94 occupational hazards in dentistry.pptx

OCCUPATIONAL
HAZARDS IN DENTISTRY
5/13/2024
Seminar on Occupational hazards in Dentistry by dr praveen 1

Contents
 Introduction
 History
 Spread of infection
 Occupational health
 Occupational hazards
 Conclusions
 References
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Seminar on Occupational hazards in Dentistry by dr praveen
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INTRODUCTION
Infectious diseases have scourged the world throughout the history
of mankind. Even today emerging infectious diseases have been
discovered at a rate of one disease per year over the past 22 years.
Infection is the process of invasion of the tissue by organisms
characterized by their multiplication in the body of the host to
produce disease.
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Some of these diseases are contained locally but others have
spread over large areas and have sometimes resulted in
worldwide epidemics.
The dental environment is associated with a significant risk of
exposure to various microorganisms.
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Dental health workers may be exposed to a variety of
microorganisms via blood or oral secretions.
As a result of the advances, quality care can be provided to the
population, but while doing so, the dentist and their teams are
exposed to a number of hazards peculiar to this profession leading to
various ailments. Occupational safety and health has been a matter
for concern.
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History
Harmful effects of work exposures to chemicals is found in
writings of Hippocrates and in Greek and Roman literature.
In 17th century, Bernardino published the first comprehensive
treatise on occupational diseases which recommended that
doctors inquire about a patients occupation when taking a
history.
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In 1959 JS Mittleman, a New York Dentist warned the
profession about the health hazard caused by turbines and
recommended regular audiograms for dental personnel.
In a study in 1966, Biller found that 65% of the dentists
complained of back pain.
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For most of the 1970s and 1980s the major concern was
inhalation of mercury vapor and its hazards of amalgam to the
dental staff.
By the mid-1980s concern regarding HIV grew which had
infected about 1 million people in the United states.
Hepatitis B also gained attention as a risk for health
professional.
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Spread of infection
Many infectious agents may be present in blood or saliva or
oral/respiratory secretions, as a consequence of bacteremia or
viremia associated with systemic infections.
Infections may be transmitted in the dental operatory through
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Direct contact with blood or oral fluids
Contaminated instruments
Operatory equipments
Air borne contaminants
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Infection via any of these routes requires that all three of
the following conditions be present:
 Host
 Pathogen
 Portal of entry
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Seminar on Occupational hazards
in Dentistry by dr praveen
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A set of infection control strategies common to all health care
delivery settings should reduce the risk of transmission of
infectious diseases.
‘Universal Precautions’ must be observed routinely in the
care of all the dental patients.
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Categories of task in relation to risk
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The ADA and the Occupational Safety and Health Act
(OSHA) guidelines advise that all dental staff in category I
and II and dentists be trained in infection control to protect
themselves and their patients.
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Occupational health
Occupational health has been defined by WHO as “the promotion
and maintenance of the highest degree of physical, mental and
social well being of workers in all occupations; the prevention
among workers of departures from health caused by their working
conditions; the protection of workers in their employment from
risks resulting from factors adverse to health and the adaptation
of work to man and of each man to his job”.
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Occupational hazards
Any person may be exposed to five types of hazards
depending on his occupation:
1. Physical
2. Chemical
3. Biological
4. Mechanical
5. Psychosocial
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PHYSICAL HAZARDS
Physical agent is defined as an entity without substance or with
minimal matter, such as radiation, atmospheric variations,
noise, and vibrations.
These agents encompass a wide range of potential health risks.
Many of these hazards can be minimized by observing some
simple precautions.
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Heat:
 Electrical hazards: Exposure may occur when there is lack of
maintenance to any electrical equipment.
 Effects: Painful shocks, burns etc.
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Noise:
 High-speed turbines, compressor, suction, ultrasonic scaler.
 Effects: Hearing loss, interference with communication,
decreased efficiency and annoyance.
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Ultraviolet radiation
 Effects: Erythema & dermatitis, Conjunctivitis, Somatic and
genetic effects, congenital defects, skin cancer.

Sharps(puncture wounds):
Glassware and sharp needles, lancets, blades, broken
ampoules, test tubes are hazardous.
Cuts, scratches, abrasions are potential locations for
infections.
Effects: cause injury, infections
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 Asbestos:
 Is a mineral, which can be crushed into fibres.
 Used for lining material for casting rings and crucibles, as a
binder, periodontal dressings and for soldering investments.
Effects :
 Cancer of lung, plueral cavity, git and pulmonary asbestosis
and fibrosis.

Radiation Protection and safety
Radiation safety has been a major concern and every effort
should be made to reduce the amount of exposure not only to
patients but also to clinicians.
Excessive exposure to ionizing radiation from the primary
beam produces changes in genetic and blood producing cells.
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Clinical features of radiation toxicity:
Excessive exposure may cause skin erythema reddening of
skin.
Ulceration of operators fingers
Changes in the blood producing organs and cell structure
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Preventive measures
The basic methods to reduce occupational exposure include:
1. Position and distance rule: operator should stand at least 6
feet at an angle between 90 and 135 degree to the primary
beam.
2. Operator should never hold the film in place.
3. Never hold the radiographic tube during exposure
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Use of thermoluminescent dosimeter or film badge to monitor
dental personnel ensures that safety rules are being followed.
Patient protection by use of
 Rectangular collimator
 Filtration of low energy rays
 Use of high speed films
 Patient shielding by use of lead barrier
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CHEMICAL HAZARDS
Dentists are exposed to various types of chemicals that are
hazardous while providing care.
These chemicals act in three ways:
1. Local action
2. Inhalation
3. Ingestion
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Mercury
Mercury is hazardous-Dental personnel
-Environment
The dental profession primarily encounters mercury toxicity
from two sources:
1. Inhalation of vapors (primary source)
2. Direct absorption into the tissues from handling mercury
containing compounds.
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Sources of contamination:
 Removing old amalgam restorations
 Faulty amalgamators
 Leaking amalgam capsules
 Expressing excess mercury over the floor
 Exposure of mercury to heat sources
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Normal levels
The normal blood mercury levels for dentists are 5-10 ng/ml.
The amount of inorganic mercury that can be tolerated by
humans is not clear but symptoms are seen at 100-200 ng/ml.
Frank toxicity due to mercury is seen at 400 ng/ml.
Normal urinary values is 0 to 0.015mg/l for a 24 hr sample.
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Symptoms of chronic mercurialism
 Muscular tremors progressing to convulsions
 Loss of appetite, nausea, diarrhea
 Nervous excitability, insomnia
 Mental depression, speech disorders
 Dark pigmentation of the marginal gingiva
 Metallic taste and excessive salivation
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Dental mercury hygiene:
 Good ventilation with periodic filter replacement
 Use of mercury-monitoring devices
 Annual urine analysis
 Minimize mercury contamination at the work area
 Store in unbreakable, tightly sealed containers
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Amalgam handling:
 Use a no-touch technique
 Use the mercury/alloy ratio recommended by the manufacturer
 Use high-volume evacuation and water spray when removing
old amalgam restorations.
 All scrap amalgam should be stored in a tightly closed
container containing sulfide solution such as fixer solution.
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Methacrylates:
 Effects: irritation to skin, eyes or mucous membranes, allergic
dermatitis, asthma, paraesthesia in fingers.
 When acrylate allergy is suspected, use nitrile gloves.
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Silica inhalation in ceramic laboratories leads to silicosis.
 The incidence depends on the chemical composition of dust,
size of particles, duration of exposure and individual
susceptibility.
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Formaldehyde is mainly used in the clinical set up for
disinfection purpose.
 Effects: acute eye and respiratory irritation from the vapors,
severe abdominal pain, nausea, laryngitis, bronchitis.
Xylene is mainly used for sterilization purpose.
 Effects: Dizziness, mental confusion, mucous membrane
irritation.
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Latex glove:
 Usually they are dusted with cornstarch powder.
 Forms an efficient barrier against most of the pathogens but
most of the professionals are allergic to this product.
 Effects: Urticaria
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Beryllium:
• Suspected carcinogen
• Causes contact dermatitis
• Highly toxic and result in respiratory irritation
• Chronic beryllium disease
Inhalation of dust containing Beryllium when working on crowns,
bridges and partial denture frameworks and they develop chronic
beryllium disease.
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 Nickle:
• Confirmed occupational carcinogen.
• Powerful sensitizer of skin
• High incidence of lung and nasal cancer
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Precautions to be taken:
 Use an alloy that does not contain nickle or beryllium
 Inform all personnel of the hazards.
 Use suction system, gloves, face shield.
 Any skin contact with the alloy should be thoroughly washed.
 Use warning labels on containers with these alloys.
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Inhalation anesthetic gases:
An estimated 35% of the dentists currently utilize techniques
of inhalation sedation.
Nitrous oxide is the single most widely used
anesthetic/sedative agents.
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The specific effects of nitrous oxide were studied and it was reported
that
 Spontaneous abortion rates were significantly higher for both wives
of exposed dentists and exposed female assistants(1.5 to 2.3 times).
 Increased risk of cancer
 Increased liver, kidney and neurologic disease
 Increased frequency of congenital abnormalities in female assistants.
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Recommendations for the dentist:
 Have an effective program of scavenging and monitoring.
 Monitor the dental office at 4-month intervals (<50ppm N2O)
 Check the machines, lines, for any leakage.
 Maintain adequate ventilation
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BIOLOGICAL HAZARDS
They are constituted by infectious agents of human origin and
include viruses, bacteria, and fungi.
Dentists may get infected either by
 Direct contact
 Indirect contact-Needle stick injury, Aerosols in saliva,
Organic dust particles
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 Main entry points of infection
Oral epithelium
Epidermis of hands
Respiratory epithelium
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AEROSOL HAZARDS
Dental aerosols may be defined as suspensions of extremely
fine air-borne particles that are liquid, solid or combinations
of both.
The major hazard arising from aerosols is associated with
their small particle size, which allows them to enter the
respiratory system.
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The degree to which they penetrate the respiratory system is
dependent on the aerodynamic diameter of the particle.
Air turbine handpieces, air-water sprays, some rotary
instruments, ultrasonic scalers, dental lathes all produce
aerosols that have the potential to cause disease due primarily
to inhalation.
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Dental aerosols may have three components:
1. Bacteria and viruses
2. Particles of tooth structure
3. Particles of dental materials
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Bacteria and viruses can become components of dental
aerosols during many types of procedures.
Disease Source
Herpetic lesions of eye Virus from herpetic oral and
lip lesions
Tuberculosis Tubercle bacilli from open
lesions
Influenza or common cold Virus from infected patients
Conjunctivitis Staphylococcus
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Micik and associates have concluded that in a controlled
environment the following three procedures produce the
maximum bacteria
1. Prophylaxis procedure using pumice
2. Air turbine hand piece with air coolant
3. Air spray from an air-water syringe.
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Aerosols of enamel, dentin, amalgam, and composite resins
are produced during high speed cutting or finishing. These
particles are known to be contaminated with microbes.
The use of high-velocity suction is recommended to reduce
aerosols and lower the health risk.
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Alginate has been singled out in several studies to determine
its contribution to dental aerosols. Alginate can be seen rising
from containers during vigorous spatulation.
Alginate aerosols contains fibers, 10% to 15% of which are
similar to asbestos fibers that are known to cause lung
malignancies.
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Role of aerosols in diseases
Two studies of dental students support the causal relationship
between aerosols and respiratory disease.
Dental students were found to have a consistently higher
incidence of respiratory disease than medical or pharmacy
students.
In another study there was a dramatic increase in positive
tuberculin tests among dental students.
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Preventive measures
Face masks and safety glasses
Rubber dam
Suction (high velocity)
Preoperative mouthrinse
Good ventilation
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Preventive measures
Avoid patients with respiratory infections
Spray operatory with disinfectant
Flush water lines on dental units
Avoid instruments that produce splatter (bristle wheels)
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Infectious and communicable disease
Frick estimates that as many as 45% of all dentists believe
they have contracted infectious illnesses in professional
practice.
Bacteria, viruses and fungi represent the most common groups
of microorganisms confronting dental professionals as
infectious disease hazards.
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Bacterial infections
Disease Causative agent Symptoms
Impetigo Streptococci -Thin walled vesicles
-Highly contagious
-Mainly on extremities
Conjunctivitis Bacteria from
aerosols
-Reddened appearance of
conjunctiva
-Purulent discharge
Tuberculosis Mycobacterium
tuberculosis
-Cough, weight loss, fever,
malaise, hemoptysis, chest
pain.
-Tubercles that break into
ulcer
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Fungal infections
Disease Causative agent Symptoms
Dermatophytosi
s (ringworm)
Fungus -Mild redness & itching
-Mechanical deformities of
nails
Candidiasis Candida albicans -Curd like plaques on the skin
-Paronychial infections
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Viral infections
Disease Causative
agent
Symptoms
Herpes simplex HSV 1 -Primary herpetic
gingivostomatitis
-Vesicles on the oral mucosa
Herpetic whitlow Direct contact
with herpetic
lesion
-Usually affects thumb/index
finger
-Vesicles coalesce
-Incapacitating pain
Ocular herpes HSV 1 - painful ulcer in the eye
-Visual impairment
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Viral infections
Disease Causative
agent
Symptoms
Hepatitis Hepatitis B
virus
-Easy fatigability
-Malaise and arthralgia
-Fever, maculopapular skin rash
AIDS HIV -Fatigue, persistent fever, weight
loss
-Life threatening opportunistic
infections
-Severe Candida & herpes
infections
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Preventive measures for infectious diseases
Perform a thorough health history and examination of each
patient.
If possible treat patients with acute active disease in a special
dental operatory.
Give these patients the last appointment of the day.
Remove from the operatory or cover unnecessary equipment
and materials.
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Protect the dental team by strict adherence to the sterile
techniques.
Carefully perform procedures that carry a high risk of skin
puncture. Double gloving is recommended.
After final usage place the instruments in 2% alkaline
glutaraldehyde prior to being sterilized.
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MECHANICAL HAZARDS
Though not alarming, it can be reduced or avoided by being
careful while operating, e.g. Traumatic injuries due to
projectiles, carelessness while using sharp instruments,
airotors etc.
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MECHANICAL HAZARDS
Percutaneous injuries among dental personnel may occur :
 Handling equipment during clean up.
 Needle recapping
 Disassembling a device such as bur in a handpiece.
 By an explorer while puncturing a cement tube.
 By an endodontic file while searching for a canal opening
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PSYCHOSOCIAL HAZARDS
Stressful situations form an inherent part of a dentist’s everyday
work.
Meeting patient’s high expectations, emergency clinical situations
and procedures with uncertain prognosis all lead to stress.
Establishment of good relation with patient forms an important
aspect of practice by which patient compliance can be achieved
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It mainly leads to development of increased tension, high
blood pressure, tiredness, depression and sleeplessness.
Dentists with their busy schedules will be deprived of social
interaction, spend less time with family leading to ‘Burn out
syndrome’.
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WORK ORIENTED PROBLEMS
Dental professionals commonly experience musculoskeletal
pain during the course of their careers.
While the occasional back or neck ache is not a cause of
alarm, if regularly occurring pain or discomfort is ignored, the
cumulative physiological damage can lead to an injury or a
career ending disability.
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Each dental team member is predisposed to injury in a slightly
different area of the body depending on his/her task.
Dentists frequently assume prolonged static postures which have
been shown to be much more taxing than dynamic forces, leading to
consequences such as muscle imbalances, ischemia, trigger points,
joint hypomobility and spinal disk degeneration.
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Some of the common musculoskeletal disorders in dentistry
include the following:
1. Chronic low back pain: often referring to the hip, or one leg.
2. Tension neck syndrome: pain, stiffness and muscle spasm in the
cervical musculature.
3. Trapezius myalgia: pain, tenderness and spasm in the upper
trapezius muscle.
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Working position of the dentist:
The sitting position should permit ease of body mobility and
minimize the possibility of abnormal positions.
The seat of the stool should be at a height that permits the
thighs to be parallel to the floor, and both the feet should be
flat on the floor.
The seat should be flat and comfortable but not too soft.
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Tilt the seat angle forward 5 to 15 degrees to increase the
lower back curve.
Sit close to the patient and position knees under the patients
chair if possible.
Use the lumbar support of the chair as much as possible to
contact your back.
Distribute your weight evenly by placing the feet on the floor.
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Preventive measures
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 Maintain the lower back curves
 Use magnification
 Chair position
 Avoid static procedures
 Alternate standing and sitting between work
 Reposition of the feet
 Positioning of the patient at proper height
 Take periodic breaks and strecthing

Office lighting:
Good lighting is necessary to improve the quality, quantity,
safety, and comfort of dental procedures as well as to reduce
the mental and physical fatigue.
The visible blue light used to polymerize composite
restorations often causes visual defects.
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Safety and comfort in the dental office:
The delivery of dental care demands a convenient access and
visibility to the oral cavity.
The needs of different specialties should be considered in the
initial architectural design of the clinic.
Office routines, pleasant surroundings and compassionate people
contribute to the physical and mental comfort of the patients and
staff.
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Conclusion
Progressive increase in serious transmissible diseases over the
last few decades have created global concern and impacted the
treatment mode of all health care practitioners.
Every health care specialty that involves contact with mucosa,
blood and contaminated body fluids is now regulated.
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Although it is impossible to completely eliminate the risk posed by
occupational hazards listed, it is possible to minimize the risk with
relatively simple and inexpensive precautions.
Sufficient knowledge and adequate information regarding
occupational hazards and its prevention will contribute in providing
quality care to patients without any doubt.
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References
Goldman HS, Hartman KS, Messite J. Occupational hazards in
dentistry.1984;1st edition, Year Book Medical Publishers.
Peter S. Essentials of Preventive and community dentistry. 2006:3rd
edition, Arya (Medi) Publishing house:752-759
Hiremath SS. Textbook of Preventive and community Dentistry.2007:1st
edition, Elsevier Publishers:459-453.
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Hamann CP. Occupation related allergies in dentistry.
JADA,2005;136:500-509.
Valachi B. Preventing musculoskeletal disorders in clinical dentistry.
JADA, 2003;134:1604-1612
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THANK YOU
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