1. Occupational Hazards Flashcards
1
Q
Types of hazard
A
- physical
- chemical
- biological
- miscellaneous
2
Q
Give physical hazards
A
- trauma (to patient, loss of confidence in yourself, litigation)
- sharps injury
- damage to mucoskeletal (back, neck)
- eye damage
- radiation
3
Q
How to prevent a sharps injury?
A
- PPE (gloves, masks, eye protection)
- vaccines
- safe work systems - eliminate high risk
- engineering control (safety lock on syringes)
- elimination
- education/training
4
Q
What vaccine is especially important for dentists?
A
- Hep B
5
Q
Management of a sharps injury
A
- wash skin, wound, non-intact skin under water with soap - no scrubbing - no antiseptics or skin washes
- gently encourage free bleeding of puncture wounds
- if mucous membranes including conjunctivae are damaged rinse with water
- make a member of staff aware asap
- contact occupational health, blood test on patient (BBV)
6
Q
How to reduce potential musculoskeletal damage?
A
- appropriate working position
- treat patients in supine position and seat yourself correctly
7
Q
How do we get eye damage?
A
- ageing (+40) leads to reduction in visual acuity
- need to use magnification
- need to use bright lighting
- vulnerable to flying debris
- you, patient and assistant
8
Q
How to reduce eye damage?
A
- wear protective glasses
9
Q
How are dentists affected by radiation?
A
- high intensity light to cure composite resins
- hand held filtration of light used
10
Q
Chemical hazards
A
- inflammable (alcohol, ethyl chloride)
- caustic and acidic materials (milton solution, acid etch gels, restorative materials)
- toxicity (mercury, anaesthetic gases)
11
Q
How to reduce chemical hazards?
A
- risk assessment for all materials
- protocol for accidents
12
Q
Biological hazards
A
- allergy
- at risk with extended glove use and regular washing
- patients too (latex, mercury, local anaesthetics, acrylic monomer)
- parasites (flees, lice, scabies)
- fungal (nail bed infections painful and hard to treat)
- bacterial (local infections of broken skin, systemic diseases - TB, actinomycosis syphilis)
- viral (cold, flu, HIV, hep B, herpes, rubella simplex)
13
Q
How to control biological hazards?
A
- cross infection control
- all patients considered infection risks
- treated following standardised cross-infection control policy
14
Q
Explain Health and Safety at work act 1974
A
- employers and employees to ensure their place of work and practices are such that there is no risk of injury/damage to health to themselves or colleagues
- requires businesses to ensure safe practices under threat of prosecution or closing down of premises
15
Q
Explain litigation
A
- ever increasing tendency for patients to complain and take legal action against health practitioners
- no excuse for negligence, fraud or malpractice
- need to keep accurate records about treatment, diagnosis, plans of treatment
- chaperone may provide further support
16
Q
Explain patient abuse
A
- verbal and physical
- hides a fear on patients’ part
- need to defuse the situation
17
Q
Explain stress and its consequences
A
- dentists work in single surgery
- patients don’t want to see you
- constant time pressure
- higher rate of divorce and substance abuse within profession
18
Q
What is an air turbine handpiece?
A
- high speed turbine used with water spray (300-400,000 rpm)
- highly desseminated aerosol
- used in surgery and adjacent rooms, similar to spread to bacteria occurring in a sneeze
19
Q
Contents of aerosol
A
- particles of enamel and dentine (inc. caries)
- particles of restorative materials including amalgam and composite resin
- calculus
- fungi, bacteria, viruses
- possibly blood and saliva
20
Q
Air turbine handpiece requires inoculation of yourself via…
A
- oral mucosa
- nasal mucosa
- conjunctiva
21
Q
How to reduce the risks of air turbine handpiece?
A
- protective spectacles
- surgical mask
- high volume aspiration
22
Q
What is mercury?
A
- liquid metal
- combines with other metals to form alloys/amalgams
- combination in dentistry is silver, tin, zinc, copper
- still popular, backbone of NHS
23
Q
Toxicology of mercury
A
- organic compounds
- alkyl compounds
24
Q
Where has mercury been used for bad?
A
- responsible for mass poisonings
- Iraq, Japan, New Mexico, Guatamala
25
Q
Explain the Minamata incident
A
- caused by industrial product methylmercury being released into the sea around Minamata
- mercury accumulated within fish/shellfish eaten by local population
- symptoms affecting nervous system and death of humans/local animals
- established Minamata convention for world wide rules governing mercury use
26
Q
Why are we more likely to suffer inorganic mercury poisoning?
A
- use the metal itself
- acute poisoning unlikely due to current legislation
- can occur after accidental or deliberate ingestion
- causes severe gastro-intestinal upset with vomiting and blood diarrhoea
- apparant recovery short lived with onset of acute kidney failure (direct damage to renal tissue)
27
Q
Initial symptoms of chronic mercury poisoning
A
- vague non-specific generally unwell
- GI upsets
- headache
- visual disturbance
- loss of appetite/weight loss
- upper respiratory disease
- kidney damage
28
Q
Established symptoms of chronic mercury poisoning
A
- tremors - fingers and lips, inability to write
- increased/decreased salivation
- personality changes (mood swings, mad as a hatter)
- inability to resist infections may lead to succumbing to relatively minor illness
29
Q
Allergy to mercury
A
- true hypersensitivity through direct contact
- practitioners and patients can both be affected
- mucocutaneous disease
- lichenoid disease
30
Q
Why are the dental team at significant risk of mercury?
A
- patient dose is greater in placement and afterwards
- but dentists see patients and place many restorations
- we polish and remove amalgam using a handpiece
- misuse may contaminate environment and increase risk
31
Q
Threshold limit value for mercury
A
50 microgramHg/m2 air (40 hrs a week)
32
Q
Short term exposure limit for mercury
A
- 150 microgramHg/m2 air
- for more than 15 mins
33
Q
What mercury responsibilities do dentists have?
A
- legal and moral obligation not to dispose of mercury rich material down drains
- patients can enquire to the safety of their fillings
- ensure we/re trained and follow procedure to limit placing and removal risks with amalgam restorations
34
Q
Metallic mercury may be absorbed by …
A
- inhalation of vapour
- passage through intact skin
- GI tract absorbing inorganic salts and organic compounds of mercury but NOT metal itself
35
Q
Universal mercury precautions
A
- wear PPE (gloves, masks, goggles)
- surgeries have a seamless easy to clean floor of non-porous nature
- surgeries well ventilated and air conditioning systems - to exhaust to outside building or Hg removing filter
- amalgam mixed chair side to avoid need for transport
36
Q
How did we used to mix amalgam?
A
by hand
37
Q
How is amalgam mixed now?
A
- uses pre-encapsulated mix separated by membrane
- mercury percentage lower as machine allows better mix
- dispose capsules in secure container
38
Q
Precautions in handling mercury
A
- water spray and high volume aspiration when cutting/grinding amalgam
- avoid overheating amalgam restorations when polishing
- salvage all waste amalgam and store under mercury suppressant fluid in tightly sealed container
- filters in dental units
- disposing all extracted teeth in amalgam marked pots
- mixing capsules disposed of in marked pots
39
Q
What if there is an amalgam spill?
A
- immediately cordon off area
- open windows for adequate ventilation
- systematically remove all visible beads using mercury collecting device while wearing gloves, mask and kneeling on a pad
- when clearance is completed, area covered with paste of equal flowers of sulphur and quicklime mixed with water
- left for 24 hours before being removed by conventional domestic means
- gross contamination requires specialist help and advice is sought from H and S executive
40
Q
Future of amalgam
A
- useful and safe
- allows restoration of teeth that may be unrestorable due to moisture control
- EU voted for phase down of amalgam by 2030
- shouldn’t be used in children under 15 or pregnant patients
- alternatives need to be studied but have drawbacks too
