Occupational hazards in dentistry: An introduction

AN INTRODUCTION
R.K.Haritha
BDS CRI
Department of Public
Health dentistry
Chettinad Dental College
& Research Institute

 INTRODUCTION
 BIOLOGICAL HAZARDS
 CHEMICAL HAZARDS
 PHYSICAL HAZARDS
 CHEMICAL HAZARDS
 PSYCHOLOGICAL HAZARDS
 PREVENTIVE MEASURES
 STANDARD PRECAUTIONS
 PUBLIC HEALTH SIGNIFICANCE
 CONCLUSION
 MCQs
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• Ionizing radiation: Taking X-ray machines in the dental office predispose dentists to suffer from ionizing
radiation.
• Non-ionizing radiation: This has recently become a concern since the use of composites and other resins,
next to the use of lasers in dentistry procedures, which has added another potential hazard to eye and other
tissues that may be directly exposed
• Chronic exposures to radiation can results, somatic (body) or genetic changes.
• The radiation effects are cumulative and this damage is totally painless yet life threatening, it may
cause acute erythema, dermatitis, chronic skin cancer, bone marrow suppression, damaged to eye
including cornea, lens and retina.
• Safety shields and use of eye glasses helps to protect from radiation damage

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• Poor illumination causes eye pain, eye strain, headache, eye fatigue where as excessive brightness
leads discomfort, and visual fatigue.
• Conjunctivitis and keratitis while using dental curing light, computer and lasers.
• Visual field constriction related to mercury exposure is reported.
• Colour vision examination has been shown as a sensitive indicator of subtle neurotoxic effects from exposure
to solvents and heavy metals.

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• Noise-induced hearing loss.
• Reason for seeking a hearing evaluation may be tinnitus.
• Sources of dental sounds - High-speed turbine handpieces, low-speed handpieces, high-velocity suction,
ultrasonic instruments and cleaners, vibrators and other mixing devices, and model trimmers. should be worth
mentioning that air conditioners and office music played too loud.
• The noise levels of modern dental equipment is below 85 db
• In dental practical classes - exaggerated noise produced by some of these devices and due to the use of a
single dental equipment by many users at the same time. This situation is aggravated when the classrooms
have hard surfaces which act as noise reflectors, as is usually the case.

• Broad descriptive term that include sharp injuries as well as cutaneous and mucous exposure to blood and
serum

• 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

They include mercury, beryllium, silica and powdered natural rubber latex (NRL).
• Local action, inhalation and ingestion.
• Maximum safe level is 50 µg/ cc of air.
• Affinity for brain tissue.
• Mercury poisoning - tumours of the face, arms or legs and may be associated with progressive, tremulous
illegible handwriting with slurred speech.
• Exposure risks minimized by - careful handling, collecting the waste part of amalgam in closed container and
subjecting it to recycling, use of proper evacuation system and avoiding the direct physical contact.
• “Sealed amalgam capsules use with lower mercury level, water irrigation and high suction,
good ventilation and proper collection, and discarding of amalgam have substantially
diminished the mercury dangers.”

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• Mixing of processor chemical components also causes the release of sulphur-dio-oxide from decomposition of
sulphite.
• Chronic exposure may result in bronchospasm
• Ammonia, a highly soluble respiratory irritant, is another potential by-product released from the breakdown of
processing chemicals.
• Another source of vapor release is the silver recovery unit. It is important that the lid be tightly secured and only
opened in a well- ventilated area.

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• Wear the appropriate gloves for the task when needed; for reusable gloves, follow the manufacturer’s guidelines for care,
decontamination and maintenance. Choose gloves resistant to holes and tears.
• Ensure gloves fit properly and are of the appropriate thickness to offer protection; ensure adequate supplies of gloves in
appropriate sizes.
• Avoid using latex gloves (due to latex allergies).
• Do not use worn or defective gloves.
• Wash hands once gloves have been removed.
• Disposable gloves must be discarded once removed. Do not save for future use.
• Dispose of used gloves into the proper container. Have separate disposal locations for gloves contaminated with chemicals
which pose a toxic hazard if mixed.
• Non-disposable/reusable gloves must be washed and dried, as needed, and then inspected for tears and holes prior to reuse.
• Remove gloves before touching personal items, such as phones, computers, pens and one’s skin.
• Do not wear gloves into and out of areas. If gloves are needed to transport anything, wear one glove to handle the transported
item. The free hand is then used to touch door knobs, elevator buttons, etc.
• Do not eat, drink, or smoke while wearing gloves. Gloves must be removed and hands washed before eating, drinking, or
smoking.
• If for any reason a glove fails, and chemicals come into contact with skin, remove the gloves, wash hands thoroughly and obtain
first aid or seek medical attention as appropriate.

• Latex allergy is a reaction to certain proteins in latex rubber. The amount of latex exposure needed to produce
sensitization or an allergic reaction is unknown. Increasing the exposure to latex proteins increases the risk of
developing allergic symptoms. In sensitized persons, symptoms usually begin within minutes of exposure; but
they can occur hours later and can be quite varied. Mild reactions to latex involve skin redness, rash, hives, or
itching. More severe reactions may involve respiratory symptoms such as runny nose, sneezing, itchy eyes,
scratchy throat, and asthma (difficult breathing, coughing spells, and wheezing). Rarely, shock may occur;
however, a life-threatening reaction is seldom the first sign of latex allergy.

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• Use nonlatex gloves for activities that are not likely to involve contact with infectious materials (food
preparation, routine housekeeping, general maintenance, etc.).
• Appropriate barrier protection is necessary when handling infectious materials. If you choose latex gloves,
use powder-free gloves with reduced protein content.
• Such gloves reduce exposures to latex protein and thus reduce the risk of latex allergy.
• So-called hypoallergenic latex gloves do not reduce the risk of latex allergy. However, they may reduce reactions to
chemical additives in the latex (allergic contact dermatitis).
• Use appropriate work practices to reduce the chance of reactions to latex.
• When wearing latex gloves, do not use oil-based hand creams or lotions (which can cause glove deterioration).
• After removing latex gloves, wash hands with a mild soap and dry thoroughly.
• Practice good housekeeping: frequently clean areas and equipment contaminated with latex-containing dust.
• Take advantage of all latex allergy education and training provided by your employer and become familiar
with procedures for preventing latex allergy.
• Learn to recognize the symptoms of latex allergy: skin rash; hives; flushing; itching; nasal, eye, or sinus
symptoms; asthma; and (rarely) shock.

Golden rule- ‘All patients should be treated as if they are infectious and routine
cross-infection control is necessary dealing with every patient ’

• HIV, HBV, HCV and Mycobacterium tuberculosis.
• Infected either directly or indirectly, i.e by a cut or wound, needle stick injury, aerosols of saliva, gingival fluid
and natural organic dust particles.
• Entry points of infection - epidermis of hands, oral epithelium, nasal epithelium, epithelium of upper airways,
bronchial tubes, alveoli and conjunctival epithelium.
• Thorough knowledge about the infection, mode of transmission and safety measures is necessary.
• Rubber dam will eliminate virtually all contamination arising from saliva or blood
• Effective sterilization of instruments using autoclave before and after use.
• OSHA - It includes requirements for an exposure control plan, exposure control precautions, laundry
procedures, mandatory hepatitis B vaccinations, housekeeping standards, and waste disposal regulations

• The risk of HIV transmissions to healthcare workers approximately range from 0.2 to 0.3% for parenteral
exposures and 0.1% or less for mucosal exposures.
• HCV transmission risk is 1.8% and is the most serious viral hepatitis infection because of its ability to produce
chronic infection in as many as 85% of those infected.

• Stress can be defined as the biological reaction to any adverse internal or external stimulus physical,
mental or emotional that tends to disturb the organism’s homeostasis.
• Dentists perceive dentistry as being more stressful than other occupations.
• 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

• A syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment that can
occur among individuals who do people work of some kind.
• Burnout is best described as a gradual erosion of the person.
• Prolonged experience of burn out may lead to depression, so early recognition of the symptom is
important.

• Anxiety disorders are chronic and relentless and can grow progressively worse if not treated.
• 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 numb feeling in the hands.
• GAD is characterized by chronic exaggerated worry and tension, even though little or nothing has provoked it.
• Depressive disorder often occurs with anxiety disorders and substance abuse.
• Major depression is an illness that involves the body, mood and thoughts. It affects the way people eat, sleep,
feel about themselves and think about things. Studies have indicated that both anxiety and depressive
disorders are observed frequently in dentists.

• Risk factors affect dentist's psychological conditions that include job-related stress, tension, depression,
emotional exhaustion, and depersonalization.
• There was no difference between levels of stress among dental specialties.
• A large number of factors are responsible for stress situations including low autonomy, work overload, and
inappropriate relation between power and responsibility. Teaching role in addition to clinical role may increase
the levels of stress, but there is also evidence that this dual role may decline job-related stress.[50]
• Understanding and controlling of the underlying physiological mechanisms precisely are necessary to develop
and implement a comprehensive approach to minimize the risks of the work-related injuries. Maintaining good
physical and mental health is emphasized to dentists to enjoy and be satisfied with their professional and
personal lives.

• Coping can be done by, participating in activities that make to feel better, going to movies or participating in
religious, social or other activities.
• Stress management workshops focusing on stress relievers may include 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 and business management, time management,
communication and interpersonal skills.
• Physical exercise - regular walking or working out at a health club
• Burn up the additional supply of adrenaline those results from stress
• Physical exercise helps develop greater self-esteem, self-control and
• People’s personalities and temperaments have a significant impact on their perceptions of stress.
•

• Muskuloskeletal disorders are common health problems reported among dentists. Its prevalence reported to be
between 38-82%.
• Musculoskeletal disorders are a group of conditions that involves: Nerves ,Tendons , Muscles and
supporting structures such as intervertabral discs.
• It has been reported that young and less experienced dentists experience more musculoskeletal disorders
compared to older and experienced one
• Common musculoskeletal problems are, low back pain, shoulder pain, headache, hand and wrist pain. Low
back pain is more prevalent than other types.
• The cause of musculoskeletal problem is due to, repeated unidirectional twisting of the trunks, working in one
position, prolonged static periods and operators flexibility
• At work, the dentist assumes a strained posture (both while standing and sitting close to a patient who remains
in a sitting or lying position), which causes an overstress of the spine and limbs.

• Back pain syndromes diagnosed in dental workers originate from spine degeneration in its different
phases.
• The posture of the dentist at work, with the neck bent and twisted, an arm abducted, repetitive and precise
movements of the hand are frequent cause of the neck syndrome and of pain within the shoulder and
upper extremities
• Fatigue and back pain as most common prevalent and chronic physical complaints
• The dentist makes constant monotonous movements, which stress the wrist and elbow joints. Also of
consequence are mechanical vibrations.

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• Ensuring proper ventilation, using new instruments with less than 85 decibals sound, following of standard
precautions, sterilisation & autoclaving protocols also ensures the safety of patients.
• Hazardous mercury & other biomedical waste are not disposed in sewers or disposed with general waste
• Latex allergy can also be seen among patients
• Eye wear should be given to patients when performing treatments with lasers, it is also advisable to use while
using curing lamps
• Patient must be made aware about the importance of disclosing the presence of any infectious diseases to their
dentists

• Occupational hazards are a natural component in any
occupation, and we as dentists have our own set of
occupational hazards which needs to be tackled by
acquiring the knowledge about these hazards & how to
prevent or manage them when the need arises with the
current research available. Hence continuing dental
education plays a pivotal role.

• Ayatollahi J, Ayatollahi F, Ardekani AM, et al. Occupational hazards to dental staff. Dent Res J (Isfahan).
2012;9(1):2-7. doi:10.4103/1735-3327.92919
• Shekhawat KS, Chauhan A, Sakthidevi S, Nimbeni B, Golai S, Stephen L. Work-related musculoskeletal pain
and its self-reported impact among practicing dentists in Puducherry, India. Indian J Dent Res. 2020;31(3):354-
357. doi:10.4103/ijdr.IJDR_352_18
• Prudhvi K, Murthy KR. Self-reported musculoskeletal pain among dentists in Visakhapatnam: A 12-month
prevalence study. Indian J Dent Res. 2016;27(4):348-352. doi:10.4103/0970-9290.191880
• Hayes M, Cockrell D, Smith DR. A systematic review of musculoskeletal disorders among dental
professionals. Int J Dent Hyg. 2009;7(3):159-165. doi:10.1111/j.1601-5037.2009.00395.x
• Babaji, Prashant. (2011). Occupational hazards among dentists: A review of literature. Int J dental and medical
research. 2011;4(2):87-93.
• https://www.cdc.gov/niosh/docs/98-113/

A. Less than 85 decibels
B. More than 85 decibels
C. None of the above

A. Skin rash
B. Hives
C. Flushing
D. Boils

A. Sulphur dioxide
B. Sulphite
C. Both
D. None of the above

A. Occupational Safety and health
administration
B. Occupational Safety and hazard
awareness
C. Occupational Safety and health
armamentarium
D. None of the above

Occupational hazards in dentistry: An introduction

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