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The Latex Problem: It’s More Complicated Than You Think by Curt P. Hamann, MD

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Many dental professionals believe that creating a "latex-free" office should resolve staff and patient problems with potential allergens. Unfortunately, this strategy eliminates only one type of the many potential allergens to which dental practitioners are exposed - the proteins found in natural rubber latex (NRL). Other known allergens are plentiful in a dental practice.

Understanding potential avenues of exposure to these allergens and how exposure can be avoided can help minimize unwanted complications in patients and adverse reactions in dental workers, leading to a healthier, happier dental practice.

Type I Allergy to NRL

More than a dozen proteins have been identified in the latex harvested from the rubber tree, Hevea brasiliensis, in a process similar to tapping maple trees for syrup. These botanical proteins can induce Type I (immediate) allergic reactions in sensitized individuals. Symptoms of Type I hypersensitivity appear within minutes to a few of hours of exposure and range from uncomfortable (hives, itching, redness, rhinoconjunctivitis) to life-threatening (vomiting, diarrhea, hypotension, tachycardia, shock, anaphylaxis). The symptoms usually subside within hours of removal of the allergen.

NRL sensitivity was recognized as a serious health hazard after the introduction of Universal Precautions, which mandated gloves and other gear be worn by health-care workers to protect them from exposure to pathogens during patient care. In the 1990s the prevalence of Type I NRL protein allergies in medical and dental personnel was reported to range between 12 and 17 percent. As awareness and understanding of the problem increased, regulatory agencies and manufacturers launched efforts to lower the level of NRL proteins in gloves and other products. For example, low-powder and powder-free gloves were introduced. Cornstarch, which is often used as powder in gloves, is an extremely rare sensitizer itself. Cornstarch, however, absorbs the NRL protein and can become aerosolized when gloves are donned and removed placing allergic individuals at risk of respiratory and other symptoms when inhaled. Other manufacturing processes such as leaching were also modified to decrease the amount of NRL protein present in gloves.

Such concerted efforts have resulted in the successful management of this occupational allergen. Among dental personnel, the prevalence of NRL sensitivity has decreased to four percent or less. Nonetheless, dental practitioners need to maintain their vigilance and awareness of this allergen, especially in high-risk groups such as patients who are health-care workers, those with spina bifida or urogenital abnormalities, or those who have undergone multiple surgeries.

Type IV Allergies

Many dental workers fail to appreciate that synthetic rubber products can also be potent sources of allergens that can cause a cellular immune-mediated inflammation localized to areas of skin contact known as allergic contact dermatitis (ACD). In contrast to Type I immediate reactions, Type IV reactions are delayed with an onset that varies between an hour and several days. They can persist for weeks or months. The localized symptoms can include swelling, skin thickening, cracking, peeling, scabbing, crusting, scaling, itchiness, redness, fissures, papules and vesicles. While not immediately life threatening, untreated or mismanaged ACD can lead to permanent skin damage. Loss of skin integrity can increase the likelihood of health-care workers being infected by or transmitting pathogens.

ACD can be caused by a variety of chemicals introduced during the manufacture of rubber products. The chemicals, which are needed for many purposes, act as accelerators, anti-degradants and emulsifiers. The chemicals most likely to be associated with ACD are thiurams, carbamates and mercaptobenzothiazoles. Some of these chemicals are present in some proportion in all "rubber" gloves, regardless of whether they are made of NRL, nitrile, neoprene or other materials. Many dental workers mistakenly selfdiagnose themselves with a latex allergy and switch gloves in the hope that their dermatitis will resolve only to find that it persists. In such cases, it is not the NRL protein that is to blame but one of the chemical additives, which is also present in the new glove. Other materials used in a dental practice, such as antiseptics, disinfectants, acrylic resins, bonding agents and adhesives, can also cause ACD. Workers may assume that their skin problems are caused by gloves when the culprit may be a chemical that breached the protective barrier of the glove.

The breadth of allergens to which dental workers are exposed, coupled with the need for appropriate barrier protection, can make glove choice challenging. Factors such as amount of total protein, antigenic protein and residual accelerators, permeability, and mechanical and chemical resistance must all be considered. The key is for users to understand their needs and personal requirements (including their personal allergic profile) and to assess their occupational hazards. Only then can workers select a glove material and brand, based on the attributes provided, that will work best for them.

Management of Allergies in Dental Practices

It is crucial to understand that there is no cure for either Type I or Type IV allergies. Allergen avoidance is the only effective management strategy. However, to avoid an allergen, it must first be identified as the causative agent. An accurate diagnosis is needed; hence, workers affected should seek the care of a physician with expertise in occupational allergies. Diagnostic procedures include skin prick tests for Type I allergies and patch testing for Type IV ACD. Although a patient's history is an important part of a reaching a diagnosis, a diagnosis based on history alone without the appropriate diagnostic test, even when delivered by an experienced clinician, can be incorrect as much as 80 percent of the time.

Once the offending allergen is known, strategies for its avoidance can be implemented. Sometimes it may be changing the brand of glove or modifying work practices. Education is paramount because products, both in the dental practice and in the home, continually change and their chemical content must be monitored. With appropriate medical attention and constant vigilance, sensitive dental professionals can remain symptom free with intact skin, the most effective barrier against pathogen transmission.

Author's Bio
Dr. Curt Hamann is the CEO and Medical Director of SmartPractice, a national dental supply and practice marketing company with a mission for healthier practices and healthier patients. He is an authority on occupational allergies, glove manufacturing, infection control and musculoskeletal disorders in dentistry and speaks worldwide on these topics. Dr. Hamann can be reached at info@contactdermatitisinstitute.com.
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September 2025
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