Significance of patient occupations and oral diseases. The environment is one of the many determinants of human health. The key to man’s health lies largely in his environment, and the study of the disease is the study of man and his environment. Hippocrates was the first person who related the environment and the disease. Later the concept of disease and environment association was revived by Pettenkofer.[1]Occupational environment’ means the sum of external conditions and influences, that prevail at the place of work and which have a bearing on the health of the working population.[1] The interaction of the individual with the physical, chemical and biological agents of the workplace place a great bearing on his physical and psychological health.

2. Significance of patient
occupations and oral
diseases
BY
R O M I S S A A A L Y
A S S I S T A N T L E C T U R E R O F
O R A L M E D I C I N E ,
P E R I O D O N T O L O G Y ,
D I A G N O S I S A N D D E N T A L
R A D I O L O G Y ( A L - A Z H A R
U N I V E R S I T Y )

3. The environment is one among the many determinants of
the human health. The key to man’s health lies largely in his
environment, and the study of the disease is really the study
of man and his environment.
Hippocrates was the first person who related the environment
and the disease. Later the concept of disease and environment
association was revived by Pettenkofer.[1]

4. ‘Occupational environment’ means the sum of external
conditions and influences, which prevail at the place of work
and which have a bearing on the health of working
population.[1]
The interaction of the individual with the physical, chemical and
biological agents of the work place as great bearing on his
physical and the psychological health.

5. Exposure to chemical, physical, and biological agents in the
workplace can result in adverse effects on workers ranging
from simple discomfort and irritation to debilitating
occupational diseases such as lung fibrosis, neuropathy,
deafness, organ damage, and cancers of various sites.[3]

10. Dental Erosion

11. Dental erosion has been defined as a progressive, irreversible
loss of dental hard tissue by a chemical process, usually by acids
other than those produced by plaque bacteria.[4]
The erosion of teeth was most commonly seen in the individuals
who worked in acid factories.[5-15]
It is a common oral finding in professional wine tasters. There
existed a significant difference for the erosion between the wine
tasters and the non-wine tasters.[16]

12. In battery factory workers the incidence of erosion was
more common in the anterior region[7,19] and the posterior region
showed incidence of attrition.[7]
However, in another study in organic and inorganic acid factories,
showed the prevalence of erosion to be more in maxillary
teeth[11,19] contrasting results were reported in the recent study
where the erosion was seen in the mandibular anterior teeth.[15]

13. Dental erosion was noticed even in the female food industry
workers, owing to the inhalation of the dust containing tartaric acid,
sucrose, magnesium sulphate and sodium bicarbonate.
It also noted that the Longer the duration of exposure more the
chances of dental erosion.[

14. Periodontal Diseases

15. the amount of sugar intake and the sweeting agent use along with
sugar increased the risk of periodontal diseases.[25]
Age of the worker was directly proportional to the poor periodontal
health and the probing depth.[21,26] Apart from this the habits had
their own share of adding the burden to the prevalence of periodontal
diseases.[26]

16. it was reported that there existed no significant difference in the
periodontal status of three groups of the factory worker; mining
equipment factory, a cotton mill and a factory of heavy machinery.
There was an increase in the periodontal pocket and attachment
loss prevalence, and it was positively associated with age of the acid
factory workers[14,28] then the control group.

17. Dental Caries

18. High caries index is one of most common oral findings in
the mining workers.[20,22,24,26,29] The literature shows that the
workers working in sweet food industries are more prone to have
higher caries index.[30,31]
Nevertheless, Massiln et al., through their study discards the
hypothesis that airborne sugar is an occupational dental health
hazard[32] and same was supported by the statement that the
confectionery industry did not seem to be an exceptionally hazardous
environment for dental health in general.

19. Dental Attrition/Wear

20. The duration of the working has a definite influence
on the enamel wear, longer the person has worked in the
mining field greater are the chances of the enamel wear. Same
has been proved in the earliest study to the latest study on the
dental wear and the working environment.[20,34,35]

21. This observation can be attributed to the mining environment,
specially the abrasive component of the air which they breathed.
Hundred percent abrasion was observed by Peterson and
Henmer (1988) in the granite factory workers and was particular
severe in the anterior teeth.[20]
So, far the occupational related abrasion studies were conducted
on cement factory workers, granite factory workers and olivine
mining workers

22. Para Functional Activities

23. Studies have shown that the individuals work in the environment
with chronic exposure to noise have greater chances of acquiring
para functional habits like bruxism.[38]
The level of noise usually ranged from 99 to 105 decibels, with
some extreme values to 130 decibels.[38] The sleep bruxism was
associated with the psychological job stress.[39-44] But it also has
been reported that sleep bruxism is weakly associate with certain job
stresses in man.[45-47]

24. a statistically significant difference was noted for different job
categories and the bruxism, with higher prevalence in highly
responsible jobs.[46] There exists a direct correlation between
temopromandibular joint disorder and bruxism.[47-50]

25. Oral Mucosal Lesions and Oral Cancer

26. The exposure of the air borne dust particles in the mining, or
the working atmosphere will lead to the cancerous lesion which
can be mortal to the workers.
Even the workers who were exposed to acidic fumes
were at risk of developing in oral mucosal lesions[52,53] and this
was more so with the workers without lip seal.[

27. The habits like tobacco chewing and pipe smoking
apart from mining environment can act as triggering factors in
causing the oral mucosal lesions.
The granite exposure, when pertaining to the general health,
may be the etiological factor for the initiation and promotion of
the malignant neoplasms.[57]

29. In regard to oral cancer, 405,000 new cases are expected
to occur every year worldwide, 80% of them in developing
countries, according to the Jose Alencar Gomes da Silva
National Cancer Institute (Instituto Nacional de Câncer
José Alencar Gomes da Silva — INCA).

30. The occupations found for the analyzed population were
categorized according the classification of risk in economic
activities recommended by the Ministry of Labor, Regulatory
Standard 046.

31. According to this classification, risk grade 1 corresponds to
economic activities with low or mild impact and grade 4 to
activities which pose higher risk to the health and safety of
workers, including occupational diseases. Risk grades 2 and 3
are intermediate levels. Thus we were able establish the degree
of risk posed by the located occupations

33. Cleaning services employ many workers worldwide,
who are daily exposed to several chemicals often indoors.
In addition to their primary components, cleaning products
also form subproducts when in contact with air
pollutants and construction materials.

34. . One of such is formaldehyde, which is present as primary and
secondary product. Disinfectants are considered the most
dangerous to health13,14.
Some evidence indicates association between exposure to
formaldehyde and OCC, OPC nasopharyngeal and
hypopharyngeal cancer.
 In this study, the largest number of cases of nasopharyngeal
cancer corresponded to this group of workers.

35. Asbestos is also present in construction, an economic
activity identified in our study.
The pharynx is one of the body sites through which inhaled
asbestos fibers travel, and there are clinical and histological
similarities between pharyngeal, laryngeal and lung cancer. Many
studies reinforce the association between occupational exposure
to asbestos and OCC and OPC
Asbestos is the name given to a group of naturally occurring
fibrous minerals that are resistant to heat and corrosion.

36. . Association with construction occupations, such as
carpenters and painters, was found, even after adjusting the
data for smoking and alcohol consumption.
The nasal and oral cells of carpenters — a category which
contributed with a large number of cases in this study —
might undergo genetic damage due to exposure to wood
dust, resulting in high risk of chromosomal instability

37. A large number of cases corresponded to agricultural
workers. According to official data, 0.2% of the population
is involved in agricultural occupations and contribute with
10.6% of the total number of cases of OCC and OPC, with
53 times higher risk23.

38. Outdoor workers, such as fishermen, farmers and gardeners,
are at high risk for lip squamous cell carcinoma, which is
associated with exposure to UV radiation7,24-
27.
•Also agrochemicals (pesticides, herbicides and
fungicides) are a part of the occupational exposures of this
population of workers

39. In regard to trade and transport, several studies indicate
that drivers and street vendors, in addition to mechanics
and police officers, are occupationally exposed to PAHs
through inhalation of exhaust fumes (gasoline and diesel
fuel),
oral intake of contaminated dust suspended in the
air and direct skin contact, especially within the
microenvironment of vehicles, which has been shown to be one of
the most contaminated
benzene-derived polycyclic
aromatic hydrocarbons (PAHs)

40. Mechanics are also a noteworthy group as concerns occupational
hazards. In a study performed in Brazil, Andreotti
et al. found that vehicle repair workers exhibited high risk
for OCC and OPC independently of age, smoking and
alcohol consumption, and that risk increased with prolonged
exposure31.

41. In addition to PAHs, vehicle mechanics are also
exposed to asbestos fibers and glass particles from insulators,
welding fumes and sooth, heavy mineral oil and strong
acid mists, metal and abrasive dust, aldehydes and solvents,
among others.

44. CHEMICAL TOXINS INVOLVED IN
CONTACT/OCCUPATIONAL
VITILIGO

45. There is anecdotal and experimental evidence demonstrating
that certain environmental chemicals are selectively toxic to
melanocytes, both in culture and in vivo (20, 51, 52) and are thus
responsible for instigating vitiligo (12, 50).
Majority of these toxins are aromatic or aliphatic derivatives of
phenolsand catechols (Table 1). Some of these compounds have
been added to bleaching creams, products used to remove hyper-
pigmented lesions

48. Foreign Bodies and Heavy Metal Exposure

49. Accidental or intentional introduction of foreign
materials into the oral cavity can result in color changes of
oral soft tissues. Graphite particles of pencils, various dyes
and inks, and charcoal dentifrices have been reported to
cause oral bluish-black pigmentation.10,24

50. The rare accidental or occupational exposure to heavy
metals that leads to systemic intoxication commonly results
in diffuse areas of oral pigmentation.29
 For example, bismuth, once used as a treatment for syphilis,
produces diffuse oral pigmentation as well as a thin blue-black
line involving the marginal gingiva.
Lead poisoning or plumbism can result in diffuse
pigmentation and a lead line (Burtonian line) along the
interproximal and free gingival margins.

51. The oral features of mercury poisoning include diffuse grayish
discoloration of the alveolar gingiva.
Argyria (silver pigmentation) can produce a permanent diffuse
bluishgray pigmentation with a shiny metallic luster, most
frequently of the hard palate.
The deposition of silver can be observed as a dark black
discoloration after the application of silver nitrate to oral
ulcerations.

54. TMD

55. Recently, the biopsychosocial model has gained interest, fostering a
broad debate about the impact of emotional factors on the etiology of
TMD [4–7].
Emotional distress, stress, anxiety, and depression have been related
to the occurrence of signs and symptoms of TMD in a variety of
populations [8–10].
•These factors, particularly stress and anxiety, can cause muscle
hyperactivity and the development of parafunctional habits,
leading to TMJ microtrauma and muscle lesions [11].