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U. S. Department of Labor
Occupational Safety and Health Administration
Directorate of Science, Technology and Medicine
Office of Science and Technology Assessment
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Preventing Adverse Health Effects From
Exposure
To Beryllium In Dental Laboratories
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Hazard Information Bulletins |
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HIB 02-04-19 (rev. 05-14-02) |
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The Occupational Safety and Health Administration's
(OSHA's) Directorate of Technical Support issues Hazard
Information Bulletins (HIBs) to provide information
about occupational hazards and/or to provide information
about noteworthy, innovative, or specialized
procedures, practices, and research that relate to occupational
safety and health. These bulletins are not standards
or regulations and they create no independent
legal obligations. They are advisory in nature, informational
in content, and are intended to assist employers in
providing a safe and healthful workplace.
Further information about this bulletin may be
obtained by contacting OSHA's Directorate of Health
Standards Programs at 202-693-1950.
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Purpose
This Hazard Information Bulletin (HIB) is to
inform employers and employees about the risk of
dental laboratory technicians developing chronic
beryllium disease (CBD). It also provides information
on the ways in which beryllium exposures can be
reduced, the type of protective equipment which can
be worn to reduce exposure, and on the type of
medical surveillance procedures that can be used to
identify workers who may be sensitized to beryllium,
or who may be in the early stages of CBD.
Background
Chronic Beryllium Disease Caused by Working
With Dental Alloys Containing Beryllium: The
Occupational Safety and Health Administration
(OSHA) is concerned that cases of chronic beryllium
disease (CBD) are continuing to occur among dental
laboratory technicians working with dental alloys
containing beryllium.1 CBD is a serious lung disease
that can be disabling and even fatal. CBD has been
reported among dental laboratory personnel in the past
(refs. 1-3), and a recent letter to OSHA indicates that
these cases continue to occur (ref. 4).
Workers exposed to beryllium in dental laboratories
are covered by the current OSHA Permissible
Exposure Limits (PELs) for beryllium. The OSHA
PELs for beryllium allow exposure to 2 micrograms
per cubic meter of air (2 µg/m³) as an 8-hour time-weighted
average (TWA), between 5 µg/m³ and 25
µg/m³ exposure for up to 30 minutes at a time, and 25 µg/m³ as a maximum peak limit that can never be
exceeded. Several studies and reports have questioned
whether the current 2 µg/m³ PEL for beryllium
in the workplace is adequate to prevent the
occurrence of CBD among exposed workers (refs.
5-7, 9-14).
The Bulletin presents a case report of a dental
laboratory technician who was recently diagnosed
with CBD. It also offers information on the types of
engineering controls, work practices, training,
personal protective equipment and housekeeping
procedures that can be used to reduce beryllium
exposure and the risk of CBD to individuals involved
in casting, sprue cutting, grinding, polishing and
finishing of dental alloys containing beryllium. This
Bulletin also provides information about a health
surveillance method that can be used to identify
beryllium-sensitized individuals.
Case Report
Beryllium Dental Alloy Exposure and Work Practices: A 53-year-old woman who had worked
as a dental laboratory technician for 13 years was
diagnosed with CBD in May 2000. From 1987 to
1995, her daily work involved sandblasting beryllium
dental alloy, cutting the metal sprue from the alloy
with a high-speed grinder, removing the bubbles with
a hand-held electric grinder and deburrer, and setting
the restoration to make sure it fit the die. While
performing this work, the worker wore a surgical-type
paper mask. Although a household-type wall
vacuum system with movable hoses was available for
cleanup, the laboratory was reported to be very dusty.
Beginning in 1996, the woman worked in a
different dental laboratory, where her duties included
the grinding of porcelain restorations, sandblasting,
metal finishing, and polishing restorations with rouge.
The dental technician also was involved in clean-up
activities, which included using a household-type dry
vacuum, emptying the bag daily by taking it outside
and shaking it, washing the bag, and hanging it outside
to dry. Shaking the bag produced a dusty cloud.
Although this lab used a beryllium dental alloy, it did
so much less often than the dental laboratory where
this worker had previously been employed. At the
second laboratory, work was performed without the
use of a mask or hood. Airborne beryllium samples
were not taken at either of the dental laboratories
where this woman worked.
The Laboratory Technician's Awareness of the
Hazards of Beryllium Exposure: The laboratory
technician reportedly received no information from
her employers concerning the health hazards associated
with beryllium exposure. The OSHA Hazard
Communication Standard (29 CFR 1910.1200)
requires that manufacturers of hazardous substances
such as dental alloys containing beryllium provide a
copy of a Material Safety Data Sheet (MSDS) to their
customers along with the beryllium dental product.
MSDSs must describe the hazards posed by these
substances and ways workers can be protected from
exposure.
The Hazard Communication Standard also
requires employers using hazardous chemicals to train
workers on the hazards to which they are exposed
and on how to use and work safely with the product.
An MSDS for a dental alloy containing beryllium
must indicate the health effects of exposure: (1) that
beryllium can cause chronic beryllium disease in
exposed workers; (2) that acute beryllium disease,
which has symptoms resembling those of pneumonia
or bronchitis, may occur as a result of exposure to
beryllium. Although this form of beryllium disease is
now rare, it has been reported in a single case involving
the grinding of dental alloys containing beryllium
(ref. 15); and (3) that beryllium is classified as a known
human carcinogen by the International Agency for
Research on Cancer (ref.16).
Diagnosis of Chronic Beryllium Disease and
Confusion with Other Lung Disease: In 1997, the
laboratory technician was diagnosed as having
sarcoidosis. CBD can be mistaken for sarcoidosis
when the diagnosis is based on clinical observation
or x-rays alone. The worker was correctly diagnosed
with CBD in May 2000. The diagnosis was based
on the results of additional diagnostic procedures that
identified a positive beryllium lymphocyte proliferation
test result and abnormal lung pathology, physiology
and function. She is currently experiencing
symptoms of CBD including dry cough, decreased
energy, shortness of breath after walking up one or
two flights of stairs or after walking rapidly on a
horizontal surface.
Identification of Dental Alloys That Contain Beryllium
Not all dental alloys contain beryllium. Dental
laboratory technicians need to inquire about the
contents of the alloys they are using. Information
about the contents of dental alloys can be found in
the MSDSs that accompany these products to the
dental laboratory.2 The synonyms and trade names
for some beryllium-containing dental alloys and
products are listed in the Appendix to this document.
Chronic Beryllium Disease
CBD primarily affects the lungs. CBD may
occur among dental laboratory technicians when they
inhale dust containing beryllium when working on
items such as dental crowns, bridges, and partial
denture frameworks made from dental alloys containing
beryllium. CBD may develop within months after
initial exposure to beryllium or may have a very slow
onset and not develop until years after exposure to
beryllium has occurred. The amount or length of
exposure to beryllium necessary to cause a specific
individual to develop CBD is not known, but recent
information suggests that even short exposures (weeks
or months) to levels of beryllium below OSHA's PEL
of 2 µg/m³ averaged over an 8-hour day may lead to
CBD in some workers (refs. 5-7).
Beryllium Sensitization: Only workers who
have become sensitized to beryllium are believed to
develop CBD. A sensitized worker is one who has
developed an allergic-type reaction to beryllium.
Some workers may become sensitized within weeks
or months of exposure on the job, while others may
not become sensitized until after leaving a job where
there has been beryllium exposure, and some workers
never become sensitized. Beryllium sensitization
may be detected through the use of a blood test called
the BeLPT, which stands for Beryllium Lymphocyte
Proliferation Test. This test measures how specific
white blood cells called lymphocytes react to beryllium.
Positive test results mean that a worker is sensitized.
In some cases, persons with CBD do not have
a positive blood lymphocyte test, but do have a
positive response to beryllium using other diagnostic
tests. Sensitization is believed to occur through
inhalation of beryllium dusts or fumes. Particles
containing beryllium that become lodged under the
skin can cause skin lesions and may have the potential
to induce sensitization. There are no known symptoms
associated with sensitization to beryllium. It is
not known whether everyone who is sensitized will
eventually develop CBD, however, between 46% and 100% of surveillance-identified workers with beryllium
sensitization already have CBD at the time of
initial clinical assessment for the disease (refs. 6, 11,
12, 17-21). It is currently estimated that individuals
with beryllium sensitization, but without CBD, have
about a 10% chance per year of progressing to CBD
(ref. 22).
Signs and Symptoms of Chronic Beryllium Disease:
Workers with CBD may not be aware that they have the disease or may have no or only mild
symptoms. Workers with clinical evidence of CBD may have one or more of the following signs or symptoms:
unexplained cough; shortness of breath, especially with activity; fatigue; weight loss or loss of appetite;
fever; or night sweats. Workers having CBD, but no symptoms can be diagnosed today because of
advances in medical testing. Because the disease may develop slowly over a period of many years, workers
may have the disease for a long time without knowing it. The individuals with CBD, who do not have
clinical symptoms of disease are generally referred to as having asymptomatic CBD, or subclinical CBD.
Recommendations
Engineering Controls, Work Practices,
Personal Protective Equipment And Training: The
following measures can be used to reduce the exposure
of dental laboratory technicians to beryllium:
1. Engineering Controls
Engineering controls are the first line of defense
in employee protection. Therefore, employers should
provide appropriate engineering controls and should
train their workers in their use and in work practices
to ensure that dental laboratory technicians exposures
to beryllium are maintained below the current OSHA
PELs. The following engineering controls are
recommended:
- Where possible, alloys that do not contain beryllium
should be substituted for beryllium-containing
alloys in dental work;
- All procedures related to casting, cutting, grinding,
or polishing beryllium-containing dental alloys
should be conducted using properly designed and
installed local exhaust ventilation;
- Vacuum systems and local exhaust ventilation
systems should be equipped with high-efficiency
particulate air (HEPA) filters.3
2. Work Practices to Reduce Beryllium Exposure
The following work practices should be used to ensure that the exposures of dental laboratory technicians to beryllium are reduced:
- Substitute work practices that generate less dust, such as hand filing, for procedures that produce
more dust, such as power grinding;
- Use local exhaust ventilation (hoods) properly to
minimize the generation of dust and fumes when
working with beryllium-containing alloys;
- Use HEPA vacuums to clean equipment and the
floor around the work area;
- Prohibit the use of compressed air to clean parts or
working surfaces;
- If a wet mop is used for cleaning, do not leave a
film of dust on the floor after the water dries;
- Monitor employee exposures to airborne beryllium
dust and fume, using personal sampling techniques
on a regular basis, to ensure that beryllium
exposures are below the OSHA PELs and are as
low as feasible;
- Limit the number of workers who have access to
areas where beryllium-containing alloys are being
cast or fabricated;
- Use appropriate respiratory protection.
3. Hygiene, Clothing, Housekeeping Procedures
and Personal Protective Equipment
Dusts containing beryllium can be carried into
cars and taken home on the shoes, clothing, and hair
of workers exposed on the job (ref. 23). CBD cases
have occurred among the family members of
beryllium-exposed workers. To minimize skin contact and to reduce take-home exposures and
beryllium contamination of non-work areas, ensure
that protective clothing is worn in areas where dental
appliances and restorations containing beryllium
alloy are being made. (Protective clothing includes
laboratory coats, booties, and other types of garments
worn over the employee's skin, hair or personal
clothing.) In addition, employers should ensure that
employees:
- Wash their face, hands, and forearms before
eating, drinking, smoking, or applying cosmetics;
- Do not take food items, drinks, cosmetics, or
tobacco products into the work area;
- Use gloves and arm sleeves to minimize skin
exposure;
- Do not enter the eating area wearing protective
clothing unless properly cleaned beforehand;
- Store street clothes separately from work clothes
in a clean area;
- Keep their work clothes as clean as possible
during the workshift;
- Vacuum their work clothing before removal
(clothes must not be cleaned by blowing or
shaking);
- Wipe off their shoes before leaving the work area
if booties are not worn;
- Do not leave the workplace wearing protective
work clothing or equipment or take it home for
laundering;
- Place work clothes in a covered container at the
end of the workshift;
- At a minimum, wash their hands and face before
leaving the worksite; and
- If possible, shower and change into street clothes
prior to leaving the facility.
4. Respiratory Protection
Recent studies suggest that exposure to beryllium
at levels below OSHA's 2 µg/m³ PEL may have
caused CBD in some workers (refs. 5-7, 9-14). Therefore,
even in situations where exposures may be
below the 2 µg/m³ limit, employers should consider
providing their beryllium-exposed workers with
National Institute for Occupational Safety and Health
(NIOSH)-approved air-purifying respirators
equipped with 100-series filters (either N-, P-, or Rtype
as applicable) or, where appropriate, powered
air-purifying respirators equipped with HEPA filters,
particularly when their workers are involved in
beryllium-containing alloy fabrication where dust can
become airborne. Wearers of respiratory protection
must be medically approved to wear a respirator and
must be fit tested to ensure that the respirator they
use fits properly (see OSHA's Respiratory Protection
Standard, 29 CFR 1910.134). [Note: in the case
report presented above, the laboratory technician
either wore no mask or wore a surgical-type mask.
Use of a surgical-type of mask does not provide
adequate respiratory protection because it does not
seal to the face or effectively filter out fine particles.
Use of this type of mask provides a false sense of
security and does not protect the workers from
exposure to airborne beryllium fume or dust.]
5. Training and Information
Employers must comply with the OSHA
Hazard Communication Standard, 29 CFR
1910.1200. Additional information will help
employers and employees prevent exposures. The
following information includes both requirements and
recommendations that will help to protect employees
from the adverse health effects associated with
beryllium exposure. Employers should ensure that
employees exposed to beryllium are trained in and
have access to the following information:
- The specific nature of the operations in their workplace
where exposure to beryllium-containing
alloys may occur;
- Material Safety Data Sheets (MSDSs) for dental
alloys containing beryllium;
- The seriousness of the lung disease (CBD) that
may occur as a result of exposure;
- The signs and symptoms of CBD;
- The potential for developing lung cancer as a
result of exposure;
- The importance of avoiding skin contact with dust
containing beryllium;
- The engineering controls the employer is using to
reduce worker exposures to beryllium-containing
alloys;
- Specific work practices that should be used to
reduce exposure to beryllium-containing alloys;
- The use of appropriate protective equipment,
including respirators and skin protection;
- Methods that may be used to detect the presence
of beryllium in the workplace, such as workplace
monitoring;
- The results of any industrial hygiene sampling the
employer or others have conducted for levels of
beryllium in the dental laboratory;
- The availability of a blood test to determine
whether an exposed worker has become sensitized
to beryllium, namely, the Beryllium Lymphocyte
Proliferation Test (BeLPT); and
- A copy of this Hazard Information Bulletin.
Health Surveillance Methods for Beryllium
Sensitization and Chronic Beryllium Disease:
1. To the Employer
Employers should consider sending beryllium exposed
laboratory technicians to a physician or other
licensed health-care professional to be evaluated for
beryllium sensitization or the presence of CBD.
Surveillance for CBD usually begins with a blood
test for beryllium sensitization (the BeLPT),4 plus any
further evaluation considered appropriate by the
health-care professional. With few exceptions, the
blood BeLPT will detect a response to beryllium
exposure earlier than breathing tests or chest x-rays.
A confirmed positive BeLPT result means that the
individual is sensitized to beryllium. It does not mean
that the worker has or will develop CBD. Some
individuals may become anxious after receiving
information that they are sensitized to beryllium
because of the uncertainty of whether or not they will
develop CBD. These individuals may wish to
consult a health care provider familiar with CBD for
further medical evaluation and counseling.
It is widely believed that beryllium sensitization
is necessary before a worker can develop CBD,
although in some situations sensitization may not be
shown in the blood test. The BeLPT is not routinely
done in most medical laboratories; however, a health
care professional may order this test from the testing
laboratory or one of the medical research centers listed
below. If a worker is sent to a health care professional
for testing, a copy of this Hazard Information
Bulletin should accompany the employee.
2. To the Employee
If you have repaired or fabricated dental
appliances or restorations made from beryllium-containing
alloys and have developed any of the
symptoms listed below, you should inform your
employer and health-care professional of your past
beryllium exposure, or seek information from a
health-care professional who specializes in occupational
lung diseases, to determine whether you may
have developed CBD:
- Unexplained cough
- Shortness of breath
- Fatigue
- Weight loss or loss of appetite
- Fever or night sweats.
If you do not have any of the above symptoms
but are concerned that you may have become sensitized
to beryllium, you should inform your employer
and health-care professional that you would like to
be tested with the blood BeLPT. Take a copy of this
Hazard Information Bulletin with you.
Blood Testing For Beryllium Sensitization:
Only the three medical research centers and the one
laboratory listed below currently offer the blood
test that identifies beryllium-sensitized workers.
Any health-care professional with access to an
overnight courier service may order this test from
one of the facilities listed below. As other research
centers and laboratories develop the capacity to test
workers' blood for evidence of beryllium sensitization,
OSHA will add them to the list.
Medical Research Centers
Cleveland Clinic Foundation
9500 Euclid Avenue, L-15
Cleveland, Ohio 44195
phone: (800) 628-6816
Division of Environmental and Occupational Health Sciences
National Jewish Medical and Research Center
Denver, Colorado 80206
phone: (303) 398-1722
Pulmonary Immunology Laboratory
Hospital of University of Pennsylvania
421 Curie Blvd.
844 BRB II/III
Philadelphia, Pennsylvania 19104
phone: (215) 573-9875
Testing Laboratory
Specialty Laboratories, Inc.
2211 Michigan Avenue
Santa Monica, California 90404-3900
phone: (800) 421-4449
References
- Kotloff RM, Richman PS, Greenacre JK and Rossman MD. "Chronic beryllium disease in a dental
laboratory technician." Am Rev Respir Dis 147:205-207, 1993.
- Muller-Quernheim J, Zissel G, Schopf R, Vollmer E and Schlaak M. " Differential diagnosis of
berylliosis/sarcoidosis in a dental technician." Dtsch Med Wschr 121:1462-1466, 1996. [Ger].
- Brancaleone P, Weynand B, DeVuyst P, Stanescu D and Pieters T. "Lung granulomatosis in a dental
technician." Am J Indust Med 34:628-631, 1998.
- Newman L, "Beryllium exposure and chronic beryllium disease caused from working with dental
alloys." Letter to Charles Jeffress, Assistant Secretary, OSHA, dated January 3, 2001.
- Kelleher PC, Martyny, JW, Mroz MM, Maier LA, Ruttenber AJ, Young DA and Newman LS.
"Beryllium particulate exposure and disease relations in a beryllium machining plant." J Occup Environ
Med 43: 238-249, 2001.
- Newman LS, Mroz MM, Maier LA, Daniloff EM and Balkisson R. "Efficacy of serial medical
surveillance in a beryllium machining plant." J Occup Environ Med 43: 231-237, 2001.
- McInerney JR, Beryllium health surveillance. "Presented at US Department of Energy Chronic
Beryllium Disease Prevention Program (CBDPP) Rule Implementation Workshop, March 6-8,"
Washington, DC, 28 slides.
- McCawley M, Tinkle S, Berakis M and Kent M. "Particle penetration through intact skin and a
method for determining potential exposure through surface contamination." Abstract # 349. American
Industrial Hygiene Conference and Exposition, New Orleans, LA, May 2001.
- Cotes JE, Gilson JC, McKerrow CB and Oldham PD. "A long-term follow-up of workers exposed to
beryllium." Br J Indust Med 40: 13-21, 1983.
- Cullen MR, Kominsky JR, Rossman MD, Cherniak MG, Rankin JA, Balmes JR, Kern JA, Daniele
RP, Palmer L, Naegel GP, McManus K and Cruz R. "Chronic beryllium disease in a precious metal
refinery." Am Rev Resp Dis 135: 201-208, 1987.
- Henneberger PK, Cumro D, Deubner DD, Kent MS, McCawley M and Kreiss K. " Beryllium
sensitization and disease among long-term and short-term workers in a beryllium ceramics plant."
Int Arch Occup Environ Health 74:167-176, 2001.
- Kreiss K, Mroz MM, Newman LS, Martyny J and Zhen B. "Machining risk of beryllium disease and
sensitization with median exposures below 2 ug/m³." Am J Indust Med 30: 16-25, 1
- Stange AW, Hilmas DE, Furman FJ and Gatliffe TR. "Beryllium sensitization and chronic beryllium
disease at a former nuclear weapons facility." Appl Occup Environ Hyg 16:405-417, 2001.
- Balkissoon RC and Newman LS. "Beryllium copper alloy (2%) causes chronic beryllium disease."
J Occup Environ Med 41: 304-308, 1999.
- Rom WN, Lockey JE, Lee JS, Kimball AC, Bang KM, Leaman H, Johns RE, Perrota D and Gibbons
HL. "Pneumoconiosis and exposures of dental laboratory technicians." Am J Pub Health 74:1252-
1257, 984.
- International Agency for Research on Cancer, World Health Organization. IARC Monographs on the
Evaluation of Carcinogenic Risks to Humans: "Beryllium, cadmium, mercury and exposures in the
glass manufacturing industry." IARC, Lyon (France) 58: 41-117, 1993.
- Deubner DC, Goodman M and Iannuzzi J. "Variability, predictive value, and uses of the
beryllium blood lymphocyte proliferation test (BLPT): Preliminary analysis of the ongoing
workforce survey." Appl Occup Environ Hyg 16: 521-526, 2001.
- Kreiss K, Newman LS, Mroz MM and Campbell PA. "Screening blood test identifiessubclinical
beryllium disease." J Occup Med 31: 603-608, 1989.
- Kreiss K, Wasserman S, Mroz MM and Newman LS. "Beryllium disease screening in the
ceramics industry: Blood test performance and exposure-disease relations." J Occup Med 35:
267-274, 1993.
- Kreiss K, Mroz MM, Zhen B, Martyny JW and Newman LS. "Epidemiology of beryllium
sensitization and disease in nuclear workers." Am Rev Respir Dis 148: 985-991, 1993.
- Kreiss K, Mroz MM, Zhen B. Wiederman H and Barna B. "Risks of beryllium disease related to
work processes at a metal, alloy and oxide production plant." J Occup Environ Med 54: 605-612,
1997.
- Newman LS. "Progress in the detection, diagnosis, and treatment of chronic beryllium disease."
Presented at US Department of Energy Chronic Beryllium Disease Prevention Program (CBDPP)
Rule Implementation Workshop, March 6-8, Washington, DC, 52 slides.
- Sanderson WT, Henneberger PK, Martyny J, Ellis K, Mroz MM and Newman LS. "Beryllium
contamination inside vehicles of machine shop workers." Appl Occup Environ Hyg 14:223-230,
1999.
Appendix
| Dental Alloys Containing Beryllium |
| Nickel alloy |
|
Pent V |
Ticonium Premium
100 Denture Alloy |
non-precious
nickel/chrome
ceramic bake-on
alloy |
----- |
Pentillium |
Ultratek |
| ADAN 2 |
Jel-Span |
Polaris |
Uniflo-B |
| Argeloy NP |
----- |
Premium NP |
Unitbond |
| Bak-On NP Pre-Solder |
Litecast B |
Rex V |
Vera Bond |
| Beta |
|
Rexillium |
|
| Biobond II |
Microbond 2000 |
Rexillium III |
Vident 550 NI-CR
Be Alloy |
Biobond II Ceramic Bonding
Alloy |
Purcast |
Rexillium V |
Vitrified V Bond |
| Co-span |
Neydium + Be |
Rexillium W |
Vitron |
| CSN Alloy |
Nickel Chromium Alloy |
Servalloy |
V Premium NP |
Dentillium
Dentsply Regalloy T Partial
Denture Alloy |
Nobil Ceram
Noble Metal Alloy |
Summit
T-3 |
W.C. V Pisces
Westbond B |
Dentsply Regalloy 100 Partial
Denture Alloy |
NPA I |
Tech Star |
Will-ceram Lite-cast B |
| Excelalloy |
NPX III |
Ticon |
Will-ceram Lite-cast B |
| Fidelity 1000 |
Odyssey |
Ticonium No. 44 |
Wiron |
| Formula 40 |
Omni |
Ticonium No. 50 |
|
| Gemini II |
Pen V |
Ticonium No. 100 |
|
| Dental Products Containing Beryllium |
| A or C Abrasive Grinding Wheels, Sticks and Hones |
1. This Bulletin applies to dental laboratories and not to dental offices unless
beryllium-containing dental alloys are fabricated, or modified in dental offices.
2. In addition to beryllium, laboratory technicians may also be exposed to other toxic materials such as nickel, chromium, cobalt, molybdenum, gallium, ruthenium, titanium, free silica, gold, silver, and platinum. Although these substances appear to demonstrate less overall toxicity than beryllium, their exposure should be avoided to the extent feasible.
3. Filters of local exhaust systems and all vacuum cleaners should be maintained regularly to minimize exposure; filters should be changed in a properly ventilated enclosure such as a laboratory hood. Personal protective equipment such as gloves, full-body overgarments, and respiratory protection may be necessary.
4. A single report in the literature by Brush Wellman, Inc. researchers (ref. 17) concludes that the BeLPT does not meet the criteria for a screening test, but is useful for a disease surveillance tool. In this report, 46% of surveillance-identified workers with sensitization had CBD at initial clinical assessment. In other studies, 49-100% of surveillance-identified sensitized workers had CBD at initial clinical assessment for the disease (refs. 6, 11, 12, 18-21).
Notes: (1) The beryllium content of these alloys typically ranges from 0.5-2.0 %. (2) This list includes
some, but not all, of the beryllium-containing products that have been used in dental applications in the past.
Their current use in not known. (3) Since 2000, Jel-Span has been manufactured without beryllium in the
alloy.
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