about facing day to day difficulties in dental profession...and coping up wiyh them

1. SUBMITTED BY-
Suditi Acharya

2. INTRODUCTION
 It can be defined as a risk to a person usually
arising out of employment it can also refer to a
work material, substance, process or situation
that predisposes or itself causes accidents or
disease at a work place

3. HISTORY
 ‘Bernadino Ramzzani’ also known as ‘Father
of occupational hazards’

4.  Working at a high level of concentration for
long hours
Dental practitioner are exposed to a number of
work related hazards-

5.  Working with anxious patient

6.  Exposure to microaersols generated by high
speed rotary headpiece
 Exposure to various chemicals used in clinic
by a dentist

7. HAZARDS IN DENTISTRY
 Biological health hazards
 Physical hazards
 Chemical hazards
 Musculoskeletal disorder and disease of the
peripheral nervous system
 Radiation exposure
 Other risks

8. Biological Health
Hazards

9.  These hazards are constituted by infectious
agents of human origin and include prions,
virus, bacteria and fungi
 Infections such as Hepatitis B, HIV, and other
types of communicable infections are at a high
risk of transmission from patient to doctor

10.  Modes of transmission
 These viral agents are easily detected in body fluids such as saliva and blood.
 They can be transmitted directly or indirectly
 DIRECTLY- when the doctor comes directly in contact with the infectious fluid
 Epidermis of hands-microorganism can pass into an individual through a cut on
the skin of hand and subsequent contact with infectious fluid
 Result of an accidental bite by the patient

 INDIRECTLY- Sources include gingival fluid, natural, organic dust particles mixed with
air and water
 Coming in contact with infectious needled
 Through respiration of the aerosol particles
 By-nasal epithelium
 Epithelium of upper airway tract
 Bronchial tube epithelium
 Epithelium of alveoli
 Conjuctival epithelium
 Through coming in contact with infectious needle or other objects
 Puncture wounds, laceration on the epithelium

11.  Transmissible disease/agent
 VIRAL DISEASE- AIDS (HIV)
 Hepatitis
 Herpes
 BACTERIAL AGENTS-tuberculosis (mycobacterium
tuberculosis)
 Staphylococcus aureus
 Corynebacterium diptheriae
 Carriers of these agents may be asymptomatic .thus
proper preventive steps should be considered.

12. Prevention and management
 In general, workers should be aware of
potential hazards
 Proper medical history of the patient
 Worker education
 Awareness about diseases
 Use of barrier techniques by using gloves,
mask, eye ware, face shields, high power
suction

13.  Proper disinfection techniques should be
followed
 Proper waste disposal
 Equipments to provide minimum aerosols
 Maintenance of proper ventilation

14. WHILE DEALING WITH HIGH
RISK PATIENT
 Identifying high risk patients
 Use of double mask, double gloves techniques for
high risk patient
 The patient should be given the last appointment
 Practitioner with any laceration or cuts on
epidermis of hands should be prohibited from
attending the operative procedures
 Proper disinfection technique and proper disposal

15.  Prevention is better than cure…..
 Proper immunization of the workers
Golden rule- ‘All patients should be treated
as if they are infectious and routine cross-infection
control is necessary dealing with every patient
’

16. PHYSICAL HAZARDS
 Dentists are at a high risk of physical injuries
during treatment
 Use of sharp may cause physical injuries to the
practitioner
 Debris from the oral cavity might strike the eye
 Cut from sharp instrument
 Puncture wounds from needles and sharp objects
 PER-CUTANEOUS EXPOSURE INCIDENT (PEI)
- Broad descriptive term that include sharp injuries
as well as cutaneous and mucous exposure to
blood and serum

17. Prevention and management
 Proper storage of sharp instrument
 Equipment maintenance
 Proper managing and handling
 Carefully carried out procedures

18. NEEDLE STICK INJURY
 Ensuring the needle and surgical blade are
sheathed/covered when not in use
 Keeping full control of sharp instruments and retaining
full concentration while handling such instruments
 Keeping gloved fingers behind the cutting edge of
surgical blades and elevators or the points of probe or
needles
 Adequate retraction of tissues and appropriate
instruments
 Placing needles in sharp safe box
 Taking care when cleaning away the surgical sharps,
wires, etc.
 Overgloving or using double gloves, whenever

19. Post accidental management-
 chemoprophylaxis
 Remove the gloves
 Wash the site of injury under running water
with soap and water
 Avoid scrubbing and encourage bleeding and
then protect
 Usually it is necessary to take blood specimen
of both the patient and the injured person- and
tested for HIV

20. IF THE PATIENT IS
SEROPOSITIVE FOR HIV
 The health care worker should be counseled about the risk of
infection and evaluated clinically and serologically as soon as
possible after exposure. A baseline HIV test should be carried
out immediately
 Advised to report and seek medical evaluation for any febrile
illness that may occur within 12 weeks of exposure
 HIV test should then be repeated approximately 6 to 12 weeks
after contamination
 Advised to follow recommendation for preventing transmission
of infection
 During this period advise from HIV counselor is of utmost
importance, regarding domestic relation and procedure at
workplace
 The practitioner should immediately evaluate by a physician

21. Chemo prophylaxis for health
care workers
TYPES DRUGS REGIMEN
Basic(28 days) Zidovudine+Lamivudine 600mg(300mg
bid,200mg tid or 100mg
4 hrly) + 150mg
Expanded(28 days) As above + indinavir or
nelfinavir or nevirapine
800mg 8 hrly, 750mg tid
or 200mg bid

22. CHEMICAL HAZARDS
 Chemicals and substance used in dental clinic
poses a major health hazard to a dental
practitioner

23.  Amalgam used in dentistry contain mercury-
which is a highly toxic metal-may lead to
mercury poisoning

24.  Direct contact with chemicals such as-
Eugenol, Phenol, Iodine, formalin, some
impression material, topical anesthesia can
cause adversereaction in the practitioner like-
contact dermatitis

25.  Latex hypersensitivity

26. PREVENTION AND
MANAGEMENT
 Proper education for the workers
 Developing safe work procedures
 Substitution of harmful products with less
harmful products ex. Latex gloves can be
substituted by vinyl gloves , use of dust-free
alginate
 Monitor leakage or spillage of any potentially
hazardous substance
 Proper storage products
 Medical monitoring of workers periodically

27. Dealing safe with Hg-
 Use of water sprays, high velocity evacuation
and rubber dam to reduce exposure
 Dental staff should wear face-mask
 Carpeting and rugs should be avoided as it is a
major repository for mercury
 Never rinse elemental mercury down the drain
 Never dispose elemental mercury in the trash
 Never dispose elemental mercury in the sharp
container or as medical waste
 Keep the filling cool during removal

28.  Cutting the amalgam into chunks-while drilling
into amalgam make sure only chunks of
amalgam is cut and the latter is then removed
by hand instruments-this result in less
formation of aerosols

29.  Categories of biomedical waste
 Category no.1- Human anatomical waste
 Category no.2- Animal waste
 Category no.3- Microbiology and biotechnology waste
 Category no.4- Waste sharp
 Category no.5- Discarded medicines and cytotoxic drugs
 Category no.6- Soiled waste
 Category no.7- Solid waste
 Category no.8- Liquid waste
 Category no.9- Incineration ash
 Category no.10- Chemical waste
Management of waste-
proper waste disposal

30. Color Type of
container
category Waste treatment
Yellow Plastic bags 1,2,3,6 Incineration or
deep burial
Red Plastic bags or
disinfectant
cleaner
3,6,7 Autoclaving,
microwaving.
Chemical
treatment
Blue /white
translucent
Plastic
bags/puncture
proof bags
4,7 Autoclaving,
microwaving,
chemical
treatment and
destruction/shredd
ing
Black Plastic bags 5,9,10 Land-filling

32. Musculoskeletal
disorder

33.  Dental surgeons are normally included in the
group of professional at a high risk of suffering
from MSDs
 Pain in neck, shoulder and other extremities
due to strained posture of a dentist at work with
the neck bend and twisted repetitive movement
of hands can cause neck syndrome and pain in
the upper extremities and shoulders
 Dental surgeons are exposed to various kinds
of MSDs- Tendonitis, Bursitis, and synovitis

34. Why MSDs are common in
dentistry???
•Repetitive motions(ex. Scaling and polishing)
•Static neck, back and shoulder position
•Grasping small instruments for prolonged periods
Prolong use of vibrating hand tools

35. Prevention and management
 The key to prevent work related MSDs is Ergonomics
 What is Ergonomics???
 It is a science dealing with designing of a workplace.
Equipments and the surrounding to ensure comfort and
efficiency for the practitioner
 Dental chair should be adjusted in a manner that the
position of the doctor is neutral and muscles are relaxed
 Instrument design- the handle should be thicker, round,
and hollow

37. RADIATION EXPOSURE
 In dentistry low level of radiation is used which
causes few cell damage but even low level of
radiation exposure over a prolong period of
time may cause potential hazards to health
 X-rays is an ionizing radiation that is capable of
initiating and producing damage to body cells
as well as carcinogenic and genetic change

38. CONSEQUENCE OF X-
RADATION
 -radiation dermatitis on hands
- And squamous cell carcinoma on figures

39.  Proper principles should be followed while taking an X-
ray
 Dentist should not hold the film in patient’s mouth
 Proper technique can ensure correct X-ray, thus
repetition is avoided
 High quality film, should be used, as they ensure good
quality image
 Workplace should be properly designed
 Appropriate shielding (use of lead apron)
 Equipment designed to minimize scatter
 Replacement of older X-ray equipment
 Monitoring the exposure
 Proper education of workers
 Periodic screening
Prevention and management

40. OTHER RISKS AND THEIR MANAGEMENT
RISKS/HAZARDS Management
Psychological hazards Worker education about the signs and
symptoms of depression, anxiety,sleep
depriviation, other mental illness
Elimination of workplace risk factors for
depression ,anxiety, sllep disorder other
mental illness
Provision of support service and
program
Appropriate sleep habits
Abuse by clients Isolation are for agitated clients
Furniture arrangement to prevent workplace
entrapment
Lockable washroom for workers
Separate from clients or visitors
Controlled access
Bright lightning in parking lot
Alarm system and panic button
Video surveillance
Management policies and procedures

41. Abuse by coworker Alarm system and panic button
Video surveillance
Management policies and
procedures
Well trained security guards
Escort service to parking lot
Falling hazards Install strip resistant flooring
Design associated to accepted
security standard
Exposure to laser beam No reflective surface
Local exhaust ventilation
Safe work procedures
Poor indoor quality Adequate ventilation should be
maintained

42. What is TECHNOSTRESS???
 Negative psychological link between people
and the introduction of new ideas. People
experience technostress when they are unable
to adapt or cope up with information
technology in a healthy manner
 Causes of techno stress-
 Quick pace of technological change
 Lack of proper training
 An increase workload
 Lack of standardization within technology
 Lack of technical support

43. How to cope up with
technostress???
 Cultivation of flexible and continuous learning
education
 Buying more adequate equipments
 Create better communication
 Create a level of reaasurance,patience,and
stability within the environment