It's all in the gloves: Developing a dental office protocol for latex reactions
By Staci Violante, RDH, BSDH, MSDH
The glove is one of the first lines of the PPE combat. It wasn’t until the mid-1980s during the HIV/AIDS epidemic that the glove became more popular among medical professionals and the term “universal precaution” was born. It was “blood and certain body fluids of all patients that are to be considered potentially infectious for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other blood borne pathogens that warranted universal precaution according to the CDC.”(1)
The universal precautions are designed to protect the healthcare worker against blood borne pathogens, mucous membranes, and non-intact skin exposures. During this time, it was advised for health-care workers who are exposed to blood to receive the immunization with HBV vaccine as an appendage to universal precautions.
It wasn’t too much later that the importance of universal preventative measures to all facets of the transmission of diseases was recognized. In 1996, the Centers for Disease Control and Prevention (CDC) replaced universal precautions to standard precautions. The new standard of care was contrived to protect the health care provider from all pathogens. The standard precautions are now designed to protect the health-care worker against any contact with blood and all body fluids as well as contact with skin and mucous membranes.
The increasing usage of latex gloves—especially within the dental profession—has led to a number of adverse reactions to not only the provider but the patient as well. These adverse reactions significantly decreased due to industrial science and the production of powder-free latex and synthetic gloves. Today, the occasional patient and health-care provider may present with a latex allergy but those risks are extremely low. But for those few, a latex allergy can range from minor skin irritations to a serious allergic reaction.(2)
Stop, I’m Allergic to Latex!
Types of Latex Allergies
Latex allergies develop after multiple exposures to latex products. Latex proteins are absorbed by the dermis, or mucous membranes, as the body’s immune system produces antibodies that counter immunologically with the antigenic proteins.(3) “The antigen is initially detected by Langerhans’ cells in the dermis, which stimulate the lymph nodes and reticuloendothelial system to produce specific antibodies and T cells against the antigen.”(4)
Immediate Type I response: Latex allergy—Type I natural rubber latex allergy (NRL) is the most serious of the latex allergies. Type I hypersensitivity can cause an immediate and life-threatening reaction such as anaphylactic shock subjective to rare cases. The reaction in Type I is immediate, developing 5 to 30 minutes after initial contact with latex. Some common symptoms consist of:(4)
- Inflammation and redness to the site of exposure
- Itching and burning
Type I Response
Delayed Type IV response: Allergic contact dermatitis (ACD)—Type IV allergy, contact dermatitis, is a reaction from the residue of the latex glove. Type IV causes a delayed response, typically 6-48 hours after initial contact and can last as long as 4 days. Some common symptoms consist of:(4)
- Redness, swelling, dryness;
- Cracking of the skin, itching, burning and can have some oozing at the site
These symptoms can also extend beyond the site of contact.
Irritant contact dermatitis (ICD)—ICD is the most common, less severe type of condition that does not involve the immune system. Avoiding latex, the irritant, will reverse the effects, so using non-latex gloves will resolve the issue. Some common symptoms consist of:(4)
- Extremely itchy rash with cracks and possible sores on the hands
- Dry, irritated hands
- Chapping
- Chafing
- Redness and scaling of the hands
Irritant Contact Dermatitis (ICD)
The first step inmanaging and preventing latex allergies in the dental setting begins with awareness, developing a plan and a course of action. The implementation of office policies and procedures is an essential preventative measure to reduce the risk of a latex reaction. These policies are set forth into place to protect both patient’s and the dental team. There should be one leader from the dental team who is responsible for the developing and preserving of these policies:(1)
- Latex-free in-office health-care program to educate dental staff and patients
- Latex-free standard procedure manual
- Latex-free items in each operatory (gloves, prophy cups, and rubber dam)
Bringing awareness to latex allergies in the dental office can be achieved through marketing an educational program using materials such as pamphlets and videos, highlighting the potential risks and symptoms of latex allergies. Dental offices today will symptomatically use latex-free alternatives and maintain a latex-free environment to avoid any possibilities of an aversion.
The dental team should be encouraged to disclose any indications of potential risk of latex allergy. A detailed questionnaire can determine any risks for both staff and patients, as the knowledge of latex allergies and its side effects can prevent a potential life-threatening emergency.
Staci Violante, RDH, BSDH, MSDH, graduated from the New York University College of Dentistry Dental Hygiene Program in 1997. She went on to complete her master’s degree at the Fones School of Dental Hygiene at the University of Bridgeport. She has been a practicing clinical dental hygienist for the past 20 years, as well as serving as clinical professor in the dental hygiene department at New York University College of Dentistry. She is currently pursuing her doctorate of health science in education.
References:
- Dentistry Today. (2004). Gloves in The Dental Office. Retrieved from: http://www.dentistrytoday.com/infection-control/1319--sp-602552556.
- Occupational exposure to bloodborne pathogens; needle stick and other sharps injuries; final rule. Occupational Safety and Health Administration (OSHA), Department of Labor. Final rule; request for comment on the Information Collection (Paperwork) Requirements. Fed Regist. 2001; 66:5318-5325.
- Nixon R. (2008). Occupational contact dermatitis in HCWs. Retrieved from: www.professional.ansell.com.au.
- Ansell Cares. (2017). Understanding Latex Allergy in the Dental Setting. A Self Study Guide for the Dental Professionals. Retrieved from: http://ansellhealthcare.com/pdf/edPro/DENTAL_CEU_LatexAllergy_Final.pdf.
- Photos retrieved from www/latex-allergy.org
