A recently identified respiratory hazard affecting dentists

A recent report from the U.S. Centers for Disease Control and Prevention described a cluster of dental professionals (eight dentists and one dental technician) who were diagnosed with idiopathic pulmonary fibrosis (IPF), a progressive form of interstitial pneumonia of unknown cause¹. IPF is characterized by fibrotic changes in the lung interstitium, with reduced lung function. Ultimately, affected individuals experience difficulty breathing and non-productive cough. In the absence of treatment, IPF invariably leads to greatly reduced lung function and death. Of concern, the prevalence of IPF is increasing, primarily among those 65 years of age and older².

Though the nine individuals had received medical care from 2000 to 2015, consideration of the number of dentists in relation to the size of the population indicated that the relative risk for IPF among this cohort was a remarkably high 23-fold.

The literature contains references to respiratory occupational hazards for dental professionals. One identified hazard is a hypersensitivity reaction following inhalation of the monomer component of methacrylate dental materials2., 3., 4., 5.. These reports note that irritation/reaction on the skin and in the eyes were often accompanying findings.

Other reports have focused on respiratory problems in dental laboratory technicians, who are at risk for these disorders due to inhalation of dust and other debris associated with grinding of dental materials required as part of fabricating dental restorations. Silicosis was reported in nine dental technicians in five states in the U.S.⁶.

An analysis of lung function in dental laboratory technicians revealed reduced function, specifically air inhalation and exhalation (spirometry). Nearly one-third of the tested technicians had restrictive or obstructive function. Seventeen percent of the laboratory technicians also had radiographic evidence of pneumoconiosis, which has been linked to chronic inhalation of dust⁷.

Further, dental clinicians and laboratory technicians are at risk for inhalation of infectious agents. The aerosol associated with use of high speed dental drills contain both non-biologic and biologic (bacteria and fungi) contaminants⁸. A case report describing occupational transmission of Mycobacterium tuberculosis involving a dental hygienist illustrates the potential risk of infection via inhalation⁹.

The report of a cluster of dentists with IPF, as well earlier reports of other respiratory hazards, emphasizes the need for proactive measures to prevent occupational respiratory complications in dental healthcare workers. Use of high-speed evacuation and new improved masks¹⁰ are important considerations for all dental personnel who are exposed to aerosols in clinical or laboratory settings. The need for continuous preventive measures is illustrated by the occurrence of IPF in dentists who were older, and had potential exposure over a number of decades.

Clinical dental practice has been associated with certain occupational hazards, and it is important that all oral healthcare workers take appropriate measures to assure their safety. Musculoskeletal problems, ocular injures, risk of infection and stress-associated problems have been well documented, and the identification of an apparently new hazard reminds us that personal hygiene and safety concerns need to be a regular part of the work routine for dental healthcare workers.

This report emphasizes that new occupational hazards associated with dental practice will continue to be identified, and that surveillance, critical review of the literature and ultimately preventive measures must be a regular part of the dental workplace routine11., 12..