评估接触受污染牙科设备水管的牙医患职业性哮喘的潜在风险。

Evaluation of the potential risk of occupational asthma in dentists exposed to contaminated dental unit waterlines.

作者信息

Pankhurst Caroline L, Coulter Wilson, Philpott-Howard John N, Surman-Lee Susanne, Warburton Fiona, Challacombe Stephen

机构信息

Unit of Distance Education, GKT Dental Institute, King's College London, UK.

出版信息

Prim Dent Care. 2005 Apr;12(2):53-9. doi: 10.1308/1355761053695176.

DOI:10.1308/1355761053695176

PMID:15901433

Abstract

INTRODUCTION

Most of the organisms isolated from dental unit waterlines (DUWL) are Gram-negative bacteria, which contain cell wall endotoxin. A consequence of endotoxin exposure is the exacerbation of asthma.

OBJECTIVES

This study examined the prevalence and onset of asthma among dentists and determined whether or not these were associated with the microbiological quality of DUWL in their practices.

METHODS

266 randomly selected dentists (100 from rural Northern Ireland, 166 from London) completed a health questionnaire, which included questions on prevalence and time of onset of asthma. Water samples taken from the dental handpieces and surgery washbasin cold taps in all the practices were analysed using standard techniques. The questionnaire data were evaluated using both single and multivariable logistic regression. The variables considered were: smoking; surgery location; time treating patients per week; DUWL counts of Pseudomonas aeruginosa, total Pseudomonas spp., fungi, Mycobacterium spp., total aerobic colony counts (ACC) at 22 degrees C and 37 degrees C.

RESULTS

There was no significant association between any of the variables tested in dentists and a history of asthma. A subgroup analysis was performed on dentists (n=33) who reported developing asthma since they started dental training. The final multivariable model indicated that passive smoking (OR 0.08, 95% CI 0.01-0.87, P=0.038) and total aerobic counts of >200 cfu/ml at 37 degrees C (OR 6.72, 95% CI 1.15-39.24, P=0.034) were significant variables for developing asthma since starting training as a dentist. ACC were significantly higher in London (P<0.0001) and London dentists were more likely to have developed asthma since they started training than their Northern Ireland counterparts (OR 4.4, 95% CI 1.09-17.72, P=0.033).

CONCLUSIONS

This study suggests that the temporal onset of asthma may be associated with occupational exposure to contaminated DUWL among dentists in London and Northern Ireland.

摘要

引言

从牙科设备水线（DUWL）分离出的大多数微生物是革兰氏阴性菌，其含有细胞壁内毒素。接触内毒素的一个后果是哮喘加重。

目的

本研究调查了牙医中哮喘的患病率和发病情况，并确定这些是否与他们诊所中DUWL的微生物质量有关。

方法

随机选择266名牙医（100名来自北爱尔兰农村，166名来自伦敦）完成一份健康问卷，其中包括关于哮喘患病率和发病时间的问题。使用标准技术对所有诊所的牙科手机和手术洗手盆冷水龙头采集的水样进行分析。问卷数据使用单变量和多变量逻辑回归进行评估。考虑的变量有：吸烟；手术地点；每周治疗患者的时间；铜绿假单胞菌、总假单胞菌属、真菌、分枝杆菌属的DUWL计数，以及22摄氏度和37摄氏度下的总需氧菌落计数（ACC）。

结果

在接受测试的牙医的任何变量与哮喘病史之间均无显著关联。对报告自开始牙科培训以来患哮喘的牙医（n = 33）进行了亚组分析。最终的多变量模型表明，被动吸烟（比值比0.08，95%置信区间0.01 - 0.87，P = 0.038）和37摄氏度下总需氧菌计数>200 cfu/ml（比值比6.72，95%置信区间1.15 - 39.24，P = 0.034）是自开始接受牙医培训以来患哮喘的显著变量。伦敦的ACC显著更高（P < 0.0001），并且伦敦的牙医自开始培训以来比北爱尔兰的同行更有可能患哮喘（比值比4.4，95%置信区间1.09 - 17.72，P = 0.033）。