Letters to the editor

Idiopathic pulmonary fibrosis: the emerging ‘silent killer’ among dentists

Recently, the United States (US) Centre for Disease Control (CDC) and Prevention reported an increased incidence of a fatal respiratory disorder from a tertiary care centre in Virginia, where nine of the 894 patients treated during 21 years were diagnosed with Idiopathic Pulmonary Fibrosis (IPF). Though this number appears extremely small, it is of grave concern since all the affected patients were dentists and dental auxiliary personnel. Subsequently, CDC scrutinized the National Occupational Respiratory Mortality System database (USA) for ‘other interstitial pulmonary diseases including fibrosis’ and revealed that 35 subjects who died of IPF worked in the ‘office of dentists’ and 19 were dental professionals.¹ The result of the survey concluded that dentists are at higher risk of acquiring interstitial pulmonary fibrosis-like diseases such as IPF. The British Lung Foundation has also reported an increase in the mortality rate due to lung diseases from 2008 to 2012, with the annual incidence of IPF being 4.6 per 100,000 person/year. IPF affects nearly 32,500 people in the UK in a year and is labelled as a ‘silent killer’ of Britain.^{2, 3} These intriguing observations indicate the urgency to screen and educate the dental fraternity for the presence of IPF.¹ IPF is an epithelial-driven disease whereby abnormally activated alveolar myofibroblasts secrete a large amount of extracellular matrix that remodels the lung architecture and reduces its elasticity.^{1, 2, 3, 4} It is characterized by unexplained slowly progressive dyspnoea and non-productive cough with an average survival rate of only 3–5 years.⁵ Although the aetiology of IPF is unknown, exposure to certain viruses, cigarette smoking, radiations, metal and ceramic dust, dental materials like silica, polyvinyl siloxane, alginate, prophylactic paste and amalgam are known to induce respiratory inflammation and scarring in the lung. Thus, it is of paramount importance that dentist and dental auxiliary personnel adopt suitable preventive measures while handling material with known risk of respiratory/alveolar toxicity to prevent the onset of this emerging ‘silent killer’ known as IPF! Additionally, further research and long-term outcome based studies are required to identify the dental materials inducing IPF and evaluate their effect on the respiratory/alveolar epithelium.