Occupational hazards in dentistry are occupational hazards that are specifically associated with a dental care environment. Members of the dental team including dentists, hygienists, dental nurses and radiographers must ensure local protocols are followed to minimise risk.
Video Occupational hazards in dentistry
Radiation
Exposure to radiation can result in harm, categorised as either deterministic or stochastic. Deterministic effects occur above a certain threshold of radiation e.g burns, cataracts. Stochastic events are random occurrences after exposure to radiation as there is not a threshold dose above which they will occur e.g. carcinogenesis. Whilst radiation occurs naturally in the environment, additional exposure for medical purposes should be limited to where benefit outweighs risk to both staff and patients.
The World Dental Federation guidelines highlight that operators of dental radiography equipment must be sufficiently trained and qualified. When operating equipment, the staff member should be at least two metres away from the source, clear from the primary beam and behind a protective shield or wall where possible. The US-based National Council on Radiation Protection recommends the shield be installed by an expert and lead may be substituted for gypsum, steel or concrete providing suitable thickness. Additionally, visual contact should be considered whilst designing the shield to allow for constant monitoring of the patient.
Regular testing of equipment is required and varies depending on local legislation, with a designated legal person or employer responsible for organising checks. Faulty equipment could lead to increased or accidental radiation exposure to staff or patients.
United Kingdom
Within the United Kingdom, the Ionising Radiation Regulations (IRR) and Ionising Radiation (Medical Exposure) Regulations (IRMER) stipulate measures for limiting risk to staff and patients. The Health and Safety Executive (HSE) enforces such regulations and additionally provides a database of radiation exposure for different groups of workers, known as The Central Index of Dose Information (CIDI) which allows analysis of trends.
Personal dosimeters should be worn where the estimated annual exposure to radiation will exceed 1mSv, which can be calculated by considering the type and number of radiographs that will be taken by the worker. According to the IRR, should the estimated exposure exceed 6mSV, then the worker is said to be classified and will require regular medical checks. However, as the doses from dental images are relatively low, should estimated doses exceed normal values then investigations are required to ensure that principles of justification, optimisation and limitation are being followed.
Whilst local regulations vary by country, IRMER specify information essential for a radiation protection folder within each dental practice operating x-ray equipment including designated control areas, contingency plans, qualified staff, pregnant staff, policy and standard procedures. Regular communication with a medical physics expert ensure guidelines are being followed and understood.
Maps Occupational hazards in dentistry
Dangerous substances
Sodium hypochlorite is a commonly used irrigant in endodontic therapy to dissolve organic matter and kill microbes, allowing removal of infection source. Case reports suggest a risk to dental professionals of chemical burns to the eyes as a result of sodium hypochlorite exposure.
Nitrous oxide is commonly used in dentistry as a method of conscious inhalation sedation, particularly for children. This has been shown in both medical and dental settings to be a very safe method of sedation for patients. However, historical evidence suggests a potential increase in risk of spontaneous abortion amongst pregnant female dental professionals, with the risk increasing with greater contact time with nitrous oxide sedation treatment and the absence of scavenging equipment to remove any leaking gas.
Dental amalgam is a mercury-containing filling material used to fill cavities once tooth decay has been removed. The use of dental fillings containing mercury is to be phased down in accordance with the Minamata Convention, however its use remains widespread. Weak relationships exist between mercury and spontaneous abortion, congenital abnormalities and reduced fertility.
Musculoskeletal disorders
Musculoskeletal problems are prevalent among dental professionals. Problems can begin as early on as dental school, with 79% of dental students reporting neck and/or back pain, at one undergraduate dental school in the UK. The problems arise from the nature of the job: focusing on fine procedures which require a close visual field and sustained posture for long periods of time. Musculoskeletal disorders were found to be more prevalent amongst dental surgeons than surgeons or physicians, and 60% of dentists reported symptoms in more than one site. Repetitive work, the need to maintain steady hands, and spending most of the day with an awkward posture can lead to musculoskeletal pain in various sites. The lower back is commonly affected, as well as the upper back, shoulders and neck.
There are a number of recommendations for dentists that can help reduce the risk of developing musculoskeletal pain. The use of magnification or loupes and good lighting aids an improvement in posture by preventing the need to crane the neck and back for better vision. The use of a saddle seat also assists improved posture by keeping the spine in it's natural 'S' curve. Patient's should be positioned with enough distance to allow the shoulders to be in a relaxed, neutral position and elbows at about a 90 degree or less flexion.
Stress
Recent studies show that dentists are at higher risk of stress-related incidences such as suicide, cardiovascular disease and mental health issues.
Potential reasons include work confinement, working with anxious patients, time pressures, complex treatment and personality traits within dentists themselves (the need for perfection, attention to detail, high expectations of themselves and others).
Between the years of 1991-200 the Office of National Statistics indicated that doctors, dentists, nurses, vets and agricultural workers have the highest rate of suicide risk compared to other professions.
According to an article released in the British Dental Journal, stress-related problems can lead to premature retirement. The most frequent causes of premature retirement were musculoskeletal disorders (29.5%), cardiovascular disease (21.15), and neurotic symptoms (16.5%).
References
Source of article : Wikipedia
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