Article Wjpps 1401536669 PDF

WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES
Raja.K et al. World Journal of Pharmacy and Pharmaceutical Sciences

SJIF Impact Factor 2.786
Volume 3, Issue 6, 397-415. Review Article ISSN 2278 – 4357
OCCUPATIONAL HAZARDS IN DENTISTRY AND ITS CONTROL

MEASURES – A REVIEW
Mr. Raja.K*, Dr. Auxilia Hemamalini Tilak
Department of Microbiology, ASAN Memorial Dental College and Hospital, Asan Nagar,
Oragadam Road, Keerapakkam Village, Chengalpet- 603105,Kancheepuram – Dt, Tamilnadu.
Article Received on
ABSTRACT
26 March 2014, Dentists, as well as other dental personnel are constantly exposed to a
Revised on 17 April
2014, number of specific occupational hazards. These cause the appearance
Accepted on 8 May 2014
of various ailments, specific to the profession, which develop and
intensify with years. In many cases they result in diseases and disease
*Correspondence for Author
complexes, some of which are regarded as occupational illnesses.
Raja.K
Relying on relevant literature, the present paper discusses occupational
Department of Microbiology,
ASAN Memorial Dental hazards like stressful situations, latex hypersensitivity, allergic
College and Hospital, Asan reactions due to various dental materials, exposure to radiation
Nagar, Oragadam Road, (ionizing and non-ionizing), percutaneous exposure incidents (PEI),
Keerapakkam Village,
hazard due to nitrous oxide gas, as well as factors leading to the
Chengalpet,Kancheepuram –
musculoskeletal system diseases and diseases of the peripheral nervous
Dt, Tamilnadu
system. Awareness regarding these occupational hazards and
implementation of preventive strategies can provide a safe working environment for all the
dental personnel. There is also a need for continuing dental education programs in dentistry
so that dentists can update themselves with the latest and newer techniques and materials.
Keywords: Dental personnel, Hazards, Infectious Disease, Stress, Control measures
INTRODUCTION
Dentists are usually exposed to a number of occupational hazards during their professional
work. These cause various ailments, specific to the profession, which develop and intensify
with years. In many cases they result in diseases and disease complexes, some of which are
regarded as occupational illnesses. Occupational hazards 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 (1). Although modern dentistry
www.wjpps.com Vol 3, Issue 6, 2014. 397

has been cited as the least hazardous of the all the occupations, many risks still challenge the
status of this occupation(2). Dental personnel are exposed to various occupational hazards
like stress, allergic reactions, higher noise levels, accidental percutaneous exposure, radiation,
musculoskeletal disorders, etc.. (3), Dental environment is also associated with a significant
risk of exposure to various micro-organisms. Infectious agents may be present in blood or
saliva, as a consequence of bacterimia or viremia associated with systemic infections. Dental
patients and Dental Health Care Workers [DHCW] may be exposed to variety of micro-
organisms via blood or oral or respiratory secretions (4). These micro-organisms may include
Cytomegalo virus ,Hepatitis B virus, Hepatitis C virus, Herpes simplex virus types 1 and 2,
HIV ,Mycobacterium tuberculosis and other viruses and bacteria, especially those that infect
the upper respiratory tract. Microorganisms can infect, through a cut on the skin of hand
while performing a medical procedure, any dental procedure resulting in an accidental biting
by the patient, or through a needle wound created while imparting anaesthesia. An indirect
infection occurs when an infectious agent is transmitted into the dental care giver through the
so-called carrier. The following are the main sources of indirect infection: aerosols of saliva,
gingival fluid, natural organic dust particles (dental caries tissue) mixed with air and water,
and accidental breakage of dental instruments and devices .during clinical practice exposes to
variety of work related hazards(5). These occupational hazards can be classified into five
types: “physical, chemical, biological, psychological and musculoskeletal disorders (6). The
paper reviews various studies relating to occupational health hazards in dental profession, and
its control measures.
HAZARDS FROM PHYSICAL AGENTS

Noise generated by dental equipments
Dental personnel are exposed to noise of different sound levels while working in dental
clinics or laboratories. Dental laboratory machine, dental hand piece, ultrasonic scalers,
amalgamators, high speed evacuation devices and other items produce sound at different
levels which is appreciable. As reported in an earlier study conducted among dentists and
dental auxiliaries, 16.6% of subjects reported of tinnitus, 30% had difficult in speech
discrimination and 30.8% had speech difficulty in a background noise(7) .The noise levels
of modern dental equipment is below 85 db and up to this point the risk of hearing loss is
negligible(8,9). But the risk is amplified while using older or faulty equipment. In dental
practical classes, the acoustic environment is characterized by higher noise levels, in relation
to other teaching areas, due to 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(10). Therefore, it should be guaranteed that, in school buildings of this type
sound levels are not detrimental to learning activities. Harmful effect is produced on the
students and lecturers due to long exposure to higher noise levels. It is well known that higher
sound levels have a negative effect on the extra-auditory systems with physical consequences
(quickened pulse, increase in blood pressure, constriction of blood vessels, etc.) and psychical
consequences (nervousness, mental fatigue and emotional frustration, low productivity etc) in
some individuals. These effects occur especially with noise levels above 80db and are
dependent on the intensity, the distance to the source, the total duration of the noise, the age
of the individual and physical condition and sensitivity(8,9). Also, it is commonly known that
exposure to noise can induce loss of hearing. It is therefore essential to control noise in
learning environments, not forgetting that acoustic comfort depends not only on the control of
the emitted sound levels but also on the acoustic characteristics of the classrooms. Ultrasonic
scalers sometimes may be a potential hazard to the auditory system of both clinicians and
patients. Damage to operator hearing is possible through air-borne subharmonics of the
ultrasonic scaler. For the patient, damage can occur through the transmission of ultrasound
through the tooth contact to the inner ear via the bones of the skull. This later hazard is
possible during the scaling of molar teeth(11). Tinnitus is an early sign of hearing loss and
may occur following ultrasonic scaling in some individuals. A small number of dentists have
experienced tinnitus or numbness of the ear after the prolonged use of ultrasonic scaler,
which indicates a small potential risk to hearing.(12). Kilpatrick(13) has listed the decibel
ratings for various office instruments and equipment, which amount to70–92 dB for high-
speed turbine hand pieces, 91 dB for ultrasonic cleaners, 86 dB for ultrasonic scalers, 84 dB
for stone mixers and 74 dB for low-speed hand pieces. The noise levels generated during
cutting were significantly higher than those of non cutting, which was proved in the course of
the measurements. These demonstrate that the noise level for laboratory machines during
cutting is 85.33 dB, without cutting – 77.51dB respectively, for the laboratory electromotor
hand piece - 82.04 and 67.86, the angled-design turbine hand piece -78.98 and 66.84, the
low-speed angled design hand piece 71.89–67.53. This may be attributed to the friction
between the cutting material and cutting tools (14).

EFFECTS OF NOISE
Auditory effects
 Auditory Fatigue (90dB or 4000 Hz)
 Deafness- Temporary (4000-6000Hz)
 Permanent (100dB)
Non Auditory Effects

 Interference with speech
 Annoyance
 Reduction in efficiency
 Physiologic damage (increased intracranial
pressure, increased heart rate, headache etc) (15)
RADIATION
Dental personnel are exposed to both ionizing and non ionizing type of radiations. Ionizing
radiation is a well established risk factor for cancer(16). However, despite the fact that most
dental offices and clinics have x-ray machines that are in frequent use [17], the exposure of
dental workers to ionizing radiation and the associated potential cancer risk have been
assessed in only a few studies. Dental staff should stand behind protective barriers and also
use radiation monitoring badges to protect themselves. Non-ionizing radiation has become an
important concern with the use of blue light and ultra-violet light to cure various dental
materials. Exposure to the radiations emitted by these can cause damage to the various
structures of the eye including the retina and the cornea (18).Use of safety glasses and
appropriate shields can minimize or eliminate the radiations in this regard. A study conducted
among Canadian dentists reported that occupational doses of ionizing radiation among
dentists and dental workers have decreased markedly since the 1950s (19). The incidence of
cancer among dental workers was lower than that for the Canadian population for all cancers
except melanoma of the skin. Direct radiation injury has been virtually eliminated by
improvements in radiologic equipment and methods and radioprotection measures.(20)
However, the potential effects of whole-body doses remain of concern (21) with secondary
radiation scattered from bones in the patient’s head now representing the greatest source of
radiation received by dentists and dental workers.(22)

PERCUTANEOUS EXPOSURE INCIDENTS [PEI]

Percutaneous injuries are a frequent problem among dentists, who are among the healthcare
professionals most involved in occupational accidents(23) particularly needle stick and sharp
instrument injuries(24, 25). This exposure is related to the fact that dentists work in a limited-
access and restricted- visibility field and frequently use sharp devices. Percutaneous exposure
incidents facilitate transmission of blood borne pathogens such as human immunodeficiency
virus [HIV], hepatitis C virus [HCV] and hepatitis B virus [HBV] (26). Estimates based on
data from the Centers for Disease Control and Prevention, suggest that a healthcare
provider’s risk of acquiring HIV infection as a result of percutaneous exposure to an HIV-
contaminated device is 0.3%(27) According to a study the prevalence of needle stick and
sharp instrument injuries in dentists was 19.2% within the previous six months(26). Burs
represented the most common device as the cause of exposure in this study. Reports of
another study carried out in Washington reveals that 66.7% of the percutaneous injuries are
sustained by dentists (28) and most of the injuries (70%) occurred during administration of
local anesthesia, recapping a needle and performing surgical procedures. According to a
study carried out in UK, glove damage is reported in 2% of latex gloves and 5% of nitrile
gloves which sustained punctures following routine clinical dental procedures(29). As
already cited, the most common “sharps” injuries among dentists continue to rise from
needles and drilling instruments, such as burs. Of concern in needle stick injuries, is the fact
that they often occur while giving injections, when there is usually some residual bodily fluid
in the needle from the punctured site. National and international guidelines, such as the
Needle stick Safety Act in 2001 were developed to help minimize the risk of blood borne
pathogen exposure to health care workers including dental settings.(30, 31) The infection risk
after accidents involving contaminated blood contact depends on various factors, such as:
type of exposure, inoculums size, host response, infectious material involved, and the amount
of blood (32). In principle, any accident should be treated equally, regardless of the
characteristics of the patient or the accident site. A careful evaluation is necessary to
determine the need for post-exposure chemoprophylaxis. Moreover, analysis of the
circumstances of the accidents can contribute to preventing other accidents.(33)
CHEMICAL
Dentists are exposed to various types of chemicals that are hazardous while providing care.
They include mercury, beryllium, silica and powdered natural rubber latex (NRL). Most
dangerous of these agents is mercury. These chemicals act by local action, inhalation and

ingestion. Mercury use in dental amalgam has potential occupational exposure to dentists.
The maximum level of exposure considered to be safe is 50 µg/ cc of air (34, 35). The active
component in mercurial vapour has a particular affinity for brain tissue. Mercury poisoning
can be characterized by tumours of the face, arms or legs and may be associated with
progressive, tremulous illegible handwriting with slurred speech.(36,37) The exposure risks
from mercury can be 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. The research conducted at the University of Calgary Faculty of
Medicine found that exposure to mercury caused the formation of "neurofibrillar tangles,"
which are one of the two diagnostic markers for Alzheimer's disease. In February, 1998, a
group of the world's top mercury researchers announced that mercury from amalgam fillings
can permanently damage the brain, kidneys, and immune system of children. Dental amalgam
fillings have been found to affect DNA. This later can leads to cancer. Damage in human
blood cells based on a number of studies in Sweden, the World Health Organization review
of inorganic mercury in 1991 determined that mercury absorption is estimated to be
approximately four times higher from amalgam fillings than from fish consumption.(37)
Inhalation of dust containing free silica or silicon dioxide in ceramic laboratories leads to
silicosis. Some of the dental alloys contain beryllium and if it inhaled while working on items
such as dental crowns, bridges, and partial denture framework, they can cause chronic
beryllium disease (CBD). As per Occupational Safety and Health Administration (OSHA)
specification, employees cannot be exposed to more than 2 microorganisms of beryllium per
cubic Meter of air for an 8 hour time weighted average(38). Formaldehyde is one of the
chemical agents routinely used in the clinical set up mainly for disinfection of operatory area.
Liquid and vapour forms of formaldehyde may cause severe abdominal pain, nausea,
vomiting and eye irritation(39). Occupational Safety measures should be followed to
minimize the side effects due to chemical agents. There are many potentially toxic materials
that are used in dentistry that may pose a health hazard in the absence of appropriate
precautionary measures. Most of the dental materials undergo an extensive range of tests both
before and after use. Even so, some dental materials are aerosolized during high speed cutting
and finishing and may thereby be inhaled by dental staff. Other dental materials are volatile
and may give rise to dermatological and respiratory effects (40)The dangers of chronic
exposure to mercury are well documented. On the contrary, it is now recognized that the
health hazards of amalgam restorations is negligible with the exception of rare allergic
reactions. The greatest exposure to mercury from dentists comes from handling amalgam and

amalgam capsules for restorations and storage and disposal of amalgam also represent
important sources of exposure(41). New filling materials have been developed to help reduce
the dependence on mercury based substances, such as composite resins, although these may
be less durable and clinically effective than mercury amalgam. Chemicals used in radiology
can also lead to occasional health problems. Developing solutions are chemicals used in the
reduction of silver bromide ions. These also contain chemicals that control the processing
speed, a preservative and a hardening agent(42). Fixing solutions include a neutralizer, a
clearing agent to remove underdeveloped silver bromide ions, a preservative and a hardening
agent. There are a number of constituents that may cause health effects: acetic acid, diethyl
glycol, glutaraldehyde, hydroquinone, potassium hydroxide etc. In medical imaging,
glutaraldehyde is primarily used as a hardening agent to prevent films from sticking together.
Skin sensitization and allergic contact dermatitis after occasional exposure have been
documented in case of glutaraldehyde. 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(42)
MUSCULOSKELETAL DISORDER
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. (43)
It has been reported that young and less experienced dentists experience more
musculoskeletal disorders compared to older and experienced ones(44). 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.(44,45,46) 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(47). Puriene A et al (48)reported Fatigue and back pain as
most common prevalent and chronic physical complaints among Lithinium dentists. The
dentist makes constant monotonous movements, which stress the wrist and elbow joints. Also
of consequence are mechanical vibrations. A number of dental doctors suffer from a defect of
the median nerve and of the cubital nerve. A consequence of the defected median nerve in the
carpal canal is the so-called tunnel syndrome. Its early phase is dominated by paroxysmal
paraesthesiae of the thumb and index finger, which occur almost without exception at night
and which are accompanied by sensomotor disorders of the thumb and index finger(49).
Pains of the epicondylus, appearing at first during strain and special movements, gradually
intensifying and radiating along the forearm, point to an inflammation of the epicondylus of
the humeral bone. Operations carried out during extractions stress not only the elbow joint
and the wrist joint but may result in chronic tendon sheath inflammation. (50)Prevention
includes maintaining correct body posture while treating patients, taking adequate rest, doing
some exercises. Prevention includes maintaining correct body posture while treating patients,
taking adequate rest, doing some exercises. Common musculoskeletal disorders occurring
among dentists. Following are the classification of some of the musculoskeletal disorders
seen commonly among dental practitioners.(50,51)

THE BIOLOGICAL HAZARDS

The biological hazards are constituted by infectious agents of human origin and include
viruses, bacteria and fungi. Transmissible diseases currently of greatest concern to the dental
professional are HIV, HBV, HCV and Mycobacterium tuberculosis. A dentist can become
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. The following are the main entry
points of infection epidermis of hands, oral epithelium, nasal epithelium, epithelium of upper
airways, bronchial tubes, alveoli and conjunctival epithelium. In order to overcome from the
infection spread, a thorough knowledge about the infection, mode of transmission and safety
measures is necessary. During many dental procedures, the use of a rubber dam will eliminate
virtually all contamination arising from saliva or blood.(52) All members of the dental
include hepatitis A virus (HAV), HBV, and hepatitis C. In a study done by Watt HIV/AIDS
was believed to be very similar to eye injury and mercurial poisoning in terms of rate of
concern amongst dental personnel team are at risk of exposure to Hepatitis B virus (HBV),
HIV infection, and other types of communicable infections(53).In the United Kingdom for
example, the carrier rate HBV in the general population is 0.5%, while dentists have a carrier
rate of approximately 1.6%.Several of the common viral agents that can cause hepatitis have
been detected in body fluids including saliva and blood. The viruses most commonly
implicated. 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. A report
published by the Centers for disease control and prevention (CDC) studied the 208 dental
exposures (percutaneous, mucous membrane, and prolonged skin exposures) reported to the
CDC from 1995 to 2001, 13% had HIV-positive source patients and did not lead to a
seroconversion (75% of exposed individuals took the three-drug PEP regimen for variable
lengths of time). Percutaneous exposure to HBV containing transmission risk about
2% for HBe Ag-negative and about 30% for HBe Ag positive blood.[14] Despite reducing
the risk for HBV transmission among healthcare workers by effective HBV vaccination
programs, measuring of anti-HBs antibody response after HBV vaccination is essential for all
vaccinated individuals with high-risk professions(54,55,56) 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. The U.S. Public Health Service
recommendations for HCV exposures implicate precise follow-up of the exposed
practitioners and referral for appropriate therapy if an infection occurs. (57)

PSYCHOLOGICAL HAZARDS
a. Stress
Dentists encounter numerous sources of professional stress, beginning in the dental clinic.
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. Dunlap J and Stewart J in their survey on 3,500 dentists found that 38
percent were frequently worried or anxious, 34 percent of the respondents felt physically or
emotionally exhausted, and 26 percent said they always or frequently had headaches or
backaches(43, 58,59)
b. Professional burnout
One of the possible consequences of chronic occupational stress is professional burnout.
Meslach and Jackson (1986) define burn out as: “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(59). In a study of three dental specialities Humphris et al reported that
general dentists and Oral surgeons had the highest levels of burnout and that orthodontists
had the lowest levels of burnout can grow progressively worse if not treated (60). 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.(59) 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.(60)

CONTROL MEASURES
Dentist has to upgrade his existing knowledge by participating in continuing dental
education. Universal precaution has to be taken while practicing to prevent occupational
hazards. Dental clinic design has to be made with, sufficient lighting, ventilation, engineering
control measure and equipped with appropriate personal protective.
ROUTINE PRECAUTIONS
Transmission of infection within the setting of dentistry may occur from the dentalhealth care
worker to the patient, from the patient to the health care worker or frompatient to patient.
Cases have been documented in which human immunodeficiency virus(HIV) or hepatitis B
virus (HBV) was transmitted from dental health care workers totheir patients and vice versa.
Patient to patient transmission, although being reportedonly in medical settings so far, may
potentially occur in dental practices.The major documented routes of transmission of HIV
and HBV in dental settings are (i) precutaneous inoculation and (ii) contact with an open
wound, non-intact (e.g. chapped, abraded, weeping or dermatitic) skin, or mucous
membranes to blood, blood contaminated body fluids or concentrated viruses. Blood is the
single most important source of HIV and HBV in dental practice. Protective measures against
HIV and HBV should focus primarily on preventing these types of exposures to blood as well
as ondelivery of Hb vaccination .Since it is now known that persons carrying blood-borne
viruses, including both health care workers and patients, may not have been identified and are
thus not aware oftheir own condition, it follows that procedures adopted routinely for ALL
practices mustbe adequate to prevent cross-infection. Under current technology, it is
recognized that the risks of accidental percutaneous injury during dental procedures cannot be
reduced to zero. While the risk of HBV transmission could be eliminated by immunization,
the risk of exposure to the blood ofHIV infected individual is a special concern to dental
health care workers. It isconsidered justifiable to apply additional infection control measures
when performing invasive procedures on individuals with known HIV infection. Dental
health care workers who consider themselves at increased risk of HIV infection should
arrange confidential testing. Those who are infected must seek appropriate medical advice to
ensure they pose no risk to patients (please refer to Advisory Council on AIDS published
document “HIV infection and the health careworkers – recommended guidelines. Protection
can be achieved by a combination of immunisation procedures, use of barrier techniques and
strict adherence to routine infection control procedures.

(i) Immunisation
All dental health care workers are advised to be immunized against HBV unless immunity
from natural infection or previous immunization had been documented
(ii) Protective coverings

 Uniforms
Uniforms should be changed regularly and whenever soiled. Gowns or aprons should be worn
during procedures that are likely to cause spattering or splashing of blood
 Hand protection
Gloves must be worn for procedures involving contact with blood, saliva o rmucous
membrane. A new pair of gloves should be used for each patient. If a glove is damaged, it
must be replaced immediately. Hands should be washed thoroughly with a proprietary
disinfectant liquid soap prior to and immediately after the use of gloves. Disposable paper
towels are recommended for drying of hands. Any cuts or abrasions on the hands or wrists
should be covered with adhesive water proof dressings at all times.
 Protective glasses, masks or face shields

Protective glasses, masks or face shields should be worn by operators and close-support
dental surgery assistants to protect the eyes against the spatter and aerosols which may occur
during cavity preparation, scaling and the cleaning of instruments.
(iii)Sharp instruments and needles

Sharp instruments and needle should be handled with great care to prevent unintentional
injury. Needles should never be recapped by using both hands indirect contact or by any other
technique that involves moving the point of a used needle towards any part of the body. The
needle can be recapped by laying the capon the tray, placing the cap in a reheathing device or
holding the cap with forceps before guiding the needle into the cap.
(iv) First aid and inoculation injuries

In the event of a skin puncture by a contaminated instrument, the wound should be
encouraged to bleed and washed thoroughly with running water All incidents should be
reported to the officer i/c of the clinic. Where there is reason to be concerned about the
possible transmission of infection, advice on appropriate serologic testing, medical evaluation
and follow-up could be sought from Accident, and the address and contact telephone of the

patient concerned should be recorded.
INSTRUMENT STERILIZATION
All instruments should be cleaned thoroughly before sterilization by rinsing and scrubbing
with detergent and water. Splashing of water should be avoided. Heavy duty gloves and,
where appropriate, face protection shield, should be worn .Items which will penetrate tissues
must be sterilized in an autoclave or hot air steriliser. Items which will touch mucous
membrane but not penetrate tissues should similarly be sterilized by heat, or, if not possible,
disinfected, e.g., by immersion in 2%glutaraldehyde solution in a closed container according
to the manufacturer instructions. All chemical residues must then be removed by thorough
rinsing before use or storage. Handpieces, ultrasonic scaler inserts/tips and air-water syringe
tips where detachable should be flushed for 30 seconds, dismantled, cleaned, oiled where
required, and autoclaved between patients. (Hand pieces, etc. left overnight should be
allowed to discharge water for two minutes at the beginning of the day). Hand pieces which
cannot be autoclaved are disinfected with an appropriate virucidal agent .Following
sterilization, all instruments should be stored in clean containers to prevent recontamination.
Surgical and endodontic instruments should be kept in closed containers. It may be necessary
to re-sterilize them immediately before they are used and care should be taken to ensure the
instruments are cool prior to use.
Aspiration and ventilation

The use of high volume aspiration will reduce any risk of cross-infection from aerosols. The
risk is further reduced by good ventilaton. The tubings of high volume aspirators and saliva
ejectors should be flushed with water between patients and with disinfectant (sodium
hypochlorite, 0.1%) regularly or according to the manufacturer’s instructions.
DISPOSAL OF WASTE
Sharp items including needles and scalpels and local anaesthetic cartridges, should be placed
into puncture proof containers which should be securely sealed. These together with all
medical waste must be disposed of in red bags, securely fastened. Red plastic bags are to be
picked up by a special collection service for hospitals and clinics. Non infective waste should
be disposed of in thick black plastic bags securely fastened .Liquid waste should be carefully
poured into a drain and then flushed with water .Spatter and splash should be avoided.

Laboratory items
Impressions and appliances should be rinsed thoroughly to remove all visible blood and
debris. Gloves should be worn when handling impressions and pouring models .Certain types
of impression material (silicone, polysulphur) can be disinfected by totally immersion in
glutaraldehyde (2%) or sodium hypochlorite (0.1%). Other materials(alginate, polyether) may
be disinfected by submerging for several seconds in sodium hypochlorite (0.1%), which
should then be wrapped in a hypochlorite saturated paper towel and kept in a closed container
for the recommended disinfectant time.
Additional precautions to be taken when performing invasive procedures on HIV infected

individuals
(a) If possible, schedule the patient surgery at the end of the list.
(b) The team should be limited to essential members of staff and the procedures should be
performed by experienced, fully trained staff.
(c) The operator should wear two pairs of gloves. Plastic gown, cap mask and protective eye
wear should be worn.
(d) All procedures should be performed in a way which minimizes the formation of droplets,
spatter and aerosols, utilizing high volume vacuum aspirators, rubber dams where
appropriate and proper patient positioning. Ultrasonic scalers should be avoided
(e) Avoid the use of instruments which cannot be easily decontaminated .Instruments and
tools used should be handled and cleansed by experienced staff before autoclaving
(f) After the operation, all surfaces inside the surgery and equipment should be cleaned and
decontaminated with appropriate disinfectants.
CONCLUSION
As this review shows, many occupational health problems remain in modern dentistry. In
order to be a protective professional one must be healthy. One thing should kept in mind that
every technology, no matter how beneficial, can exert a negative impact on some members of
the population. Immunization against various infectious diseases like HIV, HBV etc. is very
essential for every Dental Health Care Worker. Dentists should control their working hours,
pace of work, be aware of occupational hazards and observe their mental health. Strategies

for improving mental health and reducing the effects of occupational hazards should be
developed and implemented in order to secure the well being of dentists. Serious infectious
due to percutaneous exposure incidents(PEI) can be avoided by use of appropriate barrier
techniques and high level sterilization. Dental personnel should be familiar with the major
signs and symptoms of allergic reactions, including anaphylaxis in the case that an allergic
emergency should arise during a consultation. Various continuing dental education programs
should be organized so that dental professionals can gain knowledge about various newer
methods and developments.
REFERENCE
1. Pelka, M., Distler, W., Petschelt, A.: Elution parameters and HPLC-detetction of single
components from resin composite, Clinical Oral Investigations., Vol. 3, pp. 194-200,
1999
2. Leggat PA, Kedjarune U ( 2001) occupational risk of modern dentistry; a review. J occup
Health Saf (Aus Nz) 17, 279-86
3. Al-Khatib IA, Ishtayeh M, Barghouty H, Akkawi B. Dentists’ perceptions of occupational
hazards and preventive measures in East Jerusalem. East Mediterr Health J 2006; 12: 153-
60.
4. Adebola FA, Owotade FJ. Occupational hazards among clinical dental staff. J Contemp
Dent Pract 2004; 5: 134-52.
5. Jolanta Scymanska. Occupational hazards of dentistry. Ann Agric Environ Med 1999, 6,
13-9.
6. Prashant Babaji et al Occupational Hazards Among Dentists ; Journal of International
Dental and Medical Research Volume ∙ 4 ∙ Number ∙ 2 ∙ 2011
7. Caballero AJ, Palencia IP, Cardenas SD. Ergonomic factors that cause the presence of
pain muscle in students of dentistry. Med Oral Patol Oral Cir Bucal 2010; 15 : e906-11.
8. Bahannan S, el-Hamid AA, Bahnassy A. Noise level of dental handpieces and laboratory
engines. J Prosthet Dent 1993; 70: 356- 60.
9. Setcos JC, Mahyuddin J. Noise levels encountered in dental clinical and laboratory
practice. Int J Prosthodont 1998; 11: 150-7.
10. Sampio Fernandes JCS, Carvalho APO, Gallas M, Vaz P, MatosPA. Noise levels in
dental schools, Eur J Dent Educ 2006; 10: 32-7.
11. Trenter SC, Walmsley AD. Ultrasonic dental scaler: associated hazards. J Clin
Periodontol 2003; 30: 95-101

12. Ramandeep Singh Gambhir etal., Occupational Health Hazards in Current Dental
Profession- A Review The Open Occupational Health & Safety Journal, 2011, 3, 57-64
13. Kilpatrick HC: Decibel ratings of dental office sounds. JProsthet Dent 1981, 45, 175-178.
14. Bahannan S, Abd El-Hamid A, Bahnassy A: Noise level of dental hand pieces and
laboratory engines. J Prosthet Dent 1993, 70, 356-360
15. P. Roshan Kumar etal., ., Hearing Damage and it's Prevention in Dental Practice :Journal
of Dental Sciences and Research Vol. 2, Issue 2, September 2011
16. Kai M, Luebeck EG, Moolgavkar SH. Analysis of the incidenceof solid cancer among
atomic bomb survivors using a two-stage model of carcinogenesis. Radiat Res 1997; 148:
348-58.
17. Wang JX, Inskip PD, Boice JD, Jr., Li BX, Zhang JY, Fraumeni JF Jr. Cancer incidence
among medical diagnostic X-ray workers in China, 1950 to 1985. Int J Cancer 1990; 45:
889-95.
18. yenogopal V, Naidoo S, Chikte UM. Infection control among dentists in private practice
in Durban. SADJ 2001; 56: 580-4
19. Zielinski JM, Garner MJ, Krewski D, et al. Decreases in occupational exposure to
ionizing radiation among canadian dental workers. J Can Dent Assoc 2005; 71: 29-33
20. Leggat PA, Chowanadisai S, Kukiattrakoon B, Yapong B, Kedjarune U. Occupational
hygiene practices of dentists in southern Thailand. Int Dent J 2001; 51: 11-6.
21. Mandel ID. Occupational risks in dentistry: comforts and concerns. J Am Dent Assoc
1993; 124: 40-9.
22. Kuroyanagi K, Hayakawa Y, Fujimori H, Sugiyama T. Distribution of scattered radiation
during intraoral radiography with the patient in supine position. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 1998; 85:736-41.
23. Ramos-Gomez F, Ellison J, Greenspan D, Bird W, Lowe S, Gerberding JL. Accidental
exposures to blood and body fluids among health care workers in dental teaching clinics:
a prospective study. J Am Dent Assoc 1997;128: 253-61
24. Bellissimo-Rodrigues WT, Bellissimo-Rodrigues F, Machado AA. Occupational
exposure to biological fluids among a cohort of Brazilian dentists. Int Dent J 2006; 56:
332-7.
25. McCarthy GM, Koval JJ, MacDonald JK. Occupational injuriesand exposures among
Canadian dentists: the results of a national survey. Infect Control Hosp Epidemiol 1999;
20:331-6.

26. Martins A M, Santos NC, Lima MD, Pereira RD, Ferreira RC.Needlestick and sharp
instrument injuries among dentists in Montes Claros, Brazil. Arquivos Odontol 2010; 46;
127-35
27. Shah SM, Merchant AT, Dosman JA. Percutaneous injuries among dental professionals in
Washington State. BMC Public Health 2006; 6: 269.
28. Murray CA, Burje FJ, McHugh S. An assessment of the incidence of punctures in latex
and non-latex dental examination gloves in routine clinical dental practice. Br Dent J
2001; 190: 377-80.
29. Occupational Safety and Health Administration. Final standard for occupational
exposure to blood borne pathogens: December 6, 1991. 29 CFR 1910.1030.
30. The WHO Strategy regarding injection safety [monograph on the internet]; 2010 [cited
2010 March 15].
31. Haiduven DJ, Simpkins SM, Phillips ES, Stevens DA. A survey of percutaneous
/mucocutaneous injury reporting in a public teaching hospital. J Hosp Infect 1999;
41:151-4.
32. Pohl L, Bergman M. The dentist’s exposure to elemental mercury vapor during clinical
work with amalgam. Acta Odontol Scand 1995; 53; 44-8.
33. Gambhir et al.., Occupational Health Hazards in Current Dental Profession, The Open
Occupational Health & Safety Journal, 2011, Volume 3
34. Micik RE, Miller RL, Mazzarella MA, Ryge G. Studies on dental aerobiology: bacterial
aerosols generated during dental procedures. J Dent Res 1969; 48: 49-56.
35. 8. Miller RL, Micik RE. Air pollution and its control in the dental office. Dent Clin North
Am 1978; 22: 453-76.
36. Leggat PA, Kedjarune U, Smith DR. Occupational health problems in modern dentistry: a
review. Industrial Health. 2007; 45: 611-21.
37. Mutter J. Is dental amalgam safe for humans? The opinion of the scientific committee of
the European Commission. Journal of Occupational Medicine and Toxicology. 2011 ;6:
1-17.
38. Miller RL, Micik RE. Air pollution and its control in the dental office. Dent Clin North
Am 1978; 22: 453-76.
39. Chopra SS, Pandey SS .Occupational Hazards among Dental Surgeons. Medical Journal
Armed Forces India 2007; 63:23-25.
40. Pohl L, Bergman M. The dentist’s exposure to elemental mercury vapor during clinical
work with amalgam. Acta Odontol Scand 1995; 53; 44-8.

41. Martin MD, Naleway C, Chou H-N. Factors contributing to mercury exposure in dentists.
J Am Dent Assoc 1995; 126; 1502-11
42. Anderson PC, Alice E. Pendleton AE. The Dental Assistant. 7th ed. Delmar Thomsom
Learning 2001
43. Jolanta S. Occupational Hazards of Dentistry. Ann Agric Environ Med. 1999; 6: 13- 19.
44. Leggat PA, Kedjarune U, Smith DR. Occupational health problems in modern dentistry: a
review. Industrial Health. 2007; 45: 611-21
45. Abiodun-Solanke IM, Agbaje JO, Ajayi DM, Arotiba JT. Prevalence of neck and back
pain among dentists and dental auxiliaries in South-western Nigeria. Afr J Med Med Sci.
2010; 39: 137-42
46. Puriene A, Janulyk V, Musteikyte M, Bendinskaite R. General health of dentists.
Litetrature review. Stomatologija. Baltic Dental and Maxillofacial Journal. 2007; 9: 10-
20.
47. Rundcrantz BL, Johnsson B, Moritz U: Pain and discomfort in the musculoskeletal
system among dentists. A prospective study. Swed Dent J. 1991; 219-28.
48. Puriene A, Aleksejuniene J, Petrauskiene J, Balciuniene I, Janulyte V. Self reported
occupational health issue among Lithinium dentists. Industrial Health 2008; 46: 369-74
49. Ostrem CT: Carpal tunnel syndrome. A look at causes, symptoms, remedies. Dent
Teamwork. 1996; 9: 11-15.
50. Rundcrantz BL, Johnsson B, Moritz U: Pain and discomfort in the musculoskeletal
system among dentists. A prospective study. Swed Dent J. 1991; 219-28.
51. Occupational Hazards Among Dentists Prashant Babaji et al Journal of International
Dental and Medical Research Volume ∙ 4 ∙ Number ∙ 2 ∙ 2011
52. Legnani P, Checchi L, Pelliccioni GA, D’Achille C: Atmospheric contamination during
dental procedures. Quintessence Int 1994; 25: 435-39.
53. De Almeida OP, Scully C, Jorges J. Hepatitis B vaccination and infection control in
Brazilian dental practice,1990. Community Dent Oral Epidemiol.1991 Aug;19(4):225-7.
54. Ayatollahi J, Bahrololoomi R, Ayatollahi F. Vaccination of dentist and other oral health
care providers. J Den Med 2005;18:5-14.
55. Ayatollahi J, Sharifi MR, Sabzi F, Zare AR. Blood level anti-HBS due to HB vaccine in
health care personnel of Shahid Sadoughi Hospital-Yazd. Iranian Journal of Obstetrics,
Gyneocology and Infertility 2004;7:48-51.
56. Ayatollahi J. Needle-stick injuries in a general hospital: Continuing risk and under
reporting. Ann Iranian Med 2006;3:47-5

57. Updated U.S. Public Health Service. Updated U.S. public health service guidelines for the
management of occupational exposures to HBV, HCV and HIV and recommendations for
post-exposure prophylaxis. MMWR Recomm Rep 2001;50:1-52
58. Dunlap J, Stewart J. Survey suggests less stress in group offices. Dent Econ 1982; 72 :
46-54. 14.
59. Rada RE, Johnson-Leong C. Stress, burnout, anxiety and depression among dentists J Am
Dent Assoc. 2004; 135: 788-94.
60. Humphris G. A review of burnout in dentists. Dent Update 1998; 25 : 392-96.
61. CODE OF PRACTICE RELATING TO INFECTION CONTROL IN DENTISTRY
Issued by The Dental Council 57 Merrion Square Dublin 2

Article Wjpps 1401536669 PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Article Wjpps 1401536669 PDF

Uploaded by

Copyright:

Available Formats

WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

Raja.K et al. World Journal of Pharmacy and Pharmaceutical Sciences

Volume 3, Issue 6, 397-415. Review Article ISSN 2278 – 4357

OCCUPATIONAL HAZARDS IN DENTISTRY AND ITS CONTROL

Mr. Raja.K*, Dr. Auxilia Hemamalini Tilak

Keywords: Dental personnel, Hazards, Infectious Disease, Stress, Control measures

www.wjpps.com Vol 3, Issue 6, 2014. 397

HAZARDS FROM PHYSICAL AGENTS

www.wjpps.com Vol 3, Issue 6, 2014. 398

www.wjpps.com Vol 3, Issue 6, 2014. 399

Non Auditory Effects

www.wjpps.com Vol 3, Issue 6, 2014. 400

PERCUTANEOUS EXPOSURE INCIDENTS [PEI]

www.wjpps.com Vol 3, Issue 6, 2014. 401

www.wjpps.com Vol 3, Issue 6, 2014. 402

www.wjpps.com Vol 3, Issue 6, 2014. 403

www.wjpps.com Vol 3, Issue 6, 2014. 404

THE BIOLOGICAL HAZARDS

www.wjpps.com Vol 3, Issue 6, 2014. 405

www.wjpps.com Vol 3, Issue 6, 2014. 406

www.wjpps.com Vol 3, Issue 6, 2014. 407

(ii) Protective coverings

 Protective glasses, masks or face shields

(iii)Sharp instruments and needles

(iv) First aid and inoculation injuries

www.wjpps.com Vol 3, Issue 6, 2014. 408

patient concerned should be recorded.

Aspiration and ventilation

www.wjpps.com Vol 3, Issue 6, 2014. 409

Additional precautions to be taken when performing invasive procedures on HIV infected

www.wjpps.com Vol 3, Issue 6, 2014. 410

www.wjpps.com Vol 3, Issue 6, 2014. 411

www.wjpps.com Vol 3, Issue 6, 2014. 412

www.wjpps.com Vol 3, Issue 6, 2014. 413

www.wjpps.com Vol 3, Issue 6, 2014. 414

www.wjpps.com Vol 3, Issue 6, 2014. 415

You might also like