Occupational Hazards in Dentistry PDF

OCCUPATIONAL HAZARDS IN DENTISTRY Dena Mohamed CPHQ, MSc, MFDRCSI, BDS Definition of occupational hazard 01 Types of occupational hazards 02 Prevention of occupational hazards 03 OBJECTIVES Definition of occupational hazard A risk to a pers...

OCCUPATIONAL HAZARDS IN DENTISTRY Dena Mohamed CPHQ, MSc, MFDRCSI, BDS Definition of occupational hazard 01 Types of occupational hazards 02 Prevention of occupational hazards 03 OBJECTIVES Definition of occupational hazard A risk to a person usually arising out of employment. It can also refer to a work, material, substance, process, or situation that predisposes, or itself causes accidents or disease, at a work place. Biological health hazards 01 05 Noise hazards Physical hazards 02 Major 06 Radiation hazards occupation al hazards Chemical hazards 03 07 Psychological hazards 04 08 Musculoskeletal disorders Legal hazards and diseases of the peripheral nervous system Biological Health Hazards These hazards are constituted by infectious agents of human origin and include prions, viruses, bacteria and fungi A dentist can become infected either directly or indirectly. Biological Health Hazards Direct infection: Microorganisms can enter the body through: 1. A cut on the skin of his/her hand while performing a medical examination and procedure 2. As a result of an accidental bite by the patient during a dental procedure 3. A needle wound during an anesthetic procedure. Biological Health Hazards Indirect infection: Sources include; aerosols of saliva, gingival fluid, natural organic dust particles (dental caries tissue) mixed with air and water, and breaking free from dental instruments and devices Biological Health Hazards The main entry points of infection: Epidermis of hands Oral epithelium Nasal epithelium Epithelium of upper airways Epithelium of bronchial tubes Epithelium of alveoli Conjunctival epithelium. Biological Health Hazards Prevention: Apply infection control protocols Physical Hazards Sources of physical injury 1. Debris from the oral cavity striking the eyes, 2. Cuts from sharp instruments, 3. Puncture wounds from needles or other sharp instruments. Such injuries can result in the transmission of serious infectious disease to the dental worker. Physical Hazards Needlestick injuries and cuts from sharp objects and instruments (percutaneous injuries) have been reported in 1 to 15 % of surgical procedures mostly associated with suturing. Physical Hazards Percutaneous exposure incident (PEI) Is a broad descriptive term that includes needlestick and sharp injuries, as well as cutaneous and mucous exposures to blood and serum. The most common of them is from needles and drilling instruments such as burs PEI represents the most efficient method for transmitting blood borne infections between patients and health care workers. Physical Hazards Needlestick injury In the United States more than 800,000 needlestick injuries occur each year despite continuing education and efforts to prevent them. Physical Hazards Needlestick injury Prevention: Ensuring the needle and surgical blade are sheathed when not in use Use a scoop technique Dispose of the needles and any sharp instruments in sharp safe box Taking care when cleaning away the surgical sharps, wires, etc. Physical Hazards Needle stick injury Post accidental management: Remove the gloves Wash the site of injury under running water Avoid scrubbing and encourage bleeding and then protect Take blood specimen of both the patient and the injured person and tested for HIV and Hepatitis Physical Hazards Eye injury may occur from either: 1. Projectiles such as bits of calculus during scaling procedures an splatters from body fluids (bacterial and viral aerosols) while using high-speed hand pieces. 2. Intense dental curing light. Prevention: Use protective eyewear Chemical Hazards Many biomaterials and auxiliary products used in dentistry are chemically reactive. The health effect may not be known and may pose health problems taking years to manifest Chemical Hazards Mercury Amalgam used in dentistry contain mercury, the active components in mercury vapor have a particular affinity for brain tissue Mercury poisoning Route of exposure: skin and lungs Chemical Hazards Mercury Prevention: Work in proper ventilating room Use amalgam-appropriate clinical waste containers (place amalgam waste in rigid receptacles with a mercury suppressant) Never rinse elemental mercury down the drain Never dispose elemental mercury in the trash Never dispose elemental mercury in the sharp container or as medical waste Chemical Hazards Mercury Prevention: During the removal of old amalgam restorations, its recommended to use eye goggles, water spray, and suction Chemical Hazards Latex hypersensitivity The continued use of powdered natural rubber latex (NRL) gloves and disinfectants has predisposed clinical dental workers to hand dermatitis, contact dermatitis, contact urticaria, and allergic dermatitis. Prevention: Hypoallergenic nonlatex gloves (latex free gloves) are proposed to deal with latex allergy. Chemical Hazards Nitrous oxide (N₂O) Used as anesthetic agent Chronic exposure to N₂O associated with neurological abnormalities and reproductive derangements (infertility) Transient irritative reactions of the eyes and airways have been observed mostly associated with exposure to volatiles from resin-based materials, X-ray chemicals, and cleansers. These include procaine, soaps, eugenol, iodine, formalin, phenol, and other disinfectants Chemical Hazards Nitrous oxide (N₂O) Prevention: System maintenance: inspect and maintain the anesthetic delivery system to prevent N₂O leakage Ventilation: o Scavenging system o Room ventilation Work practices: o Select scavenging masks of proper sizes to fit patients o Monitor the air concentration of N₂O Chemical Hazards Cyanoacrylate (CA) Toxicity Cyanoacrylate (CA) and its homologues have a variety of dental applications as adhesives and sealing agents. Reported toxicity of CA is uncommon in the dental workplace, but may manifest as conditions such as urticaria, contact dermatitis and other dermatoses. Chemical Hazards Cyanoacrylate (CA) Toxicity Prevention: Avoid direct contact with CA and use Optimizing room ventilation Musculoskeletal Disorders Dental surgeons are exposed to various kinds of MSDs: Disc prolapse (Lumbar, Sacral or Cervical), Tendonitis, Bursitis, and synovitis Musculoskeletal Disorders Risk factors: The fixed working position using a continuous repetitive motion wrist-ache, lower backache, and neckache. The strained posture both while standing and sitting, cause overstress of the spine and limbs negatively affects the peripheral nerves of the upper limbs and neck nerve roots. Musculoskeletal Disorders Risk factors: The posture of the dentist, with the neck bent and twisted, an arm abducted, repetitive and precise movements of the hand neck syndrome and pain within the shoulder and upper extremities. Operations carried out during extractions stress the elbow joint and the wrist joint and may result in chronic tendon sheath inflammation Musculoskeletal Disorders Carpal tunnel syndrome (CTS) Dental professionals are at an increased risk for developing CTS due to our repetitive motions and the demands on our hands. Caused by pressure of the median The median nerve runs from the forearm through a passageway in the wrist (carpal tunnel) to the hand. Lead to paresthesia in the fingers (usually the thumb, index, and middle fingers are affected) Musculoskeletal Disorders Prevention: The key to prevent work related MSDs is Ergonomics What is Ergonomics? It is a science dealing with designing of a workplace Musculoskeletal Disorders Ergonomics in dentistry Means preventing musculoskeletal problems by enabling the dentist to adopt a more natural and comfortable posture, achieving patient-friendly treatment, improving treatment efficiency, and achieving treatment accuracy. Dental chair should be adjusted in a manner that the position of the doctor is neutral and muscles are relaxed Instrument design- the handle should be thicker, round, and hollow Noise hazards The noise in dental clinics is from suctions, saliva ejectors, turbines, engines, amalgamators, compressors Dentists are exposed to the noise of handpiece and ultrasonic scalers, at level of 60-99 decibels. While this level presents only a minimal risk of hearing loss, sustained exposure can result in sensorineural hearing loss. Sensorineural hearing loss is not reversible, but is preventable Noise hazards Prevention When using dental equipment, wear ear plugs or noise-cancelling headphones In selecting dental equipment, consider its noise level as factor in your purchasing decision Monitor your hearing acuity on a regular basis Radiation exposure Dentists are exposure to both ionizing and nonionizing radiation in dental practice Ionized radiation Non ionized radiation Physics Short wavelength Longer wavelength Higher frequency Lower frequency Higher energy Lower energy Effects More harmful Less harmful Example X ray Ultraviolet Gamma ray Infrared Microwave Radiation exposure Exposure to ionizing radiation The effect of low levels of exposure to ionizing radiation over periods of time may accumulate and could represent a potential hazard to health. Radiation effects are categorized as: 1. Somatic effects 2. Genetic effects Radiation exposure Exposure to ionizing radiation Prevention: Standing behind protective barrier and use Lead aprons Use fast film and collimated beam Periodic maintenance of the X-ray machine and radiation level sensors Psychological hazards Stress is the most common psychological condition that occurs in the dental profession. Many clinical situations are the source of stress to a dentist and these include: Procedures connected with anesthetization of patients, Causing pain or fear in patients, Having to cope with different levels of cooperation with patients The necessity to cope with cancelled visits or late arrivals by patients Unexpected emergency situations in which a patient’s health or life is in danger, Procedures with uncertain prognosis Legal hazards The contravention of any regulations which apply to the practice of dentistry may warrant the legal actions be brought against a dental practitioner particularly if the citizens appear more aware of their rights To help assure a safe work environment in dental treatment, the hazard awareness and prevention of legal risks should be made known to all clinical workers of the dental hospital/clinic  THANK YOU ! QUESTIONS