DEPARTMENT OF PUBLIC HEALTH DENTISTRY
Occupational Hazards In Dentistry
UNDER THE GUIDANCE OF:-
DR. SHITANSHU MALHOTRA
SUBMITTED BY:-
MOHD WAMIK
FINAL YEAR (2012-13)
SUBMITTED BY:-
MOHD WAMIK
FINAL YEAR (2012-13)
UNDER THE GUIDANCE OF:-
DR. SHITANSHU MALHOTRA
It can be defined as 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
HISTORY
‘Bernadino Ramzzani’ also known as ‘Father
of occupational hazards’
HAZARDS IN DENTISTRY
 Biological health hazards
 Physical hazards
 Chemical hazards
 Psychological hazards
Biological Health
Hazards
•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
consequences of bacteremia or viremia associated with systemic
infections.
•Infectious agents like Viruses, Bacteria, fungi, prions
•Transmissible disease greatly concern in dental profession are HBV,
HCV, HSV, and TV
•Vaccination is the best prevention
The known virus which infects humans
Herpes simplex Herpes labialis and keratitis, cold sores,
Virus (HSV) -1
Herpes simplex Genital Herpes, neonatal infection
Virus (HSV) -2
Vericella Zoster Chicken pox
Virus
Ebstein bar infectious mononucleosis
virus
Cyto –Megalo Mononucleosis- type syndrome
Virus
Human Herpes Fever with rash, Encephalistis , Myocarditis
Virus (HHV)-6 Lymphadenopathy
Human Herpes It has yet to be conclusively associated
Virus(HHV)- 7 with any disease
Human Herpes It has been identified in all AIDS and
Virus(HHV)- 8 non- AIDS releated Koposi’s sarcoma
lesions
ACUTE VIRAL HAPATITIS
The viral hepatitis is currently divided into five primary types A, B, C, D,
E.
HEPATITIS-A :- Blood and secretions probably transmit hepatitis-A. The
incubation period is 2-6 weeks
HEPATITIS-C :- It is also called parenterally transmitted non-A, non-B
hepatitis (PT-NANB). It can be transmitted by blood. The incubation
period is 2-25 weeks.
HEPATITIS-D :- It was recogniszed as an infection dependent on HBV by
Rizetto in early 1980’s. Appear only in individuals if he is infected
simultaneously with hepatitis B or carrier of Hepatitis B
HEPATITIS-E :- It is the epidemic endemic form of a non –A non- B
hepatitis. It was first discribed in 1965.
HEPATITIS-B :- The hepatitis virus was first described in 1965.
Globally, there is more than 300 million carriers of the virus.
It is highly endemic in China and South East Asia , Africa , most of the
pacific island, part of the middle east and Amazon Basin.
HBV can be transmitted by both percutaneoulsy and non percutaneously.
PERCUTANEOUSLY:- Dental treatment involves the use of small, sharp,
contaminated instruments transferred between dental care provider
during treatment.
NON- PERCUTANIOUS:- transmission in the dental care enviroment
includes transfer of infectious bodily secretions such as saliva, blood
and crevicular fluid.
PREVENTION OF TRANMISSION OF HBV:-
hepatitis B vaccine:-
 PLASMA- DERIVED VACCINE
 RECOMBINANAT DNA VACCINE
HIV INFECTION/ ACQUIRED IMMUNODEFICIENCY
SYNDROME(AIDS)
HIV is member of the retro virus family that can lead to acquired
immunodeficiency syndrome. A condition in which the immune system begins
to fall leading to life threatening oppourtnistic infections.
TRANSMISSION:- Through contact with blood and other body fluids.
CLINICAL FEATURES :- unexplained diarrhea lasting longer than 1 month,
malaise, Fatigue, loss of more the 10% body weight, night sweat,oral thrust.
PREVENTION AND MANAGEMENT OF
BIOLOGICAL HAZARDS
 In general, workers should be aware of potential hazards
 Proper medical history of the patient
 Worker education
 Awareness about diseases
 Use of barrier techniques by using gloves, mask, eye ware,
face shields, high power suction
 Proper disinfection techniques should be followed
 Proper waste disposal
 Equipments to provide minimum aerosols
 Maintenance of proper ventilation
 Identifying high risk patients
 Use of double mask, double gloves techniques for high risk
patient
 The patient should be given the last appointment
 Practitioner with any laceration or cuts on epidermis of
hands should be prohibited from attending the operative
procedures
 Proper disinfection technique and proper disposal
Prevention is better than cure…..
 Proper immunization of the workers
 Chemicals and substance used in dental clinic poses a
major health hazard to a dental practitioner
CHEMICAL HAZARDS
Amalgam used in dentistry contain mercury Which
is a highly toxic metal-may lead to
mercury poisoning
 Direct contact with chemicals such as- Eugenol,
Phenol, Iodine, formalin, some impression material,
topical anesthesia can cause adversereaction in the
practitioner like contact dermatitis
Latex hypersensitivity
PREVENTION AND MANAGEMENT
 Proper education for the workers
 Developing safe work procedures
 Substitution of harmful products with less harmful
products ex. Latex gloves can be substituted by vinyl
gloves , use of dust-free alginate
 Monitor leakage or spillage of any potentially
hazardous substance
 Proper storage products
 Medical monitoring of workers periodically
Dealing safe with Hg-
 Use of water sprays, high velocity evacuation
 and rubber dam to reduce exposure
 Dental staff should wear face-mask
 Carpeting and rugs should be avoided as it is a major
repository for mercury
 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
 Keep the filling cool during removal
PHYSICAL HAZARDS
 Dentists are at a high risk of physical injuries during
treatment
 Use of sharp may cause physical injuries to the
Practitioner
 Debris from the oral cavity might strike the eye
 Cut from sharp instrument
 Puncture wounds from needles and sharp objects
EXPOSURE TO CRYOGENIC AGENTS IN
CRYOSURGICAL PROCEDURES
 Oxygen depletion monitoring (depending upon hazard
assessment)
 Containers with pressure relief valves.
 Equipment maintenance.
 Restricted access.
 Worker education.
 Safe work practices.
POOR INDOOR AIR QUALITY
 Proper ventilation system design.
 Isolation/segretion of work processes that may create
contaminants.
 Infection prevention and controls standards.
 Procedures to report and investigate indoor air quality
EXPOSURE TO UV-A RADIATION WHEN
CURING RASIN BASED MATERIALS
 Equipment maintenance.
 Blue light filters.
 Safe work procedures including review and attention
to equipment manufacturer’s guidelines.
ELECTRICAL HAZARDS
 Ground fault circuit interrupters when used close to
water sources.
 Safe work procedures that include of electrical
cords,power bars and appliances that includes facility
approval requirements.
 Worker training.
CUTS FROM SHARP INSTRUMENTS
 Proper storage of sharps.
 Worker education.
 Safe work procedure
EXPOSURE TO LASER BEAMS
DURING DENTAL PROCEDURES
 Ensure area has no reflective surfaces
 Local exhaust ventilation
 Lock/key access for activation
 Restricted working area
 Worker education
Naver hold the X- ray
tubehead with hand while
shooting Raadiograph.
Exposure to ionizing radiation when
taking dental x-rays
 Workplace design to provide distance between worker
and source
 Equipment design to minimize scatter.
 Positioning devices to patient
 Replacement of older dental x-ray equipment with
newer equipment with additional safety features.
PREVENETIVE STRATEGIES
 Exposure to radiation can result in harm, categorized as either
Deterministic or Stochastic.
 Deterministic effects occur above a certain threshold of radiation e.g.
BURNS, CATARACTS.
 Stochastic events are radiation as there is not a threshold dose above which
they will occur e.g. CARCINOGENESIS.
 Additional exposure for medical purposes should be limited to where
benefit out weights risk to both staff and patients.
Radiation dermatitis
on hands
Squamous cell carcinoma
on figures
Prevention and management
 Proper storage of sharp instrument
 Equipment maintenance
 Proper managing and handling
 Carefully carried out procedures
NEEDLE STICK INJURY
 Ensuring the needle and surgical blade are
sheathed/covered when not in use
 Keeping full control of sharp instruments and retaining
 full concentration while handling such instruments
 Keeping gloved fingers behind the cutting edge of surgical
blades and elevators or the points of probe or needles
 Adequate retraction of tissues and appropriate instruments
 Placing needles in sharp safe box
 Taking care when cleaning away the surgical sharps, wires,
etc.
 Overgloving or using double gloves, whenever indicated
 Worker education about the signs and symptoms of
depression, anxiety,sleep depriviation, other mental
illness
 Elimination of workplace risk factors for depression
,anxiety, sllep disorder other mental illness
 Provision of support service and program
 Appropriate sleep habits
PSYCHOLOGICAL HAZARDS
TECHNOSTRESS
Related to the introduction of new technology
Management & prevention :-
 Self – education concerning new technologies
 Design of instruments or equipments with user – friendly features.
 Time managements strategies
 Back-up plans in the events of failures
 Healthy lifestyle
CONCLUSION
Dental health workers are exposed to many occupational
hazards ranging from threat of infectious disease,
toxicity to chemical routinely used in dentistry.
By identifying the control that will eliminate or reduce
the risk, we can significantly reduce the occupational
hazards.
Introduction

Introduction

  • 1.
    DEPARTMENT OF PUBLICHEALTH DENTISTRY Occupational Hazards In Dentistry UNDER THE GUIDANCE OF:- DR. SHITANSHU MALHOTRA SUBMITTED BY:- MOHD WAMIK FINAL YEAR (2012-13)
  • 2.
    SUBMITTED BY:- MOHD WAMIK FINALYEAR (2012-13) UNDER THE GUIDANCE OF:- DR. SHITANSHU MALHOTRA
  • 3.
    It can bedefined as 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
  • 4.
    HISTORY ‘Bernadino Ramzzani’ alsoknown as ‘Father of occupational hazards’
  • 5.
    HAZARDS IN DENTISTRY Biological health hazards  Physical hazards  Chemical hazards  Psychological hazards
  • 6.
    Biological Health Hazards •The dentalenvironment is associated with a significant risk of exposure to various microorganisms. •Many infectious agents may be present in blood or saliva, as a consequences of bacteremia or viremia associated with systemic infections. •Infectious agents like Viruses, Bacteria, fungi, prions •Transmissible disease greatly concern in dental profession are HBV, HCV, HSV, and TV •Vaccination is the best prevention
  • 7.
    The known viruswhich infects humans Herpes simplex Herpes labialis and keratitis, cold sores, Virus (HSV) -1 Herpes simplex Genital Herpes, neonatal infection Virus (HSV) -2 Vericella Zoster Chicken pox Virus Ebstein bar infectious mononucleosis virus Cyto –Megalo Mononucleosis- type syndrome Virus Human Herpes Fever with rash, Encephalistis , Myocarditis Virus (HHV)-6 Lymphadenopathy
  • 8.
    Human Herpes Ithas yet to be conclusively associated Virus(HHV)- 7 with any disease Human Herpes It has been identified in all AIDS and Virus(HHV)- 8 non- AIDS releated Koposi’s sarcoma lesions
  • 9.
    ACUTE VIRAL HAPATITIS Theviral hepatitis is currently divided into five primary types A, B, C, D, E. HEPATITIS-A :- Blood and secretions probably transmit hepatitis-A. The incubation period is 2-6 weeks HEPATITIS-C :- It is also called parenterally transmitted non-A, non-B hepatitis (PT-NANB). It can be transmitted by blood. The incubation period is 2-25 weeks. HEPATITIS-D :- It was recogniszed as an infection dependent on HBV by Rizetto in early 1980’s. Appear only in individuals if he is infected simultaneously with hepatitis B or carrier of Hepatitis B HEPATITIS-E :- It is the epidemic endemic form of a non –A non- B hepatitis. It was first discribed in 1965.
  • 10.
    HEPATITIS-B :- Thehepatitis virus was first described in 1965. Globally, there is more than 300 million carriers of the virus. It is highly endemic in China and South East Asia , Africa , most of the pacific island, part of the middle east and Amazon Basin. HBV can be transmitted by both percutaneoulsy and non percutaneously. PERCUTANEOUSLY:- Dental treatment involves the use of small, sharp, contaminated instruments transferred between dental care provider during treatment. NON- PERCUTANIOUS:- transmission in the dental care enviroment includes transfer of infectious bodily secretions such as saliva, blood and crevicular fluid. PREVENTION OF TRANMISSION OF HBV:- hepatitis B vaccine:-  PLASMA- DERIVED VACCINE  RECOMBINANAT DNA VACCINE
  • 11.
    HIV INFECTION/ ACQUIREDIMMUNODEFICIENCY SYNDROME(AIDS) HIV is member of the retro virus family that can lead to acquired immunodeficiency syndrome. A condition in which the immune system begins to fall leading to life threatening oppourtnistic infections. TRANSMISSION:- Through contact with blood and other body fluids. CLINICAL FEATURES :- unexplained diarrhea lasting longer than 1 month, malaise, Fatigue, loss of more the 10% body weight, night sweat,oral thrust.
  • 12.
    PREVENTION AND MANAGEMENTOF BIOLOGICAL HAZARDS  In general, workers should be aware of potential hazards  Proper medical history of the patient  Worker education  Awareness about diseases  Use of barrier techniques by using gloves, mask, eye ware, face shields, high power suction
  • 13.
     Proper disinfectiontechniques should be followed  Proper waste disposal  Equipments to provide minimum aerosols  Maintenance of proper ventilation  Identifying high risk patients  Use of double mask, double gloves techniques for high risk patient  The patient should be given the last appointment  Practitioner with any laceration or cuts on epidermis of hands should be prohibited from attending the operative procedures  Proper disinfection technique and proper disposal Prevention is better than cure…..  Proper immunization of the workers
  • 14.
     Chemicals andsubstance used in dental clinic poses a major health hazard to a dental practitioner CHEMICAL HAZARDS
  • 15.
    Amalgam used indentistry contain mercury Which is a highly toxic metal-may lead to mercury poisoning
  • 16.
     Direct contactwith chemicals such as- Eugenol, Phenol, Iodine, formalin, some impression material, topical anesthesia can cause adversereaction in the practitioner like contact dermatitis
  • 17.
  • 18.
    PREVENTION AND MANAGEMENT Proper education for the workers  Developing safe work procedures  Substitution of harmful products with less harmful products ex. Latex gloves can be substituted by vinyl gloves , use of dust-free alginate  Monitor leakage or spillage of any potentially hazardous substance  Proper storage products  Medical monitoring of workers periodically
  • 19.
    Dealing safe withHg-  Use of water sprays, high velocity evacuation  and rubber dam to reduce exposure  Dental staff should wear face-mask  Carpeting and rugs should be avoided as it is a major repository for mercury  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  Keep the filling cool during removal
  • 20.
    PHYSICAL HAZARDS  Dentistsare at a high risk of physical injuries during treatment  Use of sharp may cause physical injuries to the Practitioner  Debris from the oral cavity might strike the eye  Cut from sharp instrument  Puncture wounds from needles and sharp objects
  • 21.
    EXPOSURE TO CRYOGENICAGENTS IN CRYOSURGICAL PROCEDURES  Oxygen depletion monitoring (depending upon hazard assessment)  Containers with pressure relief valves.  Equipment maintenance.  Restricted access.  Worker education.  Safe work practices.
  • 22.
    POOR INDOOR AIRQUALITY  Proper ventilation system design.  Isolation/segretion of work processes that may create contaminants.  Infection prevention and controls standards.  Procedures to report and investigate indoor air quality
  • 23.
    EXPOSURE TO UV-ARADIATION WHEN CURING RASIN BASED MATERIALS  Equipment maintenance.  Blue light filters.  Safe work procedures including review and attention to equipment manufacturer’s guidelines.
  • 24.
    ELECTRICAL HAZARDS  Groundfault circuit interrupters when used close to water sources.  Safe work procedures that include of electrical cords,power bars and appliances that includes facility approval requirements.  Worker training.
  • 25.
    CUTS FROM SHARPINSTRUMENTS  Proper storage of sharps.  Worker education.  Safe work procedure
  • 26.
    EXPOSURE TO LASERBEAMS DURING DENTAL PROCEDURES  Ensure area has no reflective surfaces  Local exhaust ventilation  Lock/key access for activation  Restricted working area  Worker education Naver hold the X- ray tubehead with hand while shooting Raadiograph.
  • 27.
    Exposure to ionizingradiation when taking dental x-rays  Workplace design to provide distance between worker and source  Equipment design to minimize scatter.  Positioning devices to patient  Replacement of older dental x-ray equipment with newer equipment with additional safety features.
  • 28.
    PREVENETIVE STRATEGIES  Exposureto radiation can result in harm, categorized as either Deterministic or Stochastic.  Deterministic effects occur above a certain threshold of radiation e.g. BURNS, CATARACTS.  Stochastic events are radiation as there is not a threshold dose above which they will occur e.g. CARCINOGENESIS.  Additional exposure for medical purposes should be limited to where benefit out weights risk to both staff and patients. Radiation dermatitis on hands Squamous cell carcinoma on figures
  • 29.
    Prevention and management Proper storage of sharp instrument  Equipment maintenance  Proper managing and handling  Carefully carried out procedures
  • 30.
    NEEDLE STICK INJURY Ensuring the needle and surgical blade are sheathed/covered when not in use  Keeping full control of sharp instruments and retaining  full concentration while handling such instruments  Keeping gloved fingers behind the cutting edge of surgical blades and elevators or the points of probe or needles  Adequate retraction of tissues and appropriate instruments  Placing needles in sharp safe box  Taking care when cleaning away the surgical sharps, wires, etc.  Overgloving or using double gloves, whenever indicated
  • 31.
     Worker educationabout the signs and symptoms of depression, anxiety,sleep depriviation, other mental illness  Elimination of workplace risk factors for depression ,anxiety, sllep disorder other mental illness  Provision of support service and program  Appropriate sleep habits PSYCHOLOGICAL HAZARDS
  • 32.
    TECHNOSTRESS Related to theintroduction of new technology Management & prevention :-  Self – education concerning new technologies  Design of instruments or equipments with user – friendly features.  Time managements strategies  Back-up plans in the events of failures  Healthy lifestyle
  • 33.
    CONCLUSION Dental health workersare exposed to many occupational hazards ranging from threat of infectious disease, toxicity to chemical routinely used in dentistry. By identifying the control that will eliminate or reduce the risk, we can significantly reduce the occupational hazards.