occupational hazards in dentistry

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Occupational Hazards in Dentistry: An Overview Usama M. madany Consultant Periodontist, Al-Ahsaa Dental Center, Ahsaa, Hufof, KSA Professor, Oral Medicine and Periodontology, faculty of Dentistry, Al-Azhar University, Cairo, Egypt.

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Good Morning

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- As in any other working environment, dental practice can be associated with harmful effects to dentists, referred to as occupational hazards. - These hazards vary from mild and easily or self curable, as influenza and mental fatigue, to more serious and incurable as AIDS .

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Potential sources for occupational hazards to dentists 1-Working for long periods of time in physiologically improper positions. 2-Contact with patients. 3-Contact with certain chemicals and materials used in dental practice. 4-Contact with X-ray.

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1- Working for long periods of time in physiologically improper positions. This can affect the dentists’ legs spines and shoulders Leg spine shoulder pain flat foot drooping curvature varicositiy

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To avoid or minimize such effects dentists should strictly apply the following: 1- As long as possible working should be in a seated position using an operating stool. 2- If standing position is mandatory while working, it should be in an erect posture. 3- Not to frequently bow the back for better inspection or access to different areas in oral cavity while seated or standing. 4- Not to work for a long time in a fixed position in order to avoid varicosity of the lower extremities.

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2-Contact with patients. Infection Harmful effects Eye injury and/ or inflammation Mental fatigue

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Infection Aerosolization is a process whereby mechanically generated particles ( droplet nuclei ) remain suspended in the air for prolonged time periods and may be capable of transmitting an airborne infection via inhalation Aerosols are airborne particles, generally 5-10 µm in diameter, that may travel for long distances. They may occur in liquid or solid forms. Splash and spatter are large droplets that remain airborne but contribute to infection of horizontal surfaces (indirect contact)

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Infection can be transmitted to dentist from infected patients who have infectious potential. Infection transmission: A- Airborne: influenza, common cold, T.B . (Aerosols) B- Bloodborne : Syphilis, Hepatitis B and C, and AIDS. Infected blood should contact dentist’s blood (needle prick after patient injection, wound in dentist’s hands) C- Direct contact of hands with oral mucosal lesions : syphilis and herpes simplex infection. Saliva and hepatitis C ?

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Certain precautions should be taken to minimizing the risk of such infections to dentists: 1-In dealing with T.B. patient, or a patient suffering from common cold or influenza, the dental surgeon should wear a face mask 2-The use of high speed hand pieces with T.B. patients should be avoided to minimize aerosols. 3-In dealing with a syphilitic patient, the dental surgeon should wear rubber or vinyl gloves. The dentist should not scrub his hands with a brush before or after working on these patients, since scrubbing may produce minute abrasions which serve as a portal of entry for microorganisms

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4-During clinical examination, mucosal lesions should never be touched without gloves. 5-Careful handling of sharp instruments during treating hepatitis and AIDS patients. It should be always remembered that blood and blood products of hepatitis and AIDS patients carry diseases of no known cure. However, it is not possible to identify all infectious cases that seek dental help. Thus, as a golden role “All patients should be treated as if they are infectious and routine cross-infection control is necessary when dealing with every patient”

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Eye injury and inflammation: During treatments of the patient , it may happen that patient’s blood, salivary droplets (splash), calculus, or fragments of a tooth or amalgam filling might accidentally hit the eyes of the dentist. This might lead to minor trauma and/or inflammation. In such case the dentist should wash his eye(s) immediately with sterile saline, and seek the help of an ophthalmologist for any further indicated management. To avoid such hazards eye glasses should always be used while treating the patients.

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Mental fatigue: - This results from communication and dealing with the patients, added to realization of professional abilities. - Although this is not a disease, but unfortunately, it is sometimes unavoidable and it might adversely affect the quality of the dentist’s work.

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3-Contact with certain chemicals and materials used in dental practice. Direct contact with materials such as eugenol, phenol, iodine, formalin, some impression materials, topical anaesthia and others allergic dermatitis This direct contact could simply be avoided by sticking to wearing gloves. Amalgam?

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4- Contact with X-ray X-ray is an ionizing radiation that is capable of initiating and producing damage to body cells, as well as carcinogenic and genetic changes. Careless dentists used to hold the dental X-ray films inside the patient’s mouth (for obtaining better quality of image) are at risk for developing radiation dermatitis on hands, or on a long run squamous cell carcinoma of the figures.

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For protection from radiation hazards, principles and means of radiation protection should be applied and used during radiation exposure. Dentist should not hold the film in patient’s mouth. -Dentist should avoid direct exposure to X-ray beam, and proper position of the dentist in relation to either the X-ray machine or the patients should be strictly applied. -Regular checking of leakage from X-ray machine should always be performed.

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Thank you