What Hazard is Next?

Jack F. Conley, DDS

In the past dozen years, dentistry has experienced a continuous series of reviews of its various methods and materials that have been viewed by the public or regulatory bodies as hazardous to the health of patients or dental personnel. The rationale for initiating such review often seems to be based more on emotion than science. Happily, the profession has been able to achieve closure on many of these matters based upon science. Taking the positive view, it is also important to note that review of sterilization and disinfection protocols (to name just one of the areas that was under such scrutiny) eventually brought significant benefit to the public image of the dental profession.

It sometimes seems that dentistry is subject to more scrutiny than any other professional group or occupation within contemporary society. However that is unlikely. It just seems that way because of the considerable intraprofessional communication we receive on these issues on a routine basis! A partial explanation for the perceived frequency of reviews is that with advanced science and techniques both inside and outside the dental environment, new hazards to health, either real or perceived, continue to arise and must be addressed. For example, in the October 1997 New York State Dental Journal, Sara Babich, DDS, and Ronald Burakoff, DMD, reported that while lasers permit greater efficiency, their use increases the dentist's exposure to harmful microbial aerosols. In this instance, the risk (or hazard) should be easily manageable with respiratory protection.

Subject to scrutiny as potential hazards in recent years have been hazardous waste, dental amalgam, biofilm in dental unit waterlines, and, recently, air quality standards and design requirements for dental offices (American Society of Heating, Refrigeration, and Air-Conditioning Engineers).

The latest "hazard" to command the attention of organized dentistry is the concern about hypersensitivity to latex gloves or latex products coated with talc or cornstarch. Three states have legislation pending that would ban or prohibit the use of latex products in dental treatment.

While 1 percent of the general population is estimated to suffer from latex hypersensitivity (the problem), solid, validated scientific information that would either justify such a prohibition or provide a scientifically acceptable alternative to latex gloves does not exist according to the American Dental Association Council on Scientific Affairs.

At present, three available alternatives (reduced-protein, powder-free, and vinyl gloves) all appear to possess deficiencies that preclude them from being an acceptable substitute. The Food and Drug Administration reported in fall 1997 that the manufacturing process for reduction of powder and protein in powderless latex gloves could compromise their barrier properties and shelf life -- potentially far more serious problems than the potential for latex hypersensitivity. Vinyl gloves continue to receive negative marks from practitioners because of lesser tactile sensitivity.

We are fortunate to have an ADA agency that can review scientific data and represent our best interests in preventing any prohibition of the use of latex products in dentistry until or unless scientific evidence provides clear indication that such a ban is appropriate. In the interim, we must learn to have patience with scrutiny from the outside, as future advances in technology will without a doubt continue to bring forward questions about risks or hazards associated with new materials, devices, and techniques.

Loss of an Exceptional Leader

I would be remiss if I did not recognize the unexpected and untimely passing of one of dentistry's finest servants, William E. Allen, DDS. Bill, a pediatric dentist from Pasadena, was a past president of the California Dental Association and past executive director of ADA, among a multitude of outstanding contributions to the dental profession. Above all else, he was a marvelous professional person who always had a smile, a sense of humor, and something good to say.

Those of use who had the privilege of knowing Bill Allen will remember him as an extremely effective and dedicated leader, whose contributions were made at all levels within the profession. Bill Allen helped bring people together, and he will be particularly missed by those of us who knew him as a friend.