Submitted by,Bipin JoseGuided by

Dr .Mehamood muthedathDr .Azeela Ahammad

Dr. Aswathi

Occupational Hazards in Dentistry

IntroductionOccupational hazardsTypesPrevention of disease transmissionInfection control and management of

hazardous materialsOSHA regulationsCenter for disease control and

preventionConclusionReference

Outline of Contents

Introduction

- As in any other working environment, dental practice can

be associated with harmful effects to dentists, referred to as

occupational hazards. These hazards vary from mild and easily or self curable, as

influenza and mental fatigue, to more serious and incurable as

AIDS .

Classification of hazards

• Physical• Chemical• Biological• Mechanical• Psychosocial• Mucoskeletal Disorders

Physical hazards

Light Heat Noise

Radiation Sharps

HEAT

Exposure may occur when there is lack of maintenance to any electrical equipment lack of understanding of the equipment and its controls

Effects

Painful shocks burns etc

LIGHT

• Poor Illumination or excessive brightness• Poor Illumination

EffectsEye pain, eye strain, headache, eye fatigue.

• Excessive BrightnessEffects

• Discomfort and visual fatigue

Prevention• Sufficient and suitable lighting-natural or artificial is

advised

NOISE

Use of high speed turbines, compressor, suction, ultrasonic dental scaler

Effects

Auditory- temporary or permanent hearing loss

Non-Auditory- fatigue, interference with communication by speech, decreased efficiency.

RADIATION

• Contact with X-ray

• X-ray is an ionizing radiation that is capable of initiating and producing damage to body cells, as well as carcinogenic and genetic changes. Careless dentists used to hold the dental X-ray films inside the patient’s mouth (for obtaining better quality of image) are at risk for developing radiation dermatitis on hands, or on a long run squamous cell carcinoma of the finger.

Prevention

• Buying of standard radiographic equipment• Well collimated and filtered beam of at least 1.5

mm of aluminum filtration• Use of lead barriers between the dental surgeon

and the x-ray machine• Dentist should not hold the film in patients mouth • Regular checking of leakage from x-ray machine

should always be performed

SHARPS

Glassware and sharp needles, lancets,B.P-blades, test tube are hazardous

• Cut, scratches, abrasions are potential locations for infections.

Prevention• Handle with care• Mange and dispose waste sharps.

Chemical hazardsDentist are exposed to various types of chemicals that

are hazardous while providing care. They include,

• Mercury• Methaacrylates• Silica• Beryllium• Formaldehyde• Xylene• Latex glove

Mercury

The greatest risk from mercury is from vapor in the air.

• The maximum level of exposure considered to be safe is 50 microgms/cc of air.

• Average daily take of mercury from amalgam restoration is estimated to be 1.2 to1.3 microgm

• Mercury is hazardous not only• to dental personnel but also• to the environment.

Effects• Mercury poisoning

Prevention

• Use of precapsulated alloys• Use of automatic triturators• Good ventilation• Spilled mercury should be collected with

gloved hands and stored under water.

METHAACRYLATES– Effects

• Irritation to skin,eye or mucous membrane,allergic dermatitis,asthma

• PNEUMOCONIOSIS can occur due to inhalation of methylmethacrylate

Silica• Inhalation of dust containing free silica or

silicon dioxide in ceramic laboratories leads to sillicosis

BERYLLIUM• Susceptible groups are dental laboratory

technicians.• They develop chronic beryllium diseases

(CBD)

Formaldehyde• Chemical used for disinfection

Effects• Acute- eye and respiratory irritation from

the liquid and vapour forms.• Chronic- laryngitis, bronchitis.

XYLENE• Chemical used for sterilization purpose.• Acute- eye and mucous membrane

irritation• Chronic- leukemia

Latex glove

• Latex gloves dusted with corn starch powder

• Efficient barrier against most pathogens• A very good barrier against viruses• Unfortunately most of the professionals

are allergic to this productEffects- urticaria

Prevention• Non latex gloves-eg vinyl or nitril gloves

Biological hazards

Dental surgeons run a risk to different infectious agents

• Bacterial,viral, and fungal• Tuberculosis and hepatitis B appears to be

very real danger and AIDS has begun to spread like wild fire.

HEPATITIS B

• Causative agent- hepatitis B virus• It is a serious disease

• May result in prolonged illness,destruction of liver cells, cirrhosis of the liver, and death

• It is a bloodborne disease that may also be transmitted by other body fluids,including saliva.

Prevention• HBV vaccine – 3 dose

Hepatitis C

• Transmitted via blood transfusion• Contaminated needles among injection

drug users• There is no vaccine against hepatitis C

TUBERCULOSIS• Causative agent ; mycobacterium

tuberculosis• Patient may easily spread the disease

through close contact

• When the individual coughs and the tubercle bacilli which are present in the sputum are expelled through the mouth

• These bacteria are inhaled by other persons and carried to the lungs

Prevention• No effective form of protective immunization against TB

• There are drugs but these are not effective against the newer drug-resistant strains of TB

• Patients instructed to cover their mouths and nose when coughing or sneezing

• If possible dental treatment is postponed until the patient no longer has the symptoms of active TB.

• If emergency care is required it should be rendered in a facility that can provide TB isolation

Legionella

• Aerosols generated in dental operations are a source of exposure to microorganisms proliferated within dental unit water lines.

• Causative agent –Legionella pneumophila• There is no person-to-person transmission• Causes severe pneumonia

HERPES SIMPLEX VIRUS• Causative agent- herpes virus

• Causes recurrent sores on lips• Dental personnel could infect their digits from

contact with infected patients.• Herpetic whitlow

• HIV AND AIDS

HIV is transmitted by blood/blood contaminated body fluids.

• Precaution are taken to minimise state of injuries with sharp instrument.

Tetanus

• Also known as lockjaw• Dangerous and often fatal • Enter the body through a wound or break

in the skin from a solid instrument.

Prevention• Administration of a TT vaccine

Mechanical hazards

• Though not alarming it can be reduced or avoided

• Being careful while operating• Eg –traumatic injuries due to projectiles,

carelessness while using sharp instruments, airotors

Psychosocial hazards• Mental fatigue: - This results from communication and

dealing with the patients, added to realization of professional abilities.

• Although this is not a disease, but unfortunately, it is sometimes unavoidable and it might adversely affect the quality of the dentist’s work.

• This leads to development of increased tension,high BP,tiredness,depression and sleeplessness.

• Dentists with their busy schedules will be deprived of social intraction,spend less time with family leading to “burn out syndrome”.

Prevention

• Space out professional work • Sufficient rest • Allot time for social interaction and family• To overcome stress –yoga,art of living etc..

Musculoskeletal Disorders• At work,the dentist assumes a strained posture. • Both while standing and sitting close to a patient while

providing care.• Causes and over stress of the spine and limbs and PNS.• This results in,

• Back pain syndrome.• Neck discopathy.• Cervicoacromial pains.• Carpal tunnel syndrome

Carpal tunnel syndrome• Is a defect of the median nerve and cubital nerve .• It is manifested as paraesthesia of the thumb and the

index finger.

• Low back area and legs are two points where dental practitioner strains himself

• In India dentists work hard for more than 8 hours without rest cause

» Cervical spondylosis» Low back pain » Varicose veins » Knee and ankle joint osteoarthritis.» Rarely scoliosis and other vertebral column

problems

Prevention of disease transmission

• Prevention of disease transmission is of utmost importance in the dental office.

• It is necessary to break the chain of infection,consists of four parts

» Virulence.» Numbers. » Susceptible host and » Portal of entry.

• Virulence- degree of pathogenicity or strength of that organisms ability to produce disease.

• Because a person cannot change the virulence. • He or she must rely on body defenses and specific

immunization (HBV, Measles)

Numbers

Related to the bioburden present.• To reduce these numbers .

• Sterilization of all dental instruments • Disinfection of all materials and surfaces that have

become contaminated during treatment

Susceptible host – One who is unable to resist infection by a

pathogen .• Therefore, staying healthy ,washing your hands

freqently and keeping your immunizations up to date to resist infection

Portal of entry • Pathogens must have an appropriate portal of

entry into the body • These include,

– Inhalation

Breathing aerosols generated from hand pieces or the air-water syringe or uncovered ultrasonic cleaning devices

Prevention –wear face masks

-Ingestion

swallowing droplets of blood or saliva spattered into the mouth

Prevention- wear face masks, wash hands frequently

• Mucous membranes– Droplets of blood or saliva spattered in to

eyes, nose or mouth.

Prevention

wear face masks and safty glasses