VIRGINIA BEACH, Va. — Dr. Robert Pellerin figures he inhaled plenty of toxic particles in the years before dentists began wearing protective face masks.
The 73-year-old Virginia Beach dentist remembers, on occasion, even choking a little on airborne debris during particularly long sessions of grinding and polishing dental materials.
It was a small thing — "a curiosity," he said — but one that came to mind four years ago when he was diagnosed with a rare and mysterious disease called idiopathic pulmonary fibrosis. The progressive, incurable ailment scars the lung tissue, causing it to harden and making it difficult to get oxygen into the blood.
"Idiopathic" means the cause is unknown, but Pellerin theorized that the culprit was exposure to silica and other materials used in dental treatments like crowns, veneers and sealing products.
When seeking care at Inova's Advanced Lung Disease and Transplant Program in Northern Virginia, he shared his theory with Dr. Steven Nathan, medical director of the program. He also called the Centers for Disease Control and Prevention.
That was about two years ago. His effort prompted investigators to review records of 894 patients treated for IPF at the Virginia center from September 1996 to June 2017. They found eight dentists and one dental technician with the disease, according to the CDC report released in March.
That's 23 times the rate that would be expected in the general population, an alarming statistic that made headlines in health stories across the country.
The report was the first to identify such a cluster, but it has some limitations: A small number of people were tracked, and at only one site; the subjects reported other environmental exposures as well; and there were no biopsy specimens to look for similarities.
Also, only one person was available to be interviewed: Pellerin. Seven others had died.
The dentist's wife, Linda Pellerin, who works with him as a dental hygienist, was the first to read articles about the CDC report, from friends who emailed links from Newsweek and other publications.
"It was like he was the last man standing. I said, 'You're not going to believe this,' " Linda Pellerin said.
The report concluded that there was still no clear cause identified, but that "occupational exposures possibly contributed."
Robert Pellerin was not identified in the report and was a little reluctant to have his name and photograph used. But he and his wife also think it's important to educate the public about a little-known disease and to emphasize to dental professionals the importance of wearing protective gear.
He himself didn't use masks or gloves during the early years of his career. Few dentists did, he said, until various cases underscored the need — not just for the safety of dental workers but for their patients. For instance, six patients of a Florida dentist with HIV in the 1980s said they were infected with the virus after being treated by him.
In the mid-1980s, the Occupational Safety and Health Administration made recommendations for infection control. Later, it mandated changes in personal protection equipment, requiring gloves and a mask to be used during dental treatment, which Pellerin has been doing for three decades now. The CDC also adopted guidelines for protective gear.
Pulmonary fibrosis is not the only disease cluster identified in the dental field. A CDC report in 2004 noted a cluster of nine dental lab workers in five states who contracted "silicosis," a debilitating, sometimes fatal lung disease caused by inhaling crystalline silica dust. The disease is associated with mining, quarrying and sandblasting jobs.
There have also been cases of dental technicians contracting pneumoconiosis, a lung disease caused by inhaling dust with toxic components.
Pellerin's four-decade career stretches back to his first two years as an active duty dentist with the Navy. He opened his own practice after that, while also doing periodic dental clinics for the Navy at Guantanamo Bay.
The discovery of his disease followed three decades of throat clearing and a constant cough. He chalked it up to allergies.
But four years ago, a case of pneumonia led to another discovery. A radiologist noted pulmonary fibrosis on a chest X-ray. Pellerin was referred to a local pulmonologist and eventually sought treatment at the Inova lung disease and transplant center.
Linda Pellerin sent a thank-you note to the radiologist because he provided an early diagnosis of a disease that many patients go years without knowing they have. The average life expectancy is two to five years.
At the Inova lung center, Pellerin chatted with Nathan, who mentioned that Pellerin wasn't the first dentist he'd treated. In fact, during the early years of the lung specialist's career at Cedars-Sinai Medical Center in Los Angeles, he started a database of his patients after treating two dentists with IPF.
That conversation is what led Pellerin to call the CDC, which circled back to Nathan. In a phone interview, Nathan gave credit to Pellerin for calling the federal agency. He thinks the risk is mainly with older dentists who were exposed to airborne matter before masks were mandated.
The CDC report found the median age of the dentists to be 64 and also included these descriptions of the investigator's interview with Pellerin:
He never smoked. He didn't wear a mask in his early years of dentistry. Also this nugget, which made Pellerin laugh when he heard it was included in a news story:
"He also reported work-related exposure to dust while working as a street sweeper for 3 months before entering dental school and environmental exposure to dust from coral beaches for approximately 15 years while intermittently visiting the Caribbean region as a practicing dentist."
That would be a college job with the state of Massachusetts, clearing highways of sand put there during winter storms, and then his stints at Guantanamo Bay.
He wonders how many other dental workers out there have the disease and wishes there were a way to find out: "I don't know how to get that ball rolling."
Nathan said it's possible that other lung specialists with databases of patients could track down more cases. He believes that the new protective mandates will reduce the number of dentists getting IPF, but the report is a good reminder of a mantra he tries to spread: "Don't breathe in CRAP."
That stands for "circulatory respiratory aerosolized particles" and comes in a variety of forms, such as air pollution and dusty workplace air that has fine particulates like wood or metal dust — even hair spray and noxious fumes.
Pellerin credits early diagnosis of his disease with its slow progression. There are a couple of medications available to slow damage, and he opted for one called Ofev. He also lost weight, exercises regularly and eats a healthy diet.
He's thankful his disease hasn't yet advanced to the acute stage that would eventually require supplemental oxygen or a lung transplant.
The illness hasn't dissuaded him from continuing his dental work since he enjoys both his patients and his staff: "I love the people. I love taking my time to do meticulous work without being rushed, and making people look aesthetically better and being able to solve their pain problem. It's a big high."
A friend emailed him about the CDC report, to applaud the articles that would help underscore the importance of protective gear and get people diagnosed sooner:
"Bob: You finally became a national news item!!!"