January 21, 2013
Screening for solutions
There's a distinct story to be told about the health of dental professionals, and the ADA Health Screening Program has been taking note of it for many years at Annual Session.
Open wide: Dr. David Christian of Longwood, Fla., conducts a screening Oct. 18, 2012, of Dr. Anthony Ferrer of Redwood City, Calif., during the ADA Health Screening Program. Looking on is dental student Kamile Jureviciute of San Francisco. Sixteen free screenings were offered (blood pressure; body mass index; mercury; range of motion and posture; salivary diagnostic; latex hypersensitivity; carpal tunnel syndrome and more).
"The HSP is the oldest longitudinal study on the occupational health and safety of the dental team and includes the investigation of potential hazards such as HIV, hepatitis B and mercury," said Dr. Greg Zeller, senior director, ADA Research and Laboratories, Division of Science. "The Centers for Disease Control and Prevention attended the HSP to observe the ADA methodology for collecting data on HIV prevalence and subsequently propagated the ADA approach with other groups such as orthopedic surgeons."
In 2012, nearly 1,000 dental professionals were added to the ranks of about 60,000 that have received health screenings through the HSP since its introduction at the Annual Session in 1964.
As always, there were revelations. Take the possibility of a link between dental amalgam and peripheral neuropathies among dentists, for instance.
"None was found," said Curt Hamann, M.D., president and CEO of SmartHealth Inc., who has collaborated with the ADA HSP for about 18 years.
For many years, the HSP has accumulated data from nerve conduction tests, and that data recently was combined with urine and serum mercury data to identify correlations between peripheral neuropathies among dentists and their mercury status, Dr. Hamann said.
"Exposure to low levels of mercury from amalgam use in dentistry does not contribute to occupational-related peripheral neuropathies among dentists, a very important data point supporting the sustained use of amalgam," he said.
He added: "This single study if performed independent of the ADA health screen would have cost $10-plus million."
Dr. Hamann was part of a team of dentists, dental researchers, physicians and other health care professionals that conducts HSP each year at Annual Session. The data they collect at each HSP contributes to one of the largest databases of information pertaining to potential health risks associated with practicing dentistry.
Aside from leading screenings on peripheral neuropathies, including carpal tunnel syndrome, Dr. Hamann also led the screenings for latex glove sensitivity.
"We screened 541 people for latex and corn protein allergies," Dr. Hamann said. "Of those, 8—1.44 percent—screened positive for latex allergy."
Those were latex screening data for 2012, but it's the year-over-year data that has the truest value, Dr. Hamann suggested.
"I approached the ADA in the early '90s suggesting that screening for latex protein hypersensitivity and contact dermatitis be added to the ADA health screening," Dr. Hamann said.
"This effort over the next 18 years went on to create the world's largest prospective set of data documenting the rise and fall of natural rubber latex protein allergy in health care."
Dr. Hamann said that data culled from the HSP program has contributed to U.S. Food and Drug Administration modifications on regulatory labeling guidelines, which reduced the concentration of total protein in finished latex glove products.
But more strides remain to be made in the realm of the skin health of dental clinicians, according to Dr. Hamann.
"The epidemiology today would suggest that between 15 and 20 percent of full-time dental clinicians are struggling with contact dermatitis," he said, "which could be either allergic or irritant contact dermatitis. Dermatitic skin is distinct from normal skin as an environment harboring pathogenic bacteria like methicillin-resistant Staphylococcus aureus."
Dermatitic skin is an ineffective viral barrier, Dr. Hamann said, increasing risk in particular for hepatitis C, herpes and cytomegalovirus infections. "Healthy skin should be a very high priority for caregivers," he said.
Another HSP participant was Dr. David Wong, an associate dean of research and a professor at the School of Dentistry and the director of the Dental Research Institute at University of California at Los Angeles. He also has participated with the ADA program for many years, offering his expertise on salivary diagnostics since 2007.
"The emerging concept of chairside evaluation of oral and systemic diseases in the dental office is imminent and will impact the landscape of dentistry in the next three to five years," Dr. Wong said. "This is a highly impactful outcome of the current development of salivary diagnostics to involve the use of saliva and its biomarkers for oral and systemic disease detection. The convergence of these two initiatives is timely and will significantly advance the dental profession based on credible science and the opportunity to advance dentistry into primary health care."
A lot of a residual value is packed into the HSP, indicated Dr. Wong.
"In addition to the HSP being beneficial to the attendees to monitor their own health, the UCLA salivary diagnostic program presents a venue to disseminate and educate the attendees on the emerging development of salivary biomarkers for chairside early detection of oral and systemic disease including cancers, diabetes and neurological disorders.
"Considering more Americans see their dentists regularly than their physicians, this translates into significant clinical opportunities to detect life-threatening diseases at their early stages," Dr. Wong said.
In addition to peripheral neuropathies, latex sensitivity and salivary screenings, other HSP screenings involved blood pressure, height and weight, delayed hypersensitivity to common dental chemicals, blood chemistry, hepatitis C and mercury. Additional types of screenings also were available for a small fee.