Dentists and dental health care workers may face potential occupational hazards due to exposure risks inherent in the profession . Dental practitioners are at the risk of exposure to blood-borne pathogens like HIV , HBV, HCV. STRESS can never be totally eliminated from dental practise , however it can be managed .

1. PEOPLE'S DENTAL
ACADEMY
TOPIC : OCCUPATIONAL HAZARDS IN DENTISTRY
DEPARTMENT OF PUBLIC HEALTH DENTISTRY
PRESENTED BY : VASUNDHARA SHUKLA
YEAR : BDS 3RD YEAR

2. CONTENTS
 HISTORY
 INTRODUCTION
 WHO IS AT RISK ?
 HAZARDS IN DENTISTRY :
1. BIOLOGICAL HAZARDS -
a) Mode of transmission
b)Transmissible disease
c) Prevention and management
2. PHYSICAL HAZARDS -
a)Musculoskeletal (i .e . posture)
b) Ionising radiation
c) Non-ionising radiation
d) Pressure systems

3. 3. CHEMICAL HAZARDS -
a)anaesthetic gases
b)amalgam
c) acrylates
d)latex and
e) disinfectants
4. LEGAL HAZARDS
 CONCLUSION
REFERENCES

4. HISTORY
" Bernadino Ramzzani "
also known as Father of occupational hazard .
His most important contribution to medicine was
his book - 'diseases of workers '.
He proposed that physicians should extend the list
of questions that Hippocrates recommended , they
ask their patients by adding ' WHAT IS YOUR
OCUPATION ?'
FATHER OF OCCUPATIONAL
MEDICINE .

8. INTRODUCTION
• The dental environment is associated with a significant risk of exposure to
various microorganisms .Many infectious agents may be present in blood or
Saliva, as a consequence of bacterimia or viremia associated with systemic
infections .
• Dental patients and Dentak health care workers (DHCW)may be exposed to a
variety of microorganisms via blood or oral or respiratory secretions . They may
face potential occupational hazards due to exposure risks inherent in the
profession .These microorganisms may include cytomegalovirus , hepatitis B
viruse (HBV ) , hepatitis C (HCV) , Herpes simplex virus types 1&2 ,
mycobacterium tuberculosis, staphylococci , streptococci etc.

9. Who is at risk ?
All dental healthcare professionals are potentially affected, including:
> the dentist
> auxiliary dental workers (for example nurses, therapists, hygienists,
technicians) and
> others at the place of work (for example service / maintenance
personnel) .

10. • Infections may be transmitted in dental operattory through several
routes , including -
• 1. direct contact with blood , oral fluids , or other secretion.
• 2. indirect contact with contaminated instruments , operatory
equipments, or contact with airborne contaminants present in
either droplet or aerosols of oral and respiratory fluids .

12. Working with anxious patient

13.  Exposure to microaerosols generated by high speed rotary
handpiece .
Also exposure to various chemicals used in clinic by a dentist .

14. HAZARDS IN DENTISTRY
Biological health hazards
Physical hazards
Chemical hazards
Musculoskeletal disorder and diseases of the
peripheral nervous system
Radiation exposures
Other risks

15. BIOLOGICAL HAZARDS

16. • Dental practitioners as other healthcare workers confront a identified
risk of occupational exposure to blood-borne pathogens like the
Human Immunodeficiency Virus (HIV), the hepatitis B virus (HBV), and
the hepatitis C virus (HCV).
• In dentistry, sharp injuries occur because of a small operating field,
frequent patient movement, and the variety of sharp instruments used
in dental procedure.
• The risk of exposure to blood-borne infections during the clinical
dental training, consequences of non-reporting, and lack of
appropriate follow-up or even infection should constantly be evaluated
by dental institutions.

18. Transmissible disease -
• VIRAL DISEASE-
Hepatitis - transmitted through
conjuctiva of the eye .
AIDS
Herpes
• BACTERIAL DISEASE-
Mycobacterium tuberculosis
Staphylococcus aureus
Corneybacterium diphtheriae
Carriers of these agents may be asymptomatic , thus proper
preventive steps should be considered.

19. PREVENTION AND MANAGEMENT -
 All dental practice healthcare risk waste must be:
• correctly segregated, and stored in the appropriate UN-approved containers
(bags or bins depending on the nature of the waste), and stored in a secure area
with access is limited to staff .
 In general , workers should be aware of potential hazards.
 Work education
 Awareness about diseases
 Use of barrier technique like : Gloves , masks , Eye ware , face shields ,High
power suctions , gowns

20. hand hygiene should be maintained .
management of spills of blood and bodily fluids .
appropriate patient placement
 management of sharp intrument like burs
vaccination of employees
 information, training and awareness-raising with employees
 reporting of incidents, response and follow up .
Equipment to provide minimum aerosols .
Maintenance of proper ventilation.

21. WHILE DEALING WITH HIGH RISK PATIENT
• Identifying high risk patient.
• use of double mask technique
• The patient should be given the last appointment.
• Practioner with laceration or cuts on epidermis of hands should
be prohibited from attending the operative procedures.
• Proper disinfection technique and proper disposal.

22. PHYSICAL HAZARDS
a) Musculoskeletal (i .e . posture)
b) Ionising radiation
c) Non-ionising radiation
d) Pressure systems

23. OCCUPATIONAL HAZARDS IN ORAL SURGERY : -
STRESSFUL CONDITIONS :
1. Eye strain
2. Carpel tunnel syndrome
3. Musculo-skeletal Disorders [ MSDs]
4. Varicose veins
5. Psychological disorders

24. 1. MUSCULOSKELETAL i.e. psoture
1. Musculoskeletal (i.e. posture) -
During dentistry procedures, the dentist’s posture is strained, which induces
stress injury on the musculoskeletal system . This occurs in 37 .7% of work time .
The main factors associated with any task risk assessment are:
> Static positions that may be required
> Duration of task
> Awkward postures for dental personnel
> Tasks requiring - extended reach , bent or twisted necks or abducted arms
(drawing out to the side) .
Engineering controls -
> Good ergonomic design of workstation, chairs, instruments and equipment

25. > Use of automatic and ultrasonic instruments / tools
whenever possible
> Use of indirect vision when treating maxillary teeth
> Minimisation of glare through the use of appropriate lighting and window
coverings
Administrative controls :
> Adjustment of the workstation to the patient each time
> Scheduling of patients in an effort to reduce risk factors
> Training regarding ergonomic hazards and control strategies
> Early reporting system to capture symptoms of ergonomic concerns

26. 2. Radiation (Ionising )
• Dental radiology can give rise to a significant dose of radiation to the bone marrow in the
skull and cervical spine, the oral mucosa, the thyroid and the eye .
• The implications of regulation in this area for dental practices are:
> A licence must be obtained from the Environmental Protection Agency (formerly RPII)
> all radiological exposures shall be clinically justified
> a named dentist in each practice referred to as the Radiation Protection Officer (RPO),
who is appropriately trained (as approved by the Dental Council), is required to take on the
day-to- day responsibility for radiological protection

27. > all x-ray units must be commissioned by an approved *Radiation
Protection Advisor (RPA), prior to first being used on patients .
> all x-ray units shall be maintained and serviced by a suitably
qualified and competent person (records must be kept)
> a Quality Assurance (QA) assessment must be carried out on all x-
ray units by the appointed RPA every two years
> it is essential that meticulous attention be given to processing
techniques .

28. ADMINISTRATIVE CONTROL
> Radiation safety programme
> Staff training
> Procedures to reduce exposure time
> Exposure monitoring (where required)
> Periodic review by RPA, particularly if changes made
> Periodic test and examination of equipment
> Appropriately word “Radiation” warning signs posted on access doors
> Multilingual / Pictorial pregnancy signs in waiting or other
appropriate areas

29. Protective equipment controls :
 Lead aprons (for persons
holding or supporting
patients during a dental x-
ray)
 Thyroid shields (for
patients where the thyroid
will be exposed)

30. 3. NON-IONISING RADIATION
Non-ionising radiation has become an important concern with the use of blue light
and to cure various dental materials.
Lasers:
The main clinical applications of lasers in dentistry are:
> Soft tissue and periodontal surgery
> Root canal treatment
> Desensitisation
> Analgesia > Endodontics
> Tooth bleaching > Tooth cavity preparation
The main occupational hazards associated with the use of lasers are:
> Eye damage > Skin damage > Fire > Smoke inhalation (cellular and viral debris)

31. LED (Blue Light) :
a) Curing light has become an integral part of the daily practice of
restorative dentistry .
b) In this regard , visible light-cured resin-based composites are the
predominant restorative materials for both anterior and posterior
restorations .
c) Halogen lights and LED units are by far the most frequently used in
daily practice .
d) From an occupational safety perspective, the blue light used to cure
composite is not well tolerated by the human eye (i .e . solar retinitis) .

32. Chemical Agent Hazards
Dentists are at risk of occupational exposure to a variety of
chemicals such as
- anaesthetic gases
-amalgam
- acrylates
-latex and
- disinfectants .

33. 1. Anaesthetic Gases
In dentistry, a mixture of nitrous oxide (N2O and oxygen (O2) is
used in inhalation analgesia for pain relief and anxiety reduction .
The main sources of exposure to dental healthcare professionals
are from:
> the patient’s exhaled breath,
> leaks in breathing circuits and face masks .
The main controls are:
> Scavenging system
> Room ventilation
> Maintenance of equipment
> Routine air monitoring

34. 2. Amalgum used in dentistry contain mercury which is highly toxic metal - may lead to
MERCURY POISONING .

35. 3. Acrylate and its Compounds
Dental polymer materials based
on Methacrylate, used as a filler,
seem to be a major cause of
contact dermatitis in dental
personnel and also a cause of
occupational asthma .

36. 4. LATEX
Natural rubber latex (NRL) can cause asthma and
dermatitis . Latex is used in medical gloves, but is also
found in medical products.
>Using Low-protein (hypoallergenic), powder-free gloves
is unlikely to lead to new cases of latex allergy;
> individuals with existing latex allergy should continue
to take latex-avoidance measures;

37. Psychosocial Hazards
1. Work-related Stress : -
• 83% of dentists believe dentistry is “very stressful”, with nearly 60% believing
that dentistry is more stressful than other professions .
• Some of the main sources of stress in dentistry include:
• > Overcoming pain and fear
• > Administration of anaesthesia
• > Patient dissatisfaction with treatment
• > Running behind schedule
• > Work–life balance
• > “Technostress”

38. Negative stress reactions include
:-
> Fatigue
> Anxiety
> Depression
> Physical illness

39. Legal Hazards
In every nation there are relevant laws and regulations which apply
to the practice of dentistry.
The breach of any of these may warrant that legal actions be taken
against a dental practitioner particularly in developed countries
where the populace 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 dental professionals .

40. CONCLUSION
It is very clear from the above discussion that despite numerous
advancements, many occupational health hazards still exist in
present dental profession.
It is, therefore, recommended that regular workshops and seminars
various continuing dental education programs on occupational
hazards be organized for all clinical dental staff periodically to
update their knowledge about various newer methods and
developments and, hopefully, influence their work practices.

41. Reference's
SOBEN PETER.(2013).Essentialsof public heath and dentistry
(community dentistry ). 5th ed: Arya