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Dr. Lee Newman:
Beryllium exposure and chronic beryllium disease caused from working with dental alloys

    
 

January 30, 2001

Ohio Citizen Action
614 W. Superior Ave. #1200
Cleveland, OH 44113

To Whom It May Concern:

I have recently diagnosed Chronic Beryllium Disease (CBD) in a dental technician who has worked in the dental field for 13 years. She has symptomatic CBD due her occupational exposures to beryllium alloys used in the production of bridges and crowns. I fear that there are many other such cases like hers in the U.S. dental industry and that action must be taken to raise awareness of the hazards of beryllium in this segment of the American workforce.

The patient developed chronic beryllium disease as a consequence of her employment that involved working with beryllium dental alloys, including Rexillium III. The remainder of her time was spent working with nickel, gold, chromium, silver, and palladium.

From 1987 to 1995 her daily work involved: sandblasting the metal; cutting the metal sprues with a high-speed lathe; removing the bubbles with a hand-held electric grinder and burr; and setting it to make sure it fit the die. This work was performed while wearing only a paper dust mask. The room was approximately the size of a combined living room and dining room. There was a wall vacuum system with moveable hoses used for clean up; however, the room remained very dusty.

In 1996 she worked in a different lab where her duties included: grinding of porcelain; sandblasting; metal finishing; and polishing with a hand-held rouge. This lab also used Rexillium III, but with much less frequency. This work was done without the use of a mask or hood. She was also involved in clean up. A dry vacuum was used daily, and the bag was emptied monthly. The bag was taken outside to be shaken, washed and hung out to dry. Shaking the bag resulted in a dusty cloud. Periodically the carpet would be replaced. Three people worked in this lab.

In 1997, the patient was diagnosed with sarcoidosis based on noncaseating granulomas found in a cervical lymph node biopsy. Sarcoidosis, however, is often mistaken for CBD when based on pathology alone. She was correctly diagnosed with chronic beryllium disease in May 2000 at age 53. Her current diagnosis is based on the following tests:

  1. Bronchoscopy with transbronchial lung biopsies and bronchoalveolar lavage (BAL). The lavage yielded an elevated number of white blood cells with 33% lymphocytes; this is a highly abnormal lymphocytosis and is consistent with CBD. The transbronchial lung biopsies showed non-necrotizing granulomas in the right lung also consistent with CBD;
  2. Abnormal bronchoalveolar lavage beryllium lymphocyte proliferation test (BAL BeLPT);
  3. Pulmonary function tests (PFTs) showing in restricted function and an abnormal diffusing capacity for carbon monoxide (DLco);
  4. Exercise tests resulting in an abnormal gas exchange with a drop in oxygenation that was exercise-limiting; and
  5. High resolution CT scan that revealed mild mediastinal lymphadenopathy with irregular linear and hazy opacities bilaterally with greater involvement in the upper lobes consistent with our previous publications of the CT pattern of CBD.

She is symptomatic, experiencing shortness of breath after walking up one or two flights of stairs or with rapid walking, dry cough, decreased energy, and bloating from the prednisone that is used to treat her CBD. She is currently taking prednisone to try to improve her CBD and halt disease progression.

Since 1996 she has worked in a lab where she spends most of her time in the model department. Rexillium III has been used once since she has been there and her boss sent her home once he learned of her CBD diagnosis. She reports that this lab was also dusty, with poor attention to industrial hygiene.

Notably, she demonstrated very limited understanding of the hazards of beryllium and received no information from her employers concerning the risks. Prior to diagnosis she had never seen an MSDS for beryllium alloys.

It is my impression that even today her current and past employers, like others in this industry, are largely unaware or neglectful of the hazards of beryllium.. There has been information published in the medical literature on the beryllium hazards for dental workers, but such information is unlikely to reach this segment of industry aware of the hazards. I strongly encourage OSHA to take action in making this industry and its workers aware of the beryllium hazard.

If there is additional information that you would find helpful, please contact me. As always, I am interested in prevention of occupational lung disease and will help any way that I can.

Sincerely yours,

Lee S. Newman, M.D., M.A.

Head, Division of Environmental and Occupational Health Sciences
National Jewish Medical and Research Center

Professor
Department of Medicine and Department of Preventive Medicine and Biometrics
Division of Pulmonary Sciences and Critical Care Medicine University of Colorado School of Medicine

Cc:
Albino Perez, , CDT, M.S. Ed
John Rosenberg
Peter Infante, M.D.