Interview: “The number of dentists treated for IPF was 23 times higher than expected”

By Dental Tribune International
October 11, 2019

The health and safety of dental practitioners is an important topic. When a number of dental professionals were diagnosed with the commonly fatal condition of idiopathic pulmonary fibrosis (IPF) at a single Virginia clinic, researchers from West Virginia University School of Dentistry and the National Institute for Occupational Safety and Health (NIOSH) wanted to find out more. In an interview with Dental Tribune International, Dr. Randall Nett from the Respiratory Health Division at NIOSH spoke about the research and current developments.

Dr. Nett, what exactly is your study focusing on and can you tell us something about the current stage of the research?
We initially described a series of IPF cases that occurred in nine dental practitioners (eight dentists and one dental technician) who were treated at a specialty clinic in Virginia in the eastern U.S. during 2000–2015. The number of dentists treated for IPF was 23 times higher than expectations based on the number of dentists in the general population. In the months since this report was initially written, and unrelated to the report, two additional dentists were treated for IPF at the same clinic. That meant that the number of dentists treated for IPF during 2000–2017 was now 29 times higher than the number expected.

This case series described a small number of dentists from a single specialty clinic, so we are limited in the conclusions we can draw. The findings need to be replicated in other treatment centers or to be drawn from a larger population, and we need better studies that can begin to look at work-related exposure that could possibly have led to these cases of illness.

Based on the limited results thus far and on some other clues from the published medical literature that indicate that dentists and other dental personnel might be at higher risk of certain lung diseases than the general population, we are planning to conduct exposure assessment studies at a range of dental clinics as well as several health studies of dental personnel. These studies are scheduled to begin in October 2019 and will continue for four years.

Can you tell us a little more about the cases of IPF at the Virginia clinic?
In total, we identified 11 dental practitioners, ten of whom were dentists, who were treated for this condition at the specialty clinic during 2000–2017. The patients were male and the average age was 65 years. The majority of the patients had died and we were only able to interview two of them. The two dentists we interviewed reported the kind of exposure you would expect in dentistry. Their activities had included polishing dental appliances, preparing amalgams and impressions, assisting or demonstrating denture placement using adhesives, and developing radiographs. We were able to confirm through medical record reviews that five of the dentists had smoked, which is a risk factor for IPF. The amount of information about work-related and other environmental exposure that we could recover from archived medical records was limited.

The health and safety of dentists is seldom talked about. How might the results from your study be best implemented in the dental field?
Because the dentists and the dental technician identified in the case series were older, we hope to establish whether there are exposures in dental practice settings that are potentially hazardous but which can be controlled over time to prevent respiratory disease.

What have the data you have collected thus far told you?
We are in the very early stages of our work. We intend to begin the exposure assessment and health studies in October 2019. It will take several years to collect, analyze, and report the results from these studies. We plan on presenting and publishing the initial findings of these studies as soon as we can.

Is there a need for more occupational health and safety regulations to help advise dentists on best practice when it comes to their own health and the health of their colleagues?
Larger and more sophisticated studies evaluating dental practice exposure, health outcomes among dental personnel, and the link between dental practice exposure and health outcomes are needed before we can recommend any additional health and safety regulations.

The initial study, titled “Dental personnel treated for idiopathic pulmonary fibrosis at a tertiary care center—Virginia, 2000–2015,” was published on March 9, 2018, in Morbidity and Mortality Weekly Report.