RISK ASSESSMENT IN WORK OF DENTAL

MEDICINE. OCCUPATIONAL DISEASES.

KEY MEASURES FOR PREVENTION OF
PHYSICAL, TOXIC-CHEMICAL AND
BIOLOGICAL HARMFUL FACTORS IN
DENTAL PRACTICE
Risk Assessment - a systematic examination
of all aspects of work in order to establish to
what factors are involved and are responsible
for the occurrence of adverse health
conditions can the dangers be eliminated and
if not - what preventive measures should be
taken to put risk under control.
 Risk assessment involves:
1. Workflow
2. Work equipment
3. Workrooms
4. Workplaces
5. Labor organization
6. Materials and technologies
7. Other adverse factors that may
posing a risk.
Factors in the workplace and work
environment:
1. Mental strain with neuro-sensory, neuro-motor
and emotional tension.
2. Work stress - eustres and distress.
3. Physical - noise, vibration, microclimate, lighting.
4. Chemical - toxic gases, vapors, aerosols, dust
5. Biological - pathogenic micro-organisms, viruses
and other pathogens of infectious diseases.
6. Ergonomic
7. Associated with new technologies - metal,
Metal and others.
8. Psychosocial.
 Methodology for risk assessment
There is no single methodology for risk
assessment.
The following approaches:
1. Monitoring of the workplace and working
environment.
2. Identification of work activities which must be
included in risk assessment.
3. Monitoring of employment.
4. Assessment of exposure hazards
5. Assessment of external factors that may affect the
working environment.
6. Assessment of psychological, physiological and social
factors contributing to stress at work.
7. Assessment of the organization in providing safe and
healthy working conditions
Must comply with the principles:
1. Compliance with legislation in the field
of occupational medicine.
2. Prevention of risk is importance
through preventive measures.
Assessing the risk of jobs include the
following steps:
I. Classification of operations performed
 Describe all work activities that place the physician in DM in
the workplace.
Activities are grouped in a rational way to evaluate.

II. Identification of hazards in various work activities:

 Identification and analysis of existing hazards, sources and
possible ways and means of their effect on the human organism.
 The following approaches:
 monitoring of employment.
 measuring work environment factors - noise, vibration,
microclimate, toxic substances, lighting and more. by licensed
agencies and companies.
Questionnaires to be completed by the physician in DM (worker,
employee).
III. Determination of employees (doctors DM) at
risk and frequency of exposure.

IV. Determination of the risk elements:

 in Belgian methodology is accepted numerical

expression of grading:
- probability (P)
- exposure (E)
- effects (F)

Risk is the product of three parameters:

R = PxEx.F
V. Risk Assessment
Based on three parameters (P,E,F), and the
formula is made ​of the risk rating of identified
hazards:
 Mental strain

 Forced labor posture

 Stress

 Chemicals

 Biological factors

VI. Description of preventive measures for

reducing or eliminating risk.
VII. Develop a common action plan in
which the measures are grouped and
sorted by priority with periods,
responsible and necessary funds.

VIII. Evaluate the effectiveness of

preventive measures carried out.
 Risk assessment reviewed when:

1. Changes in technology, equipment, work

organization, new facilities, new materials.

1. Legislative changes.

1. Invalid data from the measurements of work

environment factors.

1. Ineffective preventive measures.

1. Presence of accidents and occupational

diseases.
 Occupational diseases related to
dental practice.
Occupational disease - a disease that occurs exclusively or primarily
under the influence of harmful factors of working environment and
working process on the human organism and is included in the list of
occupational diseases.
Suffer from occupational diseases 90% of doctors in DM.
Depending on the specific work environment factors and the labor
process, the following three groups:
I. Specific occupational diseases:
1. Allergic reactions and diseases - occur in contact with substances
with allergenicity.
 Bronchial asthma with occupational etiology
 Contact dermatitis - 80% of cases affect the hands.

In 25% of dentists established allergic damage from drugs and materials.

Global trend is a gradual increase in allergic reactions and diseases.
2. Disabilities of the musculoskeletal system:

 Forced standing working posture creates conditions for developing a

functional scoliosis (lateral curvature of the spine caused by unilateral loading
of the body), lumbar hiperlordozi (very forward protrusion of the spine) and
varices.

 Sitting posture with static muscular effort over time can cause static
deformation as:
- Smoothing of cervical lordoza
- Increasing the thoracic kyphosis
- Functional disorders in the body - congestive phenomena
 Tendinitis - Caused by chronic congestion of the arm muscles caused by
involuntary unnatural working posture. Can lead to occupational disability.

3. Professional solid ear (noise disease) - caused by the continued

impact of noise on the auditory analyzer.

4. Vibration disease - risk factors are local, low frequency (below 10 Hz)
vibration.
5. Dynamic disabilities (occupational neuroses)
Disability movement and sensation due to the chronic
congestion of the upper limbs caused by work fine
dental instruments and handpieces.
Complaints occurring in performance of a specific
movement - manipulation.
Risk factors - forced working posture and non-
ergonomic handles of tools.
II. Conditional occupational diseases
Due to the specifics of the work is more common in
certain occupational groups, but those diseases can be
established and persons who had professional contact
with certain hazards. They include:

Infectious and parasitic diseases - hepatitis A, B, C,

HIV-infection.

Myopia - congestion of the visual system (insufficient

lighting and non-ergonomic position), different for both
eyes, more pronounced on the left eye.
III. Paraprofesionalni diseases
They are only harmful production trigger and not
the main reason for their appearance:
 Hypertension, stroke, myocardial infarction,
arrhythmias

 Neuroses, depression

 Diseases of the gastrointestinal tract - peptic

ulcer disease, gastritis, colitis
 Some occupational diseases of the patients
involved in contact with toxic substances
1. Cadmium intoxication - golden-yellow
color of tooth necks "cadmium ring.

2. Lead poisoning - strip Burdon

(olovosulfidna garland on gum edge).

3. "Sugar confectionery or decay" when

working in contact with organic acids in
the food industry.
 General measures for prevention of
physical, toxic-chemical and biological
harmful factors in dental practice to
prevent occupational diseases.

1. Legislative measures
 General (laws, Labor Code)

 specific (Ministry of Health regulations and

other regulations)
2. Means of protection
 collective (with priority)

 individual (personal protective equipment)

3. Technological measures
 prevent the entry of harmful factors in the workplace

4. Technical measures
 eliminate or reduce the spread of already received harmful
factor at work - ventilation, gas and dust extraction and
others.

5. Architectural planning and ergonomic measures

6. Medical measures
 preliminary and periodic medical examinations
 clinical examination and active surveillance
 safety - professional catering
 healthy lifestyle
7. Administrative and organizational measures

 risk assessment in the workplace

 comprehensive assessment of working conditions

 physiological modes of work and rest

 coaching, training and information to workers about potential

hazards and ways and means of prevention

 involvement of employees in providing safe and healthy working

conditions

 periodic monitoring of the levels of harmful factors in the

workplace.
Risk assessment in the workplace

Workplace:
1. Dentist
1.1. Diagnosed apply proper treatment,
advise patients undergoing dental
prophylaxis. Examines dental disease
and develop methodologies.
 1.2. Hazard identification

AIPPDP Workplace: Dentist Date:10.09.2009

Hazard Identification

Hazards Mental strain Stress Chemicals Biological Forced labor

(№ Apps acc... 1 ) factors posture

Measures taken to Mode of Mode of PPE, PPE Mode of work

protect work and rest work and protective and rest
rest food
1.3. Determination of workers exposed to hazards.

AIPPDP Rab. Location: Doctor of Dental Medicine Date: 10.09.2009

Identification of exposed people

Hazards Mental strain Stress Chemicals Biological Forced labor

(№ acc. Apps. 1 ) factors posture
Number of exposed 1 1 1 1 1
persons

Outsiders who may 0 0 1 0 0

be exposed
1.4. Determine the elements of the risk of mental
strain.
Probability (P) Frequency of exposure (Е) Consequences (C)

6.0 3.0 3.0

1.4.1. Determining the risk of mental strain.

R=PxExC=54
( small risk needs attention )

1.4.2. Measures: Physiological mode of work and

rest
1.5. Determine the elements of the risk of stress.

Probability (P) Frequency of exposure(Е) Честота на

експозицията (C)
6.0 3.0 3.0

1.5.1. Risk assessment of stress. R=PxExC=54

( small risk needs attention )
1.5.2. Measures: Physiological mode of work and
rest
1.6. Determine the elements of risk when
working with chemicals.
Probability (P) Frequency Consequences (C)
exposure (Е)
1.0 3.0 3.0
 1.6.1. Risk assessment when working with
chemicals. R=PxExC=9
( very limited, acceptable risk )
1.6.2. Measures: collective protective equipment,
PPE, protective food.

1.7. Determine the elements of the risk of

biological agents.
Probability (P) Frequency of exposure (Е) Consequences (C)

6.0 6.0 3.0

Risk assessment of biological factors. R=PхЕхC=108

( measures are necessary to reduce risk )
1.7.2. Measures: PPE

1.8. Determine the elements of the risk of forced

working posture.
Probability (P) Frequency of exposure (Е) Consequences (C)

3.0 6.0 3.0

1.8.1. Assessment of risk of forced working

posture.R=PxExC=54
( small risk needs attention )

1.8.2. Measures: Saline mode of work and rest

Thank you for attention.