GLOVES AND DENTISTRY

GLOVES AND DENTISTRY | THE HIDDEN AGENDA

Irritation

The simple effect of deleterious substances from gloves can be irritant contact dermatitis (ICD). This is a non-specific inflammatory reaction to irritant chemicals being put in contact with the skin. Surveys have shown that about a third of dentists suffer from it. ICD can also be caused or exacerbated by poor handwashing techniques which leave pools of hyperosmotic detergents on the hands. Non-removal of rings or watches can cause stagnation areas underneath them which can also result in ICD; this can be manifested by so called ring dermatitis.

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The Powder Problem

Gloves and hands have routinely been dusted with a variety of agents usually in powder form. The powders are either starch or other agents which absorb sweat and also aid the donning or removal of the glove from the hand. Starch powder can be used by the skin flora as a growth nutrient and this may predispose to skin irritation.5 When left in surgical wounds it can cause granulomas which can be misdiagnosed as neoplasms. Residues of starch can also cause peritonitis and delayed wound healing. It is preferable therefore to use non-starch powder gloves.

Other agents are used to aid the donning of gloves; these include cetyl pyridium chloride (CPC). The use of CPC avoids all the deleterious problems of starch and also has other advantages. CPC is a mild disinfectant and kills some bacteria and viruses, it could therefore act as `microbial' barrier beneath gloves.

Allergic Dermatitis

The other type of dermatitis is the allergic dermatitis (AD).This type of dermatitis is rare but may be due to delayed or immediate hypersensitivity.

Delayed hypersensitivity is a Type IV or cell-mediated hypersensitivity reaction. It slowly evolves usually taking 24-48 hours to cause swelling, erythema, pruritis, vesiculation and cracking of the skin. A variety of chemicals can induce delayed hypersensitivity including the thiurams, dithiocarbamates, phenols, peroxides, organic pigments. This type of dermatitis is cured by removing the stimulus (i.e. the glove), and the use of topical steroids in severe cases.

Immediate hypersensitivity type 1 reactions to gloves is a serious reaction which is fortunately quite rare. It is caused by prior exposure to a glove antigen which has got into the circulation and caused the generation of IgE antibodies. These antibodies bind with the antigen on repeat exposure. The antigen-antibody complex binds to mast cells or basophils and trigger a severe immune reaction and in some cases anaphylaxis. There is usually intense swelling, itching, wheals on the skin and there may be cardiac arrhythmia and difficulty in breathing. The most common antigen to cause these problems are low molecular weight latex proteins.

Proteins

Natural latex contains numerous species of proteins. The proteins present in latex have been studied in detail in the last few years as they appear to be related to allergy. The proteins from natural latex have molecular weights of 5, 14, 29 and 46 KDa these are ammoniated during stabilisation of the latex. The protein content of latex examination gloves can vary from 0.17 to 4001æg/g latex. The proteins in gloves are water soluble but in some surgical gloves are almost totally removed. Exposure to these proteins is not good for health-care workers as Type 1 allergies may develop.

The Future

The prevention of problems for health care with gloves demands a systematic approach to hand care. Good handwashing techniques, the use of emollient creams and powder and protein-free gloves are necessary to avoid hand problems.

What should I do if I am allergic to latex?

Be sure to inform your dentist about your latex allergy as part of your complete medical history. This includes any drug allergies. If you have been diagnosed with latex allergy, inform your dentist before treatment and ask the office whether it has latex-safe products available for use during a dental procedure or surgery. Request that your appointment be scheduled as the first procedure of the day before latex proteins can build up in the air; this can lessen your exposure to latex allergens.

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Take the following precautions:

• Carry an adrenaline kit (Ana-Kit or EpiPen) to treat possible severe allergic reactions.

• Use a medic alert bracelet that clearly states your allergy. You may also want to carry a letter of explanation from your allergist.

• Carry a pair of latex-free gloves (gloves made of nitrile or vinyl are alternatives to latex) in case of an unscheduled emergency visit with a dentist.

• Avoid contact with latex products as much as you can.

• Take steps to find out which products around you contain latex.

• Find other products that you can use that do not contain latex.

• If you are not aware that you have the allergy (which many people are not) and you suffer symptoms following a dental procedure or from contact with any latex products, consult an allergist immediately and inform your dentist.