CDC puzzled over increase of lung disease in dentists

CDC puzzled over increase of lung disease in dentists

The USA Centers for Disease Control and Prevention (CDC) has noted an increase in dental personnel treated for Idiopathic Pulmonary Fibrosis (IPF) at one Tertiary Care Center in Virginia, 2000–2015. However it says that ‘No clear etiology has been identified, but occupational exposures are possible’, perhaps due to inadequate face mask protection.

In April 2016, a Virginia dentist who had recently received a diagnosis of idiopathic pulmonary fibrosis (IPF) and was undergoing treatment at a specialty clinic at a Virginia tertiary care center contacted CDC to report concerns that IPF had been diagnosed in multiple Virginia dentists who had sought treatment at the same specialty clinic.

IPF is a chronic, progressive lung disease of unknown cause and associated with a poor prognosis. Although IPF has been associated with certain occupations, no published data exist regarding IPF in dentists. The medical records for all 894 patients treated for IPF at the Virginia tertiary care center during September 1996–June 2017 were reviewed for evidence that the patient had worked as a dentist, dental hygienist, or dental technician; among these patients, eight (0.9%) were identified as dentists and one (0.1%) as a dental technician, and each had sought treatment during 2000–2015.

Seven of these nine patients had died. A questionnaire was administered to one of the living patients, who reported polishing dental appliances and preparing amalgams and impressions without respiratory protection. Substances used during these tasks contained silica, polyvinyl siloxane, alginate, and other compounds with known or potential respiratory toxicity.

Although no clear etiologies for this cluster exist, occupational exposures possibly contributed. This cluster of IPF cases reinforces the need to understand further the unique occupational exposures of dental personnel and the association between these exposures and the risk for developing IPF so that appropriate strategies can be developed for the prevention of potentially harmful exposures.

IPF is a form of chronic, progressive fibrosing interstitial pneumonia of unknown cause. IPF is associated with histopathologic and radiologic patterns of usual interstitial pneumonia in the absence of other known causes of interstitial lung disease and is characterized by unexplained slowly progressive dyspnea that can be accompanied by a nonproductive cough.

Available treatment options for IPF include pharmacotherapy (i.e., pirfenidone and nintedanib) and lung transplantation. The estimated median survival after diagnosis is 3–5 years. Although the etiology of IPF is unknown, exposures that have been suggested as contributing factors include viral infections, cigarette smoking, and occupations where exposure to dust, wood dust, and metal dust are common.

In the United States, on the basis of the case definitions used by separate studies to analyze data collected during 1988–2005, the estimated annual incidence of IPF varied from 6.8 to 17.4 per 100,000 population, and the estimated prevalence varied from 14.0 to 63.0 per 100,000 population (3) and increased with increasing age (2). No published data could be found regarding dental personnel and IPF.

Link to CDC release:

Report compiled from CDC release

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