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KCS: Hazards and Theme 10 > 1. Occupational Hazards > Flashcards

1. Occupational Hazards Flashcards

1
Q

Types of hazard

A
  • physical
  • chemical
  • biological
  • miscellaneous
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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
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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
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4
Q

What vaccine is especially important for dentists?

A
  • Hep B
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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)
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6
Q

How to reduce potential musculoskeletal damage?

A
  • appropriate working position
  • treat patients in supine position and seat yourself correctly
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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
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8
Q

How to reduce eye damage?

A
  • wear protective glasses
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9
Q

How are dentists affected by radiation?

A
  • high intensity light to cure composite resins
  • hand held filtration of light used
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10
Q

Chemical hazards

A
  • inflammable (alcohol, ethyl chloride)
  • caustic and acidic materials (milton solution, acid etch gels, restorative materials)
  • toxicity (mercury, anaesthetic gases)
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11
Q

How to reduce chemical hazards?

A
  • risk assessment for all materials
  • protocol for accidents
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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)
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13
Q

How to control biological hazards?

A
  • cross infection control
  • all patients considered infection risks
  • treated following standardised cross-infection control policy
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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
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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
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16
Q

Explain patient abuse

A
  • verbal and physical
  • hides a fear on patients’ part
  • need to defuse the situation
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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

KCS: Hazards and Theme 10 (5 decks)

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