Occupational hazards

Occupational hazards in Public Health perspective and Occupational hazards in Dentistry

1. s Seminar - 8 Dr. Nabeela Basha 2

2. Contents: Introduction Historical background Definition Health of workers Occupational Hazards Occupational Cancer Occupational Hazards of Agricultural Workers Accidents in Industry Sickness Absenteeism Prevention & control of occupational diseases Ergonomics 3

3. Occupational Hazards in Dentistry. Conclusion Previous year questions References 4

4. Introduction 5

5. Harry McShane, age 16 years, 1908. Had his left arm pulled off near shoulder, and right leg broken through kneecap, by being caught on belt of a machine in Spring factory in May 1908. He had been working in factory more than 2 yrs. No attention was paid by employers to the boy either at hospital or home according to statement of boy's father. No com- pensation . Location: Cincinnati, Ohio.   http://www.loc.gov/pictures/item/ncl2004000031/PP/ 6

6. HISTORICAL BACKGROUND A review of the historical background of occupational diseases and occupational environment brings to light the 3 distinct phases of development and may be designated as: Pre- Ramazzini Phase Ramazzini Phase Post- Ramazzini Phase Hippocrates – lead toxicity in miners. Galen – miners, tanners, chemists Father of Industrial hygiene Gave two famous exhortations Legislations in England & other European countries 1930 – industrial hygiene 1940 – importance realized 7

7. Definition Occupational health should aim at the promotion and maintenance of the highest degree of physical, mental and social well being of the 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; the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological equipment and to summarize the adaptation of work to man and of each man to his job. ( ILO/WHO 1950 and revised in 1996) 8

8. Preventive medicine and occupational health have the same aim – The prevention of disease and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; Levels of application: Health promotion, specific protection, early diagnosis and treatment, disability limitation and rehabilitation. 9

9. Occupational Health is application of preventive medicine in all places of employment. 10

10. HEALTH OF THE WORKER Factors that influence the health of the population also apply equally to industrial workers i.e. housing, water, sewage and waste disposal ,nutrition and education. Aim: Occupational health is to provide a safe ‘occupational environment’ -to safeguard the health of the workers and to increase industrial production. 11

11. OCCUPATIONAL ENVIRONMENT Occupational Environment is the sum of external conditions and influences which prevail at the place of work and have a bearing on the health of working population. 12

12. Man and physical, chemical and biological agents Physical agents :- The physical factors - adverse to health are heat, cold ,humidity , air movement ,heat radiation, light, noise, vibrations and ionizing radiation Factors act in different ways on the health and efficiency of the workers -singly or different combinations. Amount of working and breathing space, toilet, washing and bathing facilities are important. 13

13. Chemical Agents Comprise a large number of chemicals, toxic dusts and gases which are potential hazards to the health of workers. Some chemical agents cause disabling respiratory illnesses injuries to the skin deleterious effect on the blood and other organs of the body. 14

14. Biological agents The workers may be exposed to viral, rickettsial , bacterial and parasitic agents - close contact with animals or their products, contaminated water, soil or food. 15

15. Man and Machine Industry or factory implies the use of machines driven by power with emphasis on mass production. Unguarded machines, protruding and moving parts, poor installation of plant, lack of safety measures -causes of accidents. Working- long hours in unphysiological postures -causes fatigue, backache, diseases of joints and muscles and impairment of worker’s health & efficiency. 16

16. Man and man Numerous psychological factors operate at place of work. These are human relationships amongst workers themselves on the one hand and those in authority over them on the other. Psychological factors - type and rhythm of work, work stability, service conditions, job satisfaction, leadership style, security, workers participation, communication, system of payment, welfare conditions, degree of responsibility. 17

17. Occupational environment of the worker can not be considered apart from his domestic environment both are complimentary to each other. Ecological approach -occupational health represents a dynamic equilibrium or adjustment between the industrial worker and occupational environment . 18

18. OCCUPATIONAL HAZARDS 19

19. Physical hazards Light Light 20

20. Heat and Cold Common physical hazard in most of industries. Direct effect as heat stroke, heat exhaustion and heat cramp. Indirect effect are decreased efficiency, increase fatigue and enhanced accident rates. The Indian factories act has not laid down any specific temperature standard. 21

21. Occupational exposure to extremely low temperature is experienced by divers, fishermen, dairy workers, refrigerator repairmen, etc. Important hazards associated with cold works are chillbains , trench foot and frostbite. General hypothermia is common. 22

22. Light Workers may be exposed to risk of poor illumination or excessive brightness The acute effect of poor illumination are eye strains, headache, eye fatigue, eye pain, lacrimation. The chronic effects - miner’s nystagmus Exposure to brightness or glare -discomfort annoyance and visual fatigue. Intense direct glare - blurring of vision and lead to accidents. Sufficient and suitable lighting, natural and artificial whenever persons are working. 23

23. Noise Noise is a health hazard in many industries. Auditory effects - temporary or permanent hearing loss Non-auditory effects - nervousness, fatigue, interference with communication by speech, decreased efficiency and annoyance. The degree of injury -depends on intensity and frequency range, duration of exposure and individual susceptibility. 24

24. Vibration Vibration- frequency range 10 to 500Hz - tools such as drills and hammers. Vibration usually affects the hands and arms . After some months or years of exposure, the fine blood vessels of the fingers may become increasingly sensitive to spasm (white fingers) Exposure to vibration may also produce injuries of the joints of the hands and shoulders. 25

25. Ultraviolet radiation Occupational exposure to ultraviolet radiation, mainly affects the eyes, causing intense conjunctivitis and keratitis(welder’s flash) Symptoms - redness of the eyes and pain, these usually disappear in few days with no permanent effect on the vision or on the deeper structures of the eye. 26

26. Ionizing Radiation Increasing application in medicine and industry Eg . X-rays and radioactive isotopes (cobalt 60,P32) Tissues - bone marrow are more sensitive , hazardous to genes when the gonads are exposed. Radiation hazards -genetic changes, malformation, cancer, leukemia, depilation, ulceration, sterility, and in extreme cases death. 27

27. The International commission of Radiological Protection has set the maximum permissible level of occupational exposure at 5 rem per year to the whole body. 28

28. Biological hazards Workers - exposed to infective and parasitic agents at the work place. It may cause brucellosis, leptospirosis, anthrax, hydatidosis , tetanus, fungal infection such as schistosomiasis . Persons working among animal products and agricultural workers are specially exposed to biological hazards. 29

29. Chemical hazards The chemical hazards in various occupations can be due to gases, vapours , fumes, mists, dust, etc. The risk associated with occupational exposure to gases was first shown in mines. Gases can cause damage due to: Asphyxiation, Irritant action, Toxic action, Necrotization . The gases that cause occupational health hazards are: Asphyxiant gases: Carbon Monoxide, Hydrogen sulfide Irritant gases: Ammonia, Chlorine, Sulphur dioxide Toxic gases: Arsine Inert gases: Methane, Carbon dioxide. 30

30. PNEUMOCONIOSIS This is a special type of chemical hazard produced by occupational exposure to dusts. These are categorized as: Major pneumoconiosis: Silicosis, Asbestosis, Anthracosis . Minor pneumoconiosis: Bagassosis , Byssinosis, Farmer’s Lung. 31

31. Silicosis The major cause of permanent disability and mortality. It is caused by inhalation of dust containing free silica or silicon dioxide (SiO2). Reported in India from the Kolar Gold mines Mysore in 1947. Mica mines of Bihar out of 329 miners examined 34.1% were found suffering from silicosis. Ceramic and pottery industry -incidence depends upon chemical composition of the dust, size of the particles duration of exposure and individual susceptibility. 32

32. Silicosis is characterized by a dense nodular fibrosis the nodules ranging from 3 to 4 mm in diameter. Impairment of total lung capacity (TLC) is commonly present. X-ray of chest shows snow storm appearance The only way silicosis can be controlled is by Rigorous dust control measures such as substitution, complete enclosure, isolation good housekeeping. Regular physical examination of workers Silicosis was made a notifiable disease under the factories act 1948 and the Mines Act 1952. 33

33. Asbestosis Asbestos is used in manufacture of cement, roof tiling, brick lining. Enter in the body by inhalation and fine dust may be deposited in alveoli. Amongst its different varieties, Blue Amphibole variety is more hazardous, which causes fibrosis of lung tissue. Asbestosis with cigarette smoking – great risk of bronchial cancer. 34

34. Disease is characterized by dyspnoea . Sputum - show asbestos bodies. Ground – glass appearance on radiography. Preventive measures. Substitution of other insulants eg :glass fibres calcium silicate etc. Rigorous dust control Periodic examination Continuing research 35

35. Anthracosis Seen among Coal workers in coal mining. Manifests as simple pneumoconiosis or progressive massive fibrosis (PMF). Respirable coal dust concentration should not exceed 2mg/m 3 . Anthracosis has been declared a notifiable disease under the Indian Mines Act 1952 also compensable in the Workmen’s Compensation (Amendment)Act of 1959. 36

36. Byssinosis It is due to inhalation of cotton fiber dust over long periods of time. Symptoms are chronic cough and progressive dyspnoea , ending chronic bronchitis and emphysema. Incidence of byssinosis is reported to be 7-8% -surveys carried out in Mumbai, Ahmedabad and Delhi. 37

37. Bagassosis Caused by inhalation of bagasse or sugar cane dust . 1st reported in India by Ganguli and Pal(1955) in cardboard manufacturing firm in Kolkata. Bagassosis is due to thermophilic actinomycete for which name Thermoactinomyces sacchari . Symptoms -breathlessness ,cough, haemoptysis and slight fever. 38

38. Farmer’s Lung Is due to the inhalation of moldy hay or grain dust In grain dust or hay with a moisture content of over 30% bacteria and fungi grow rapidly causing a rise of temperature to 40 -50 deg.C This heat encourages the growth of thermophillic actinomycetes of which Micropolyspora faeni is main cause of farmer’s lung. Repeated attacks cause pulmonary fibrosis. 39

39. Lead poisoning More industrial workers are exposed to lead than any other toxic metal. Mode of absorption:- Inhalation: fumes or dust of lead. Ingestion:may be ingested in small quantities from lung, food or drink by contaminated hands. Skin: organic compound such as tetraethyl lead 40

40. Body Stores Body store of lead in an average adult is 150-400 mg and blood vessels average about 25 microgm /100ml. Increase up to 70microgm /100ml - clinical symptoms Normal adult ingest : 0.2-0.3mg of lead per day- food and beverages. 41

41. Lead poisoning or plumbism is different in inorganic and organic lead exposures Toxic effect of inorganic lead exposure- abdominal colic, obstinate constipation ,loss of appetite ,wrist drop, foot drop. Toxic effect of organic lead compound - CNS – insomnia, headache, mental confusion, delirium etc. Diagnosis History Clinical features :Loss of appetite, headache, abdominal cramps, constipation, joint and muscular pains, blue lines on gums. 42

42. Laboratory test s Coproporphyrin in urine(CPU) ; in non exposed person it is less than 150 microgram/ litre . Amino levullinic acid in urine (ALAU) if exceeds 5 mg / L indicates clearly lead absorption. Basophilic stippling of RBC Lead in blood and urine:- over 0.8 mg /L in urine and 70 microgm /100ml in blood. 43

43. Preventive measures Pre placement examinations Substitution General & Local exhaust ventilation to reduce particulate lead concentrations. Modification: Moistening of earth in Lead mining. Management A saline purge will remove unabsorbed lead from gut D- penicillamine - chelating agent promotes lead excretion in urine. Lead poisoning is a notifiable and compensable disease in India. 44

44. OCCUPATIONAL CANCER Occupational cancer is a serious problem in industry. The sites of the body most commonly affected are skin, lungs, bladder and blood forming organs. 45

45. Skin cancer Percival Pott was first to draw attention to cancer of scrotum in chimney sweeps in 1775. Coal tar was responsible to produce cancer of skin and scrotum. Nearly 75% occupational cancers are skin cancer. Commonly found in gas workers ,cake oven workers, tar distillers, oil refiners. 46

46. Lung cancer It is hazard in gas industry, asbestos industry, nickel and chromium work ,arsenic roasting plants and in mining of radioactive substances Arsenic, beryllium and isopropyl oil are suspected carcinogens More than nine-tenths of lung cancer are attributed to tobacco smoking, air pollution and occupational exposure. 47

47. Cancer bladder Cancer bladder was first noticed in man in aniline industry in 1895, later it was found in rubber industry. Cancer bladder caused -aromatic amines, which are metabolized in the body and excreted in urine. Industries associated with cancer bladder are the dye-stuffs and dyeing industry, rubber, gas and the electric cable industries. Possible carcinogens beta napthylamines , benzidine, paraamino -diphenyl, and auramine. 48

48. Leukemia Exposure to benzol , roentgen rays and radioactive substance give rise to leukemia. Benzol is a dangerous chemical and is used as solvent in many industries. Leukemia may appear long after exposure has ceased . 49

49. Characteristics of occupational cancer Appear after prolong exposure. The period between exposure and development of the disease may be as long as 10-25years. The disease may develop after cessation of exposure. The localization of tumours is remarkably constant in any one occupation 50

50. Control of industrial cancer Elimination or control of industrial carcinogens, technical measures like exclusion of the carcinogen from the industry, well designed machinery, closed system of production, etc. Medical examination. Inspection of factories. Notification Licensing of establishments Personal hygiene measures Education of workers and management Research 51

51. Occupational hazards of Agricultural workers Occupational health in agricultural sector is a new concept. Agricultural workers have a multitude of health problems a fact which is often forgotten because of the widespread misconception that occupational health is mainly concerned with industry and industrialized countries. The hazards to which a worker in agricultural activities is exposed are:- Physical hazards Chemical hazards Biological hazards Accidents 52

52. Accidents in industry Accident are common feature in most industries In fact some industries are known for accidents e.g. mining specially coal , construction work. It was estimated that nearly 3 million men are lost yearly due to industrial accidents. Causes are human and environmental Physical Physiological factors Psychological factors. Environmental factors are the temperature, poor illumination, humidity, noise unsafe machines. Unsafe machine account for 10-20% of all accident. 53

53. Prevention 98% accidents are preventable The principle of accident prevention are Adequate pre-placement examination. Adequate job training Continuing education Ensure safe working environment Establishment of safety department in organization under competent safety engineer Periodic survey for finding out hazards Carefully reporting and maintenance of records and publicity. 54

54. Sickness Absenteeism Sickness absence is important health problem in industry. As the production techniques become more sophisticated , absenteeism tends to increase. Absenteeism is a useful index in industry to assess the state of health of workers and their physical, mental and social well being. Causes Economic causes 3. Medical causes Social causes 4. Non occupational causes 55

55. Health problems due to industrialization Environmental and sanitation problems Communicable diseases Food sanitation Mental health Accidents Social problems Morbidity and Mortality 56

56. Prevention & Control of Occupational diseases Medical measures Safety / Engineering measures Legislative measures 57

57. Medical measures Pre –placement examination Periodical examination Medical care services Health care Notification 58

58. Engineering / Safety measures Design of building Good housekeeping General ventilation Mechanization Substitution Dusts Enclosure Isolation Local exhaust ventilation Protective devices Environmental monitoring Statistical monitoring Research 59

59. Legislation The most important factory laws in India are The Factories Act 1948 The Employees State Insurance Act 1948 60

60. The Factories Act, 1948 1 st Indian factories act-1881. Revised in year 1987. A factory -defined as a place using power, employs 10 or more workers, or 20 or more workers without power or were working any day of the preceding 12 months. Health, Safety and Welfare(chapter III, IV IVA and V) A minimum 500Cu.ft of space for each worker has been prescribed. 61

61. Precaution should be taken for ensuring the safety of workers. State government are empowered to prescribe maximum weights may be lifted or carried out by men women and children. The 1976 amendment (section 40 B) -Safety Officers in every factory wherein 1000 or more workers are ordinarily employed Crèches - factory wherein more than 30 women workers are ordinarily employed 62

62. Employment for Young Person Prohibits employment of children below -14 years . Declares Persons between ages 15-18 to be adolescents. Adolescents should be certified by the certifying surgeons Adolescents employee is allowed to work only between 6 A.M. & 7P.M. Maximum 48 working hours per with rest for at least ½ hour after 5 hours of continuous work. For adolescents the hours of work have been reduced from 5 to 4and ½ hours. 63

63. The Employees State Insurance, Act 1948 The ESI Act was passed in 1948, amended in 1975, 1984, 1989 and 2010. An important measure of social security and health insurance in this country. Provides for certain cash and medical benefits in case of sickness, maternity and employment injury. The ESI Act applies to any premises, where 10 or more persons are employed 64

64. Under these enabling provisions, most of the State Govts. have extended the ESI Act to Medical and Educational Institutes, shops, hotels, restaurants, cinemas, preview theatres, motor transport undertakings, newspaper and advertising establishments etc., employing 10 or more persons . With effect from 1-05-2010, the Act covers all employees getting upto Rs.15,000 per month. This has been further revised to Rs.21,000 per month as per notification of ESIC on 6-09-2016. 65

65. Administration of the ESI Scheme-ESI corporation The scheme is run by contributions by employees and employers and grants from central Govt and state Govt. Employer contributes 4.75%, employee contributes 1.75% of the wages. State govt share of medical expenses is 1/8 th of total cost of medical care. ESI corporation’s share is 7/8 th of total cost of medical care 66

66. Medical Benefit - Medical benefit consists of "full medical care" including hospitalization, free of cost, to the insured persons in case of sickness, employment injury and maternity. Medical care is provided either directly through the agency of ESI hospitals and dispensaries, or indirectly through a panel of private medical practitioners (panel system) appointed as "insurance medical practitioners". 67

67. Sickness Benefit - It consists of periodical cash payment to an insured person in case of sickness, if his sickness is duly certified by an Insurance Medical Officer or Insurance Medical Practitioner. The benefit is payable for a maximum period of 91 days, in any continuous period of 365 days, the daily rate being about 50% of the average daily wages. 68

68. Maternity Benefit- The benefit is payable in cash to an insured woman for confinement/miscarriage or sickness arising out of pregnancy/ confinement or premature birth of child or miscarriage. For confinement, the duration of benefit is 26 weeks, for miscarriage 6 weeks and for sickness arising out of confinement etc. 30 days. 69

69. Disablement Benefit- The Act provides for cash payment, besides free medical treatment, in the event of temporary or permanent disablement as a result of employment injury as well as occupational diseases. The rate of temporary disablement benefit is about 70 per cent of the wages as long as the temporary disablement lasts. 70

70. Dependants’ Benefit- In case of death, as a result of employment injury, the dependants of an insured person are eligible for periodical payments. An eligible son or daughter is entitled to dependant's benefit up to the age of 18: the benefit is withdrawn if the daughter marries earlier. Funeral expenses- Funeral benefit is a cash payment payable on the death of an insured person towards the expenses on his funeral, the amount not exceeding Rs . 10,000. (1.4.11) 71

71. Rajiv Gandhi Shramik Kalyan Yojna The ESI corporation has launched a new Yojna for the employees covered under ESI scheme. This scheme provides an unemployment allowance for the employees covered under ESI scheme who are rendered unemployed involuntarily due to retrenchment/ closure of factory etc. after fulfilling certain eligibility conditions. The scheme came in to effect from 1 st April 2005. Unemployment Allowance maximum period of 6 months. 72

72. During this period person is eligible for medical care for himself and family from ESI dispensaries, Panel clinics and hospitals to which he /she was attached before unemployment. 73

73. s Seminar – 8 (Session – 2) Dr. Nabeela Basha 75

74. Contents: Introduction Historical background Definition Health of workers Occupational Hazards Occupational Cancer Occupational Hazards of Agricultural Workers Accidents in Industry Sickness Absenteeism Prevention & control of occupational diseases 76

75. Session - 2 Ergonomics Occupational Hazards in Dentistry. Conclusion Previous year questions References 77

76. ERGONOMICS Well recognized discipline and constitutes an integral part of any advanced occupational health service. Ergonomics –derived from Greek ergon -work and nomos -law. Simply means- “fitting the job to the worker” Object- “to achieve the best mutual adjustment of man and his work ,for the improvement of human efficiency and well-being” Application of ergonomics has made significant contribution to reducing industrial accidents and to overall health and efficiency of the workers. 78

77. Occupational hazards in dentistry 79

78. Physical hazards Heat Lack of maintenance of electrical equipment. Effects-painful shocks, burns, etc Light Poor illumination-eye pain, eye strain, headache,fatigue etc. Excessive brightness- discomfort, annoyance, visual fatigue. Prevention-Sufficient and suitable lighting. Noise High speed turbines, compressor, suction, ultrasonic dental scaler. Auditory-temporary or permanent hearing loss. Non-auditory-fatigue, interference with communication by speech, decreased efficiency and annoyance. 80

79. Ultraviolet radiation, computers, lasers Eyes are affected –conjunctivitis and keratitis. Radiation-X rays. International commission of radiological protection –maximum permissive level of occupational exposure-5 rem per year to the body. Effects-erythema and dermatitis. Chronic-skin cancer and bone marrow suppression. Genetic effects-developmental defects in offsprings . 81

80. Radiation Protection and Prevention Goal-minimize radiation exposure of personnel and patients Recommendations for safety of practitioner: Buying of standard radiographic equipment –follows National Council on Radiation Protection and Measurements(NCRP) and ISI recommendations. Filtered beams and collimators should be used. Use of lead barriers between surgeon and X rays.2 mm thick sheet. 82

81. Use of barium plaster which absorbs scattered radiation. Lead aprons should be used. Thyroid shield for patients. Surgeons must use a film badge service provided by Bhabha Atomic Research Centre (BARC) Mumbai for personnel monitoring. 83

82. Sharps: Glassware and sharp needles, lancets, B.P blades,test tubes are hazardous. Cuts, scratches, abrasions are potential locations for infections. Prevention: Handle with care Biomedical waste management. 84

83. 85 Post accidental management Remove the gloves Wash the site of injury under running water with soap and water Avoid scrubbing and encourage bleeding and then protect Usually it is necessary to take blood specimen of both the patient and the injured person- and tested for HIV

84. 86 IF THE PATIENT IS SEROPOSITIVE FOR HIV…… The health care worker should be counseled about the risk of infection and evaluated clinically and serologically as soon as possible after exposure. A baseline HIV test should be carried out immediately. Advised to report and seek medical evaluation for any febrile illness that may occur within 12 weeks of exposure. HIV test should then be repeated approximately 6 to 12 weeks after contamination.  

85. 87 IF THE PATIENT IS SEROPOSITIVE FOR HIV…… Advised to follow recommendation for preventing transmission of infection. During this period advise from HIV counselor is of utmost importance, regarding domestic relation and procedure at workplace. The practitioner should immediately be evaluated by a physician.

86. Chemical Hazards Mercury : may cause mercury-poisoning during amalgam restoration. It can be prevented by using precapsulated alloys, good ventilation and proper mulling. Methacrylates ; causes irritation to skin, eyes, allergic dermatitis and asthma. It can be prevented by using nitrile gloves. Silica ; causes silicosis by inhaling free silica and silicon dioxide in ceramic laboratories. 88

87. Formaldehyde Used in clinical setup for disinfection. Effects-Acute-eye and respiratory irritation from liquid and vapor form. Severe abdominal pain, nausea, vomiting and possible loss of consciousness could occur. Chronic- Laryngitis, bronchitis. Latex glove Covered with cornstarch powder –barrier against pathogens. Most professionals are allergic. Effects- Urticaria Prevention-non-latex gloves. Eg : vinyl or nitrile gloves. 89

88. Dealing safe with Mercury 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 or trash Never dispose elemental mercury in the sharp container or as medical waste Keep the filling cool during removal 90

89. Biological Hazards Dentist can get infected by viruses, bacteria, fungi either directly or indirectly i.e by cut, wound ,needle-stick injury, aerosols of saliva, gingival fluid etc. Main entry points for infection are: epidermis of hands, oral epithelium, nasal epithelium, epithelium of upper airways, bronchial tubes, alveoli and conjunctival epithelium. Transmissible diseases –dental professionals are HBV,HIV,HCV,HSV and Mycobacterium tuberculosis. 91

90. PSYCHOSOCIAL HAZARD Stress situations from dentist’s everyday work like meeting high expectation of patient and emergency clinical situations This leads to increase 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 many depression syndrome It can be prevented by space out professional work, having sufficient rest, by interacting with family, doing exercise and yoga. 92

91. Musculoskeletal Disorders At work-dentist assumes strained posture both while standing and sitting close to patient - causes overstress to spine and limbs, and peripheral nervous system. Back pain syndrome, neck discopathy , cervicoacromial pains, and carpel tunnel syndrome. 93

92. CARPAL TUNNEL SYNDROME is a defect of the median nerve and cubital nerve. In its early phase, it is manifested as paresthesia of the thumb and index finger which is accompanied by disorders of the thumb and index finger as well as by the atrophy of the thenar . 94

93. Ergonomics in Dentistry The scope of ergonomics in dentistry is large: it ranges from chemistry between the dental team to lighting, noise and odor conditions and naturally to the used equipment and software. The treatment environment with the patient chair, dental unit, operating light, dynamic and hand instrumentation, cabinetry and peripheral equipment must be flexible. 95

94. Dentists need to adapt and guarantee good working postures, sufficient lighting and easy access to required instrumentation and materials for different working practices, clinical procedures and patient types. 96

95. Few guidelines of how to work.. Student/clinician should be properly seated in neutral posture a) Feet should rest flat on floor b) Angle between spine and the thighs should be 90 to 110 degrees c) Upper arms should be close to body and shoulders should be maintained in a horizontal line. d) Elbow / forearm angle is close to 90º 97

96. e) Wrists should be in line with the fore-arm with no more than 20-30 degrees extension. 2. Patient should be seated such that oral cavity is at a height equal to the height of seated clinician’s heart. 3. For Maxillary arch, should be such that chin should be up and for mandibular arch, chin should be down. 4. Turn head of the patient towards left/right depending upon the quadrants. 98

97. 5. Use light weight instrument with hollow or Round, textured handles. 6. Color-coded instruments should be used as it makes instrument identification easier reducing eye strain. 7. Dental chair should be constructed of rigid cast frame with proper lumbar support that will not distort with time and use. 99

98. Recommendations: Ergonomic practices should be made compulsory in the undergraduate curriculum. Unnecessary twisting ,placing instruments far from reach and awkward positions should be strictly discouraged. Magnification aids should be used. Four handed dentistry should be promoted. Ergonomically designed instruments should be utilized-larger handles to reduce pain and fatigue. Proper methods of lighting should be monitored among students. Chairs that provide adequate adjustability must be used. Ergonomics awareness training should be given to students. 100

99. Occupational Safety and Health Administration (OSHA) is an agency of the United States Department of Labor. It was created by Congress under the Occupational Safety and Health Act, signed by President Richard M. Nixon, on December 29, 1970. Its mission is to prevent work-related injuries, illnesses, and deaths by issuing and enforcing rules (called standards) for workplace safety and health. 101

100. Provide Hepatitis B immunization to employees without charge within 10 days of employment. Require that universal precautions be observed to prevent contact with blood and other potentially infectious material. Saliva is considered to be a blood-contaminated body fluid in relation to dental treatments. Implement engineering controls to reduce production of contaminated spatter, mists and aerosols. OSHA Regulations 102

101. Implement work practice control precautions to minimize splashing, spatter or contact of bare hands with contaminated surfaces Provide facilities and instructions for washing hands after removing gloves and for washing skin immediately or as soon as feasible after contact with blood or potentially infectious materials. Prescribe safe handling of needles and other sharp items. 103

102. Prohibit eating, drinking, handling contact lenses etc. in contaminated environments. Ban storage of food and drinks in refrigeration or other spaces where blood or infections materials are stored. Place blood and contaminated specimen to be transported or stored into suitable closed containers that prevent leakage. As soon as feasible after treatments attend to housekeeping requirements including floors, sinks etc that are subject to contamination. 104

103. Provide written schedule for cleaning. Contaminated sharps are regulated waste, discard in hard walled containers. Place reusable contaminated sharp instruments into a basket in a hard-walled container for transportation to the clean-up area. Personnel must not reach hands into containers of contaminated sharps. 105

104. CONCLUSION Occupational health risks are present in every profession. With advent of advanced technology, no matter how beneficial it is, can exert a negative impact on some members of the population. The reality is to balance maximum benefit and minimum harm to the population and wellbeing. Once identified and recognized as risk, new guidelines, precautions and protocols should be rapidly instituted to reduce or even eliminate the hazards. 106

105. Application of ergonomics and administrative measures contribute greatly in reducing the occupational hazards in the professional groups. 107

106. PREVIOUS YEAR QUESTIONS Discuss the various Occupational Hazards related to Dental Practice and add a note on its control. (RGUHS M.D.S. Degree Examination - April / May 2007) 20 marks. Occupational hazards in Dentistry. (RGUHS M.D.S. Degree Examination – October 2010) 10 marks. Occupational hazards. (RGUHS M.D.S. Degree Examination – May 2013) 10 marks. 108

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108. 5. Hiremath SS. Textbook of Preventive and Community Dentistry. 3rd edition. Elsevier Publishers, New Delhi; 2016. 6. V.V.R.Seshu Babu . Review in Community Medicine. 2 nd edition. Paras Medical Books Pvt Ltd, Hyderabad; 2011. 7. KN Abhishek, Jain J, Khanapure SC, M Shilpa . Ergonomics –Work Smart, Be Safe!!. J Adv Med Dent Scie 2013;1(2):34-39. 8. Gopinadh A, KN Neelima Devi, Chiramana S, Manne P, Sampath A, MS Babu . Ergonomics and musculoskeletal disorder: As an occupational hazard in Dentistry J Contemp Dent Prac , March-April 2013;14(2):299-303. 110

109. 9. OSHA, US Department of labour Safety and health Administration Technical Manual, Section VI, 1999: 1-12. 111