CONTENTS

⚫ INTRODUCTION
⚫ BIOLOGICAL HAZARDS
⚫ CHEMICAL HAZARDS
⚫ PHYSICAL HAZARDS
⚫ PSYCHOLOGICAL HAZARDS
⚫ CONCLUSION

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 INTRODUCTION
⚫ Dental workers may be exposed to a variety of
workplace hazards in the course of performing
their functions.
⚫ The type and degree of exposure is dependent
upon the type of services, the type of patients and
the specific tasks performed.
⚫ The occupational hazards in dentistry may be
classified as:
▪ Biological hazards
▪ Chemical hazards
▪ Physical hazards
2 ▪ Psychological hazards
 BIOLOGICAL HAZARDS

⚫ The dental environment is associated with a significant

risk of exposure to various microorganisms.
⚫ Dental patients and dental health care workers (DHCW
) may be exposed to a variety of microorganisms via
blood or oral or respiratory secretions.
⚫ These microorganisms may include cytomegalovirus,
hepatitis B virus, human papilloma virus, herpes
simplex virus type 1 and 2, human immunodeficiency
virus, mycobacterium tuberculosis, staphylococci,
streptococci and other virus and bacteria especially
those that infect upper respiratory tract.

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 THE KNOWN HERPES VIRUS WHICH INFECTS HUMANS
HERPES SIMPLEX VIRUS 1 HERPES LABIALIS AND
KERATITIS, COLD SORE,
ENCEPHALITIS
HERPES SIMPLEX VIRUS 2 GENITAL HERPES, NEONATAL
INFECTION

VARICELLA ZOSTER VIRUS CHICKEN POX

EPSTEIN BARR VIRUS INFECTIOUS MONONUCLEOSIS
CYTOMEGALOVIRUS MONONUCLEOSIS TYPE
SYNDROME
HUMAN HERPES VIRUS 6 FEVER WITH RASH,
ENCEPHALITIS,
LYMPHADENOPATHY,
MYOCARDITIS AND
MYELOSUPPRESSION
HUMAN HERPES VIRUS 7 IT HAS YET TO BE
CONCLUSIVELY ASSOCIATED
WITH ANY DISEASE
4
HUMAN HERPES VIRUS 8 IT HAS BEEN IDENTIFIED IN ALL
 TREATMENT FOR HERPES INFECTION

⚫ Routine use of universal precautions, uses of

gloves and avoidance of direct contact with oral
mucosal HSV ulcers provide adequate protection
against HSV in dental care workers.

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 ACUTE VIRAL HEPATITIS
FEATURES HEPATITI HEPATITIS HEPATITIS HEPATITIS HEPATITI
S A B C D SE
CAUSATIVE HEPATITIS A HEPATITIS B HEPATITIS C HEPATITIS D HEPATITIS E
AGENTS VIRUS VIRUS VIRUS VIRUS VIRUS
TRANSMISSION FECO ORAL PARENTERAL, PARENTERAL, PARENTERAL, FECO ORAL,
SEXUAL, SEXUAL SEXUAL, ABRUPT
INSIDIOUS ABRUPT
INCUBATION 15-45 DAYS 30-180 DAYS 13-160 DAYS 30-180 DAYS 15-60 DAYS
PERIOD
ASSOCIATED NO PRIMARY HEPATOCELLU CIRRHOSIS, NO
DISEASE HEPATOCELLU LAR FULMINANT
LAR CARCINOMA HEPATITIS
CARCINOMA,
CIRRHOSIS
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 MODE OF TRANSMISSION IN DENTISTRY
⚫ Dental practitioners are considered as a group with
one of the highest risk of exposures to HBV.
⚫ HBV is transmitted both percutaneously and non
percutaneously.
⚫ Because dental treatment involves the use of small,
sharp, contaminated instruments transferred between
dental care providers during treatment, multiple
opportunities exist for inadvertent percutaneous
wounds to the operator and staff.
⚫ Non percutaneous transmission in the dental
environment includes transfer of infectious bodily
secretions such as saliva, blood and cervicular fluid.
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 Treatment

⚫ Effective treatment is still not available.

⚫ However subcutaneous administration of interferon
alfa-2b was effective in inducing a sustained loss of
viral replication.

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 HIV INFECTION/ ACQUIRED
IMMUNODEFICIENCY SYNDROME
⚫ HIV is a member of the retro virus family that can lead to acquired
immunodeficiency syndrome, a condition in which the immune
system begins to fail leading to life threatening opportunistic
infections.
⚫ HIV transmission occurs through contact with blood and other body
fluids. ⚫ Clinical manifestation of HIV :
⚫ Oral manifestations of HIV : ▪ Unexplained diarrhea lasting more than
▪ Hairy leukoplakia a month
▪ Kaposi’s sarcoma ▪ Fatigue
▪ Candidiasis ▪ Malaise
▪ Aphthous ulcer
▪ Loss of more than 10% body weight
▪ Angular stomatitis
▪ Xerostomia ▪ Fever, night sweats
▪ Gingivitis ▪ Generalized lymphadenopathy
▪ Opportunistic infections like
pneumonia, meningitis, tuberculosis,
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herpes simplex infection
 PRECAUTIONS AGAINST HIV PATIENTS
⚫ Care in handling sharp objects like needles, blades.
⚫ All cuts and abrasions in an HIV patient should be covered with a
waterproof dressing.
⚫ Equipments and areas that are contaminated with secretions
should be wiped with sodium hypochlorite solution or 2%
glutaraldehyde.
⚫ Contaminated gloves, cottons should be incinerated.
⚫ Separate operation theatre and staffs to do surgeries to HIV
patient is justifiable.
⚫ Suction bottle should be half filled with freshly prepared
glutaraldehyde solution.
⚫ Spilled body fluids should be immediately washed with soap and
water thoroughly.

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 AFTER CONTAMINATION
⚫ Regardless of the decision to use post exposure
prophylaxis, the wound should be cleansed immediately
and antiseptic applied.
⚫ Post exposure prophylaxis :
⚫ A combination of two nucleoside analogue reverse
transcriptase inhibitors given for less severe exposure for 4
weeks, zidovudine and lamivudine.
⚫ Combination of two nucleoside analogue reverse
transcriptase inhibitor plus a third drug given for 4 weeks
for more severe exposures, zidovudine+ lamivudine+
indinavir or nelfinavir or other protease inhibotors.

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 Tuberculosis
⚫ Tuberculosis is one of the oldest infectious disease known to
humans.
⚫ Mycobacterium tuberculosis is the microorganisms which
commonly affects the lungs but may involve any organ in the
body.
⚫ TB mimics many respiratory conditions therefore when the
practitioners observes a cough of more than 3 weeks of
duration, sputum possibly tinged with blood, unexplained
weight loss, night sweat.
⚫ The patient should be referred for a TB skin test and treatment.
⚫ If diagnosed with active infection the patient must be treated till
pronounced non infectious and then may access dental care.
⚫ Dentists and staff must undergo testing for the disease on a
periodic basis, especially if living in endemic areas where the
12 prevalence is high.
 TREATMENT

⚫ Anti-tubercular therapy for 6-12 months.

⚫ First line drugs are rifampicin, isoniazid, ethambutol,
pyrizinamide.
⚫ Drugs regimen :
2 months of initiation phase: all four drugs are
given
4 months of continuation phase: isoniazid and
rifampicin are given.

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 Biological hazards
POTENTIAL BIOLOGICAL HAZARDS PREVENTIVE STRATEGIES
Exposure to biological agents in blood and •Obtain medical history of patients
saliva of patients through contact with blood •Equipment to minimize formation of
and saliva or through contact with aerosols (rubber dams, high speed
contaminated needles or sharp instruments evacuations)
(including orthodontics wire) •Proper disposal of waste materials
•Proper disinfection of instruments and
decontamination of environmental surfaces,
lab supply and materials
•Immunization program
Exposure to respiratory infectious disease •Medical history of the patients
through droplet transmission including •Compliance with all infection prevention and
splatters from body fluids and projectiles controlled practices
while using high speed devices •Immunization program
•Workers examination
Exposure to environmental biological •Maintenance of ventilation system
contaminants from ventilation system, water •Preventive maintenance of ventilation
or food systems and water supply systems with
regular testing to ensure proper functioning.
•Early detection and remediation of mold
(fungus)
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 Chemical hazards

POTENTIAL CHEMICAL HAZARDS

▪ Exposure to methyl methacrylate used as fillers or

exposure to various metals or silica
▪ Exposure to mercury when handling mercury
containing amalgam
▪ Exposure to latex from contact with latex gloves or
components of medical devices
▪ Exposure to a variety of disinfecting and cleaning
agents in routine cleaning activities related to patient
care

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 PREVENTIVE STRATEGIES

⚫ Substitution with less harmful products

⚫ Develop safe work procedures
⚫ Educate workers in the nature of the hazards
⚫ Medical monitoring of workers
⚫ Elimination of mercury containing amalgams
⚫ Local exhaust ventilation when removing old
amalgams
⚫ Ensure good hygiene practices
⚫ Purchasing controls to limit latex containing materials
from entering facilities

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 MERCURY HAZARDS

⚫ Mercury is a known toxic, bio accumulative substance

and it often finds its ways into body through dental
amalgams, which is used to restore cavitated tooth.
⚫ The mercury releases in body and negatively affects
brain, nervous system, kidney, etc.

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 MERCURY IN DENTAL AMALGAM
⚫ The silver fillings used by dentists to restore are composed
of a metal “amalgam” containing roughly 50% elemental
mercury and 50% other metals (mostly silver with some tin
and copper).
⚫ The mercury found in amalgam fillings has raised some
safety concerns over the years. Amalgam release small
amounts of mercury vapor over time, and patients can
absorb these vapors by inhaling or ingesting them.
⚫ Taking out filings with a high speed dental bur generates a
cloud of particles, at least 65% of which are one micron or
less in size. These are fully respirable, get deep into the
lungs, where the microscopic particles are broken down
and the mercury is systematically absorbed within a few
18 days.
 ⚫ Toxic effects of mercury depends upon :

Amount of exposure
Length of exposure
Length of mercury accumulation in the body
Amount of accumulated mercury
Overall health of the patients (for detoxification )

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 Mercury symptoms on oral cavity
⚫ Bleeding gums
⚫ Alveolar bone loss
⚫ Loosening of teeth
⚫ Excessive salivation
⚫ Foul breath
⚫ Metallic taste
⚫ Burning sensation, tingling of lips, face
⚫ Tissue pigmentation
⚫ Stomatitis
⚫ Ulcerations of gingiva, palate, tongue.

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 OTHER TOXIC EFFECTS OF MERCURY ON BODY
⚫ Headaches, vertigo
⚫ Memory loss
⚫ High blood pressure and heart problems
⚫ Weight gain
⚫ Digestion problems
⚫ Skin rashes
⚫ Joint stiffness
⚫ Immune dysfunction
⚫ Persistent cough

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 DENTAL MERCURY HYGIENE
RECOMMENDATIONS
⚫ VENTILATION : provide proper ventilation in the places by
having fresh air exchanges and periodic replacement of
filters, which may act as traps for mercury.

⚫ MONITOR OFFICE : monitor the mercury level in the office

periodically. This may be done by using dosimeter badges
and vapor analyzer.

⚫ OFFICE DESIGN : use proper work area design to facilitate

spill containment and cleanup.

⚫ PRECAPSULATED ALLOYS : use precapsulated alloy.

Eliminate the possibility of bulk mercury spill, otherwise
store bulk mercury properly in unbreakable containers on
22 stable surface.
 ⚫ AMALGAMATOR COVER : use an amalgamator fitted with a
cover.

⚫ HANDLING CARE : use care in handling amalgam, avoid

skin contact with mercury or freshly mixed amalgam, avoid
dry polishing.

⚫ EVACUATION SYSTEM : use high volume evacuation when

finishing or removing amalgam. Evacuation system have
traps or filter. Check, clean/replace traps and filter
periodically.

⚫ SPILLS : clean up mercury properly by using bottle

tapes/fresh mixes of amalgam to pick up droplets/use
commercial clean up kits. Do not use household vacuum
cleaner.

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 ⚫ SELECT AN APPROPRIATE ALLOY : proper mercury:alloy
ratio to avoid the need to remove excess mercury before
packing.

⚫ RECYCLING : store amalgam scrap under radiographic fixer

solution in covered container. Recycle amalgam scraps
through refiners.

⚫ USE RUBBER DAM : during insertion, condensation, and

polishing of amalgam.

⚫ GALLIUM BASED ALLOYS : can be used instead of mercury

alloy to prevent mercury hazards.

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 TREATMENT OF MERCURY TOXICITY

⚫ Chelation therapy is the administration of chelating agents

to remove heavy metals from the body.
⚫ It is commonly used in the treatment of heavy metal
poisoning.
⚫ A chelating agent can be given orally, intramuscularly, or
intravenously.
⚫ Chelation therapy for acute inorganic mercury poisoning
can be done with 2,3-dimercaptosuccinic acid (DMSA),
2,3-dimercapto-1-propanesulfonic acid (DMPS),
D-penicillamine (DPCN), or dimercaprol. Only DMSA is
FDA-approved for use in children for treating mercury
poisoning.
⚫ Correct dosage is required as inappropriate dosages
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increase toxicity.
 Physical hazards
POTENTIAL PHYSICAL HAZARDS PREVENTIVE STRATEGIES

Ergonomic hazards associated with •Ergonomically designed workstations, chairs and

computer use or workstation design equipments
•Adjustment of workstation and chair to fit users
•Worker education regarding ergonomic hazards and
control measures

Exposure to ionizing radiation when •Workplace design to provide distance between

taking dental X-rays worker and source
•Appropriate shielding materials
•Equipment design to minimize scatter
•Replacement of older X-ray equipment with the
newer equipments with additional features

Exposure to laser beams during dental •Ensure area has no reflective surfaces
procedures •Safe work procedure (placing laser in standby mode
when not in use)
•Laser safety program
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 Falling hazards associated with slips, trips •Install slip resistant flooring
and falls •Ensure adequate lighting
•Inspect ladders prior to use
•Implement a spill cleanup program
Cuts from sharp instruments •Avoid use of sharps when not required
•Replace sharps with Safety Engineered
Medical Devices
•Proper storage of sharps
Nuisance or irritating noise •Sound absorber materials
•Lubrication of equipments with moving parts
•Location of noisy equipments to more
isolated areas
•Sound-masking technology
Exposure to cryogenic agents in cryosurgical •Substitution (CO2 instead of N2O where
procedures possible)
•Proper storage of containers including
exhaust ventilation, scavenging systems,
storage away from moisture, ignition sources
and flammable materials
•Restricted access
•Spill and exposure emergency response
equipment and procedures

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 PSYCHOLOGICAL HAZARDS
PSYCHOLOGICAL HAZARDS PREVENTIVE STRATEGIES

Mental illness as a response to excessive •Worker education about the signs and
workplace stressors symptoms of depression, anxiety, sleep
disorders, other mental illness
•Programs to maintain or build resilience or
coping skills
•Communication with family physician
Stress related to work-life conduct •Management policies and procedures that
support work life balance
•Time log used to track time
•Work activities are isolated from home time
•Appropriate sleep habits
Abuse by clients or members of the public or •Isolation areas for agitated clients
co-workers •Controlled access bright lighting in parking
lots
•Video surveillance
•Alarm systems and panic buttons
•Well trained security guards
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 “Technostress” related to the introduction of •Design of instruments or equipments with
new technology user-friendly features
•Provision of sufficient training for workers
•Self-education concerning new technologies
•Backup plans in the event of failures

Hazards related to working alone •Communication devices

•Bright lighting
•Mirrors to facilitate seeing around corners or
hallways, surveillance cameras
•Scheduling to avoid having workers work
alone
•Adequate security

Hazards related to impacts of aging on •Management policies and procedures that

workers ensures no age discrimination
•Training opportunities for aging workers
•Aging workers as trainers/mentors
•Job redesign to accommodate aging workers

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 CONCLUSION

⚫ Dental health workers are exposed to many

occupational hazards ranging from the threat of
infectious disease, toxicity to chemicals routinely used
in dentistry and musculoskeletal disease
consequential to a poor working position.
⚫ Nonetheless, awareness of these hazards and
implementation of preventive strategies can provide a
safe environment for all concerned.

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 REFERENCE

⚫ ESSENTIALS OF PUBLIC HEALTH DENTISTRY, SOBEN PETER,

6TH EDITION.

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