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v i l Practice Administration

Original article:

Number 1 Repon 2169

January 1983 Pagel

Occupational Hazards in the Dental Office and their Control


1. Measures for Controlling Infections
M. M. Littner. D.M.D. I. Kaffe, D.M.D. Section of Oral Pathology, Oral Medicine A. Tamse, D.M.D. Section of Endodontology Tel Aviv University, Sackler Faculty of Medicine Address: School of Dental Medicine, Tel Aviv, Israel

Introduction The dental profession cannot ignore the potential health hazards associated with the transmission of infectious organisms and the use of toxic agents and Xradiation in the dental office. Awareness of these problems is necessary because of the moral responsibility of the dentist to protect his own well beingand that of his employees and his patientsfrom al! possible sources of injury. The dentist also must consider his legal responsibility as an employer. In several countries, laws have been passed for the protection of employees in any business activity.^ In this series, we point out possible hazardous agents in the dental office, discuss protective and preventive measures, and recommend ways to minimize the risk of injury to exposed personnel. Sources of Infection Rowe and Brooks^ in 1978 stated that practitioners in the health professions are a high risk group with regard to infectious diseases because of their fre"Quintessence International" 1/1983

quent and intimate contact with a large number of patients. Fortunately, the dentist enjoys an unusual immunity to the low grade pathogens circulating within his community. His greatest danger appears to arise from exposure to dangerous infectious diseases such as tuberculosis, hepatitis, herpetic dendritic ulcer of the eye, venereal disease, upper respiratory infections, childhood diseases, and other viral or bacterial diseases."'"'' Miller and Micik' in 1978 found that the tuberculin test of 42 % of one dental class converted to positive between their freshman and senior years, in contrast to a tuberculin conversion rate of only 2 % for a comparable male populafion in the U.S. Between 1962 and 1973 the death rate due to respiratory diseases for practicing dentists was 113 % that of the general population. The dentist may unwittingly contract disease from a patient carrier, and by ignoring the principles of antisepsis, disseminate infectious organisms to other patients." The routes of contamination vary. Contamination may occur via personal con67

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tact with the patient's skin or by dispersal of bacteria from the patient's body, clothes, beard or hair. Infection may be transmitted by the patient's breathing, coughing or sneezing, or bacteria may be airborne by high or low speed rotary instruments, a triple syringe or the heating and cooling system. The most hazardous mediums of contamination are high speed rotary instruments and the triple syringe, which produce an aerosol consisting of a suspension of particles of various size, composed of water, bacteria, viruses, secretions, exudates and dental materials. The smaller particles (0.5 to 5 microns in diameter) easily can penetrate the body, and are inspired through the lungs; the larger particles (50 microns to several millimeters in diameter) have limited ability to penetrate via the respiratory system. The smaller particles can be airborne for great distances and stay airborne for hours or days; viable streptococci have been shown to remain airborne longer than 24 hours.^^'^-^ The number of airborne particles produced during dental operations exceeds normal levels associated with speaking by 10 to 10,000 fold. Bacterial or viral aerosols also may penetrate the heating and cooling system, to carry the particles from the mouths of the patients from room to room.
Protective and Preventive Measures

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1. The source of infection can be only a patient who is either sick or a carrier of infectious disease. Therefore the dentist, except in emergencies, must never treat a patient suffering from an infectious disease.'' 2. The dentist should record a complete medical history and perform a thorough examination.^ 3. The dentist must be acquainted with the signs and symptoms of common
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infectious diseases and be able to recognize an infected patient.^ If in doubt, the dentist must require the patient's physician to certify that the patient is no longer contatninated." It is recommended that the patient's mouth be rinsed with a disinfecting mouthwash before treatment is begun. This has been proved a very effective method of reducing the i concentration of bacteria, especially" in aerosols generated in the mouth during dental treatment.^ Adding a bactericidal agent to the rinse may reduce the level of microbes by 75%.^ As municipal water supply systems have been shown to be infected with bacteria, it is recommended that the water supply to the dental unit be disconnected, and that the dentist use a special water tank which can be chlorinated with 50 ppm chlorine.^ To minimize and control the aerosol produced during dental procedures, a high velocity suction system should be employed. The suction system should operate at a higher flow rate than the air turbine handpiece or the air-water syringe. By using such high power suction, 1000-fold reduction in aerosol concentration can be established.^ I The dentist and auxiliary staff should wear protective eye-glasses, even if they enjoy perfect vision. Face masks are excellent filtration systems, reducing the amount of bacteria inhaled or exhaled by 99 %. Masks are especially useful in cases of respiratory infection in one of the staff members.^ Using a rubber dam technique can help to minimize saliva rv contamination in aerosol generatr-. ' hy rotating instruments.
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11. Rubber gloves should be used during every dental procedure in which there is a possibility of the patient being infected, and especially when infectious hepatitis is suspected.''' 12. It is necessary that the operatory be ventilated by a good ventilafing system or simply by opening the windows to replace the air in the room with fresh outside air. Exposure of the entire office space to sunlight is the best possible aid against niicrobial pollution of the office air.^ 13. Working surfaces should be wiped with a bactericidal solution.*^ 14. Handpieces and other equipment should be washed with a bactericidal solution between patients, 15. A sterilization procedure should be selected that is effective against bacteria, spores and viruses. Proper procedures must be correctly followed,-^'^ 16. Disposable articles should be used whenever possible,^" 17. The dental chair and controls should be covered with paper or other material and the cover should be changed for each pafient. 18. It is essenfial that the dentist and staff maintain personal hygiene and wash hands between patients and especially after work. It is highly recommended that separate clothes, in addition to the dental smock, be worn in the dental office and changed before leaving, 19. If, despite meticulous care, a member of the staff unfortunately is

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exposed to an infectious agent, the following is recommended: a) Puncture wounds should be washed immediately and treated with antiseptic. b) The patient's medical history should be rechecked. If the patient is found positive for infectious hepatitis, tuberculosis or any other contagious disease, the staff member should seek medical attenfion immediately.^ All these measures and investments will protect the health and well being of the dentist and his family, the dental staff and the patient.''
References 1, Mantyla, D, G, and Wright, O, D, Mercury toxicity in the dental office: a neglected problem, JADA 92:1189-1194. 1976, 2, Rowc. N, H, and Brooks, S, L, Contagion in the dental office. Dent. Clin. N. Amer, 22:491-503. 1978, 3, Miller, R, L, and Micik, R, E, Air pollution and its control in the dental office. Dent, Clin, N, Amer, 22:453-476. 1978. 4, Westbrook, S, D, Dental management of patients receiving hemodialysis and kidney transplants, JADA 96:464-468, 1978. 5, Mosley, J, W. and White, E, Viral hepatitis as an occupational hazard of dentists, JADA 90:992, 1975, 6, Micik, R, E., et al. Studies on dental aerobiology, I, Bacterial aerosols generated during dental procedures, J. Dent. Res, 48:49-56. 1969, 7, Micik, R, E,, Miller, R. L, and Leong, A, E. Studies on dental aerobiology. III, Efficacy of surgieal masks in protecting dental personnel from airborne bacterial particles, J, Dent, Res. 50:626-630. 1971, 8 Pokowitz. W, and Hoffman, H, Dental aerobiology. Quint, Int, 3(10):83-87, 1973,

(To be continued)

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