Screening for latex allergy with a questionnaire: comparison with latex skin testing in a group of dental professionals

BACKGROUND: Latex allergy has emerged as an important cause of allergic reactions particularly in health workers. Due to the lack of a standardized extract for objective skin testing a screening questionnaire was developed. METHODS: At the 1995 Australian Dental Association Conference, all attendees were invited to complete a questionnaire and undergo skin testing to assess the level of latex allergy in this population and to assess the performance of the questionnaire as a screening test for latex allergy. RESULTS: The questionnaire had high specificity but poor sensitivity compared to skin testing with latex extract. CONCLUSION: This study compares at risk individuals identified by a screening questionnaire with those identified by objective skin testing. A questionnaire designed to screen for latex allergy was reliable for identifying those with low risk while overestimating those at risk of true latex allergy, demonstrating the need for objective testing with reliable allergens.     

Latex allergy in dentistry. Review and report of case presenting as a serious reaction to latex dental dam

Latex allergy may have severe consequences including development of anaphylaxis. This report describes a patient who underwent a reaction to latex dental dam manifesting as erythema, facial swelling and mild airway compromise. Restorative procedures under latex dental dam were performed under local anaesthesia on two occasions resulting in reactions of increasing severity. Following the first event the cause of the reaction was undetermined, but attributed to a possible allergy to local anaesthetic, and managed with corticosteroids and antihistamines. On a subsequent occasion the swelling was more severe, associated with difficulty in swallowing and mild airway compromise, and was managed as previously with adrenaline also being required. Latex allergy was subsequently confirmed.     

Natural rubber latex allergy: implications for the orthodontist

Abstract

Natural rubber latex (NRL) allergy can have potentially serious consequences, and reports of orthodontic patients reacting to NRL have increased significantly over recent years. It is therefore important for the orthodontist to know how to manage patients with an NRL allergy and how to deal with possible reactions to NRL. Safe and effective practice depends on recognizing patients who are at risk of NRL allergy, and an awareness of materials and equipment that contain NRL and the availability of suitable NRL-free alternatives.     

Latex allergy and filaggrin null mutations

Objectives

Natural rubber latex (NRL) contains over 200 proteins of which 13 have been identified as allergens and the cause of type I latex allergy. Health care workers share a high occupational risk for developing latex allergy. Filaggrin null mutations increase the risk of type I sensitizations to aeroallergens and it is possible that filaggrin null mutations also increase the risk of latex allergy. The aim of this paper was to examine the association between filaggrin null mutations and type I latex allergy.

Methods

Twenty latex allergic and 24 non-latex allergic dentists and dental assistants, occupationally exposed to latex, were genotyped for filaggrin null mutations R501X and 2282del4. Latex allergy was determined by a positive reaction or a historical positive reaction to a skin prick test with NRL.

Results

41 individuals were successfully genotyped. Three individuals were filaggrin mutation carriers. One (2.4%) was a 2282del4 heterozygote and two (4.9%) were R501X heterozygote. No homozygote or compound heterozygote carriers were detected. No association between filaggrin null mutations and type I latex allergy was found (p = 0.24). Patients with type I latex allergy more often reported contact dermatitis.

Conclusions

This is the first study to examine a highly plausible association between filaggrin null mutations and type I latex allergy. The study subjects were occupationally exposed to latex but no association between latex allergy and filaggrin mutations were detected. Sensitization to latex in the cases in this study may not have occurred through direct skin contact but through the respiratory organs via latex proteins that are absorbed in glove powder and aerosolized.     

Classification of written examinations in dental education in Norway according to educational aims

abstract – The purpose of the present study was to assess to what extent retention of factual knowledge or higher cognitive abilities, such as analytical/critical evaluation, were required by the students in the written examinations in clinical departments of dental schools in Norway in 1973–1975. A modified version of Bloom's taxonomy of educational objectives was used to classify the examination questions. Most of the questions were covered by the teaching program and concerned factual knowledge. When clinical examinations included a complete patient history and/or radiographs, judgment of the available information was demanded from the students. A great number of minor questions usually represented a lower taxonomic level than the use of a few essay questions.     

Nickel allergy and nickel-containing dental alloys

Abstract – Test pieces from five cobalt-chromium casting alloys intended for use in removable partial dentures were attached to the skin of 10 women with known allergy to nickeL Patch tests were also performed with nickel and cobalt salts. Nine of the 10 women showed clear-cut or strong patch test reactions to the alloy with 7% nickel, one patient also to one of the other alloys (7lt;1% nickel). In five patients with contact allergy reactions to both nickel and cobalt salts mild or marked responses to some of the other alloys were observed. Corresponding observations were made in three out of the five patients with contact allergy reactions to nickel salt but not cobalt salt.     

Immunogenic potential of some mercury compounds in experimental contact allergy of the rat oral mucosa

Abstract — The contact allergenic potential of substances included in a "dental screening test" has been investigated in a previously established animal model for producing contact allergy. We were unable to produce contact hypersensitivity with any of the original formulas. HgCl₂ was selected for further studies and, in order to improve its penetration, butanol was used as a solvent. Sensitization was, however, not obtained with any of the HgCl₂/butanol formulas. Our results are discussed in relation to the requirements of reaching immunogenic threshold levels of mercury in the tissue.     

Titanium allergy in dental implant patients: a clinical study on 1500 consecutive patients

Background: In dentistry, allergic reactions to Ti implants have not been studied, nor considered by professionals. Placing permanent metal dental implants in allergic patients can provoke type IV or I reactions. Several symptoms have been described, from skin rashes and implant failure, to non-specific immune suppression.
Objective: Our objective was to evaluate the presence of titanium allergy by the anamnesis and examination of patients, together with the selective use of cutaneous and epicutaneous testing, in patients treated with or intending to receive dental implants of such material.
Material and methods: Thirty-five subjects out of 1500 implant patients treated and/or examined (2002–2004) were selected for Ti allergy analysis. Sixteen presented allergic symptoms after implant placement or unexplained implant failures [allergy compatible response group (ACRG)], while 19 had a history of other allergies, or were heavily Ti exposed during implant surgeries or had explained implant failures [predisposing factors group (PFG)]. Thirty-five controls were randomly selected (CG) in the Allergy Centre. Cutaneous and epicutaneous tests were carried out.
Results: Nine out of the 1500 patients displayed positive (+) reactions to Ti allergy tests (0.6%): eight in the ACRG (50%), one in the PFG (5.3%)( P =0.009) and zero in the control group. Five positives were unexplained implant failures (five out of eight).
Conclusions: Ti allergy can be detected in dental implant patients, even though its estimated prevalence is low (0.6%). A significantly higher risk of positive allergic reaction was found in patients showing post-op allergy compatible response (ACRG), in which cases allergy tests could be recommended.     

Oral and written instruction of oral hygiene: a randomized trial

Background: This randomized, evaluator-masked, controlled study evaluates the effectiveness of oral in contrast to written instruction of oral hygiene. Methods: Eighty-three students without clinical signs of periodontitis were randomly assigned to either a control group or one of three experimental conditions: 1) written instruction, 2) standardized oral instruction, or 3) individualized oral instruction. Plaque and bleeding indices were assessed to analyze intervention effects on oral health and oral hygiene skills. Measurements took place at baseline and 4 weeks after intervention. Results: Groups differed significantly with respect to gingival bleeding and were tentatively significant with respect to oral hygiene skills. Participants who had received oral individualized instructions showed the best results. Conclusion: A gradient of effectiveness of the instruction methods was observed with most favorable results for the individualized instruction.     

Antibiotic prophylaxis in a patient with penicillin allergy and recurrent bacterial endocarditis: A case report

Bacterial endocarditis (BE) is a rare and life-threatening heart infection that can be caused by oral microorganisms. Patients with specific cardiac valvular abnormalities as well as those with a history of recurrent episodes of endocarditis are considered to be at high-risk for developing BE. Antibiotic prophylaxis is recommended for high-risk individuals when bleeding is anticipated during dental procedures. Penicillins are the antibiotics of choice in preventing endocarditis, while other medications are indicated for patients with penicillin allergies. This case presentation outlines antibiotic prophylaxis prior to restorative care for a 44-year-old man who had a prosthetic heart valve, history of recurrent infective endocarditis and penicillin allergy. Intravenously administered van-comycin and gentamicin were prescribed due to the patients' level of risk and bleeding propensity. This article was written to raise the awareness of dental practitioners to the antibiotic prophylaxis options available for the treatment of patients with cardiac and associated systemic conditions.     

Natural rubber latex allergy: implications for the orthodontist

Natural rubber latex (NRL) allergy can have potentially serious consequences, and reports of orthodontic patients reacting to NRL have increased significantly over recent years. It is therefore important for the orthodontist to know how to manage patients with an NRL allergy and how to deal with possible reactions to NRL. Safe and effective practice depends on recognizing patients who are at risk of NRL allergy, and an awareness of materials and equipment that contain NRL and the availability of suitable NRL-free alternatives.     

E-learning and the future of dental education: opinions of administrators and information technology specialists.

The digital revolution and growth of the Internet have led to many innovations in the area of electronic learning (e-learning). To survive and prosper, educators must be prepared to respond creatively to these changes. Administrators and information technology specialists at six dental schools and their parent institutions were interviewed regarding their opinions of the impact that e-learning will have on the future of dental education. Interview questions encompassed vision, rate of change, challenges, role of faculty, resources, enrolment, collaboration, responsibility for course design and content, mission and fate of the institution. The objective of this qualitative study was to sample the opinions of educational administrators and information technology specialists from selected US universities regarding the impact of e-learning on dental education to detect trends in their attitudes. Responses to the survey indicated disagreement between administrators and informational technology specialists regarding the rate of change, generation of resources, impact on enrolment, responsibility for course design and content, mission and fate of the university. General agreement was noted with regard to vision, challenges, role of faculty and need for collaboration.     

Continuing dental education: evaluation of the effectiveness of a disinfection and decontamination course

Aim: To evaluate a disinfection and decontamination dental postgraduate course run by the Wales Dental Postgraduate Deanery between 2008 and 2010. Methods: Pre‐ and post‐course multiple choice questionnaires were completed by 1177 course attendees. Mean scores before and after participation on the training course were compared and analysed. Results: Mean pre‐course score was 45.3%, rising to 87.0% in the post‐course assessment, reflecting an improvement of 41.8%. Prior to training, 30.7% achieved a satisfactory score of 13/20 (65%) compared to 98.3% on completion of training. Dental technicians were found to score significantly lower than other occupation groups both before and after course attendance. Decade of graduation had no effect on results. Theoretical microbiology was the question area which showed least improvement. Conclusion: Attending the disinfection and decontamination course significantly improved participants’ knowledge. Theoretical microbiology, as a topic area, may be targeted for improvements in future courses to improve results further.     

Supply of dental health information by 182 Dutch organizations working in the field of dentistry

Abstract Little is known about the exchange of Dental Health Information (DHI), as part of the dental health education process, between the Dutch public, organizations active in or related to dentistry and Dutch dental professionals. Based on the ideas of Havelock a communication model was developed. The main question was: how and through which organizations is information supplied, on what subjects related to dental health? A group was formed, consisting of 182 organizations and institutions and 85% decided to collaborate with the study. Telephone interviews were used for the sampling of the data. Of the 154 organizations and institutions only 56% reported to be active in the field of DHI. Preventive information appears to be the main subject. Not the public, but dental professionals and other provider groups are seen as the main target groups. DHI activities appear to consist mainly of providing written information material with a preventive content. These activities are hardly evaluated. Further on: there seems to be no central coordination for DHI activities in the Netherlands. It is concluded that in the field of DHI activities the resource system (organizations and institutions who generate information) and the users system (the public and dental patients) are not in accordance with each other.     

Internet and information technology use by dental students in Chile

As part of a larger cross-country survey of dental students, students from the School of Dentistry, The University of Valparaiso, were invited to participate in a study to describe their use of information and communication technology (ICT). Information was derived from a 124-item questionnaire which included 14 socio-demographic items and 29 items asking about ICT use. ICT items were derived from a University of Birmingham, UK, battery. Data was collected in July and August 2004. A total of 162 of the 249 dental students participated in the study. The average age of students was 21.0 years (SD 2.4 years). The majority of participants (62.1%) were female. All participants had access to a computer, and 96.4% used the Internet. Most students had home Internet connections (73.4%). The most commonly used Internet sites on at least a weekly basis were: email (92.2%); and search engines (88.3%). However, a very few (21.1%) used the Internet to search for dental information for their studies on at least a weekly basis. Furthermore, although the majority (70.4%) found Internet use easy/very easy, 56.2% indicated that any search for information was easy/very easy. The majority (72.2%) indicated that the use of virtual education would not affect their class attendance. The final multivariate model explained 26% of the variance in ICT use, significant predictors for ICT use were gender, year of study, level of difficulty in using Internet, and place of Internet use. However, Internet use was mostly for non-dental purposes.     

Electrochemical properties of mono-particle-layer films of polyaniline-coated latex microspheres

Latex particles with the structure of a polystyrene core and a polyaniline shell were synthesized. They were nearly mono-dispersed spheres 1.62 μm in diameter. The aqueous suspension of the latex particles was spread on a glass substrate and dried in a mono-particle layer. The arrangement of the spread particles depended on the concentrations of the latex, those of the surfactant, and drying speed. The particles were also arranged on a platinum electrode in a mono-particle layer at a very slow drying speed although the particles were likely to gather at the boundary between the platinum and the insulating wall. The cyclic voltammograms of the mono-particle layer were similar to those of electrochemically polymerized films and of the film prepared by spreading and drying the polyaniline-dissolved pyrrolidone. The peak currents at high scan rates deviated downward from a linear relation with the scan rate. The mono-particle layer was inserted into tetrahydrofuran to remove the core-polystyrene. The resulting film covered the electrode surface smoothly. Its voltammetric peak current was almost proportional to the scan rate, as was observed at electropolymerized films.     

A case of mucositis due to the allergy to self-curing resin

A 59-year-old woman noticed a swelling and redness in the buccal and palatal mucosa 12 h after setting of a temporary crown (TEK) made of self-curing resin at a dental clinic. When she came to our hospital, the edema and redness in the buccal and palatal mucosa around the right upper molar were seen. The TEK had already been removed at the clinic. We suspected an allergy to TEK, and performed a patch test to the chemicals of the resin. The only liquid component of resin showed a positive reaction. Topical glucocorticoid ointment was applied, and the symptoms almost subsided 3 days later.     

Analysis of oral health information in the Spanish mass media

The purpose of this study was to evaluate oral health information delivered by the Spanish mass media. The study was composed of two parts. In a quantitative study three media were selected: press, radio, and television. The study was carried out between December 1987 and March 1988, and the media with largest numbers and audience were selected. Information variables were: politics/economy-labor/culture-education/interviews-events-reports/sport s/ leisure/publicity/health/oral health/miscellaneous. The mass media studied dedicated a very small percentage of their space/time to health information, with a clear predominance of other themes such as publicity, politics, and sports (17/1). In relation to oral health, results were even more significant because the space/time dedicated to health in relation to oral health was 180/1 (P less than 0.01). Most of the oral health time was given via promotional or politico-professional issues (P less than 0.05). In a qualitative study all available information relating in any way with oral health was selected from a survey of all written news by the non-specialized Spanish press that appeared during 1 yr (Jan 1987-Jan 1988). Reports dedicated to education were only 170 (31.48%) of the total (540) oral health reports. From 170 reports dedicated to oral health, 33 (19.41%) presented some sort of error and 137 (80.59) had an adequate educative content. Caries was the topic more frequently covered, 77.06% of the data, in contrast to periodontal disease, dealt with by only 33.53%. The qualitative level of data using a Score Level Index (SLI) was 42.73% of the highest possible level. Implications for public health dentistry are discussed.     

Efficacy of protection by latex gloves during orthodontic therapy

The wearing of gloves during orthodontic or dental treatment is generally indicated for reasons of hygiene and protection against infection. This study was aimed at determining the extent and localization of perforations caused by the various orthodontic treatment techniques and interrupting the infection barrier.The impermeability was tested by means of a water retention test according to European standard EN 455, Part 1, performed on 1600 Centramed^® (Centramed, Koblenz), Tekmedic^® and SafeEx^® non-sterile disposable latex gloves (both by Safe Med, Switzerland) and Safe Gan^® latex gloves with an additional acrylate coating (also by Safe Med).The perforation rate in unused gloves was between 0.5% and 7.5%, rising on average to 11% with increasing use. 36% of the total number of lesions resulted from handling removable appliances, and 57% from handling fixed appliances, especially when replacing archwires and elastics. Most lesions were in the thumb, index finger and palm region. Only 18% of the defects were noticed by the dentists themselves. The gloves worn by beginners in their first year of postgraduate orthodontic training had about twice as many defects as those worn by qualified orthodontists.When patients with an increased risk of infection are to be treated, additional hand disinfection measures should be taken and 2 pairs of gloves worn in view of the relatively unreliable protection offered by commercially available latex gloves.