The CDC studied an unexplained cluster of lung disease among dental professionals: What should you know?

By now, you may have seen alarming headlines regarding a recently published article in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report detailing an investigation into an unexplained cluster of idiopathic pulmonary fibrosis (IPF) among dental professionals treated at a Virginia dental clinic. (1) Here’s DentistryIQ’s quick rundown of what dental professionals ought to know:

What is the disease?

According to the National Heart, Lung, and Blood Institute, IPF is a serious lung disease in which a person experiences unexplained scarring of the lungs. This scarring interferes with oxygenation of the blood. The prognosis for this disease is poor—most patients live only about three to five years after diagnosis, and there is no cure. (2)

Who has this disease cluster affected?

The cluster is comprised of nine patients: eight dentists and one dental technician. At the time of the study, seven of the patients were deceased. All patients were male and about 64 years old when they consulted with the clinic where the cluster was found. Five of the patients were from Virginia, three were from Maryland, and one was from Georgia.

What working conditions might have been involved?

A questionnaire was given to one of the living dental professionals, a dentist, “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.” This same dental professional reported that he did not wear an NIOSH-approved respirator during his 40-year practice of dentistry.

How does this rate of illness compare with the general population?

Although a cluster of nine patients may seem small, the number of dental professionals presenting for treatment at this clinic was 23 times higher than the CDC expected based on the total number of dental professionals in the population, prompting the investigation.

What are the limitations of this data?

The CDC says that its findings have important limitations:

• The individuals who had contracted IPF originated from only one treatment center. Given that the treatment center specializes in IPF, its patients tend to be of high socioeconomic status. This may have led to an overrepresentation of dentists.
• Only two of the individuals who had contracted IPF were living, and only one was able to complete a questionnaire.
• Several of the individuals who had contracted IPF had been exposed to other IPF risk factors, such as tobacco use.
• Biopsies were not available.

Bottom line: Should you be worried?

The study acknowledges that “inhalational exposures experienced by dentists likely increase their risk for certain work-related respiratory diseases,” but at this time, there is no evidence indicating that IPF was directly caused by hazards encountered during the practice of dentistry. The CDC reiterated that proper respiratory protection should be used, and the correlation should be further studied.

Chris Salierno, DDS, chief editor of Dental Economics, commented, “We have a correlation here, not a causation. It would be interesting to learn if this condition is as prevalent in the rest of the United States or if there is something happening in Virginia and the surrounding states. And are the rates of the disease more prevalent in dentists across the country? It is always good to be reminded of the importance of OSHA standards to protect ourselves and our team members. It’s a bit early to say if dentists have a new, legitimate occupational concern.”

If this story is making you want to review your knowledge of PPE and occupational safety, though, we have some material on the subject:

Personal protective equipment you need to hear about

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Protecting dental staff from the most hazardous job in America

References
1. Nett RJ, Cummings KJ, Cannon B, Cox-Ganser J, Nathan SD. Dental personnel treated for idiopathic pulmonary fibrosis at a tertiary care center - Virginia, 2000-2015. MMWR Morb Mortal Wkly Rep. 2018;67(9):270-273. doi: 10.15585/mmwr.mm6709a2.
2. Idiopathic pulmonary fibrosis. National Heart, Lung, and Blood Institute website. https://www.nhlbi.nih.gov/health-topics/idiopathic-pulmonary-fibrosis. Accessed March 20, 2018.

Amelia Williamson DeStefano, MA, is an associate editor in the PennWell Dental Group working on Dental Economics, RDH eVillage, RDH magazine, and Apex360.