Interstitial Lung Disease in a Dental Technician Diagnosed Through an Integrated Multidisciplinary Approach

Abstract

Evidence from the literature indicates that workers in the dental care sector are routinely exposed to hazardous airborne agents, particularly mineral and metal dusts. This occupational risk is further amplified in settings with inadequate ventilation and insufficient use of personal protective equipment. We discuss the case of a dental technician with a significant history of occupational exposure who presented to our clinic with exertional dyspnea. High-resolution computed tomography revealed fibrosing nonspecific interstitial pneumonia associated with emphysema, and spirometry showed a severe reduction in carbon monoxide diffusion capacity. After a multidisciplinary evaluation, we performed bronchoscopy with bronchoalveolar lavage (BAL), which revealed an abundance of macrophages. Scanning electron microscopy with energy-dispersive spectrometry of the BAL detected silicon oxide, calcium, iron, and traces of metals typical of dental alloys (titanium, aluminum), as well as rare earth elements and toxic pollutants. These findings supported the diagnosis of interstitial lung disease due to long-term occupational exposure in dental laboratories, enabling a minimally invasive diagnostic approach. This strategy obviated the need for transbronchial biopsy, thereby avoiding a procedure associated with a high risk of pneumothorax in this patient.