Occupational hazards in dentistry
[1] 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.
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.
[2] 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.
[3] Regular testing of equipment is required and varies depending on local legislation, with a designated legal person or employer responsible for organising checks.
The Health and Safety Executive enforces such regulations, and additionally provides a database of radiation exposure for different groups of workers, known as the Central Index of Dose Information, which allows analysis of trends.
[8] Sodium hypochlorite is a commonly used irrigant in endodontic therapy to dissolve organic matter and kill microbes, allowing removal of infection source.
[9] Case reports[10] suggest a risk to dental professionals of chemical burns to the eyes as a result of sodium hypochlorite exposure.
[15][16] Researchers believe that when operating rooms without proper ventilation systems have high non-scavenged gas exposures, the risk of spontaneous abortion increases.
[16][17][18] It is found that despite intact scavenging systems in dental clinics, sometimes nitrous oxide exposure exceeds the NIOSH recommended limit of 25 ppm by more than 40 times.
NIOSH advises dental professionals to use additional ventilation or increase air circulation in the operating rooms to tackle the high nitrous oxide exposure.
[22] Minute quantities of elemental mercury elevate the concentrations in dental clinics, such that it poses threat to human health.
[20] Acute exposure to elevated levels of mercury leads to headaches, insomnia, irritability, memory loss, and slow sensory and motor nerve function along with depressed cognition, renal failure, chest pain, dyspnea, and impaired lung activity.
Apart from microorganisms, these aerosols may consist of particles from saliva, blood, oronasal secretions, gingival fluids, and micro-particles from grinding of the teeth.
[40] The problems arise from the nature of the job: focusing on fine procedures which require a close visual field and sustained posture for long periods of time.
[42] Repetitive work, the need to maintain steady hands, and spending most of the day in an awkward posture can lead to musculoskeletal pain in various sites.
The use of magnification or loupes and good lighting aids an improvement in posture by preventing the need to crane the neck and back for better vision.
However, according to a Cochrane review published in 2018, there is insufficient evidence about the effects of ergonomic interventions in preventing musculoskeletal disorders among dentists and other dental care practitioners.
[45] Recent studies show that dentists are at higher risk of stress-related incidents such as suicide, cardiovascular disease and mental health issues.
[46] Between 1991 and 2000 the UK's Office for National Statistics indicated that doctors, dentists, nurses, vets and agricultural workers have the highest suicide risk compared to other professions.
[57] This may be inside a patient's open body cavity, wound or confined space in which the fingertips may not be completely visible at all times.
One example is of a single use syringe barrel which removes the risk of re-sheathing a needle as there is a plastic shield which slides down to safely cover the sharp point.
