Download occupational hazards of cement dust on oral cavity: a brief review

OCCUPATIONAL HAZARDS OF CEMENT DUST ON ORAL CAVITY: A BRIEF
REVIEW
Sultan, A.M.,
MBBS, M. Phil, Ph.D.,
Department of Physiology, College of Medicine,
King Khalid University Hospital, Riyadh.
Running title: Effects of Cement dust on oral cavity.
Key words: Occupational hazards, Cement dust, Teeth, Periodontal disease.
Address for correspondence:
Dr. Sultan Ayoub Meo, Department of Physiology, College of Medicine, King Khalid
University Hospital, P.O. Box 2925. Riyadh 11461. K.S.A.
Tel: 009661-4671604. Email: [email protected]
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ABSTRACT
Oral hygiene plays a significant role in the general health, an acceptable oral hygiene prevent
the community from many diseases not only at the oral cavity level but also at systemic level
of the body. Many agents affect the oral health including environmental and occupational
factors. A lot of enquiries were directed that Occupational exposure to substances like
asbestos, coal products, welding fumes, wood dust, cotton dust, cement and many other
industries produce smoky / dusty environment. Especially in developing countries millions of
people daily worked in a dusty environment, the cement industry is also one of the industries
that produce dust. The frequently reported symptoms in cement mill workers are cough,
phlegm production, chest tightness, impairment of lung functions, bronchial asthma,
headache, fatigue and also carcinoma of lung, stomach and colon. However, with respect to
oral cavity, the commonly reported symptoms in cement mill workers are inflammation of
gums (gingivitis), calculus and pockets formation, dental caries and non carious tooth surface
loss. No previous work has attempted to evaluate the effects of exposure to dusty
environment e.g., cement dust and by considering its effects on oral cavity similarly no
review was published to collectively highlight the general effects of cement dust on oral
cavity especially the teeth. Therefore, the purpose of this review was to highlight the different
studies concerning cement dust and its potential toxic effects on oral health situation in
particular teeth of workers in the cement industry.
Key words: Occupational hazards, Cement dust, Teeth, Periodental disease.
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Background:
Occupational and environmental respiratory disease has a long history, observations of the
relationship between health and environment can be traced, in which philosophic reasoning
and observation led to the idea that ill health resulted from an imbalance between human
beings and their environment. Industrial, technologic, scientific, political and social
developments led to interventions that shaped contemporary responses to occupational and
environmental disease. Technology altered the nature of work and created new hazards and
social reformers brought the new dangers to public attention. The deteriorating urban
environment has caused health problems associated with air pollution, drinking water
problem, sewerage disposal and the growth of slums. The rapid development of mines and
factories led to polluted air, polluted water and inordinate number of occupational diseases
and accidents1.
Cement industry is one of the industries that create dust. The story of the invention of cement
was begin when creature beings start to made structures for their living which were composed
of earth some times raised in the form of walls or domes by ramming successive layers of
stone blocks, set one above another without the aid of any cementing material as in
prehistoric megalithic structures and in the cyclopean masonry of Greece. In early eleventh
century human beings start to mix a clay and sand lime stone with each other to provide
support to their structures. The usual attribution to Joseph Aspdin, in October, 1824, used a
hard lime stone for repairing of roads, crushed and calcined it and mixed the lime with clay,
grinding to fine slurry with water. Then he broke the mixture into suitable lumps and calcine
them in furnace, similar to a lime kiln till the carbonic acid is expelled. The mixture was so
calcinied and ground, beat or rolled to a fine powder. The name Portland cement was given to
the product from a fancied resemblance of the color of a cement after setting to Portland
stone2. In developing countries millions of people work daily in dusty environment especially
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in construction industries. Cement is one of the leading construction industry in which
maximum number of employees were engaged at a time.
Characterization:
Cement may be defined as a gray powder-like adhesive substance3 capable of uniting
fragments or masses of solid matter to a compact whole. It may also be defined as mineral
dust which when mixed with a water form a plaster like adhesive mass 4.
Compositions:
Portland cement is a combination of calcium oxide (CaO) (62% - 66%), silicon oxide (SiO2)
(19% - 22%), Aluminum tri oxide (AL2O3), (4%-8%), ferric oxide (Fe2O3) (2% - 5%),
magnesium oxide (MgO) (1% - 2%) 5 and also selenium 6, thallium 7 and other impurities8.
Types:
There are two types of cement, natural and artificial cement. The artificial cement is also
called Portland cement. Portland cement is further classified into Ordinary or Rapidhardening cement, Sulphate resisting cement, White cement, Colored cement, Low heat
cement, Masonry cement, Hydrophobic cement, Water-replant cement, Expanding and non
Shrinking cement, High Aluminum cement, Blast furnace cement and Oil well cement 2.
Pathogenesis:
The route of entry of cement dust in the body is respiratory tract and / or through the
gastrointestinal tract by inhalation or swallowing respectively. Both routes of entry are
exposed to numerous potentially harmful substances in the cement mill environment .9 The
deposition of inhaled particles influenced by the physical and chemical properties of the
inhaled agent and also by various host factors. The physical properties of importance include
particle size and density, shape and penetrability, surface area, electrostatic charge, and
hygroscopicity.10 The deposition of inhaled material is primarily dependent on particle size of
solids substances and is best described in forms of an aerodynamic diameter. All particles
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with an aerodynamic diameter in excess of 10m are deposited on the mucous membrane in
the nose and pharynx. Because of their momentum, they do not follow the air stream as it
curves downward into the lungs and they impact on or near the tonsils and adenoids in the
back of pharynx. Particles between 3 and 10m in diameter can be deposited throughout the
tracheobronchial tree, where they initiate reflex bronchial constriction and coughing. Particles
between 0.1 and 3m in diameter are mostly deposited within the alveoli. Particles smaller
than 0.1m remain in the air stream and are exhaled 11. However, the particles enter through
the oral cavity are either split out or swallowed with saliva. The cement particles enter into
the oral cavity, were attached with gums and teeth and produce friction and cause
inflammation of gums as well as damage the teeth by its exasperating properties. The
pathogenesis is due to its Irritating and sensitizing properties.
Effects of Cement dust:
General and systemic effects:
Prolong exposure to cement dust, can develop local and systemic effects like cough, phlegm
production, chest tightness, impairment of lung functions, pneumoconiosis, skin irritation,
dermatitis, skin burn, conjunctivitis, headache, fatigue12 and also carcinoma of lung, stomach
and colon 13,14.
According to previous studies reported with respect to oral cavity, the frequently reported
symptoms in cement mill workers are inflammation of gums / gingivitis, calculus and pockets
frmation, dental caries, loss of surface area of teeth and also periodontal diseases16-20.
.
Effects on oral cavity:
Many metals are used and / or produced in different industries and effect their workers, these
metals are deposited in oral tissue if inhaled during breathing or ingested15. In cement
industry cement dust contain few metals and effects the different tissues including oral cavity.
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Struzak and Bozyk
16
observed the condition of oral mucosa in the workers of the cement
plant. Clinical examination demonstrated in all workers exposed to cement dust features of
mechanical trauma and oral mucosal inflammation.
Tuominen 17 reported the effect of cement and stone dust on teeth, the sample consisted of 36
workers who had been exposed to the dust and 62 control workers. Tooth surface loss was
observed in 72.2 per cent of the exposed workers and in 48.4 per cent of the controls. In both
the maxillae and the mandible the amount of tooth surface loss was greater in the exposed
workers than in the controls and both anterior and posterior teeth were affected. These
findings indicate that tooth surface loss caused by work-related dust should be considered an
occupational hazard.
Wysokinska
18
Using histochemical methods and activity of alkaline and acid phosphatase
was determined in the gingivae of 38 workers aged from 26 to 59 years employed in work
with greatest exposure to dust. The control group comprised 11 men aged 23 to 49 years, not
exposed to cement dust. The activity of alkaline phosphatase in the group with exposure and
with deep gingivitis of lower intensity was very high, while it was lower in the group with
highest intensity of the inflammatory process. However, the activity of acid phosphatase
increased with increasing intensity of pathological changes.
Bozyk and Owczarek
19
showed that the intensity of the parodontal disease was greater in
workers exposed to cement dust than in controls, and a very high incidence of deep
parodontitis was noted in young workers in the cement plant.
Petersen and Henmar
20
observed the oral health condition of workers in the stonework
industry and describe the prevalence and severity of dental diseases. They reported that
workers exposed to dust revealed a high prevalence of dental caries with number of decayed,
missing, and filled surfaces. The workers' periodontal conditions was poor. They also
reported the cases of teeth with gingivitis, calculus and pockets deeper than 5 mm. The
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prevalence of dental abrasion was 100%, in particular, abrasion was observed on the front
teeth. However, The severity of abrasion and the affection ratio increased by duration of
exposure to dust.
Conclusion:
Along with systemic effects Cement dust may contribute inflammation of gums / gingivitis,
calculus and pockets formation, dental caries and non carious tooth surface loss.
Recommendations:
Cement industry workers should wear protective attire, mask, safety goggles and mandatory
get pre-employment and periodic medical surveillance. For oral hygiene point of view, these
workers should visit dentist at lease twice in a year. These measures would help to identify
susceptible workers in due time, improve the technical preventive measures that will decrease
the risk of occupational hazards of cement dust in the cement industry workers.
Acknowledgement: I am thankful to Dr Khalid Almas Assistant Professor College of
Dentistry, King Saud University Riyadh, for his valuable suggestions.
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