Idiopathic Pulmonary Fibrosis (IPF) Among Dental Personnel

Dentist examining a patient teeth

Photo by ©Antonio Guillem/Getty Images

What You Need to Know

In 2016, approximately 730,000 people worked as dental personnel (i.e., dental assistants, dental technicians, dental hygienists, and dentists). This is according to the United States Department of Labor, Bureau of Labor StatisticsExternal.

A study was conducted of 10 dentists and one dental technician treated for idiopathic pulmonary fibrosis (IPF) at a Virginia specialty clinic during 2000–2017. IPF is an ongoing, worsening lung disease of unknown cause and associated with a poor outcome. This is the first known cluster of IPF involving dental personnel. None of the employees worked in the same dental clinic. The number of dentists treated for IPF was 29 times higher than the number of dentists expected to be treated.

No clear cause for IPF was identified. It is possible work-related exposures in dental clinics or dental laboratories contributed. Dental personnel can be exposed to a variety of breathing hazards, including:

  • Bacteria
  • Viruses
  • Chemicals
  • Dust
  • Radiation
  • Other hazards

The cluster of IPF cases reinforces the need to better understand breathing exposures that occur while working in dental clinics and laboratories and the use of appropriate personal protective equipment.

  • Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive lung disease without a known cause. Typical symptoms include difficulty breathing that slowly worsens and dry cough.
  • A careful health history and physical exam are required before diagnosing IPF. Additional tests are necessary to make the diagnosis. These tests might include:
    • Lung function tests (e.g., spirometry)
    • Chest x-ray
    • CT scan of the chest
    • Surgical lung biopsy
    • Additional diagnostic tests to exclude other lung diseases
  • Limited treatment options are available for IPF. Supportive treatment options include oxygen and pulmonary rehabilitation. Two drugs, nintedanibExternal and pirfenidoneExternal, have recently been approved for the treatment of IPF. Patients with worsening lung health can be treated with lung transplantation.
  • Unfortunately, the prognosis for those diagnosed with IPF is poor. The average survival time from diagnosis is only 3 to 5 years. However, the rate of disease progression cannot be predicted for individual patients.

Dental personnel who have persistent or worsening cough or shortness of breath should see their doctor.

 

References:

-Lederer DJ, Martinez FJ. Idiopathic pulmonary fibrosis. N Engl J Med. 2018;378(19):1811-1823.

-Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183:788-824.

  • Idiopathic pulmonary fibrosis (IPF) is most often diagnosed in people aged 50-60 years. More men than women are diagnosed with IPF. The number of cases increase with age. IPF is rarely seen in people aged less than 50 years.
  • In the United States, an estimated 10 to 60 people per 100,000 are living with IPF. The number of people over 65 years living with IPF is much greater. One studyExternal estimated that 494 people over the age of 65 years per 100,000 are living with IPF.
  • Risk factors
    • Cigarette smoking
    • Environmental exposures (e.g., metal dusts, wood dust, farming, raising birds)
    • Working in certain industries (e.g., production of wood buildings and mobile home, metal mining)
    • Gastroesophageal reflux disease (GERD)
    • Genetic factors

 

References:

-Lederer DJ, Martinez FJ. Idiopathic pulmonary fibrosis. N Engl J Med. 2018;378(19):1811-1823.

-Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183:788-824.

-Pinheiro GA, Antao VC, Wood JM, Wassell JT. Occupational risks for idiopathic pulmonary fibrosis mortality in the United States. Int J Occup Environ Health. 2008;14:117-123.

-Esposito DB, Lanes S, Donneyong M, et al. Idiopathic pulmonary fibrosis in United States automated claims. Incidence, prevalence, and algorithm validation. Am J Respir Crit Care Med. 2015;192(10):1200-1207.

Page last reviewed: February 14, 2019