1. Alternative latex hits the market
By Monica F. Anderson, D.D.S.
March 12, 2009
The familiar itching began in my right eye. Panic rising, I ran to the
bathroom thinking, "Oh no, not again!" One glance confirmed what I
already knew: That innocent looking baby doll I'd patted on the back
during a CPR class was not so innocent. It contained latex. Nothing
else makes my eyelids itch and swell within minutes of exposure.
Was I destined for the emergency room for the second time in two
months?
More than 3 million people in the U.S. are allergic to natural rubber
latex. While that's only 1% of the population, the problem affects 8%
to 17% of healthcare workers, according to the American Latex
Allergy Association. At its worst, the reaction can cause fatal
anaphylaxis. Constant vigilance is required to avoid latex, which is
in more than 40,000 products, including many used daily in dental
offices: dental dams, gutta percha, bitewing tabs, toothbrush
handles, anesthetic cartridges, prophy cups, orthodontic elastics --
and, of course, gloves.

2. In fact, while most hospitals have phased out
latex, the majority of dental offices have not,
and repeated exposure is causing a dramatic
increase in allergy sufferers. While
alternatives -- such as gloves made from
synthetic materials like nitrile -- are available,
many dentists complain the gloves are so
thick that they interfere with tactile sensitivity.
So the news that a new alternative, guayule
Guayule latex gloves
latex, is now commercially available has
are scheduled to hit
latex allergy sufferers and dentists alike the market within a
excited. year. All photos
courtesy of Yulex.
The FDA approved guayule latex last year as
safe for people with type I latex allergy. Yulex, an Arizona company,
has developed technology for extracting latex from the guayule
plant (Parthenium argentatum), which is native to the southwestern
U.S. Yulex expects to release its first gloves, now on trial at Johns
Hopkins, within a year. And today at the 2009 Western Regional
Dental Convention in Phoenix, it introduced its first guayule latex
product: a dental dam.
Until now, latex has come mostly from Hevea brasiliensis, a South
American plant cultivated in Southeast Asia. The guayale latex
products will be a little more expensive than Hevea latex products,
according to Jim Mitchell, Yulex vice president of technology and
development. But he argued that buying them will support the U.S.
rubber industry.
The latex-free conundrum

3. Though latex gloves have been around since 1894, when Johns
Hopkins pioneered them, latex sensitivity was scarcely an issue
until the HIV epidemic hit, prompting manufacturers to speed up
production by eliminating a step that leaches the gloves of protein.
The increased protein content makes them more sensitizing
because more "free" latex is present on the surface.
The potential routes of exposure
for patients and staff are skin,
mucous membranes, inhalation,
and blood. Everything a staff
member touches with latex gloves
while assisting, cleaning, or doing
lab work, for example, is
The guayule plant (Parthenium contaminated by free latex. The
argentatum) is native to the loose proteins stick to the powder
southwestern U.S. and is being in surgical gloves. When gloves
grown in Arizona and Australia. are donned or removed, the
powder goes into the air where it can be inhaled, causing a serious
allergic reaction.
Since latex is present in so many products found throughout a
dental office, including mouse pads, adhesives, pens with comfort
grip, and rubber stamps, creating a totally latex-free office is
probably impossible. However, some doctors have successfully
designed latex-safe environments by using alternative products.
Wendy Churchill, D.M.D., of Tampa, FL, was diagnosed with latex
allergy in 1997 while still in dental school. "It was awful," she said. "I
was just praying God would get me out of there because I couldn't
control my environment." After graduation, she had a difficult time
obtaining a position because doctors balked at the potential

4. expense of buying latex alternatives and the liability posed by her
condition. It took her a couple of years to build her own practice.
(The task has become easier as more substitutes for latex products
have come on the market. For a list, visit the American Latex Allergy
Association).
The products Dr. Churchill uses cost about the same or less than
products containing latex, she said. She doesn't plan to rush out
and buy guayale latex products right away. "I don't like to put my
faith in the FDA too much. ... They approved Vioxx," she said. The
FDA has a 1998 rule that requires all medical devices containing
latex -- paradoxically including Yulex products -- to carry a warning
about the risk of allergic reactions.
Make your office latex-safe
Types of latex
allergies
There are three types
of latex reactions:
1. Irritant contact
dermatitis
A nonallergenic
skin reaction
often caused by
repeated
exposure to latex
gloves. The
symptoms are
redness, itching,
burning, and

5. Dr. Churchill believes that latex can make or dryness.
break a dental practice. "This is a life- 2. Allergic contact
threatening allergy. If a patient's airway dermatitis
closes up, you're in trouble." She also noted A delayed
that one of her colleagues who failed to take reaction to the
chemical
the issue seriously enough had to retire after
additives in latex
developing debilitating heart and respiratory causing a rash
problems. On the other hand, Dr. Churchill 24-48 hours after
has patients who travel five hours to visit her contact. The
latex-safe practice. symptoms are
similar to contact
The key is to minimize the risk for susceptible dermatitis, but
patients and staff by taking a careful medical the reaction is
history, then using every available precaution more severe and
lasts longer.
to protect them. Don't forget the Rubbermaid
3. Latex
gloves in the lab or the possibility that your
hypersensitivity
lab tech wore latex gloves while polishing or An actual allergic
packaging that crown. It is important to tell reaction. It may
the lab about your patient's allergy on the present as
prescription. rhinitis,
conjunctivitis,
Wash prosthetics with soap and water before and/or hives that
you insert them. Also, remind your staff to progress to low
wash their hands before and after wearing blood pressure,
respiratory
latex gloves. Don't just use hand sanitizer. If
difficulty,
you purchase latex gloves, always get anaphylactic
powderless ones. If a patient does have an shock, and
inadvertent reaction during treatment, early possibly death.
intervention is essential.
In my case, the sensitivity grew gradually. After eight years in
practice, I developed dermatitis. But I thought I'd controlled the

6. problem by using synthetic gloves and coping with the occasional
lapse with diphenhydramine (Benadryl). Then last December I had
to rush to the emergency room for treatment with epinephrine,
famotidine (Pepcid), and diphenhydramine. When the symptoms
came again -- ironically during that CPR course -- I was able to
stave them off with epinephrine and diphenhydramine on my own.
Going forward, I've realized my future depends on a lot more than
wearing the right type of glove and masks. Latex is everywhere.
And I'm hoping more of my colleagues realize that.
Monica "Dr. mOe" Anderson, D.D.S., is a general dentist, writer,
and motivational speaker in Austin, TX.
Copyright © 2009 DrBicuspid.com
Related Reading
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