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Occupational Hazards in Dentistry

Occupational hazards are potential risks to staff in their place of work, some are specifically associated with a dental care environment. Members of the dental team including dentists, hygienists, dental nurses and radiographers must ensure local protocols are followed to minimise risk.

Sharps Injuries

(Management, Statistics, BBV, availability of safety plus needles)


Dangerous substances

(NAOCL, NOx gas (pregnancy), Mercury)

aerosol, risk to eyes

Laws and Legislation explain differs between countries, perhaps link to main wiki page on HSW, COSHH

Stress

(burnout, suicide risk?, heart attack

Back Pain

posture, statistics,

Allergy

(Latex) and contact Dermatitis from soap, resin sensitivity

Workplace Related Violence    

http://www.hse.gov.uk/radiation/ionising/doses/dose2003.htm

Radiation

Wall shielding worker from primary beam whilst allowing visual communication with patient.

Exposure to radiation can result in harm, categorised as either deterministic or stochastic. Deterministic effects occur above a certain threshold of radiation e.g burns, cataracts. Stochastic events are random occurrences after exposure to radiation as there is not a threshold dose above which they will occur e.g. carcinogenesis. Whilst radiation occurs naturally in the environment, additional exposure for medical purposes should be limited to where benefit outweighs risk to both staff and patients.

The World Dental Federation guidelines highlight that operators of dental radiography equipment must be sufficiently trained and qualified. When operating equipment, the staff member should be at least two metres away from the source, clear from the primary beam and behind a protective shield or wall where possible. The US-based National Council on Radiation Protection recommends the shield be installed by an expert and lead may be substituted for gypsum, steel or concrete providing suitable thickness. Additionally, visual contact should be considered whilst designing the shield to allow for constant monitoring of the patient.

Regular testing of equipment is required and varies depending on local legislation, with a designated legal person or employer responsible for organising checks. Faulty equipment could lead to increased or accidental radiation exposure to staff or patients.

Personal Dosimeter

Within the United Kingdom, the Ionising Radiation Regulations (IRR) and Ionising Radiation (Medical Exposure) Regulations (IRMER) stipulate measures for limiting risk to staff and patients. The Health and Safety Executive (HSE) enforces such regulations and additionally provides a database of radiation exposure for different groups of workers, known as The Central Index of Dose Information (CIDI) which allows analysis of trends.

Personal dosimeters should be worn where the estimated annual exposure to radiation will exceed 1mSv, which can be calculated by considering the type and number of radiographs that will be taken by the worker. According to the IRR, should the estimated exposure exceed 6mSV, then the worker is said to be classified and will require regular medical checks. However, as the doses from dental images are relatively low, should estimated doses exceed normal values then investigations are required to ensure that principles of justification, optimisation and limitation are being followed

Whilst local regulations vary by country, IRMER specify information essential for a radiation protection folder within each dental practice operating x-ray equipment including designated control areas, contingency plans, qualified staff, pregnant staff, policy and standard procedures. Regular communication with a medical physics expert ensure guidelines are being followed and understood.