An Analysis of Skin Prick Tests to Latex and Patch Tests to Rubber Additives and other Causative Factors among Dental Professionals and Students with Contact Dermatoses

Abstract

Background: Dental workers often experience unwanted allergic and nonallergic skin reactions resulting in different contact dermatoses (e.g., contact urticaria, irritant and allergic contact dermatitis) that are often attributed to rubber gloves. Objective: To examine allergic and nonallergic contact dermatoses by different methods amongst dental professionals and dental students, more specifically, reactions to natural rubber latex (NRL), rubber additives, and other causative factors. Methods: In this cross-sectional study we surveyed a total of 444 subjects (dentists, assistants, technicians, and students); 200 agreed to be tested to latex by the standard skin prick test (SPT) and prick-by-prick test, of whom 107 were patch tested to rubber additives (mercapto mix, thiuram mix, carba mix, and N-isopropyl-N-phenyl-4-phenylenediamine [IPPD]). Results: Skin lesions appeared significantly more frequently with longer work experience (p = 0.002; V = 0.181), frequent glove changes (p < 0.001; V = 0.310), and hand washing (p < 0.001; V = 0.263), and in subjects with a history of allergies (atopic dermatitis, allergic rhinitis, allergic conjunctivitis, and others) (p < 0.001; V = 0.183). Positive SPTs to latex occurred in 14/200 subjects (7%), of whom 5/14 subjects (35.7%) were also positive in prick-by-prick tests. Patch tests were positive in 5/104 subjects (4.8%) (mercapto mix 1%, thiuram mix 1.9%, and carba mix 1.9%). Conclusion: Only a small number of our subjects were allergic to latex (7%) or rubber additives (4.8%). Thus, self-reported contact dermatoses (during NRL product use) in dental professionals and students are not commonly caused by allergies to latex and rubber additives, as is often assumed, but by other factors.

Skin reactions among Bulgarian dental students: A self‐report questionnaire survey

“…There was an increase in Type I latex allergy in healthcare workers in the late 1980s and early 1990s, due to the increased demand for latex protective gloves and poor manufacturing control. The introduction of low‐protein powder‐free latex gloves over recent years has resulted in reduced exposure in healthcare workers to latex antigens, and served to prevent sensitization to NRL (natural rubber latex) . Nitrile rubber gloves do not cause immediate‐type allergy but may contain important contact allergens such as carbamates, thiurams, or mercaptobenzothiazoles, which may cause allergic contact dermatitis .…”

“…The introduction of low-protein powder-free latex gloves over recent years has resulted in reduced exposure in healthcare workers to latex antigens, and served to prevent sensitization to NRL (natural rubber latex). [24][25][26] Nitrile rubber gloves do not cause immediate-type allergy but may contain important contact allergens such as carbamates, thiurams, or mercaptobenzothiazoles, which may cause allergic contact dermatitis. 27 In our study, immediate and delayed skin reactions were not differentiated based on the questionnaire.…”

Common Allergies and Allergens in Oral and Perioral Diseases

“…One of the most commonly mentioned allergens is rubber, which can be found in latex gloves (worn by dentists and their assistants) and rubber dams (used to isolate the operative site from the rest of the mouth) [17][18][19] . Cases of adverse patient reactions to latex gloves worn by dental health care workers have been reported by Agrawal et al Their study results showed that 16% of dental professionals reported allergy to latex gloves, with the prevalence significantly higher in those who had allergy to pollen grains, foodstuffs and rubber dam, asthma and eczema in their medical history 17 .…”

“…during dental treatment (when dentist's glove comes in contact with the lip, or in contact with cinnamaldehyde, menthol or eugenol in toothpaste), etc. 18,19 . In dental practice, also possible are allergic reactions to formaldehyde (used for disinfection in root canals), immediate-type allergies to local anesthetics or delayed-type allergies from longer operative procedures (e.g., additives from the glove rubber or rubber dam) 1,7 .…”

Respiratory Symptoms of Exposure&nbsp;to Substances in the Workplace among Bulgarian Dental Students: a Self-report Questionnaire Survey

“…The introduction of low protein powder-free latex gloves over recent years resulted in a reduction of the exposure of healthcare workers to latex antigens, and served to prevent sensitization to NRL (natural rubber latex). [14][15][16] Dental students pointed out plastics as the major cause for adverse respiratory reactions. Plastic materials used in dentures are based on acrylic resins.…”