Chronic occupational lead poisoning in an adult male: A case Robert emphasising, oral and systemic

manifestations.

Fatima Alsuaibi, Majmaah University

Abstract

Lead poisoning, remains a significant occupational health hazard, particularly in industries involving battery
production, painting and plumping. this report presents a 54-year-old male with chronic workplace lead
exposure, exhibiting both systemic and oral symptoms. Typical of lead toxicity.

Introduction: Systematic examination revealed pale conjunctiva, which

is consistent with anaemia, as well as a slight tremors in
Lead poisoning is an established occupational health the extremities.
concern, primarily affecting industries where lead Laboratory investigations showed a significantly elevated
exposure is frequent. blood lead level (BLL) of 65 ug/dL (with normal llevels
Chronic lead poisoning arising from prolonged low-level- for adults being below 5 ug/dL as per CDC guidelines),
exposure often manifest subtly and can be challenging to confirming lead toxicity.
diagnosis compared to acute cases. Lead’s effects span
Blood Level
multiple or systems noticeably impacting the nervous, Timeline Interpretation
(µg/dL)
hematopoietic, and renal systems. Oral signs such as
Burton’s line, offer early diagnostic and insights for dental Initial (Before Elevated -
professionals. This report present a case of occupational Treatment) 65 Confirming lead
toxicity
After 1 Month of Decreased but still
Chelation 45 elevated

3-Month Continued
Follow-up improvement with
30 treatment

6-Month Within safe range

Follow-up Below 10

His complete blood count CBC revealed mild anaemia

with haemoglobin at 11.2 and basophilic stippling of
erythrocytes, a hemological hallmark associated with
chronic lead poisoning. Additionally, his renal function
lead poisoning, emphasising oral symptoms that contribute test indicates an elevated serum creatinine level of 1.8
to diagnose and exploring the management approach in mg/dL, suggesting potential lead-induced nephrotoxicity.
light of existing literature.
Radiographic imaging also showed “lead lines” ( Figure
Case presentation: 1B ) on his long bones indicative of chronic exposure.

A 54-year-old male presented with chronic fatigue,

frequent headache, abdominal discomfort, joint pain and
tremors in his hands. He had been employed in a battery
manufacturing facility for over 25 years, when he was
frequently exposed to lead dust and fumes, due to
inconstant use of protective equipment, his medical history
was notable only for mild-diet-controlled hypertension
with no significant family history of disease.

On oral examination, a bluish-grey line along the gingival

margin, known as Burton’s line ( Figure 1A) , suggesting
chronic exposure. The patient also reported a persistent
metallic taste and occasional dryness in his mouth. Figure 1A Figure 1B

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In considering differential diagnosis mercury poisoning Discussion:
was initially considered due to the neurological symptoms,
but it was ruled out with specific heavy metal testing other chronic lead poisoning remains a critical occupational
possible diagnosis such as multiple sclerosis are essential health risk, especially in industries like battery
tremor. We’re also ruled out through neurological imaging manufacturing where employees are exposed to high lead
and assessments. levels over prolonged periods.
Distinguishing lead poisoning’s systemic effects are well documented
Condition Key Symptoms affecting multiple organ systems, including the nervous,
Features
hematopoietic, renal, cardiovascular, and reproductive
Burton's line, systems. The nervous system, especially the peripheral
Presence of Burton's
Lead abdominal pain, nervous system in adults often shows early signs of
line; high blood
Poisoning tremors, fatigue, toxicity, such as tremors, irritability, and memory
lead level
metallic impairment (8). Lead’s impact on the hematopoietic
system is seen in reduced haemoglobin synthesis, leading
Neurological
to anaemia, a frequent finding in chronic exposure cases
symptoms, Elevated mercury
Mercury (9).
memory loss, levels in blood/urine
Poisoning Oral manifestations are significant in identifying systemic
mood swings,
lead poisoning. One of the most distinctive signs is
tremors
Burton’s line which appears as blue grey pigmentation
Muscle weakness, along the gingival margin, resulting from the reaction of
coordination MRI shows lesions circulating lead with hydrogen sulfide produced by oral
Multiple issues, vision in CNS; no elevated bacteria. This line forms the visible marker of lead
Sclerosis problems, tingling lead level poisoning, and is more apparent in patient with poor oral
in limbs hygiene due to increased lead sulfide deposition (7, 14,
15).
Tremors (usually
No Burton's line or Other symptoms include a sweet metallic taste, halitosis
Essential hands), may
and dyspepsia (16). This case underscores the diagnostic
Tremor worsen with stress other lead poisoning
signs value of Burton’s line and dental examination
or caffeine
examinations which can promote early referral for lead
Iron deficiency anaemia was differentiated based on the poisoning assessment.
patient’s occupational exposure history, and the presence Management in this case involved Chelation therapy with
of basophilic stippling, which aligned more closely with EDTA, which effectively reducing (BLL) and alleviated
led toxicity. systematic symptoms. Recent studies showed that EDTA
Treatment was initiated with chelation therapy using is preferred in severe cases. Also suggest that oral
ethylenediaminetetraacetic acid (EDTA) to help remove chelators like succimer (DMSA) may offer a safer and
lead from the body, along with supportive measures, such more convenient alternative, with less adverse effects,
as calcium and iron supplementation to counteract lead’s mainly in chronic cases (6). This patient’s mild residual
interference with mineral absorption. tremors highlight a limitation in managing chronic lead
The patient was advised to avoid further lead exposure poisoning as long-term exposure can cause neurotoxic
was provided with educational resources on workplace Action
Stage Symptoms/Findings Taken
safety and was referred to occupational health services for
workplace adjustments. Fatigue, abdominal Oralexam and
discomfort, blood test reveal
Initial tremors high lead levels
Symptoms

Burton's line, pale Diagnosis

conjunctiva, confirmed with
Diagnosis
anemia blood lead test

EDTA chelation therapy Reduction in

begins blood lead level
Treatment
and alleviation
Initiation
of symptoms

Mild tremors remain, Continued

improved energy monitoring of
Follow-up blood lead and
kidney function

effects that are challenging to reverse. Early detection and

intervention are critical to minimising these irreversible
effects (10).
At the three month follow-up the patient’s blood lead level Occupational environment, safety and prevention: In
had decreased to 30 µg per Desie lead his fatigue and work environments where exposure to lead is high,
abdominal discomfort had improved significantly. effective preventative measures are essential. To reduce
Although mild tremors persisted, continued occupational lead inhalation and skin absorption, proper protective gear,
health assessments in primary care, follow up, were such as respirators and gloves, should be made available to
arranged to monitor his renal and neurological function to employees in high-lead exposure industry like battery
ensure he remain free from further lead exposure . manufacture. In addition to monitoring blood levels

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regularly, making sure it’s in the safe levels will improv
the chances of early detection of lead poisoning (11, 5).
Monitoring for long-term effects long-term effects
Long-term follow-up care is essential for patients who
have experienced chronic lead exposure. Regular
monitoring of blood lead levels, renal function and
neurological status should be performed to assess any
delayed effects of lead poisoning.
The takeaways from this case include the pivotal role of
oral health professionals in detecting systemic conditions
like lead, poisoning through oral examination. Awareness
of burton’s line and other signs among dentists can lead to
early diagnosis, prompt medical referrals and
interdisciplinary collaboration enhanced occupational
health measures are necessary to protect workers in lead-
exposed industries with dental professionals contributing
significantly to this early detection and preventive
approach.

Conclusion

This report highlights the systemic and oral impacts of

chronic occupational exposure illustrating the diagnostic
importance of oral signs such as burdens line effective
management of lead poisoning, necessitates, timely,
intervention, collation therapy and proactive lifestyle.
Adjustments to avoid re-exposure, enhance to awareness
among dental practitioners regarding heavy metal toxicity
signs can significantly influence patient outcomes through
early detection and interprofessional collaboration .

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