Nurse with Latex Allergy prompts Dentist to Change to Latex Safe Practice
Evelyn I. Bain M Ed, RN, COHN-S, Associate Director, Occupational Safety and Health Specialist in cooperation with Marie Mannion BSN, RN, Member , MNA Congress on Health and Safety

The Congress on Health and Safety will showcase activities and practices that make the workplace and the lives of injured workers better. The first, in this endeavor, is Dr. Raymond Wise, DDS of Lee, MA. Marie Mannion RN, BSN, a member of the Congress, developed a series of questions that were asked of Dr. Wise to help others follow his lead to provide latex allergic clients with a very necessary health service, adult restorative dentistry. Dr Wise’s responses are the foundation for this article.

Dr. Raymond Wise DDS, became interested in the latex allergy issue because one of his hygienists began having symptoms and one of his patients, Emily Goudey, RN, a nurse at Berkshire Medical Center and an MNA member, developed latex allergy. Dr. Wise attended the Latex Allergy Symposium in September of 1998 co-sponsored by the Massachusetts Nurses Association, the Massachusetts Dental Society, the Massachusetts Medical Society and the New Hampshire Electrolysis Association. At that meeting he met latex allergy survivors, educators, and activists Gail Lenehan, EdD, RN, member of the MNA Congress on Health and Safety and Ellen Patterson, DDS, from New Jersey. He credits this meeting and the influence of Dr. Lenehan and Dr. Patterson along with information provided by the Latex Allergy News with helping him to switch to a latex safe office. Latex Allergy News periodically identifies latex safe materials, equipment and suppliers for various health care settings.

Dr. Wise has taken steps to educate his office staff about latex allergy. This is important on two levels. Education informs the staff of their potential for developing latex allergy and develops an awareness of identifying and protecting patients with latex allergy. The change to non-latex gloves in the office has eliminated the potential for exposure in both workers and patients. The National Institute of Occupational Safety and Health (NIOSH), in the 1997 NIOSH ALERT, recommended workers with the potential for exposure to natural rubber latex should be educated about it’s hazards. The Occupational Safety and Health Administration, (OSHA) in a 1999 Technical Information Bulletin noted that gloves made of alternative materials are appropriate in health care settings.

The switch to a latex safe dental practice was relatively easy according to Dr. Wise. The exception being local anesthetics which utilize a carpule delivery system. In the office, vinyl gloves are now used for short procedures and nitrile for all others. Rubber mouth props are wrapped in a nitrile glove and tied with floss prior to use. An air filtration device is in use and lidocaine and epinephrine are purchased in glass ampules. A terumo syringe is used as are non latex dental dams and prophy cups and stainless steel saliva ejector tips. Dr. Wise tells us he had to spend hours on the telephone looking for the glass ampules of 2% lidocaine. Although the product was available, it was difficult to purchase in the small quantities that a single practice office would use.
Xylocaine has been difficult to purchase in a glass ampule or a latex safe carpule. His discussions with the company met with much resistance, a surprise to Dr. Wise as he saw this as an opportunity for the company to meet the needs of the consumer. There is also a need for a latex safe syringe to administer local anesthetics.

While he believes there have been increased costs to the practice for the use of latex safe alternatives, Dr. Wise has not documented the increase. He feels that using vinyl gloves for exams and short procedures cuts down on some of the cost.
Non-latex gloves and latex safe products (exception – anesthetics), are used on all patients. Thus, there is no need to for elaborate scheduling schemes to accommodate latex allergic patients. The general patient population appreciates that they have taken an extra step to protect their health.

Emergency procedures are in place in the office should an adverse situation develop. While the local hospital claims to be “latex safe” their main change at this time is to powder free latex gloves. While this change does reduce the amount of airborne latex, it would still pose a hazard to latex allergic patients.

The majority of latex allergic patients in his practice are health care workers, many drive long distances to his office for safe care. For this reason he tries to schedule as much care in one visit as possible but feels this is inconvenient for these patients at the very lease. Dr. Wise does not provide root canal, periodontal surgery or involved extractions. Finding a latex safe office for referrals is another inconvenience for Dr. Wise and his patients as very few exist at this time.

Dr. Wise describes his latex allergic health care worker patients as having learned to ask the right questions, being demanding when it is needed, staying informed and advocating for themselves in terms of health care choices. He noted the appreciation that he receives from them for his efforts is gratifying.

Although Dr. Wise is not sure how soon the dental profession will move to address latex safe standards, he feels the changes needed are minimal and the benefits are great for patients and staff. He can be reached at 413.243.1222.

The members of the MNA Congress on Health and Safety appreciate and applaud Dr. Wise’s willingness, interest, time and efforts in protecting the health of his staff and responding to the needs of latex allergic nurses and others.