Latex glove allergy in dental practice

Skin reactions due to the use of latex examination gloves occur frequently in dental practice. They consist of immediate type I allergy to natural latex protein, type IV delayed hypersensitivity to rubber additives and irritant dermatitis. Type I allergy to latex protein can cause contact urticaria, angioedema, rhinoconjunctivitis and asthma in the dentist, the dental assistant and also in the patient. Exceptionally, latex allergy can cause a life-threatening anaphylactic reaction. Cross reactions to tropical fruit can occur in the latex allergic patient. Type IV allergy causes allergic contact dermatitis. Rubber additives are also present in synthetic rubber. Glove advice for latex allergic patients are presented.     

Prevalence of contact dermatitis among dental personnel in a Swedish rural county

The use of acrylate-based polymers in dental care in Sweden has increased dramatically in recent years. Acrylate monomers are sensitizers and can cause contact dermatitis. Allergy to latex, e.g. in rubber gloves, is also an increasing problem in health care and especially in dental care. The aim was to estimate the prevalences of work related allergies in dental personnel in a Swedish county with almost 700 dentists, dental nurses and dental hygienists. A questionnaire was distributed to all dental care units in the county and 98% of the population completed it. Specific allergy was verified with standard patch and prick testing. Work related allergy symptoms were reported by 189 subjects, 28%. The prevalences of acrylate eczema and latex allergy were 3,0% and 3,7% respectively. The prevalence of all work related skin allergy was estimated to 8%. The estimated prevalence of acrylate allergy was close to those of a few other published reports. However, the prevalence of hypersensitivity to latex rubber was lower than those reported from other studies. It is concluded that almost one dental care worker out of ten has a risk of contact dermatitis, unless measures to reduce hazardous exposure have been taken.     

Protection by latex or vinyl gloves against cytotoxicity of direct bonding adhesives

The cytotoxicity of orthodontic bonding agents (OBAs) has been demonstrated in both animal and in vitro studies. Many practitioners and their assistants have experienced contact dermatitis of the fingers following contact with OBA. Latex gloves have also been reported to cause similar symptoms in several reports. The purpose of this study was to evaluate and quantify the toxic effects of latex and vinyl gloves, several OBAs, and combinations of these in vitro to determine the kind of glove that should by worn by practitioners when manipulating an OBA. It was determined that when OBAs are applied to washed latex, the combined toxic effect on cultured cells exceeded that of the washed gloves alone. However, when vinyl glove material instead of latex was tested, the toxic effects decreased more than 50%. Therefore, we suggest that practitioners who experience contact dermatitis in orthodontic practices wear vinyl gloves instead of latex, especially when manipulating OBAs. We also acknowledge the need for further research on the subject.     

Contact allergy in and around the mouth

Contact allergic reactions in and around the mouth are not frequent, but they can have very unpleasant consequences. Discussed are the most important materials that can cause reactions in patients and dental personnel. Particulary the enormous increase in the use of latex gloves has caused a rise in latex allergy and contact dermatitis by rubber additives. Acrylates are also important contact sensitizers; they can cause the dentist serious trouble.     

Occupation-related allergies in dentistry

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.     

Prevention of allergy to acrylates and latex in dental personnel

Contact allergy to acrylate monomers and immediate hypersensitivity to latex gloves in dental personnel calls for preventive measures to reduce the risks. The aim of the study was to evaluate the preventive effect of an information campaign after a 3-year follow-up. The campaign included instructions and training according to an ordinance, both in writing and orally, e.g. concerning the choice of products and protection devices and the proper handling of the materials. The follow-up was carried out through 1997-2000 and included all eligible 513 subjects. Information on new cases was ascertained by a questionnaire and reports from the occupational health service and the department of dermatology. The number of expected new cases was based on the incidence rate, derived from a preceding prevalence study in the same county, and the exposed years at risk in the follow-up period. No new case of allergy to acrylates or latex rubber was found in the follow-up period as against 4.91 expected (p = 0.007). In conclusion, this study indicates that occupational allergies can be prevented successfully, but requires vigorous measures to influence the behaviour and the routines of daily work in dental practice.     

Occupational health problems of dentists in southern Thailand

AIMS: To investigate the prevalence and nature of some occupationally related health problems in dentists in southern Thailand. DESIGN: A cross-sectional study using a self-report questionnaire distributed to all 220 dentists working in 14 provinces in southern Thailand in 1997. PARTICIPANTS: One hundred and seventy-eight dentists aged between 22 to 54 years responded. RESULTS: The most common occupational health problems were musculoskeletal pain (78 per cent) and percutaneous injury (50 per cent). Associated factors were analysed using multivariate analysis. About 22 per cent of these dentists had a history of contact dermatitis mostly caused by allergy to latex gloves, 15 per cent had eye problems, and 3 per cent had hearing problems. CONCLUSIONS: Continuing education in the avoidance of percutaneous injuries would be beneficial, as exposure to potential infectious agents is of concern. Further studies are needed to identify causes of musculoskeletal pain and to identify appropriate interventions to reduce its prevalence, as would similar measures to reduce exposure to agents which may be producing contact dermatitis.     

The effect of glove contamination on the bond strength of resin to enamel

Over the past twenty years infection control protocol has evolved and use of gloves is now mandatory. Practitioners have become aware of potential interactions between the latex gloves and many of the dental material used as well as the potential for contamination from the gloves. The purpose of this study was to evaluate the shear bond strength of bonded restorations to enamel of uncontaminated and contaminated resin adhesive with powder free and powdered latex gloves. The results of the study demonstrated that the resin bonding agent that was in contact with either powdered or non- powdered latex gloves did not have a significant effect on the shear bond strength of the bonded restoration.     

Permeability of protective gloves to (di)methacrylates in resinous dental materials.

Dentists may develop contact allergy induced by handling resinous dental materials, and vinyl and latex gloves may provide protection against the monomers of these materials only during the time it takes for a monomer to permeate the glove. The passage times and rates of penetration of four commonly used (di)methacrylates--HEMA, TEGDMA, BISGMA, and UEDMA--for 11 protective gloves were measured. The passage time for HEMA and TEGDMA through vinyl gloves was 1-3 min, and around 20 min for BISGMA and UEDMA. The rate of penetration of HEMA and TEGDMA in vinyl gloves was 0.5-4.5 mumol.min-1.cm-2. The passage time of HEMA and TEGDMA through most of the latex or the modified latex gloves was 5-8 min and the rate of penetration 0.5-3.1 mumol.min-1.cm-2. Latex or modified latex gloves provide a protection against BISGMA and UEDMA for 80 min or more with one exception (Elastyrene), which burst after about 50 min in contact with the resins. Of the tested gloves Ansell, Neutralon, Mediglove, and Biogel D provide protection against HEMA and TEGDMA for at least 5 min.     

Skin problems associated with routine wearing of protective gloves in dental practice

Guidelines on cross-infection control recommend the wearing of operating gloves by dental practitioners whilst carrying out routine examinations and treatment on all patients. However, there are a number of dermatological problems that may be associated with the routine wearing of protective gloves in dental practice. This paper describes the aetiology and clinical features of three types of contact dermatitis, ie irritant contact dermatitis, allergic contact dermatitis and contact urticaria. The management of these skin conditions is discussed. Advice is given concerning routine handcare for all dental practitioners.     

Permeability of protective gloves to (di)methacrylates in resinous dental materials

Dentists may develop contact allergy induced by handling resinous dental materials, and vinyl and latex gloves may provide protection against the monomers of these materials only during the time it takes for a monomer to permeate the glove. The passage times and rates of penetration of four commonly used (di)methacrylates - HEMA, TEGDMA, BISGMA, and UEDMA - for 11 protective gloves were measured. The passage time for HEMA and TEGDMA through vinyl gloves was 1–3 min, and around 20 min for BISGMA and UEDMA. The rate of penetration of HEMA and TEGDMA in vinyl gloves was 0.5–4.5 μmol · min⁻¹· cm⁻². The passage time of HEMA and TEGDMA through most of the latex or the modified latex gloves was 5–8 min and the rate of penetration 0.5–3.1 μmol · min⁻¹· cm⁻². Latex or modified latex gloves provide a protection against BISGMA and UEDMA for 80 min or more with one exception (Elastyrene), which burst after about 50 min in contact with the resins. Of the tested gloves Ansell, Neutralon, Mediglove, and Biogel D provide protection against HEMA and TEGDMA for at least 5 min.     

Dental management of children with latex allergy

This paper reviews the aetiology, epidemiology and dental management of children with latex allergy. The issue of latex allergy has serious consequences for the dental management of children with one or more of the following risk factors: spina bifida, atopy, first surgery before one year of age, history of multiple surgical procedures, congenital urologic abnormalities, gastrointestinal malformations, hydrocephalus internus, ventriculo-peritoneal shunts, spinal cord injuries, and family history of atopy. Management of latex allergy is based upon the diligent avoidance of latex exposure. Universal use of powder-free low-allergen latex gloves is recommended.     

Minimizing the risks of latex allergy: the effectiveness of written information

BACKGROUND: Latex allergy has been identified as an occupational risk for the dental profession. This study assessed whether identified latex-allergic dental personnel changed their practices after receiving verbal and written information about the management of latex allergy. METHODS: A survey conducted at the 1998 Australian Dental Association Congress identified 157 dental personnel with clinical latex allergy, or at high risk from latex exposure. The workplace implications were then explained to them by a consultant allergist. Four weeks later, follow up written information on latex allergy was mailed out. The information sheet outlined possible symptoms and cross-reactions, implications for the workplace, hand care advice and management strategies to reduce latex exposure in the workplace. After six weeks, a questionnaire, designed to assess whether appropriate steps to reduce latex exposure had been taken, was mailed out. RESULTS: Seventy per cent of the questionnaires were returned. All respondents felt the information was easy to understand and informative. While 50 per cent of respondents indicated that they had changed to powder-free or non-latex gloves, only five respondents were fully compliant with all instructions. CONCLUSION: Compliance with instructions regarding minimizing exposure to latex in a group of latex-allergic dental personnel was poor.     

Allergic reactions to rubber gloves in dental patients: report of three cases.

Three cases of allergy to rubber are described, in which the patients exhibited peri-oral rashes following dental treatment by personnel wearing latex rubber gloves. Two of the patients were aware of possible allergy to domestic rubber products but did not reveal this as part of their medical history. With the increase in numbers of dentists wearing rubber gloves it is probable that there will be many more such cases reported in the future. Rubber products must then be added to the list of potential allergens which may be of some import to the practice of dentistry.     

Allergic contact stomatitis from colophony

Colophony is an ubiquitous contact sensitizer which may be present in dental materials, such as periodontal dressings, impression materials, cements, fix adhesives and varnishes. Exposure to a sensitizer in a hypersensitive person may initiate an allergic contact dermatitis/stomatitis.This usually occurs after direct skin/mucosa contact with the sensitizer. This paper reports the case of a colophony hypersensitive male who developed contact stomatitis after dental treatment with a colophony-containing product. CLINICAL RELEVANCE: Sensitizing colophony is present in Duraphat 2.26%F varnish, a fluoride varnish used all over the world. A case of hypersensitivity to Duraphat 2.26%F varnish is presented in a patient who, at the initial visit, indicated only an allergy to sticking plasters.     

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.     

Permeability of protective gloves by HEMA and TEGDMA in the presence of solvents

The breakthrough times and permeation rates of two commonly used allergenic components in dentin bonding agents or resins, HEMA and TEGDMA, were measured for 5 types of latex gloves and 5 types of nitrile gloves. In addition, the breakthrough times and permeation rates for the gloves were measured for HEMA and TEGDMA when diluted with either ethanol or acetone-solvents often appearing in dentin bonding agents. The mean breakthrough times for the 5 latex gloves for HEMA and TEGDMA, concentrated, diluted in ethanol, or diluted in acetone, were 4.9, 4.8, and 2.8 min, respectively. For the 5 nitrile gloves the equivalent breakthrough times were 15.7, 9.9, and 2.8 min, respectively. There were great variations between the various gloves, and 1 nitrile glove showed a breakthrough time of 28-30 min when tested with concentrated HEMA and TEGDMA. Compared to latex gloves, nitrile gloves have a longer-lasting protection against skin contamination with methacrylates in the absence of solvents. The longer protection was reduced or not present for methacrylates diluted in organic solvents, especially acetone. In addition, the nitrile gloves showed fairly high permeation rates in the presence of this solvent. The results indicate that latex and nitrile gloves only give a limited protection against allergenic methacrylates in dentin bonding agents when they contain acetone.     

Permeability of protective gloves by HEMA and TEGDMA in the presence of solvents

The breakthrough times and permeation rates of two commonly used allergenic components in dentin bonding agents or resins, HEMA and TEGDMA, were measured for 5 types of latex gloves and 5 types of nitrile gloves. In addition, the breakthrough times and permeation rates for the gloves were measured for HEMA and TEGDMA when diluted with either ethanol or acetone-solvents often appearing in dentin bonding agents. The mean breakthrough times for the 5 latex gloves for HEMA and TEGDMA, concentrated, diluted in ethanol, or diluted in acetone, were 4.9, 4.8, and 2.8 min, respectively. For the 5 nitrile gloves the equivalent breakthrough times were 15.7, 9.9, and 2.8 min, respectively. There were great variations between the various gloves, and 1 nitrile glove showed a breakthrough time of 28-30 min when tested with concentrated HEMA and TEGDMA. Compared to latex gloves, nitrile gloves have a longer-lasting protection against skin contamination with methacrylates in the absence of solvents. The longer protection was reduced or not present for methacrylates diluted in organic solvents, especially acetone. In addition, the nitrile gloves showed fairly high permeation rates in the presence of this solvent. The results indicate that latex and nitrile gloves only give a limited protection against allergenic methacrylates in dentin bonding agents when they contain acetone.     

The permeability of dental procedure and examination gloves by an alcohol based disinfectant.

OBJECTIVES: The usage of gloves in dentistry has increased greatly over the last 10 years and this has highlighted certain problems when gloves are being worn extensively. While skin irritations and allergies caused by latex proteins and accelerators have been the main focus of attention, dental materials such as disinfectants have also become known as a source of skin reactions. This study was performed to evaluate the permeability of various gloves by ethanol. METHODS: The tip of the middle finger of 13 glove brands (natural latex gloves (NLG) powdered or unpowdered, powdered vinyl, nitrile and synthetic elastomer) was exposed to 5 ml of a hand disinfectant (Desderman). After a penetration time ranging from 2 min to 8 h the permeation of Desderman was detected with a gas chromatograph. RESULTS: Only one component of the disinfectant (ethanol) could be detected to have gone through the gloves. After only 2 min the vinyl and one nitrile glove and after 10 min all glove types were permeated. Powder seemed to have no real influence on the penetration of ethanol. Some natural latex gloves showed a low rate of leakage, while vinyl and nitrile gloves were penetrated quickly and to a great extent. The synthetic elastomer (Biogel Neotech) was the only one with a significantly lower penetration even after 2-8 h. SIGNIFICANCE: While there are reports of adverse skin reactions to alcohol the amount of ethanol (up to 40 microliters after 2 h) detected in this study is much too low to cause irritations and certainly not toxicity, but it could possibly initiate allergic reactions.     

On permeability of methyl methacrylate, 2-hydroxyethyl methacrylate and triethyleneglycol dimethacrylate through protective gloves in dentistry

Continuous glove use is more common in dentistry than in most other occupations, and the glove should offer protection against blood-borne infections, skin irritants and contact allergens. Methacrylate monomers are potent contact allergens, and it is known that these substances may penetrate the glove materials commonly used. The aim of this study was to assess the permeability of various types of gloves to methyl methacrylate (MMA), 2-hydroxyethyl methacrylate (HEMA) and triethyleneglycol dimethacrylate (TEGDMA) with special reference to combinations with ethanol or acetone. The permeation rate and time lag breakthrough (lag-BT) for MMA (neat, or diluted to 30% in ethanol or acetone), HEMA (30% in water, ethanol, or acetone) and TEGDMA (30% in ethanol or acetone) were investigated for different protective gloves. Nine different types of gloves were tested for one or several of these methacrylates. The lag-BT for neat MMA was 相似文献