Dentists mysteriously succumbing to lung disease finds the CDC

By Dr. Ananya Mandal, MDMar 8 2018

The U.S. Centers for Disease Control and Prevention (CDC) has found nine dentists and dental healthcare workers with a progressive lung disease of which seven died. This was published in the CDC’s Morbidity and Mortality Weekly Report yesterday (8th March 2018).

The CDC report spans from 2000 to 2015 where this cluster of patients have been noted at a facility. Dentists and dental healthcare workers seem to be contracting a lung disease called idiopathic pulmonary fibrosis. This is a form of long term or chronic lung disease that has a poor outcome and as of now the cause is unknown.

Dr. Randall J. Nett, lead author of the study and medical officer at Respiratory Health Division, National Institute for Occupational Safety and Health, CDC, explained that this was a cluster of cases which meant that the number of cases exceeded normal occurrence and were grouped in a region within a period of time. The report states that there were 894 patients treated for idiopathic pulmonary fibrosis during the study period at the Virginia hospital. One percent of these or 9 patients were found to be dental healthcare workers (1 dental technician and 9 dentists). According to Nett, this is a 23 times higher incidence than expected. According to Nett and his colleagues, these patients were all men and had an average age of 64 years and their ages ranged between 49 and 81 years.

The patients had shortness of breath and difficulty breathing on exertion. They had a productive cough and throat irritation too. Four of the patients were smokers, three were former smokers and one of them had never smoked, they noted. One of the living patients had to undergo a lung transplant 3 years back. On CT scan, they patients showed a typical picture called “honeycombing” appearance of the damaged lungs and fibrosis.

They speculate that there may be an occupational hazard that was till now unknown. Nett explained that dental healthcare workers are often exposed to microbes – bacteria, viruses etc. as well as radiation, dusts and gases. These are all hazards to the respiratory system and lungs. Silica is often used in dental works along with other compounds, they write. These could ne potential respiratory toxins. One of the survivors said that they worked on preparing and polishing the dental impressions and prostheses without wearing protective masks. Nett urges dental healthcare workers to use “certified respiratory protection” and try and improve ventilation at their facilities to prevent such exposures.

According to Nett and his colleagues, it was too early to pinpoint at an exact cause but this was certainly a warning bell. More studies would be needed before a correlation can be found, he said. CDC would be following up this new cluster and check for more such cases that have not yet been reported, he said. Surveillance of the 650,000 dental healthcare workers throughout the nation could also be on the cards he said.

According to other experts such as Dr. Paul Casamassimo, chief policy officer of the American Academy of Pediatric Dentistry's Pediatric Oral Health & Research Center, this new report is not a surprising one since, it is well known that dentists are exposed to toxins to the respiratory system. Older dentists also fail to use protective gear he added. Laboratories meet the safety ventilation guidelines he explained and this could be a reason why younger dentists who delegate their work to labs and use protective gear are less exposed.