Idiopathic Pulmonary Fibrosis – a new risk in dental care

Idiopathic Pulmonary Fibrosis or 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 and increased with increasing age. No published data could be found regarding dental personnel and IPF.

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.

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.

It was reported that substances used during the polishing of dental appliances and preparing amalgams and impressions, contained silica, polyvinyl siloxane, alginate, and other compounds with known or potential respiratory toxicity.

One of the two surviving dentists reported that he did not use respiratory protection during these tasks.

Randall Nett, an epidemiologist at the Center for Disease Control and one of the lead authors on the study, says it’s important to highlight the dangers of this work. “As we learn about potentially harmful exposures in dental practice, NIOSH [The National Institute for Occupational Safety and Health] works to make recommendations for a safer and healthier workplace,” Nett told Yahoo Lifesetyle. “That is why it is important we learn more about what potentially caused this cluster of IPF among dentists, so that we can identify specific risks and work to reduce potentially high-risk exposures.”

The Department of Labor’s Occupational Safety and Health Administration (OSHA) echoes Nett’s concerns on its website, stating that dentists “may be at risk for exposure to numerous workplace hazards … including but not limited to, the spectrum of bloodborne pathogens, pharmaceuticals and other chemical agents, human factors, ergonomic hazards, noise, vibration, and workplace violence.”

Nett says it’s too soon to prove that the chemicals are what caused the lung disease, but stresses the importance of finding a high prevalence of it in one group. “This cluster of IPF cases reinforces the need to understand further the unique occupational exposures of dental personnel,” Nett says, “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.”

Sources: Yahoo Lifestyle, CDC Report by 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;67:270–273. DOI:

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Jessica van Zyl

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