Home Previous Issues Subscription Advertistment Guidelines Contact ASN

ACTA
STOMATOLOGICA
NAISSI

 Table of Contents for
December 2003 • Volume 19 • Number 44

 

PROTECTIVE GLOVES AND UNDESIRABLE EFFECTS
IN HEALT-CARE WORKERS

 

Vesna Branković,
Ana Pejčić,
Branislava Mirković,
Ivana Grigorov

CLINIC OF STOMATOLOGY IN NIŠ - DEP. OF ORAL MEDICINE AND PERIODONTOLOGY, NIŠ, SERBIA


 

Introduction

Hands are identified to be a very important factor in cross-infection. It is known that, protective gloves present the basic protection which is used by health-care workers, whenever they come in touch with blood or other body liquids, which may be contaminated.1

The law of cross-infection control strictly recommands using of gloves by the dentist during some routine examinations and treatment of all patients. In recent years, there has been a tendency for gloves usage in dental practice. However, there is a considerable percentage of workers who use them only occasionaly. For example, they do it only for procedures and for patients which they think belong to high risk group. Some physicians complain about the difficulties they face in stomatological practice, when surgical gloves are used. They also complain of dificulties in small instrument manipulation, unacceptable patients' reaction, insufficient adherance to hands, sticky surface development, exessive sweating under gloves, as well as fear of hands being damaged.

The investigations have shown that one quarter of dentist surgeons have very expressive skin problems caused by gloves usage, such as nail cutting and hands dryness.2,3,4 In Sweden, the physicians reported about 42% of problems, as some skin problems which are associated with moderate dryness and hands itching to blisters appearence, but is some cases bleeding and desquamation appeared, caused by damage on hands.5

Contact dermatitis is freqently connected with allergens, such as rubber, nickel, and chromatin. It can be facial contact dermatitis which appears due to rubber objects usage, or contact stomatitis as a reaction to chewing of rubber, finding them on pencils or tooth brushes (interdental stimulator). More frequent reactions appear on lips than on oral mucous.6

The first symptoms with contact allergy is the feeling of chaffing and itching and the signs are blushing and swelling at the place of contact. Subjective symptoms are more expressive than physical signs. We can find contact dermatitis as a reaction to rubber, of which surgical prevent gloves are made.7 In our professional literature there are not many data about posible problems in our health-care patients while using protective gloves.


The aim of the study

The aim of this work is to examine the usage of protective gloves in health-care workers of Clinic of Stomatology in Nis as well as the appearance of undesirable effects as a conse-quence of gloves usage.


Material and methods

All health-care workers at Clinic of Stomatology in Nis have been examined, about 126 of them. The examination included 46 physicians of all profiles (surgeons, parodontho-logists, pediatric dentists, etc.) 68 dentist assistants, students and 12 hygienists. The age group of the examined was from 17 to 63 including both sexes.
The examinees were given questionnaire with the following questions such as:
1. Do you use latex gloves at work?
2. How many times do you change them during your work? (occasionally, after each intervention, or you don´t change them at all)?
3. Do you have undesirable consequences?
4. Do you react to latex or PVC gloves?
5. Are changes so intensive that you must ask dermatologist for help?
6. Have you got dermatological diagnosis?
7. Describe symptoms when using latex gloves?
8. Do you take suitable therapy?


Results

General information of examinees have been shown in Table 1.
This table shows that there were more female examinees, and that in relation to occupation, there were more dental nurses which were examined.
 

Table 1. General characteristic of examinees


The answers of the examinees have been shown in Tables 2 and 3.
The results given in Table 2 show that out of 126 examinees, there are 16 who do not put on gloves at all. Only 24 of those who use the gloves, change them occasionally. There are 73 of them who change gloves after each intervention, mainly dentists and dental nurses, but those of the examinees who do not change them are hygienists. Out of one hundred and ten examinees who change latex gloves, 21 (23%) complain that they have some problems after using them. During the examination, seven out of 21 examined persons with problems, react to latex gloves, four of them react to PVC gloves, whereas ten examinees react to powder.

Sixteen examinees that have subjective diffi-culties feel itching, 10 of them feel, apart from itching, hand ryness as well. Eight examinees show some kind of irritate dermatitis as the changes are accopanied with the blush of hand skin.

Only three examinees had changes such as the burst of hand skin under gloves, which can appear like possible changes of Eccem. Only 11 exami-nees need dermatologist´s advice, while only three of them use protective cream in their therapy.


Table 2. Results of using latex gloves and undesired effects

 

Table 3. Symptoms and dermatologist's help
 


Discussion

There are a lot of dermatological difficulties which can appear during routine using of gloves in dental practice.
The most common manifestations appear as Contact dermatitis in three various forms: 1. Irritate contact dermatitis, 2. Allergical contact dermatitis, 3. Contact urticaria.3,7,8

According to the results of our work, all changes which have been noticed in our examinees, belong to irritate contact dermatitis (18 persons). Irritate contact dermatitis is non-immunologic skin inflammation, which is the results of direct damage of protective hornily layer by toxic-chemical substances or irritants such as soaps, detergents, acid, and alkali. Exacerbating factors include rubbing, sweating much moisture, warmth and coldness. Everyone being exposed to irritant substances, in insufficient concentration for a longer period of time, is going to get irritant contact dermatitis, especially if those persons have hyperirritable skin. Irritant contact dermatitis is particularly accompained with moist work, and it can be often seen in housewives, hairdressers, hygi-enists in nurses as well as in dental nurses.9 Among 21 examinees who suffer from de-rmatitis, eleven of them were nurses, seven physicians and three hygienists. Dusting powder and moisture with referance to sweating under gloves, were among the most frequent irritant expedients which have been reported. The chronical type of irritant dermatitis was found in our examinees, with dry red scared skin between fingers and on dorsal hand side.

Only three examinees, three dental nurses, had manifestations on their hand skin, which responded to allergic contact dermatitis. The changes manifest like Eccem which starts on the place of contact with allergens, with later possibility for expanding. Once gained allergy has tendency to exist permanently, which is coincidence with our examinees. This type of allergic reaction belongs to IV type of immunological reaction caused by T-lymphocytes.

The third type of contact dermatitis is contact urticaria, which we didn't prove in our examinees. That is type I of immunological reaction, caused by skin contact with material, which directly stimulates releasing of histamine and vasoactive agenses from fat cells-nonimmunological contact urticaria or by producing IgE antibodies when they themselves cause releasing of histamine-immunological contact urticaria.10 Symptoms appear few minutes or hours after leaving gloves.

A lot of works, report information about contact dermatitis in personnel using latex gloves.11,12 Gloves are made of latex, a material which is very often allergen and leads to allergic manifestation.13,14 To minimize latex allergy effects in personnel, there are a few alternatives. It means producing of plastic gloves made of polimer, including PVC polyvinilalcohol, poly-thene and polyvinilacetat (PVA).

Both vinil and nitril gloves can satisfy everyone's demand, because the contact sensitiveness is relatively rare.
Our examinees reported that they react more to latex gloves, and there were more dentists than dentist nurses and hygienists. There were some examinees who react to PVC gloves as well, but it was because oy the presents of dusting powder which causes the feeling of dry hands, itching and dandruffing, which is in accordance with other authors.12,9

Turjanmak et al. (1990)6, reported the fact that out of 1034 examined persons, 16% of them had undesired effects. Our results have a greater percentage, which is 23% of our examinees.

The same author has reported the most frequent reactions such as: hands itching (83%), hands blush (68%) and so on. Eyes itching appears in 27% of them, nose running in 20% of the examinees, but there were only few, who had breathing difficulties (5%) as well as facial swelling (4%).
The results of our examination also show that the most frequent reactions are hands itching (33%), minor hands blush with eccem (16%). No other reactions, apart from local changes on hands have been recorded.

We didn't get any information, during the examination, that the patients had any reaction. That is explained by a possibile fact, that if there were any reactions by the patients, they didn't return to us with possible changings.


Conclusion

Routine using latex protective gloves in dental practice, is a new concept, but it is more frequently in use. We have shown, with this examinations, that skin problems are possible along with using gloves.
Possible undesired effect can be prevented by using gloves with a reduced irritant activity as well as by intensive hands washing and frequent gloves changings.
However, if it heppens that changes appear with stronger intensity such as eccem, one should be obliged to ask for dermatologist´s help with available therapy application.


References

  1. Glenwright HD, Shovelton DS. The prevention of cross infection. Progress in the West Midlands. Br Dent J 1989; 166: 125-7.
  2. Mitchell R, Russell J. The elimination of cross infection in dental practice-A 5 year follow up. Br Dent J 1987; 166: 209-211.
  3. Van Ketel WG, Van Den Berg W. The problem of the sensitiation to dichiocarbamates in thikram-allergic tobiens.Dermatologia. 1984; 169: 70-75.
  4. Ellis H. Harards from surgical gloves. Ann R Coll Surg Engl 1997; 79: 161-163.
  5. Rustage KJ, Rothwell PS, Brook IM. Evulation of a dedicated dental procedure gloves for clinical dentistry. Br Dent J 1987; 163:193-195.
  6. Turjanmak K. et al. Allergy to latex gloves: unusual complication during delivery. Br Med J 1998; 297-299.
  7. Nutter AF. Contact urticaria to rubber. Br J Dermatol 1979; 101: 597-598.
  8. Cohen M. Donald, Hoffman M Heblincoln. Contact stomatitis to rubber products. Oral Surg Oral Med Oral Pathol, 1981; 491-494.
  9. Ellis H. The harards from surgical glove dusting powders. Surg Synecol Obstel 1990; 171: 521-527.
  10. Sussman G, Tarlo S, Dolovich J. The spectrum of IgE-mediated responses to latex. JAMA 1991; 265:284-287.
  11. Handfield-Jones SE. Latex allergy in health-care workers in an English district general hospital. Br J Dermatol 1998; 138: 273-276.
  12. Turjanmak K, Rennale T. et al. Allergens in latex surgical gloves and powder. Lancet 1990; 336: 1588-1589.
  13. Baur X, Jager O. Airborne antigens from latex gloves. Lancet. 1990; 335: 912-913.
  14. Slater JE, Chhabra SK. Latex antigens. J Allergy Clin Imunnol 1992; 89: 673-678.

 
...Authors and Reprint Information
 

Adress for correspondence:

V. Branković, D.D.S.
52 Braće Tasković Street
18000 Niš
Serbia and Montenegro
Telefon: +381 (0) 18 326 216

  • Copyright © 2003 by The Editorial Council of The Acta Stomatologica Naissi