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Occupational Hazards in Dentistry-A Review

Article in Indian Journal of Public Health Research and Development · December 2019
DOI: 10.37506/v10/i12/2019/ijphrd/192325

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 Volume 10 Number 12 December 2019

till date.
2186 Indian
Indian Journal of Public Health Journal
Research & of Public Health
Development, Research
December &DOI
2019, Development,
Vol.Number: November 2019, Vol.10, No. 11 97
10, No. 1210.37506/v10/i12/2019/ijphrd/192325

Occupational Hazards in Dentistry―A Review

Alagarsamy Venkatesh1, Balasubramanian Anuradha2, Suresh Mitthra2, Sanjana T3

1
Professor, 2Reader, 3Undergraduate Student, Department of Conservative Dentistry and Endodontics,
Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research,
Narayanapuram, Pallikaranai, Chennai, Tamilnadu, India

ABSTRACT
Occupational health hazards are not uncommon. Continuous education on potential risk, precautions and
protocols should be rapidly instituted to greatly reduce or even eliminate the occupational hazard. This
review article is regarding the occupational hazards in the field of Dentistry, various classification and its
management has been discussed

Keywords: biohazard, radiation, aerosols, dental materials

Introduction Classification: These hazards are grouped into:

Occupational health hazards are present in every 1. Physical

profession, which is an unavoidable circumstance for the 2. Chemical
dentist and his team.. Precaution has to be taken while
3. Biological
practicing to prevent these hazards. A study by brooks
SL et al [1] reported that dentists, more frequently have 4. Mechanical
worse health problems than other high risk medical
5. Social aspects
professionals.
Handbook of Occupational Hazards and Controls
Definition:
for Dental Workers by government of Alberta in year
z Occupational hazard is the risk to a person usually 2011 classified as follows:
arising out of employment.
1. Biological
z It can also refer to a work, material, substance,
2. Chemical
process, or situation that predisposes, or itself
causes accidents or disease, at work place. [1,2,3] 3. Physical
4. Psychological

Babaji P et al stated that dentists during clinical

practice are exposed to variety of work related hazards
which are classified into five types: [4,5,6]
Corresponding Author:
Alagarsamy Venkatesh., M.D.S., 1. Physical
Professor, 2. Chemical
Department of Conservative Dentistry and Endodontics,
3. Biological
Sree Balaji Dental College and Hospital,
Bharath Institute of Higher Education and Research, 4. Psychological
Narayanapuram, Pallikaranai,Chennai -600100. 5. Musculoskeletal disorders
Tamilnadu, India
Phone: 9444118878 Physical Hazard: The dentists are at risk of physical
Email:denvenkat@gmail.com injuries during dental procedures that includes:
 98 Indian Journal of Public Health Research
Indian Journal&ofDevelopment,
Public HealthNovember
z Poor illumination
z Excessive brightness
z Ionising radiation
z Non-ionising radiation
z Pressure system
z Aerosols
z Exposure to cuts from sharp medical instrument
Poor illumination: Causes- eye pain, eye strain,
headache and eye fatigue
Excessive brightness:
Causes- discomfort and visual fatigue: The study
done in Norway reported that public health dentists
complained 13% of eye problems. An investigation done
on Flemish dentists in Belgium revealed that 52% had
vision problems and eye injuries. [4,6,7]
Prevention
z Sufficient and suitable lighting
z Natural or artificial is advised
Radiation [8-11]: Dental radiology gives rise to a
significant dose of radiation to the bone marrow in the
skull and cervical spine, the oral mucosa, the thyroid and
the eye. Dental personnel are exposed to both ionizing
and non-ionizing type of radiations
Non- ionising radiation injury - Exposure to Dental
Curing Light and Lasers
Causes- conjunctivitis and keratitis: Non-ionising
radiation has become an important concern with the use
of blue light and to cure various dental materials (for
example composites and other resins) (Gambhir, 2011).
Lasers: The main occupational hazards associated with
them are:
z Eye damage
z Skin damage
z Fire
z Smoke inhalation (cellular and viral debris)
Prevention
z Good workplace design
Research &2019, Vol.10, No.
Development, 11
December 2019, Vol. 10, No. 12 2187
z Ensure no reflective surfaces
z Local exhaust ventilation
z Fail-safe systems
z Lock/key access for activation
z Gloves
z Gown
z Protective eye wear during usage
Curing Lights: Curing lights have become an integral
part of daily practice in restorative dentistry. In this
regard, visible light-cured resin-based composites are
the predominant restorative materials for both anterior
and posterior restorations (Singh, 2011). Halogen and
LED units are by far the most frequently used in daily
practice. From an occupational safety perspective, the
blue light used to cure composite is not well tolerated by
the human eye (i.e. solar retinitis).
Prevention
z Good workplace design (covering curing site), and
z Blue light filters.
z Staff training,
z Equipment maintenance as per manufacturer’s
guidelines,
z Eye protection
Ionising radiation injury-Exposure to radiation:
Causes- acute erythema, dermatitis, chronic skin cancer,
bone marrow suppression, damaged to eye including
cornea. Radiation effects are cumulative and this
damage is totally painless yet life threating. Ionising
radiation is a well established risk factor for cancer. The
study conducted among Canadian dentists reported that
occupational doses of ionizing radiation among dentists
and dental workers have decreased markedly since
1950s. [5]
Prevention
Following are the recommendations for safety of the
practitioner [5, 11-5]
z Buying standard radiographic equipment, which
rigidly follows the National Council on Radiation
Protection and Measurements (NCRP) and ISI
recommendations.
2188 Indian
Indian Journal of Public Health Journal
Research & of Public Health
Development,
December
z Well-collimated and filtered beam of at least 1.5
mm of aluminium filtration, should be available.
z Special conch shell designs are recommended for
the X-ray departments. During construction use
special barium plaster, which absorbs the scattered
radiation.
z .Dental surgeons must use a film badge provided
by the Baba Atomic Research Centre (BARC),
Mumbai for personnel monitoring
z Operator should leave the room or take a position
behind a suitable barrier or wall during exposure of
the film.
z Walls must be of sufficient density or thickness.
z The operator should stand at least 6 feet from
patient, at an angle of 90° to 135° to the central ray
of X-ray beam.
z Lead aprons routinely used for all patients and
children special thyroid shield should be used.
z Use of fast films
z Films should never be held in place by the operator
(use film holding instruments).
z The radiographic tube should never be stabilized by
the operator or patient during the exposure.
z To ensure the above, advice to use film badges.
These badges contain a piece of sensitive film or
radiosensitive crystal by which the quantity of
radiation exposure or dose can be determined. The
instrument used to measure radiation dose is known
as dosimeter.
Pressure System [16-18]: Typical pressure equipment used
in dentistry includes:
z Autoclaves
z Compressed air systems (fixed and portable).
The failure of pressure equipment can result in
serious injuries to staff/patients and cause major damage
to structure/property. The control measures to prevent
such failures relate to the mechanical integrity of the
equipment involved.
Autoclaves: The most serious risks associated with
autoclaves are the uncontrolled release of stored energy
include:
Research
& Development,
2019, Vol. 10, No. 12November 2019, Vol.10, No. 11 99
z Scalding
z Explosion of sealed glass containers containing
liquids.
Control measures to mitigate such risks include:
z Determine the type of equipment and control
system (manual or automated)
z Assess the risk of door opening violently,
underpressure;
z Verifying “nil” pressure before opening door;
z Operator training and instruction;
z Thorough examination of pressure equipment as per
schedule 12 part b of the safety, health and welfare
at work (general application) regulations2007 to
2016,
Compressed air systems: The most serious risks
associated with air receivers come from the uncontrolled
release of stored energy. i.e., catastrophic failure of
vessel whilst under pressure.
Control measures:
z Thorough examination of air receivers (every
26months as per Schedule 12 Part B of the
Safety,Health and Welfare at Work (General
Application) Regulations 2007 to 2016
z Maintenance and inspection (as per manufacturer’s
recommendations and undertaken by competent
person).
Injury due to sharps [7,8]: Exposure-prone procedures
(EPPs) include situations where the worker’s hands
(whether gloved or not) may be in contact with sharp
instruments, needle tips or sharp tissues (spicules of
bone or teeth) inside a patient’s wound or confined
anatomical space where the hands or finger tips may not
be completely visible at all times. There is an increased
risk of transmitting blood-borne viruses between
Dental health professionals and patients during these
procedures.
Prevention
z The use of personal protective equipment
(disposable gloves)
z Vaccination of employees
z Prevention of re-capping needles
z Reporting of incidents, response and follow up.
 100 Indian Journal of Public Health Research
Indian Journal &
of Development, November
Public Health Research
Aerosol: It is defined as particles less than 50 µm
in diameter. These are produced from operating site
and suspended in the air and are airborne infection in
dentistry. Therefore, are contaminated with bacteria and
blood. [14-20]
Procedures Shown To Produce Airborne Bacterial
Contamination:
z Ultrasonic and sonic scalers - Shown to be the
greatest source of airborne contamination.
z Air polishing - Bacterial counts show that airborne
contamination is nearly equal to ultrasonic scalers.
z Air-water syringe - Bacterial counts indicate
that airborne contamination is slightly less than
ultrasonic scalers.
z Tooth preparation with an air turbine hand piece -
Minimal airborne contamination if a rubber dam is
used.
Prevention: High volume evacuator will reduce airborne
bacteria by nearly 99%.
Chemical Hazards [21-25]: Dentists are exposed to
many various types of chemicals that are hazardous
while providing care. These include beryllium, silica,
powdered natural rubber latex (NRL), formaldehyde and
mercury.
Silica: Inhalation of dust containing free silica or silicon
dioxide in ceramic laboratories leads to silicosis.
Beryllium: 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
two microparticles of beryllium per cubic meter of air
for an 8 hour time weighted average.
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
causes severe abdominal pain, nausea, vomiting and eye
irritation.
Natural Rubber Latex (NRL): Latex gloves (dusted
with cornstarch powder) form an efficient barrier against
most pathogens. Unfortunately most of the professionals
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are allergic to latex content of gloves. The powder in latex
gloves itself is not the allergen. It only provides binding
sites for latex protein and aids in carrying the protein
into the skin. It has also been reported that airborne
powder particles causes asthmatic allergic reactions or
even anaphylaxis. Dental personnel should note that
latex is present in other personnel protective equipments
like masks, eyewear, rubber dam and clinical gowns.
Clinical symptoms of latex allergies include: urticaria,
conjunctivitis accompanied by lacrimation and swelling
of eyelids, mucous rhinitis, bronchial asthma and
anaphylactic reaction.
Dental Materials: Many products used in dentistry may
act as allergen to a part of population. The free monomers
may cause a wide range of adverse health effects such as
irritation to skin, eyes or mucous membranes, allergic
dermatitis, asthma and parasesthesia in the fingers.
Nitrous oxide [21-24]: The National Institute for
Occupational Safety and Health (NIOSH) in 1994 issued
a warning to hundreds of thousands of medical, dental
professionals who work with nitrous oxide (N2O). If used
in high concentrations during anesthetic administration,
it causes increased absorption and thereby liver and
kidney damage with neuralgic disease and congenital
abnormalities.
Mercury: Waste dental amalgam is considered to
be hazardous waste. Mercury causes the formation
of „neurofibrillar tangles,“ which are one of the two
diagnostic markers for Alzheimer‘s disease. In February,
1998, it was announced that mercury from amalgam
fillings can permanently damage the brain, kidneys, and
immune system of children.
Prevention: Amalgam capsules, waste amalgam,
amalgam sludge and used amalgam filters on suction
units as well as extracted teeth with amalgam fillings must
be segregated from other waste, stored in special UN-
approved, labelled containers with vapour suppressant.
Biological Hazard are constituted by infectious
agents of human origin and include viruses, bacteria
and fungi. Therefore it is greatest concern to the
dental professional. They are HIV, HBV, HCV and
Mycobacterium tuberculosis. A dentist can become
infected either directly or indirectly.
Possible sources of exposure to biological agents for
dental healthcare professionals include:
2190 IndianResearch
Indian Journal of Public Health Journal&ofDevelopment,
Public HealthDecember
Research2019,
z Contact with contaminated sharps
z Respiratory infectious disease through splatters
from bodily fluids and/or projectiles while using
high-speed rotary handpieces.
z Environmental biological contaminants from
water/ventilation systems (for example, legionella).
Musculoskeletal disorder : It has been reported
[23,25]
that young and less experienced dentists experience
more musculoskeletal disorders compared to older
and experienced one. Common 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.
Prevention of Neck, Shoulder and Back Disorders
z Change Posture
z Use Support
z Safe reaching [within a distance of about 20 inches
(50 cm)]
z Normal arm posture
z Use Comfortable Equipment
z Manage Time
Legal Hazards: To help assure a safe work environment
in dental treatment, the hazard awareness and prevention
of legal risks should be made known to all clinical
workers of the dental hospital.
Psychological Hazards: Dentists encounter numerous
sources of professional stress, anxiety, and depression,
beginning in dental clinic.
Some of the main types of mental health promotion
interventions are:
z At organisational level – ensuring adequate staffing
levels and skill mix, organising shift patterns.
z At organisation/individual interface level –
improving relationships, establishing support
groups, improving person-environment fit.
z At individual level- stress management, counselling
Dental Unit Water Lines (DUWLs): Dental Unit Water
Lines (DUWLs) are prone to microbial contamination,
& Development, November 2019, Vol.10, No. 11
Vol. 10, No. 12 101
build-up of biofilm and are a potential source of
legionellosis. The manufacturer’s instructions should
be followed for the periodic disinfection of water lines.
Regular disinfecting with a chemical agent is the most
effective approach.
Summary
Dentist has to upgrade their existing knowledge
by participating in continuing dental education, regular
workshops and seminars on occupational hazards. Dental
clinic design has to be made with, sufficient lighting,
ventilation, engineering control measure and equipped
with appropriate personal protective. More effort should
be made by management officials to educate the staff
about the importance of vaccination.
Conclusion
Occupational hazard is an unavoidable circumstance
for the dentist and his team. The aim of infection control
is to control iatrogenic, nosocomial infections among
patients, and potential occupational exposure of care
providers to disease causing microbes during provision of
care. Disease transfer to the dentist and dental staff during
dental care is considered an “occupational exposure” to
a given pathogen while disease transfer from one patient
to another in the dental clinics is considered “cross-
infection”. Therefore, the dental health care provider
must be knowledgeable about the diseases commonly
encountered in the dental operatory and must follow high
standards of infection control for the safety of the patients
and the dental health care workers.
Conflict of Interest: Nil
Source of Funding: Nil
Ethical Clearance: Not required for review manuscript
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