Occupational hazard is one of the important risk factor encountered in the dental practice. In carrying out their professional work, dentists are exposed to a number of occupational hazards. These cause various ailments, specific to the profession, which develop and intensify with years. In many cases they result in diseases and disease complexes, some of which are regarded as occupational illnesses. Close contact with the patients, with their saliva and blood, exposes the dentist to occupational biohazards, mainly of the contagious kind.
Dental medicaments, materials and disinfectants used in dental surgeries, are cause for allergies and skin diseases. Moreover, the adverse effects of mercury and nitrous oxide are well-known, while of visible blue light are unknown.
The following are the main sources of indirect infection: Aerosols of saliva, gingival fluid, natural organic dust particles (dental caries tissue) mixed with air and water which breaks free from dental instruments and devices. Needlestick sharp injuries and direct contact (in case of herpetic infections) are the most common source of direct infection.
The following are the main entry points of infection for a dentist: Epidermis of hands, oral epithelium, nasal epithelium, epithelium of upper airways, epithelium of bronchial tubes, epithelium of alveol and conjunctival epithelium.
It is important that strict infection control guidelines are adhered to, following any “sharps” injury during dental practice, as this has been an area previously identified as needing more effective management by dental personnel. Prevention remains the key and measures such as the introduction of safety syringes have reduced needlestick injuries.
Gloves and a mask form an integral part of dentist’s protective equipment. Latex gloves dusted with cornstarch powder are most often used. The gloves and the mask form an efficient barrier against most pathogens and as recently proven – they also constitute a very good barrier against viruses, provided the gloves and the mask are intact. However, they may also be a source of allergies – primarily in those persons who use rubber products on a regular basis.
The most important risk factor of immediate allergies is repeated exposure to latex products. Atopy is another essential factor contributing to the increased number of allergic cases.
The clinical symptoms of latex allergies include: urticaria, conjunctivitis accompanied by lacrimation and swelling of eyelids, mucous rhinitis, bronchial asthma and anaphylactic shock.
Use of totally latex free gloves and materials.
Dental polymer materials based on methacrylate, its polymer and polyelectrolytes, seem to be a major cause of contact dermatitis in dental personnel. Dentistry uses a variety of different polymer materials. The setting of restorative materials and adhesives is initiated chemically by mixing two components or by visible light. In both cases, polymerization is incomplete and monomers, not reacted (also known as free monomers), are released.
These free monomers may cause a wide range of adverse health effects such as irritation to skin, eyes or mucous membranes, allergic dermatitis, asthma and paraesthesia in the fingers. Additionally, disturbances of the central nervous system such as headache, pain in the extremities, nausea, loss of appetite, fatigue, sleep disturbances, irritability, loss of memory and changes in blood parameters may also be noted.Management
Stress situations form an inherent part of a dentist’s everyday work. Although seldom discussed, they should be considered in view of the hazards connected with this profession.
The psychological aspects of dentist–patient cooperation are very important. In everyday clinical practice a dentist should treat each patient individually, depending on his/her mental state and personality. In most cases, the knowledge of psychology, good communication skills and establishment of a proper relation between dentist and patient are the most crucial factors deciding whether the prophylactic steps and the treatment will be successful. Meeting a patients high expectation can be stressful for the dentist.
Important sources of stress in everyday dental practice are identified as proper professional standard, aspiration to achieve technical perfection, causing pain or fear in patients, the necessity to cope with cancelled visits or late arrivals by patients and to cope with different levels of cooperation from patients.
In many dentists stress situations may trigger painful thoughts, emotions or fears. It may also contribute to the development of such immediate reactions as increased tension, higher blood pressure, tiredness, sleeplessness, touchiness and depression. Dentists are also prone to contract common illnesses from patients, such as sore throats and common colds, possibly as a result of infective bioaerosols in the dental clinic.
The dentist should identify the problem and take appropriate measures to prevent these factors affecting their general and psychological health.
Exposure to both ionising and non-ionising radiation may occur in dental practice. Radiographic equipment is commonplace in dental clinics and radiographs are an integral part of clinical assessment. As such, it is important that good radiation practice be employed to protect both the dental patient and staff.Risks
Non-ionising radiation has become an increasing concern amongst dentists with the use of ultraviolet and blue light to cure or polymerize various dental materials, especially composite resin, bonding agents and sealants. Exposure to these wavelengths can cause damage to the eyes, including the cornea, lens and the retina. Ionising radiation is a matter of concern ever since its inception. The health hazards of ionising radiation are seldom known to dentists.
At work, the dentist assumes a strained posture (both while standing and sitting close to a patient who remains in a sitting or lying position), which stresses the spine and limbs. This negatively affects the musculoskeletal system and the peripheral nervous system; above all, it affects the peripheral nerves of the upper limbs and neck nerve roots.
Back pain syndromes diagnosed in dental workers originate from spine degeneration in different phases. Neck discopathy results in cervical nerve pains or cervico-acromial pains, which are particularly common among dental practitioners. Operations carried out during extractions strains not only the elbow and the wrist joint but may result in chronic tendon sheath inflammation.
A number of dental doctors suffer from a defect of the median nerve and of the cubital nerve. An early syndrome of a defected median nerve shows in acroparaesthesia.
Seek medical attention as early as possible. The review of the above described, relatively less known hazards to which dentists are exposed daily indicates the need for special medical care for this professional group.
The following universal infection control precautions are advised by the World Health Organization to protect health care workers from blood- borne infections including HIV :-