Dental technicians are at risk of chemical exposure, including metals, acrylic monomers, and free silica particles. The intensity of long exposure to metal and acrylic dust during the finishing and grinding process in the manufacture of dental prostheses can increase the risk of pneumoconiosis, asthma, chronic obstructive pulmonary disease (COPD), cancer, fibrosis, and pulmonary granulomatosis in dental technicians.1–3
Since they are biocompatible, have high strength, are corrosive resistant, and are relatively less expensive than gold, cobalt-chromium (Co-Cr), and nickel-chromium (Ni-Cr) alloys are commonly used in dentistry for removable partial dentures, porcelain-fused-to-metal crowns, and metal frames.4 Metal alloy exposure, as well as improper working conditions and worker protection, is hazardous to worker health during the production process, notwithstanding the benefits.
Research conducted by Sivakumar reported that 53 out of 70 dental technicians had pneumoconiosis due to dust from processing dental materials. One of the metal materials in dental care is Ni. Ni-Cr and Co-Cr, are popularly used by dental technicians to make removable partial dentures, porcelain fuses, and bridges.5 The base alloy was chosen to replace the gold (IV) alloy type due to its lower cost.4,6 This content is also found in endodontic instruments, metal brackets, curved cables, ribbons, springs, and cable ties.
Occupational Ni exposure has been linked to a variety of health problems, including skin allergies, pulmonary fibrosis, and lung cancer. Given the importance of Ni in the development of high-quality dental alloys, evidence-based comprehensive reviews of existing knowledge and understanding of biological reactions and biocompatibility of Ni-containing dental alloys are recommended regularly. Some Ni compounds are designated as carcinogens to people by inhalation exposure, and Ni metal particles are classed as carcinogenic materials to humans.7
High levels of metals in the blood can cause elevated levels of Reactive Oxygen Species (ROS), reduced enzyme activity on metabolism, and detoxification of Reactive Oxygen Species (ROS). Excessive Reactive Oxygen Species (ROS) can cause oxidative stress and p53 gene mutations that are generally in the form of GC-TA transversion, mitochondrial dysfunction, disruption of the antioxidant system superoxide dismutases (SOD), which are very important antioxidant defenses against oxidative stress in the body, or a combination of these factors improves ROS.8
Oxidative stress is a normal phenomenon that occurs in cells or tissues when oxygen radical production exceeds antioxidant capacity. Excess free radicals can damage important macromolecules from cells, cause abnormal gene expression, disruption in receptor activity, cell proliferation or death, immune disorders, and mutagenesis, proteins. Antioxidant enzymes catalyze the decomposition of ROS.9 Superoxide radicals are considered the "primary" ROS, being able to interact further with other molecules to produce "secondary" ROS. This can be achieved either directly or indirectly through enzymes or metal catalysis processes.10
In response to a free radical associated with oxidative stress, the body has a natural defense system in the form of endogenous enzymes that neutralize and expedite the breakdown of free radical compounds to prevent damage to components of cell macromolecules. Superoxide dismutase (SOD), catalase, and glutathione peroxidase are examples of preventive defense systems, while glutathione peroxidase is an example of antioxidative defense systems.11
The most significant antioxidant is superoxide dismutase (SOD). SOD catalyzes O2 dismutation for H2O2 and O2. SOD is an antioxidant enzyme that plays a role in fighting against superoxide, radical oxygen which is released in the inflammatory pathway and causes connective tissue damage. This enzyme is formed as a homeostatic mechanism to protect tissue and can be detected in extra and intracellular compartments.12
The goal of this study is to see if there's a link between nickel metal (Ni) exposure in the workplace and superoxide dismutase enzyme (SOD) activity and p53 mutations in dental technicians. Dental technicians must follow safety protocols and requirements. Personal protection equipment (PPE) such as work clothing, protective masks, protective gloves and goggles, and ventilation are required for dental technicians. The amount of nickel in the air can be reduced by using proper ventilation, exhausters, and filters.