Dental Workers Could Be at Risk of Developing Pulmonary Fibrosis, Study Reports

Dentists and other dental healthcare personnel could be at risk of developing idiopathic pulmonary fibrosis at work, the U.S. Centers for Disease Control and Prevention (CDC) reports.

An article about the danger appeared in CDC’s Morbidity and Mortality Weekly Report. It was titled “Dental Personnel Treated for Idiopathic Pulmonary Fibrosis at a Tertiary Care Center — Virginia, 2000–2015” appeared in CDC’s Morbidity and Mortality Weekly Report.

News organizations in the United States and elsewhere have given the report considerable coverage.

In the 21 years between September 1996 and June 2017, nine of the 894 patients who received treatment for IPF at a care center in Virginia were dental workers — eight dentists and one technician. Seven died of the disease.

“This is the first known described cluster of IPF occurring among dental personnel,” the authors of the report wrote.

While the cause of IPF in the cluster is unknown, the authors said they suspect it was linked to their occupation.

During 2016, dentists represented a little less than 1 percent of the patients receiving treatment at the Virginia IPF center. Given that only 0.04 percent of Americans are dentists, the percentage represented at the Virginia center was 23 times what might be expected.

All of the eight dentists and the dental technician were men. Five were white, one was black, and the race of the three others was unknown.

Patients experienced shortness of breath and difficulty breathing when they exerted themselves. The pulmonary function of three patients remained normal, but five developed mild to severe restrictions. Data on pulmonary function was not available for one patient.

The impaired lung function was accompanied by damage to the lungs and fibrosis, as shown by a honeycombing appearance in CT scans.

One of the patients who survived had a lung transplant three years after diagnosis.

The other survivor said he had not used a device to protect against respiratory diseases  during his 40-year dental practice. During his last 20 years he did wear a surgical mask, however. He was the only dentist in the cluster who spoke to researchers.

As part of his daily job, he had to polish dental appliances, prepare amalgams and impressions, and develop x-rays using film developing solutions. Compounds like silica, alginate, polyvinyl siloxane, and others with known or potential respiratory toxicity were used while performing these tasks.

The dentist also reported that he was exposed to dust during the three months in which he worked as a street sweeper before entering dental school and to dust from coral beaches during 15 years of intermittent visits to the Caribbean as a practicing dentist.

The authors of the report speculated that respiratory contaminants, such as infectious organisms, chemicals, dusts, gases, and radiation, could have contributed to the Virginia dental personnel developing IPF.

The fact that the findings involved a single center and that only one of the dental personnel agreed to an interview with the study team were two limitations of the research, the authors noted. They called for additional studies to confirm their findings.

“This cluster of IPF cases reinforces the need to understand further the occupational exposures of dental personnel and the association between these exposures and the risk for developing IPF so that strategies can be developed for prevention of potentially harmful exposures,” they wrote.