Dental

KEMH Dental Practice Risk Assessment

The following table shows the results of the assessment by identification of those at risk to each hazard or
risk, the controls already in place and \ or the action to be considered to minimise risk.

Significant hazards Those at risk Existing controls or action required

Accidents, Slips, All staff, patients and ▪ Good quality flooring which is well maintained
Trips and Falls visitors ▪ All staff trained to maintain good housekeeping
standards
Risk of injury ▪ Spills are cleared up immediately
▪ Walk areas kept unobstructed

Aggression and All staff ▪ Practice policy zero tolerance to violence. Call help
Violence and
999 in the case of an emergency
▪ Equipment and hazardous substances or
pharmacological agents are stored in a safely locked
area, which is out of reach from patients.
▪ Hygienist works unaccompanied-open door policy
(breach of confidentiality)

Action to be taken:
▪ Provide a Dental Nurse or trainee for the Hygienist
 Dental

Biological agents Dentist, dental ▪ Biological agents are covered by COSHH

Risk of infection from – ▪ nurse, hygienist, ▪ Protective safety goggles, gloves, mask and clothing
Blood/saliva patient worn during dental treatment by all staff. Special eye
▪ wear and bib provided for patient safety during
treatment
Bacteria/microorganis ▪ Universal precautions and current infection control
ms guidelines are followed
▪ Relevant staff are immunised against hepatitis B and
their responses checked
▪ Regular training in infection control procedures is
provided
▪ Medical History taken for each patient/reviewed
during each appointment
▪ Water checks, 3 monthly lab testing for legionella
and other pathogens
▪ Water temperature checked weekly by engineering
department.
▪ Lines are cleaned weekly with oxygenol

Action to be taken:
Regular training and updates in infection control
guidelines for all staff as part of CPD.

▪ Hazardous substances are covered by COSHH

Chemicals (COSHH) Dentist, dental
nurse, hygienist,
Risk of skin, eye and cleaner, patient,
respiratory tract visitors and
irritation, asthma, contractors
allergy and poisoning
▪ Staff made aware of the risks from the hazardous
substances they work with and the precautions
needed to avoid or control these risks
▪ Substances assessed include acids, adhesives,
blood and saliva, disinfectants, strong detergents
and other cleaning agents, latex gloves, mercury,
nitrous oxide, solvents and x-ray chemicals.
▪ Protective safety goggles, gloves, mask and clothing
worn during dental treatment by all staff. Special eye
wear and bib provided for patient safety during
treatment
▪ Rubber dam used during certain procedures to avoid
contact of amalgam, sodium hypochlorite or other
hazardous chemicals with oral mucosa
▪ Safe disposal of mercury by filtration through suction
equipment. Excess mercury disposed in specially
prepared containers which are safely secured.
▪ Any capsules and left over amalgam are disposed of
in amalgam waste containers.

Children Patients or visitors ▪ Not to be left unaccompanied anywhere in the

practice. During dental x rays children are not to be
Risk of accidents, trips, left alone in the surgery but should accompany
falls, hot surfaces. parent/guardian and stand in controlled zone with
dental staff.
 Dental
▪ Equipment and hazardous substances or
pharmacological agents are stored in a safely locked
area, which is out of reach from children.
▪ All children under 16 must be accompanied by an
adult for medical history and consent for X-ray.

Action required:
All staff to ensure parents supervise children.

Compressors Dental team and • Annual inspection of compressor by KEMH medical

Risk of explosion, fire patients. engineer team
• Daily drained and examined.
• Release of compressor air weekly
• Filter cleaning weekly
• Weekly checks from engineer department

Curing Lights Dental team and ▪ Light curing systems are battery-driven. Electrical
patients checks carried out prior to use. Checks carried out
Risk of eye cataracts, once a week by dental nurse.
retina damage. ▪ Protective eye wear against UV light
▪ Orange shield used during use of unit to protect dental
team from eye cataracts.
▪ Rubber dam used in some cases where patient has
shown adverse reaction to light curing unit.

Electrical appliances Dental team ▪ Staff advised to visually check plugs, cables or
equipment for signs of overheating or damage and
Risk of: electric shock, report these to the practice manager for remedial
burns or fire from action.
damaged equipment ▪ Visual inspection of all portable appliances is carried
out annually/six monthly by the practice owner [or
other competent member of staff] and findings
recorded
 Dental
▪ All electrical equipment is inspected and tested by a
qualified electrician at regular intervals (every three
years suggested)

Action to be taken:
Training for staff to include simple visual checks of
electrical equipment.

Eye injury Dentist, dental ▪ Use of protective eyewear during clinical procedures
nurse, hygienist, for both staff and patients and when cleaning
Risk of: patient instruments and equipment prior to sterilisation
▪ Use of high speed aspiration for procedures involving
▪ flying debris and
rotary instruments
splatter from
▪ Immunisation against hepatitis B for all clinical health
rotary instruments
care workers and response to the vaccine checked.
▪ Splashing during
the cleaning of
instruments. ▪ We have an eye washing kit in First Aid kit, also an
incident response flow chart to follow in case of injury.

Fire All staff, patients ▪ Fire alarm system in place, Fire control board is
and visitors located near the ward.
Risk of burns, ▪ Fire fighting equipment is checked and tested annually
respiratory by Stanley’s fire fighting service
problems, choking, ▪ Fire exits and fire-fighting equipment are clearly
death. marked
▪ Fire alarm is tested every Friday 1000 AM.
▪ Any flammable materials are stored following
instructions by manufactures.
▪ Appointed fire marshals
 Dental

▪ Access to exits and extinguishers is kept clear at all

times
▪ Procedures to be followed in the event of a fire are
displayed in health and safety file.
▪ Smoking is not allowed anywhere on the practice
premises

First Aid Dental team and ▪ First aid kit safely located at dental office. Easily
patients. accessible by all staff, AED machine is located by
A&E, and Hospital ward.
▪ Contents of kit are checked by lead first aider every
month (expiry dates and replacement of anything
Risk of cuts, burns, missing.
needle-stick
▪ Daily oxygen tank checks.
▪ Automatic electronic notifications to check use by
dates on drugs. When drugs are OOD these are
handed to pharmacy for destructions and replace.
▪ Practice first aid trained personnel are; Pat Warburton
(Dental Hygienist), Jodie Robson (Dental
Nurse/office manager, Kayleigh Scott-Pillow
(Dental Nurse), Ina Belova (Dentist).

Hot Water Dental team,

patients, visitors. ▪ Spillage is avoided by having hot water in each surgery
Burns, scalds ▪ Coffee machine risk to children

Action to be taken:
Ensure that parents supervise children near coffee
machine
Hot surface stickers needs to be added to surfaces
where there is risk
 Dental

Infection Control All dental staff, ▪ Cross infection control policy present in infection
patients, visitors. control file
▪ Equipment: All dental health professionals have been
Risk of contamination suitably trained to deal with infected equipment.
Handling of infected equipment carried out by the
of surfaces, dental
transmission of
▪ Nurse/Hygienist using gloves. Infected equipment to
bacteria/viruses to
be disinfected and then sterilised in autoclave. Sharps
sterilised equipment,
to be disposed in specially prepared bins
instruments or
surfaces, transmission ▪ Surgery surfaces: All surfaces are disinfected
of bacteria/virus to between patients and dentist/nurse wash their hands
patients. and change gloves and masks.
▪ Dental staff: Safety eyewear worn by all members of
the dental team during treatment as well as the
patient. All staff are immunised against Hepatitis B.
▪ Single use covers are used for digital x-ray film and
light curing units. Single use tips and burs used.
▪ Impressions sent to the lab are disinfected before they
leave the surgery.

Ionising Radiation Dental team and

patients ▪ Dental staff involved in the taking and processing of x-
Risk of accidental rays have received the appropriate training and
overexposure from x- possess the relevant knowledge
ray ▪ X-ray equipment is regularly checked and maintained
equipment ▪ Dentist to logs any errors
▪ All the dental team take regular CPD training on
radiography protection

Latex Allergy Patients or other • Regular reviews of medical history. Patients are asked
members of staff before any dental treatment is provided whether they
Risk of mild to severe who are allergic to are allergic to anything
anaphylaxis episode latex • Use of latex-free gloves and other equipment

Action needed:
Latex-free cartridges to be made available (citanest is
latex free)
 Dental

Lone workers Dental staff and • Dentist carries out dental treatment under the
patient continuous presence of their Dental nurse. This is to
Risk of injury, assault, minimise accidents, injuries, assaults and litigations for
sexual harassment sexual harassment.
• Some hygienists in our practice work alone so we have
an instant panic message service, should the hygienist
require assistance.
• If dental nurse and dentist get called on weekends
then have to sign in/out at hospital main reception,
before coming in to the department.

Action needed:
Nurse to be provided for hygienist whenever possible,
and whenever Hygienists treat patient with history of
unusual behaviour.

Manual Handling All staff involved in ▪ Training and information provided including how to
Risk of injury to back or lifting and/or recognise harmful manual handling and good handling
other part of the body awkward or techniques
repetitive handling ▪ Information on manual handling techniques is available
(for example, stock (HSE leaflet) and kept
deliveries,
assisting elderly Action needed:
and disabled Annual review of manual handling techniques to be
patients into and undertaken (practice meeting).
out of chair

Medical emergencies Patients (mostly) • All members of staff have been suitably trained to deal
and dental team. with medical emergencies. Training is updated at least
Risk of injuries once a year.
increases under • Emergency drug box and 2 x oxygen tanks kept in a
stressful conditions safe place where access is easy for all members of
(dental treatment) or staff.
due to administration • Contents of drug box are checked, weekly by Dental
of a drug interacting Nurse lead (expiry dates). Oxygen cylinders are
with other drugs, checked daily, as well as battery life on the defibrillator.
allergic shock etc • Policy followed in the case of a medical emergency is
obtained from the Resuscitation Council UK
• Practice training carried out every 6 months &
discussed monthly in team meetings.
 Dental
• Any medical emergencies are recorded very carefully
in patient notes.
• Defibrillator training incorporated into annual CPR
training.

Medicine storage Patients and dental • Antibiotics are stored and stocked at pharmacy
team • Access is limited to Drs, midwifes and dentists.
Risk of drug abuse • Pharmacy checks weekly availability of drugs and
expiry dates.
• Local anaesthetic and stock used are kept in locked
storage room.

Mercury Dental team and • Excess amalgam is not thrown away in the clinical
patients waste bags but in plastic amalgam containers, which
Risk of chronic are then disposed.
illnesses, autoimmune • During drilling of amalgam fillings, the excess amalgam
disease, birth defects, is filtered through the suction system - centrifugal
oral lesions, mental amalgam separators and is then disposed of into
disorders etc. plastic containers containing a suitable suppressing
solution.
• In some cases amalgam fillings are removed with
rubber dam placement
• No amalgam is placed in children under 16, pregnant &
breastfeeding women.
• No amalgam is removed whilst pregnant or
breastfeeding.
 Dental

Pregnant and nursing Pregnant and • X-rays should not be taken on pregnant women during
mothers nursing mothers the first trimester.
(Patients and staff) • If a pregnant woman does require an x-ray in an
emergency situation thenw e have a lead drape.
• Pregnant DCPs should be out of the radiation zone
whilst exposure is taking place
• No amalgam fillings should be removed or placed
whilst the patient is pregnant
• Patients should avoid being laid back fully in the dental
chair
• Complex dental treatment should be avoided if
possible until after birth.
• Pregnant DCPs should not handle mercury, heavy
equipment or deliveries.

Action to be taken:
Separate risk assessment/ health and safety policy
should be completed for pregnant staff to include
general precautions, regular breaks when needed,
opportunity for the employee’s anxieties to be acted
upon.

Seating (posture) Dental team, • BDA guide on posture for DCPs included in health and
patients. safety file. Exercises to be undertaken daily by DCPs
Risk of back problems, (voluntarily) to improve posture and prevent health
problems.
spine collapse
• Medical history checks are carried out on every patient
in order to screen the patient in danger.
• We have saddle chairs to help posture.

Dentists, dental ▪ All staff trained in the safe use and disposal of sharps
nurses, hygienists. ▪ Sharps are discarded into a yellow sharps bin
▪ All staff immunised against hepatitis B and their
response to the vaccine checked
▪ Sharps injuries are reported immediately and dealt with
as appropriate
▪ If required, medical advice will be sought as soon as
possible.
 Dental
Sharps
For action:
Risk of infection from Regular updates on the procedures to be followed in
used needles, the event of an inoculation injury.
instruments and
spicules of teeth or
bone

Smoking
• Strict ‘NO SMOKING’ practice policy anywhere on the
Risk of fire, smoke Dental staff and practice premises.
inhalation, pollution. patients. • Smoking is illegal in any closed areas.

Vaccinations
Dental staff and • All staff have to be immunised against Hepatitis B,
Risk of contracting patients tuberculosis, diphtheria and tetanus
blood borne viruses or • Immunisation records are kept in their file.
any other infection by
needle stick incidents,
inhalation, eye injury
etc.

Ventilation Dental team and • All surgeries have a reasonably sized window and air
patients. supply is from the external environment
Risk of transmitting • Ventilation needed in the case of a fire-window may
bacteria or viruses act as a fire escape but also to allow fire and smoke to
between the dental escape from premises.
team or your patients,
 Dental
fire

Dental department is within the hospital King Edward Memorial Hospital, access to A&E if required is accessible,
as well as pharmacy.
Pathology/Public health do ou
 Dental

List three things that could be improved and how to improve them

● Manual handling: Techniques on how to lift boxes should be added to the induction process.
● Lone workers: Hygienist should be provided with a dental nurse or trainee when available to avoid and
risks of injury, sexual harassment or violence.
● Children: We should ensure children do not walk around the hallway, parents should be reminded the risks
by staff.

List three things that meet the legislation and how to maintain them
● First Aid
● Chemical storage, use and precautions
● Medicine storage

The best way to maintain protocols, policies and legislation is by ensuring all staff is suitably trained and
familiar with it.
Regular CPD, visuals, charts, flow charts to remind staff, regular checks to staff and ensuring these are part
of the induction plan to any relevant employee.
Dental