Health and Safety
Executive / Commission
Latex Allergies
Natural rubber latex (NRL) products may impact on dental healthcare workers (ie dentists, nurses, hygienists) because:
Ensure you have and are familiar with:
It is important that you protect yourself against breaches of the skin barrier which can result from frequent use of skin cleansers and occlusive glove-wear, especially if you have an atopic background (asthma, hay fever or flexural eczema) where damage to the skin from irritants is more common. A compromised skin barrier will increase your chances of developing Type IV rubber chemical or Type I NRL allergy. Hand-disinfectant agents and protective gloves need to be selected with great care and it is also important to use a suitable aqueous based emollient at the end of the session and also at other times if your skin has any tendency to dry out.
The British Dental Association* offers the following tips on hand care:
The Faculty of General Dental Practice UK is presently developing NRL guidelines.
If you or your patient are not NRL-sensitive and you choose to wear NRL gloves to protect yourself from blood-borne pathogens choose Powder-Free and Low Protein (<50ug/g) gloves only.
Ensure that gloves comply with national and international standards of performance (British and European Standard BSEN 455, 1993). These should carry the 'CE' mark.
If you suspect that you may be allergic to NRL, it is best to seek a referral to a dermatologist or immunologist via your GP or Occupational Health Physician so that this can be appropriately investigated as soon as signs and symptoms develop.
If you are found to be NRL-sensitive, then it is essential that your work environment is adapted as soon as possible to avoid unnecessary exposure to NRL, which would increase your sensitivity and put you at risk of more severe reactions.
If you are diagnosed with Type I allergy, it may be possible for you to continue to work in the clinical environment, although this depends on the severity of reactions you experience (see above).
It is important that you learn to avoid NRL proteins in consumer and medical products both at home and at work. As gloves are the main cause of allergic reactions to NRL, it is essential that you replace NRL gloves with suitable NRL-free gloves for yourself and ensure that you are not working in powdered NRL environments (ie from the use of powdered NRL gloves worn by colleagues).
A minority of allergic workers can only work symptom free in a strict NRL-free glove environment so it may become necessary for colleagues to switch to using NRL-free gloves also or that other modifications to the work environment are required.
It is recommended that you wear a Medic-Alert® bracelet.
If you have been advised to carry adrenaline for self-administration (eg Epipen® or Anapen®), colleagues should be instructed on how to use it.
If you are diagnosed with Type IV allergy to a rubber chemical, then you need to find a glove that does not contain the chemical to which you are allergic. The Dermatologist who has diagnosed this should be able to help you with appropriate glove selection.
Establish a patient history to identify whether your patient needs to be treated in an NRL-safe environment. Questions include:
Contact with natural rubber latex in dental equipment and products (including medicines) must be avoided in patients with diagnosed or suspected Type 1 NRL allergy and NRL-free alternatives used instead.
Treatment at the beginning of the working day is preferred, before environmental levels of NRL allergens rise with increased activity in the surgery.
Patients with NRL allergy have often been treated in a General Dental Practice without significant problems when adjustments have been made by the dental team to manage the patient's allergy. However if the dentist is in doubt or lacks confidence (eg managing a highly reactive patient), the patient may need to be referred for appropriate management, possibly in a community CDS or PDS or in a hospital setting.
All forward planning and documentation should inform future carers of the patient's sensitisation by effective recording in notes and the use of Labels for Patient Notes .
Possible sources of NRL in dental practice include:
General:
Emergency equipment:
For the more reactive patient or member of staff, other items should be checked for their latex content eg mixing bowls, spatula, chip syringes, needle guards, dappens pot.
Ensure that NRL-free emergency equipment and medicines are readily available to treat any allergic reaction from mild (eg urticaria and asthma) to severe (ie laryngeal oedema / bronchospasm / cardiovascular collapse from anaphylaxis) and that staff are fully trained in resuscitation techniques*.