Occupational hazards

 The occupational hazards : are the diseases that are caused as

a result to the jobs.
 Classification:

 I- in industry

 II- in dentistry

I – In industry:
 The field of industrial dentistry has been widened lately, as
the oral manifestations may be the first manifestations of
many occupational diseases, as in metal poisoning.
 The industrial causative agents are either:

- inhaled as gases, fumes, or dust

- ingested as solids and liquids
- directly absorbed through skin or mucous membranes.
 Oral occupational diseases affect either:

 A- Hard tissues: (teeth) in form of:

tooth abrasion
-tooth erosion
-caries
B- Soft tissues: in the form of inflammation and pigmentation. It
is caused by:
 - lead poisoning
- mercury poisoning

 1- Tooth abrasion:

 It is the wear of the tooth structure due to friction with

foreign body.
 Clinically: the dentin is exposed and appeared highly
polished. A V- shaped groove may appear at the incisal
margin from the facial surface.
 Histopathlogically: there is:

 Formation of sclerotic secondary dentin, or dead tract.

 Regressive changes in the pulp.

 Classification: abrasion is classified according to the cause

into:
 Non occupational causes: eg.
 Brushing with stiff bristles( cause abrasion of canine)
 Using highly abrasive past or powders
 Dental floss silk
Pipe smoking
 occupational causes: eg.
 Cloth makers (due to biting threads)
  Metal pattern workers, and galvanized iron workers: there is
abnormal tooth wear with sever periodontal disturbance due
to the frequent habit of holding heavy blue marking chalk
between the anterior teeth.
 Glass blowers: the abrasion is due to the contact with the
rotating pipe against the 2nd incisor and the canine.
 Carpenters: due to holding and passing nails between
anterior teeth .
 Hair dressers:
Stone cutters, and sand plaster workers: abrasion of the occlusal
surface of posterior teeth
 Hafez (1970) classified occupational abrasion in glass
blowers into:
 Grade I abrasion: loss of enamel only
 Grade II abrasion: dentin involvement.
 In this group the abrasion was found to be of grade I only.

 2- tooth Erosion:

 It is the progressive superficial loss of tooth structure that is

caused by chemical or acid disintegration of the tooth surface
and not associated with bacterial activity.
 Causes:

 Non occupational causes: eg.

 - soft drinks - acidic fruit juices
- continuous vomiting
- drug induced as anti-histamenic drugs
 Occupational causes:
- storage battery workers
- acid dippers
 The first sign of erosion is manifested at the first 1-6 months.
The enamel decalcification increase by 3-5 times when the
surface is affected also by abrasion
 Erosion is classified according to the extent, into:

 I- etching of the enamel surface, which appear as dull,

ground glass surface
 II- grade I: loss of enamel only

 III- grade II: loss of enamel and dentin is involved

 IV- grade III 2ry dentin is exposed.

 The extent of erosion , depends on:

1- type and concentration of the acid

2- the length of exposure
3- the method of handling the product
4- temperature of the acid
5- lack of adequate ventilation.
 Clinical picture:

 It usually affect the incisal half of the labial surface of the

upper anterior teeth, and sometimes the lower anterior also.
The lesion usually extend towards the central line.
 The affected surfaces are hard, smooth, and stained brown to
black depending on the type of the chemical.
 Sever erosions affecting the upper and lower anterior teeth
may cause anterior open bite.
 The eroded area is sensitive to stimuli, as acids, and temp
changes.
 Histopathological features:

- 2ry dentin formation

- degenerative changes in the pulp
 Treatment:

 A- Prophylactic treatment:

- Prevention of air pollution at the working atmosphere.

- Covering the acid sources carefully
- Insuring adequate ventilation
- B- Tooth protector: acrylic plates covering the labial and
lingual surfaces of the anterior teeth.
- Jacket crowns may be used also.
- C- Preventive measures:
 - periodic dental examinations
- teaching the correct oral hygiene using soft tooth brush, and
alkaline tooth paste.

 3- Caries:

 Occupational causes:

 Candy workers: as they have the frequent habit of

eating the retentive sweets between meals, during their
working hours.

 Inflammation and pigmentation of oral mucosa

 1- Lead poisoning: (intoxication)

 It occurs due to inhalation of fine lead particles of lead dust

or fumes.
 Causes:

 lead workers
 Metal workers
 Battery manufacture workers
 Iron and steel workers
 Clinical picture:
 It appears as a blue- black line 1mm away from the free
gingival margin, especially with bad oral hygiene.
  Diagnosis:
- occupational history
- specific signs and symptoms
- investigations:
A- Blood analysis: (lead is more than 80ug/100 ml)
B- Urine analysis: (coproporphyrine is more than 300ug/L
C- Ala: aminolevlonic acid. It is more specific and accurate the
urine analysis.

 2- Mercury poisoning:

 Mercury is a heavy metallic liquid that vaporizes even at the

room temp., causing poisoning mainly through the
respiratory tract.
 Medical staff may be affected by mercury due to the use of
several apparatus containing mercury.
 Amalgam is not important source for mercury.

 General manifestations:

- erithism - tremors
- speech disorders
- kidney injury - visual restriction
 Oral manifestations:

- painful gingivitis and stomatitis with ulceration

 - teeth exfoliation - difficulty in chewing

- enlarged, painful tongue, lymph nods and salivary glands

- viscid saliva - dry, cracked lips

- metallic taste, and etching sensation

- mercurial line along the teeth margin