As in any other working environment, dental practice can beassociated with harmful effects to dentists, referred to asoccupational hazards. These hazards vary from mild andeasily or self curable, as influenza and mental fatigue, to . more serious and incurable as AIDS
Potential sources for occupational hazards to dentists• -Working for long periods of time in physiologically improper positions.• Contact with patients.• Contact with certain chemicals and materials used in dental practice.• Contact with X-ray.• dental equipments and accessories produce sound noise at different sound levels.• Dealing with different personalities.
Working for long periods of time in physiologically improper positionsDentists have to contort their bodies while using a variety ofelaborate hand tools in order to perform work in the oralcavity. They are required to maintain these positions forprolonged periods of time. This creates a problem of havingstatic contractions and subsequently developing muscleischemia. Muscle ischemia is thought to be a primary causeof myofacial trigger points, which can result in pain,restriction of movement and muscular atrophy. Weakness ofthe postural muscles may lead to a progressive of theoperator’s posture, when then leads to pain”. This can affectthe dentists’ legs, spines and shoulders, Leg spine shoulderpain, flat foot and varicositiy .
How to mitigate the risk of musculoskeletal pains?Maintain an erect posture :adjust your seating to minimise bendingforward, thereby preserving normal curves in your spine as you sit to treat yourpatient.Keep your body in a relaxed natural position:do not work with your armselevated and tensed. Try to bring your patient close to you so that your elbowsand arms stay close to your body.Ensure that your hands and wrists do notremain contorted for an extended period of time.Change posture as frequently as you can: frequent switching between sittingand standing helps to reduce fatigue and the risk of problems associated withstatic muscle ischemia.Use dental equipment and tools that are easy on your hands:ergonomicallydesigned equipment are available.Take regular breaks between treatment: These breaks will enable you to dosome stretching exercises. This will reduce muscular tension and give you time torecompose.
Try to bring your patient close to you so that your elbows andarms stay close to your body.
working in standing position, both the back and the neckpostures are more asymmetric and at extremes of flexion, or,in other wordsin ergonomically inappropriate positions while the neckpostures when working at a sitting position are more neutralthan those postures while standing.
Contact with patientsInfection Harmful effects Eye injury and/ or inflammation .Infection Aerosolization is a process whereby mechanicallygenerated particles remain suspended in the air for prolongedtime periods and may be capable of transmitting an airborneinfection via inhalation. Aerosols are airborne particles, that maytravel for long distances. They may occur in liquid or solid forms.Splash and spatter are large droplets that remain airborne butcontribute to infection of indirect contact.Infection can be transmitted to dentist from infected patients whohave infectious potential. Infection transmission: A- Airborne: influenza, common cold, T.B . (Aerosols) B- Bloodborne : Syphilis, Hepatitis B and C, and AIDS. Infectedblood should contact dentist’s blood (needle prick after patientinjection, wound in dentist’s hands) C- Direct contact of hands with oral mucosal lesions : syphilisand herpes simplex infection. Saliva and hepatiti
precautions should be taken to minimizing the risk of infections1-The dental surgeon should wear a face mask.2-The use of high speed hand pieces with T.B. patients shouldbe avoided to minimize aerosols.3-In dealing with a syphilitic patient, the dental surgeon shouldwear rubber or vinyl gloves.4-The dentist should not scrub his hands with a brush before orafter working on pt with AIDS,TB or hepatitis, since scrubbingmay produce minute abrasions which serve as a portal of entryfor microorganisms .5-clinical examination, mucosal lesions should never be touchedwithout gloves . .6- 5-Careful handling of sharp instruments .7-Eye glasses should always be used while treating the patients.
Golden role“All patients should be treated as if they are infectious and routinecross-infection control is necessary when dealing with everypatient”.Universal cross Infection Control routines :Sterilization; Barriers; Chemical Disinfectants ; Disposable of Wastesnote: barriers mean gloves; masks; goggles; protective clothing. Theseserve as protective barriers against the transmission of diseases.Gloves are disposed of after each patient.
Contact with certain chemicalsDirect contact with materials such as eugenol, phenol,iodine, formalin, some impression materials, topicalanaesthia and others could cause allergic contactdermatitis.mercury exposure may lead to Hg poisoning.Adverse health effects of this exposure includingneurological effects have also been well documented .
How to protect contact dermatitis• Use machinery and tools to clean equipment, rather than yourhands.• Wear non-latex gloves where possible, especially when cleaning(care needs to be taken when selecting gloves if you are allergic toany materials used in gloves).• Do not use abrasive skin cleaners and keep the use ofdisinfectants to a minimum.• Dry your hands thoroughly with a soft, disposable paper towel .• Protect your hands by moisturising them regularly with anemollient (soothing and softening skin product). Use a product thatis free from fragrances and preservatives• Avoid sensitisers that you are allergic to (investigation by yourdermatologist will help identify these).
Dealing safely with Hg-Use of water spray, high velocity evacuation and rubber dam reduceexposure.- All dental staff should wear face masks.-carpeting and rugs in dental offices should be avoided as it is a majorrepository of mercury.-Never rinse elemental mercury down the drain.-Never dispose of elemental mercury in the trash.-Never dispose of elemental mercury in the sharps container or asmedical waste.-Dont mix a double-use capsule if a single-use capsule will do.-Keep the fillings cool during removal .-Cutting the Amalgam into Chunks:Most mercury-safe dentists use a removal process that’s commonlyreferred to as chunking. This involves less drilling, because the dentistonly drills enough to cut the filling into chunks, which can then be easilyremoved by a hand instrument or suction and minimize Hg vapouring. - Do not use latex gloves as mercury can penetrate latex.
Contact with X-rayX-ray is an ionizing radiation that is capable ofinitiating and producing damage to body cells, as wellas carcinogenic and genetic changes. Carelessdentists used to hold the dental X-ray films inside thepatient’s mouth (for obtaining better quality of image)are at risk for developing radiation dermatitis onhands, or on a long run squamous cell carcinoma ofthe figures.
protection from radiation hazardsprinciples and means of radiation protection should beapplied and used during radiation exposure.- Dentist should not hold the film in patient’s mouth. -Dentist should avoid direct exposure to X-ray beam. - proper position of the dentist in relation to either the X-ray machine or the patients should be strictly applied. -Regular checking of leakage from X-ray machineshould always be performed.- Radiation monitoring.
Perspnal protective equipments• Medicalgloves(different types)• Eye wears• Masks• Protective clothing(medical and lead aprons)
perilous auditory effectThe hearing threshold in humans varies with the frequency ofsound, and it is well known that dentists experience gradualhearing loss during their working life, especially because high-speed dental air turbines emit frequencies that can cause.hearing lossDental laboratory machine, dental hand piece, ultrasonicscalers, amalgamators, high-speed evacuation and otherdental equipments and accessories produce sound noise at.different sound levelsit is imperative that dentists remain well versed regarding up-to-date measures on how to deal with newer technologies and .dental equipments in clinical use
Pscychological hazardsa. Stress:Coping with difficult or uncooperative patients, over workload, constant drive for technical perfection, underuse of skills, low self-esteem and challenging environment are important factors contributing to stress among dentist.b. Professional burnout: “A syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment.it is best described as a gradual erosion of the person.c. Anxiety disorder and Depression:Two common and potentially overlapping anxiety disorders are panic disorder and generalized anxiety disorder, or GAD. In panic disorder, feelings of extreme fear and dread strike unexpectedly and repeatedly for no apparent reason They are accompanied by intense physical symptoms like feeling sweaty, weak, faint, dizzy, flushed or chilled; having nausea, chest pain, smothering sensations, or a tingly or numbfeeling in the hands. GAD is characterized by chronic exaggerated worry and tension, even though little or nothing has provoked it.
Coping with Psychological hazards-Stress management :deep breathing exercises;progressive effective relaxation of areas of the body;listening to audiotapes of oral instructions on how to relax;meditation; information on the topics of practice andbusiness management, time management, communication.-Physical exercise, such as regular walking or working out.People’s personalities and temperaments have a significantimpact on their perceptions of stress. Those who havestrong, positive self-images and know how to relax so as toreduce mental and emotionalpressures also cope betterwith stress,-Stressors such as failing to meet personal expectations,seeing more patients working quickly can be managed bybreaking the large task into small ones.