Virginia Beach dentist helps reveal disease cluster among colleagues

Photo: Damien Walmsley via Flickr

In a recent piece for the Virginian-Pilot, reporter Elizabeth Simpson told the story of a local dentist whose hunch about his rare illness helped reveal a troubling disease cluster among fellow dental professionals.

It was four years ago that Virginia Beach dentist Robert Pellerin was diagnosed with idiopathic pulmonary fibrosis (IPF), a mysterious and incurable ailment that scars and hardens the tissues of the lungs.

“Idiopathic’ means the cause is unknown,” Simpson wrote, “but Pellerin theorized that the culprit was exposure to silica and other materials used in dental treatments like crowns, veneers and sealing products.”

Federal safety and infection control rules now require dental care providers to wear protective masks and gloves, but such standards were not in place when the 73-year-old Pellerin began his career drilling and repairing teeth. He recalled that sometimes in his early days as a dentist he would choke a little on the airborne debris generated as he ground and polished restorative materials.

He did not smoke and so blamed allergies after developing a chronic cough. It was only after Pellerin also came down with pneumonia that a radiologist identified the signs of IPF in a chest x-ray. The early diagnosis allowed Pellerin to seek treatment for an ailment that typically claims victims in two to five years, Simpson wrote.

At the Inova Advanced Lung Disease and Treatment Center in Northern Virginia, Pellerin shared his suspicions about the possible occupational links to his illness with the program’s medical director, Steven Nathan. The physician told Pellerin he was not the first dentist he had treated for IPF.

Pellerin also called the Centers for Disease Control and Prevention (CDC).  “His effort prompted investigators to review records of 894 patients treated for IPF at the Virginia center from September 1996 to June 2017,” Simpson wrote.

The investigators, who released their findings in a March CDC report, said they identified eight dentists and one dental technician among the IPF patients whose records they reviewed.

“That’s 23 times the rate that would be expected in the general population, an alarming statistic made headlines in health stories across the country,” Simpson wrote.

The CDC finding represents “the first known described cluster of IPF occurring among dental personnel,” investigators wrote. The study had its limits because it only included records from one IPF treatment center. Also, some of the patients had other risk factors for IPF such as exposure to dust and tobacco smoke. Plus, there were no biopsy specimens to compare.

Then there was this: seven of the nine dental workers had already died.

Pellerin, who was not named in the report, was the only one of the nine available for investigators to interview.

“It was like he was the last man standing,” Pellerin’s wife Linda Pellerin, a dental hygienist, observed in Simpson’s story.

The questions he raised deserve more study, according to the CDC report.  “Dentists and other dental personnel experience unique occupational exposures, including exposure to infectious organisms, dusts, gases and fumes. It is possible that occupational exposures contributed to this cluster,” the authors wrote. “Further investigation of the risk for dental personnel and IPF is warranted to develop strategies for prevention of potentially harmful exposures.”

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