Risk Assessment in Dental Practice

The dental practice is dedicated to providing quality dental screening services, preventive and corrective dental treatment, general dental care as well as cosmetic treatments. Dental practice forms part of the universal health services and can also be accessed through private services. The purpose of the dental practice is provision of general health dentistry and restorative dental care in a safe setting. The dental practice incorporates both private and public health aspect of care. This dental practice provides a broad spectrum of treatments using modern techniques and equipment which includes computerized imaging and x-ray diagnostics. The dental practice also provides dental surgeries. The dental care facility consists of one floor of the building, with reception, clinic bay, examination room, surgery, and decontamination rooms according to guidelines and best practice.

The rapid evolution of dentistry as well as the related technologies has led to significant changes to dentists' and dental team responsibilities towards risk assessment and safety with growing requirements from regulatory agencies and diverse patients' expectations applying a constant influence on every aspect of safety and risk assessment in dentistry practice, leading to the rapid development of dental safety team roles as well as the development of the dental practice safety management roles.

This paper focuses on the safety improvement methodology of identifying and controlling significant risks of injury, accidents and disease within the dental practice. The initial stage and key element of this dental practice risk assessment program is the identification of every situation and event which may affect the safety of patients or workers in the dental practice. The methodology used is benchmarking from available literature on guidelines and best practices which describe methods for risk assessment and safety in the field of dental practice. This research of available literature on risk assessment in dental practice has enabled the establishment of findings which outline basic information related to the physical, biological, chemical and psychological risks, together with the primary control approaches which dental practice can use. The literature and information examined in this research paper is intended to provide guidance on continuous improvement of occupational health OHS systems for the dental practice.

Risk Assessment

Risk assessment represents a vital phase of activities in the protection of dental practice professionals as well patients and in complying with laws and regulations. According to the United States Department of Labor; Occupational Safety and Health Administration, a risk assessment assists in focusing on the risks which are significant for the dental practice. These significant risks have the potential of causing harm. (Gomaa et al, 2015). This risk assessment procedure is to be followed in reducing: Accidents; Injuries; Faults; and Near misses. The Risk assessments also enables the defining of dental practice processes and protocols, supporting dental practice policy, improvement in quality of service and keeping everyone safe.

Risks

Risks are things or events which have the potential for causing harm, injury and illness to an individual. These may consist of chemicals, physical or biological agencies, for example fire, slips and trips, fall from a height, electricity or radiation sources. There are multiple risks in the dental practice that require identification, evaluation and assessment to establish the level of potential harm which may be caused. Identification of risks is conducted by walking about the dental practice facility and evaluating potential risks as they are encountered then documenting these findings.

Assessing of Risks

The reception area has risks related to the working environment which the receptionists, nurses, dentists and other workers use. These work environment risks are concerned with ergonomics of furniture, equipment and facilities which are used. Evaluating the reception area reveals that a poorly designed area could cause injury to dental practice workers accessing and using this area. Risks of injuries in the reception area include, possible electric shock from power outlets, trips and falls due to stray cables and ill health due to badly designed workstations.

Dental practice workers become exposed to other occupational risks including exposure to infectious diseases, radiation exposure, musculoskeletal disorders, psychological difficulties, respiratory disorders and eye problems are the most significant risks. Percutaneous exposure incidents are however the major concern, because exposure to severe infections is a present risk. (Ramich, Eickholz & Wicker, 2017). Essentially, with relation to infection control procedures, dental practitioners must have complete awareness of personal protective measures as well as the necessary sterilization and additional higher-level infection control methods. Consistent education of dental practice workers combined with suitable intervention studies about risk assessment are required in reducing the incidence and impact of these risks. Consequently, it is essential that dentists and dental practice workers continually remain updated concerning the measures and methods for dealing with every risk in dental practice, and also remain aware of the implications of these risks to occupational health while remaining vigilant to identify new risks and needs for special interventions.

Conducting the Risk Assessment

In conducting a risk assessment, the risks related with the dental practice must first be well understood. Identification of every risk and establishment of reasonable control measures. In the course of risk assessment, we consider the way accidents might occur and also consider what might result in ill health during dental practice work. Evaluating the identified risks then deciding the probability for harm. It may be impossible to eliminate every risk and it is also not possible to predict every accident that might happen nevertheless, it is necessary to establish the major risks and what their consequences might be. We may ask at this stage of the analysis if it is possible to get rid of the risk. If the risk is impossible to get rid of then we may ask how the risk can be adequately controlled.

After identification and evaluation of risks, record is made of the significant results from the assessment of risks. All records must have the accurate dates when conducting the risk assessment. All relevant dental practice team members must be requested to always be familiar with risk assessments that are related to respective job functions. Employee understanding of risk assessment relating to their responsibilities is particularly critical during induction periods for joining members of the dental practice workforce. Risk assessment within dental practice facilities must normally be reviewed yearly and when significant incidents occur.

The dental practice risk assessment should be appropriate and relevant, which means the risk assessment must demonstrate that:

§ A required check was done

§ Considers who might get affected by the risk

§ Dealing with every noticeable significant risk, with consideration of the number of employees who might get involved

§ The described measures are reasonable, with the remaining risk being insignificant

§ All dental practice workers and their representatives must be involved in the risk assessment process

Essential Risk Assessments

Multiple risk assessments are required within dental practice field and it is recommended to conduct occupational health and safety policy reviews with checklists developed from the dental practice risk assessment. Dental practice workers must get trained on the following areas in order to prevent major incidents.

§ Decontamination evaluation and Infection control

§ Infectious viruses and vaccinations

§ The safe use of sharps

§ Safely disposing of sharps

§ Methods for Zoning

§ Cross infection control methods such as hand washing, sterilization and surface disinfection

§ Transporting contaminated materials

§ Safely disposing hazardous waste

§ Documented system for legionella

§ Spills of bodily fluids

§ Spillage of Mercury

§ Medication, medical and diagnostic equipment

§ Medical safety data sheets and instructions

§ Safely storing medications

§ Safely disposing medications

§ Required safety checks for every medicine as well as medical equipment

§ Control of Substances Hazardous to Health (COSHH)

§ Materials safety data sheets for all the sourced products

Fire safety

The objective of risk identification is proactively determining all the risk sources, activities and situations caused by dental practice activities. Consequently the risk assessment processes gets applied to the activities which include every routine and non-routine activities such as occasional and periodic emergencies, all dental practice employees and visitors who have access to the dental practice health facility workers, patients, suppliers and contractors; workplace behavior, skills and social factors.

Major Dental practice Risks

During dental practice procedures, the dental teams consisting of the dentist and other assistants have their postures constantly strained, inducing considerable stress as well as harm for the musculoskeletal system. The primary aspects related with the risk assessment activities in the area of posture consist of: Stationary postures which may require prolonged duration leading to stress on the muscles and body structures. This prolonged duration of certain tasks combined with awkward postures for dental practice employees means that the risk of injury is considerably significant.

Dental practice procedures additionally involve tasks which require extending reach; bending and twisting of necks together with vibrations of the hand and arms during drilling. All these factors present major occupational health risks. Strained posture when working causes problems of the musculoskeletal alignment leading to a stooping spine. This stooping posture additionally involves particular categories of muscles and bones which eventually causes musculoskeletal diseases.

Ionizing Radiation is a major risk for dental practice workers as it is responsible for a major proportion of radiation exposure for populations. Dental radiology has the potential of giving significant doses of radiation leading to serious health implications and procedures should be employed which minimize the risks of lethal dosing. Non-ionizing radiation also represents a significant risk for dental practice workers because of using blue light for curing dental materials. The United states Department of Labor provides guidelines, regulations and documents which help in the assessment and prevention of occupational hazards and illnesses related with radiation.

Typical pressure equipment used in dental practice includes, fixed as well as portable compressed air systems, compressed gas cylinders and autoclaves with the risk for failure of these pressure equipment holding serious implications. The failure or malfunction of compressed air systems and equipment can cause severe injuries for dental practice staff not to mention the harm that would be caused to patients and damage to the dental practice facility. The cause of compressed air system and equipment failures might mainly be related to the quality and operational integrity of failing equipment.

There are also risk associated with chemical substances dentistry materials and medications together with disinfection agents used during dental surgery. These risks have the potential of causing mild to severe skin conditions and diseases, skin allergies, chemical burns and even fatalities due to excessive inhalation. Other risks of occupational exposure to chemicals in dental practice also include anesthetic gases, latex, amalgam, disinfectants and acrylates. The risk of exposure to anesthetic gas in dentistry may result from leaking breathing circuits and equipment.

Work-related psychological disorders which are collectively referred to as stress is also a risk which has impact on the health of dental practice workers. The risk factors that impact dentistry workers include psychological conditions of stress, depression, tension, exhaustion depression and lack of motivation. These risks arise from the fact that dental practice can become very demanding. Dental practice employees face many stress factors both in personal and professional areas. (Kulkarni et al, 2016). Evidence further suggest that dental practice staff encounter elevated levels of work-related stress. (Davidovich et al, 2015).

Dental practice staffs also face the risk of noise-induced problems of the ear which may lead to varying levels of hearing loss. Even though not symptomatic, hearing loss and complications may lead to serious problems for the involved person. The risk for dental practice workers is noise which is generally present at most times during dentistry work. Sources of noise in the dental practice setting consist of sounds from hand-held high-speed turbines, lower-speed hand-pieces, suction equipment, and ultrasonic equipment, drilling and cleaning devices

Conclusion

Dental practice professionals are usually at risk of exposure to many occupational hazards and becoming aware of potential risks within the dental practice environment enables the staff as well as patients to become less exposed to injury. Having a detailed and well defined risk assessment program is a critical procedure for identifying, controlling and prevention of risk in the dental practice workplace. Typically, the dental practice employer has the overall responsibility for employee occupational safety and workplace risk assessment. Dental care practice aims to provide helpful, quality dental care which is delivered according to the individual’s requirements as well as expectations. All these factors lead to a necessity for safety at work in dental practice because of legislation, regulations and the objective of running sophisticated dental practice operations.

Current trends in the delivery of dentistry services influence changes within the practice and it is required for every person to understand and be aware of the commitment to safety development as part of the professional skills in the field of dental practice. All these risk assessment and safety policy creation as well as implementation must be facilitated beginning at the administrative level of the organization. An effective dental practice operational approach is the hierarchical arrangement that has patients' needs at the top and dentists together with the members of the dental team supporting the patient needs while also enabling the dental practice to operate at the optimum capability.

References

Davidovich, E., Pessov, Y., Baniel, A., & Ram, D. (2015). Levels of stress among general practitioners, students and specialists in pediatric dentistry during dental treatment. Journal of Clinical Pediatric Dentistry, 39(5), 419-422.

Kulkarni, S., Dagli, N., Duraiswamy, P., Desai, H., Vyas, H., & Baroudi, K. (2016). Stress and professional burnout among newly graduated dentists. Journal of International Society of Preventive & Community Dentistry, 6(6), 535.

Ramich, T., Eickholz, P., & Wicker, S. (2017). Work-related infections in dentistry: risk perception and preventive measures. Clinical oral investigations, 21(8), 2473-2479.