated with butylene glycol dimethacrylate (BuMA), EGDMA and urethane dimethacrylate (UDMA), as well as with the co-monomer crosslinker ethylene glycol dimethacrylate (EGDM) (27, 28). Also, isobornyl-acrylate (IBOA), which can be present in dental materials such as dental resins (composite fillings and adhesives), may trigger both contact allergic or irritant reactions and was named 2020 contact allergen of the year responsible for many adverse skin reactions.

Thus, recommendations have been proposed to decrease the amount of residual monomer in acrylate polymerization, such as additional initiation or immersion in an aqueous water bath before application (27=26). Also, according to the ISO standard recommendations, the maximum allowed amount of residual MMA for hot polymerized acrylate is 2.2%, and for cold polymerized acrylate it is 4.5% (29). However, acrylates have become an integral part of dentistry and many industries (30). Despite their great practical value, frequent exposure carries the risk of adverse skin reactions, especially ICD and, less commonly, ACD. In general, allergic reactions to acrylates are rare, which aligns with our research, in which only 6 positive reactions were recorded out of 53 participants tested. However, a patch test could potentially be performed to check for a contact allergy to acrylates (30). Despite rarely recorded allergic reactions in our research, our participants often had persistent skin/mucosal changes, recorded among 55.7% dental technicians, 38.5% dental assistant/nurse 33.3% dentists, and 12.9% students. Still, prevention and education are vital in protecting the health of dental professionals and students.

In addition to the side effects of acrylates in dentistry, other sources of acrylates can be identified. Thus, we recorded that contact with diabetic devices, TENS and ECG electrodes were significantly more frequently associated with hand eczema/fissuring, while contact with lenses or hearing aids was a significant predictor of periungual dermatitis. This confirms that individuals in frequent contact with devices containing acrylates (diabetic devices, TENS and ECG) also had more frequent manifestations, such as hand eczema and cracking finger skin, than those who did not have such contact. Also, contact with lenses and hearing aids was a significant predictor of periungval dermatitis, creating a 5.3x greater likelihood of dermatitis, and contact with false eyelashes and hair extensions was a predictor of mucosal symptoms, with a 107.1x greater likelihood. In addition, mucosal symptoms (eyes, nose, and respiratory system) were more common in examinees working in/studying dentistry that also had contact with false eyelashes and hair extensions than in those who did not; for the other tested products containing acrylate, there was no significant association with manifestations.

Caution and awareness of different types of exposure are required when working with acrylates. Reactions can occur from both skin and airborne exposure and can cause even systemic reactions. Sometimes, manifestations can occur on parts of the body not directly exposed, such as the thighs or genitals (12). In beauticians, studies have recorded symptoms affecting the eyes and nasal and respiratory mucosa. Other studies have shown that nail salon workers' contact with (meth) acrylates affected breathing, both the lungs and the airway (31). Such findings support the fact that acrylates can be strong irritants. According to one research survey conducted on females interested in applying manicures using gel nail polish, the majority reported side effects associated with using gel nail polish, including those that occur during wearing the manicure (21.2%) and after removing it (75.2%) (32). Also, skin lesions were reported by 3.1% examinees (hands, lip oedema, widespread), while 52.9% reported subjective symptoms like itching, a burning sensation or pain during wearing the gel nail polish (15.53%) and after removing it (6.99%). One Italian study has recently shown an increasing ACD prevalence related to 2-HEMA (33). The authors suggest that this increase is mainly caused by increased nail product use and a lack of regulation around 2-HEMA (33). Although 2-HEMA use in the workplace is currently restricted under EU regulations, these regulations do not prevent the cross-reaction of 2-HEMA with other acrylates in nail cosmetics that are still readily available to the general public. The growing exposure from nail products requires further research, greater public awareness about the risks of exposure, as well as stronger government action to monitor acrylate use (33, 34).

When considering potential preventive measures, healthcare professionals should identify potential occupational hazards in dentistry and implement measures to avoid skin lesions or contact dermatitis, including the correct use of personal protective equipment such as protective gloves, goggles, masks and disposable aprons (13, 35). To avoid skin exposure to chemicals, non-contact techniques are important. It is also of great importance that product labels of dental acrylic materials display all contained acrylic compounds, even acrylic monomers/impurities at concentrations lower than 1%, which could help in selecting products that a sensitized person could use. Also, when selecting protective gloves, it should be taken into account that nitrile rubber gloves offer better protection against MA penetration for shorter exposures of 15–20 minutes. They are considered more effective than latex gloves, providing greater penetration resistance and lower monomer penetration rates (12). Frequent glove changes have also been emphasized, e.g., some authors suggest using nitrile gloves for a maximum period of 30 minutes, after which they should be changed if the procedure is not completed (36). It has also been observed that during long-term exposures, acrylates could diffuse from nail gel and cause skin changes. In addition, general skin care, especially of the hands, including moisturizing and the use of alcohol-free disinfectants, is needed to maintain a strong skin barrier or restore a damaged epidermal layer. Implementing such measures prevents flare-ups. It is also important to wear a mask and protective eyewear to prevent inhalation and eye irritation. Also, it is very important to control the environment (working in a well-ventilated area or use ventilated manicure tables), as well as to keep acrylates away from other products and work areas to avoid contamination. These masures are especially important for dental technicians who were most common group in prevalence of unwanted reactions to acrylates among dental professionals. In addition, environmental controls such as good ventilation, proper curing, and chemical analysis methods (e.g., gas chromatography for airborne exposure and tape-stripping techniques for dermal exposure) serve as very useful measures for their protection. Concerning measures related to professional nail care procedures, it is useful to change protective coverings on manicure stations after each customer, ensure proper product handling and curing (avoiding touching uncured polish, ensuring all nails are properly cured under the lamp for the required time) and to not use tools, such as nail files, from acrylate procedures for conventional manicures to avoid cross-contamination (37). Taken together, applying these basic precautions is effective in preventing new cases of eczema and contact dermatitis, thereby reducing an individual’s need to change their occupation (13). Given that awareness of the sensitizing properties of acrylates has increased in recent years, and due to the more frequent use of personal protection, as well as the popularity of non-contact techniques, the number of dental personnel allergic to methacrylates has decreased (12).

However, a limitation of our research is the relatively small sample size. Furthermore, the results relied predominantly on self-reported data regarding skin and mucosal changes; these symptoms may not be uniquely attributable to acrylate exposure but could also stem from other preexisting dermatological conditions. Additionally, potential confounding factors outside the occupational or academic environment exist. Consequently, larger, multicenter studies are recommended to enable a more precise determination of the frequency of adverse reactions to acrylates resulting from occupational exposure.

Conclusion

The most common work-related skin changes were confirmed in dental professionals and students in dentistry (in more than half of dental professionals and students, especially in technicians) and their association with acrylatesm highlights the clinical significance of occupational exposure, especially among dental technicians. Acrylics have become an integral part of dentistry and many industries and are widely used in medical and cosmetic products that come into close contact with the skin and mucous membranes, and despite the benefits of their use, there is a risk of adverse health reactions. Frequent exposure can cause adverse skin reactions, especially irritant changes or lesions on exposed skin such as the hands and face. Despite the above-mentioned limitations, this study confirms that dental technicians—those most frequently exposed to acrylates—report the highest prevalence of skin problems. Our findings highlight the importance of preventive measures, protective equipment, improved work techniques, better skin care and continuing education, and prevention and education are key to protecting the health of dental professionals and students. Future studies should be multicentric and should explore other dermatologic conditions that may coexist with acrylate-related changes. With a larger sample size and broader demographic representation, it could be possible to provide deeper insights into susceptibility patterns. Thus, continued research and interdisciplinary collaboration is encouraged so that diagnostic accuracy can improve and that clinical work can offer greater benefits to patients.