A higher than average incidence of idiopathic pulmonary fibrosis among dentists is making the CDC ask Why?—and dentists and patients consider how to respond.
Let’s have a quiet moment for our dentists.
OK, That’s enough.
My dental history has basically been an unrelenting quest for a dentist who doesn’t scare the bejesus out of me. And gets that saying “Relax” once will have to suffice, and saying “Open” over and over again will have to do for now.
One died on me. His successor moved to a city 100 miles away. (I drove.) In Asia I’ve collected them like baseball cards, and they’ve been fine if a shifty lot. Literally, here today, gone tomorrow.
My rare, reluctant, lopsided smile reveals my dental history like the badges on a major general’s uniform. Dentally speaking, I’m a twenty-car pileup with teeth that look like they were installed by committee. A contentious committee. Because in effect they were.
The dentist who died on me—while I was his patient, I mean, not actually while I was in the chair—did, once, literally cry on me. He was the only dentist in the long parade of them who would not work beyond my slightest flinch of pian without administering another shot of Novocain.
Our only dispute was over my refusal to breathe the nitrous he wanted me to huff. I had to convince him I didn’t like it, that it made me feel bad. That may have been the time he burst into tears, saying how intolerable he found it giving people pain—and how suicidal dentists as a group were. He was not a suicide, but he did quit dentistry for “health reasons.”
The first time in a while I dived into a newspaper article was this weekend, when the Sunday Washington Post of March 10, ran an article headlined, “Dentists keep dying of this lung disease. The CDC can’t figure out why.”
I’ll spare you my first ten responses to the headline because most of them were, I have to admit, less than high-minded. But the best I could do before reading on was saying to myself, “Well at least they’re not killing themselves.”
But for me the penny dropped that one of the subliminally scarier aspects of going to the dentist—the rest were all too visible—was the mask. While I kept hearing “Open wider,” the slightly muffled sound was coming from somewhere south of pair of eyeballs whose expression I could not read.
I mark the beginning of my adulthood as the day, all too recently, when it hit me that my dentists weren’t having a great time either. First, that they were smelling the same things I was, burning bone mostly. Also, that they were smelling, which was to say breathing, the same caustic chemicals and creepy “alloys” I was. Just they were doing it more or less all day long. I stopped begrudging them their lakeside summer homes.
What’s showing up on the x-rays?
In April 2016, a dentist being treated at a Virginia clinic newly diagnosed with idiopathic pulmonary fibrosis (IPF), a rare, progressive, and incurable lung disease, called the CDC. What he knew, or found out, or put together, was that several other dentists had gone to the same clinic for the same reason.
A preliminary check of the clinic’s records of 894 patients who had been treated for IPF over a 21-year-period included nine that shared a work history: eight dentists and a dental technician. One percent—one in a hundred—may not sound alarming, statistically speaking. But by the time the CDC released a report March 9, based on a more exhaustive survey, it turned out that dentists and dental professionals were 23 times more likely to contract IPF.
The CDC estimates that at any one time, some 200,000 Americans have IPF.
What is IPF?
IPF causes scarring of the lung tissue that progressively limits the amount of oxygen delivered to the heart and brain. Early symptoms include shortness of breath, chronic dry cough, weight loss, joint and muscle pain, and clubbed fingers or toes. Alert readers will note that all but the last are early symptoms of a broad range of illnesses.
Most people with IPF die within three to five years from diagnosis. It also appears more regularly and progresses more rapidly in older patients.
What causes IPF? To be determined.
What makes dentists more susceptible?
Dentists, being doctors, and therefore at some level being scientists, are weighing in on the discussion. They know that they routinely work with silica, polyvinyl siloxane, alginate, and other toxic substances that at certain concentrations could well prove hazardous.
Quoted in a CNN report of March 9, Dr. Paul Casamassimo, chief policy officer of the American Academy of Pediatric Dentistry's Pediatric Oral Health & Research Center, called the report "not surprising. We do work with materials and with human bioproducts that are potentially damaging to our bodies if we inhale them."
The fact that the patient cluster that got the CDC’s attention included more older dentists suggests several things. One is that lengthier exposure to the hazardous materials has greater consequences. Another is that more modern approaches and the education of younger dentists to those specific hazards may be leading to a decline in cases.
Dr. Casamassimo added that, in the words of the CNN reporter, “Younger dentists are taught differently than in the past, so they know to delegate certain work or procedures to laboratories that meet more safe and stringent ventilation requirements. Today, dental personnel also have required protections from the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health.”
Dr. Randall J. Nett, lead author of the new CDC report commented that "Dentists and other dental personnel have unique exposures at work. These exposures include bacteria, viruses, dusts, gases, radiation, and other respiratory hazards."
After the work on the report was finished, another dentist was diagnosed with IPD at the same Virginia clinic.
If no cures, are there remedies?
For the dentists, whose work environment it is, maintaining adequate ventilation is an critically important safety measure. Many have for years done certain types of work using a personal face ventilator. Face masks that offer greater protection than disposable paper masks are also clearly indicated. Whether the protection offered by the N95 masks that doctors say are the only meaningful protection from airborne viruses remains to be seen.
For obvious reasons, such protections for patients are more limited. That said, patients, like their dentists, can request and wear eye protectors during procedures. A recommendation that cannot be made strongly enough is that maintaining oral hygiene at the highest level will necessarily reduce the amount of time patients will spend in the clinic.
And people like me might give a thought to our dentists’ health and well-being. We could remember that although the short-term pain seems one-way, the long-term hazard may not be. We could take a minute to think that a session in the chair is an experience at least three people are having.
We also could, as but one example, reschedule appointments when we’re seriously ill with communicable illnesses. And we might not feel so put upon when we’re put under what feels like a suicide vest while the technician pops behind a window to take our mouth x-rays.
And even if we forget to say as much, we can be grateful for any evidence that our dentists are doing all they can to protect themselves, their employees, and us. We could even be a little kind, and even say thank you, for doing something risky to keep us healthy.
Now rinse, and go take better care of your teeth—and your dentist.