94 occupational hazards in dentistry.pptx

It describes occupational hazard to dentist

1. Occupational hazards in dentistry 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 1

2. Contents Introduction History Spread of infection Occupational health Occupational hazards Conclusions References 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 2

3. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 3

4. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 4

5. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 5

6. History Harmful effects of work exposures to chemicals is found in writings of Hippocrates and in Greek and Roman literature. In 17 th century, Bernardino published the first comprehensive treatise on occupational diseases which recommended that doctors inquire about a patients occupation when taking a history. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 6

7. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 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. 7

8. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 8

9. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 9

10. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 10

11. Infection via any of these routes requires that all three of the following conditions be present : Host Pathogen Portal of entry 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 11

12. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 12

13. Categories of task in relation to risk 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 13

14. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 14

15. 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”. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 15

16. Occupational hazards Any person may be exposed to five types of hazards depending on his occupation : Physical Chemical Biological Mechanical Psychosocial 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 16

17. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 17

18. Heat : Electrical hazards: Exposure may occur when there is lack of maintenance to any electrical equipment. Effects: Painful shocks, burns etc . 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 18

19. Noise: High-speed turbines, compressor, suction, ultrasonic scaler . Effects: Hearing loss, interference with communication, decreased efficiency and annoyance. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 19

20. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 20 Ultraviolet radiation Effects: Erythema & dermatitis, Conjunctivitis, Somatic and genetic effects, congenital defects, skin cancer.

21. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 21

22. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 22 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 .

23. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 23

24. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 24

25. Preventive measures The basic methods to reduce occupational exposure include: Position and distance rule: operator should stand at least 6 feet at an angle between 90 and 135 degree to the primary beam. Operator should never hold the film in place. Never hold the radiographic tube during exposure 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 25

26. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 26

27. CHEMICAL HAZARDS Dentists are exposed to various types of chemicals that are hazardous while providing care. These chemicals act in three ways: Local action Inhalation Ingestion 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 27

28. Mercury Mercury is hazardous- Dental personnel -Environment The dental profession primarily encounters mercury toxicity from two sources: Inhalation of vapors (primary source) Direct absorption into the tissues from handling mercury containing compounds. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 28

29. Sources of contamination: Removing old amalgam restorations Faulty amalgamators Leaking amalgam capsules Expressing excess mercury over the floor Exposure of mercury to heat sources 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 29

30. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 30

31. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 31

32. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 32

33. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 33

34. Methacrylates: Effects: irritation to skin, eyes or mucous membranes, allergic dermatitis, asthma, paraesthesia in fingers. When acrylate allergy is suspected, use nitrile gloves. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 34

35. 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 . 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 35

36. 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 . 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 36

37. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 37

38. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 38

39. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen Nickle : Confirmed occupational carcinogen. Powerful sensitizer of skin High incidence of lung and nasal cancer 39

40. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 40

41. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 41

42. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 42

43. Recommendations for the dentist: Have an effective program of scavenging and monitoring. Monitor the dental office at 4-month intervals (<50ppm N 2 O) Check the machines, lines, for any leakage. Maintain adequate ventilation 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 43

44. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 44

45. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen Main entry points of infection 45

46. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 46

47. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 47

48. Dental aerosols may have three components: Bacteria and viruses Particles of tooth structure Particles of dental materials 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 48

49. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 49

50. Micik and associates have concluded that in a controlled environment the following three procedures produce the maximum bacteria Prophylaxis procedure using pumice Air turbine hand piece with air coolant Air spray from an air-water syringe. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 50

51. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 51

52. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 52

53. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 53

54. Preventive measures Face masks and safety glasses Rubber dam Suction (high velocity) Preoperative mouthrinse Good ventilation 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 54

55. Preventive measures Avoid patients with respiratory infections Spray operatory with disinfectant Flush water lines on dental units Avoid instruments that produce splatter (bristle wheels) 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 55

56. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 56

57. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 57

58. Fungal infections Disease Causative agent Symptoms Dermatophytosis (ringworm) Fungus Mild redness & itching Mechanical deformities of nails Candidiasis Candida albicans Curd like plaques on the skin Paronychial infections 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 58

59. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 59

60. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 60

61. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 61

62. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 62

63. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 63

64. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 64

65. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 65

66. 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’. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 66

67. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 67

68. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 68

69. Some of the common musculoskeletal disorders in dentistry include the following: Chronic low back pain : often referring to the hip, or one leg. Tension neck syndrome : pain, stiffness and muscle spasm in the cervical musculature. Trapezius myalgia : pain, tenderness and spasm in the upper trapezius muscle. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 69

70. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 70

71. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 71

72. Preventive measures 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 72 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

73. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 73

74. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 74

75. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 75

76. 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. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 76

77. References Goldman HS, Hartman KS, Messite J. Occupational hazards in dentistry.1984;1 st edition, Year Book Medical Publishers. Peter S. Essentials of Preventive and community dentistry. 2006:3 rd edition, Arya ( Medi ) Publishing house:752-759 Hiremath SS. Textbook of Preventive and community Dentistry.2007:1 st edition, Elsevier Publishers:459-453. 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 77

78. 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 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 78

79. THANK YOU 11/20/2009 Seminar on Occupational hazards in Dentistry by dr praveen 79