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List of harmful substances in the work of a dental technician. Chemical factors of the working environment in the work of a dentist

PHYSICAL FACTORS:

Temperature, humidity, air speed, thermal radiation;

Non-ionizing electro magnetic fields and radiation: electrostatic fields, constant magnetic fields (including hypogeomagnetic), electric and magnetic fields of industrial frequency (50 Hz), broadband EMFs created by PCs; electromagnetic radiation radio frequency range, electromagnetic radiation of the optical range (including laser and ultraviolet);

Ionizing radiation;

Industrial noise, ultrasound, infrasound;

Vibration (local, general);

Aerosols (dusts) of predominantly fibrogenic action

Lighting - natural (absence or insufficiency), artificial (insufficient illumination, direct and reflected glare, pulsation of illumination);

Electrically charged air particles are aeroions.

Install the turbine compressor outside the office;

Use earplugs as an individual means of hearing protection for the doctor;

Constantly monitor the technical condition of universal dental units;

Biological harmful production factors in the work of dentists, preventive measures.

BIOLOGICAL FACTORS:

Pathogenic microorganisms - pathogens infectious diseases;

Microorganisms-producers;

Living cells and spores contained in bacterial preparations.

Prevention: hand washing, disinfection and sterilization of instruments.

The concept of ergonomics.

ERGONOMICS (from the Greek Ergon - work, nomos - law) - the science of adaptation job responsibilities, workplaces, equipment, computer programs for the safest and most efficient work of the employee; designing equipment taking into account the anatomical and physiological characteristics of a person and his psychophysiological capabilities (elimination of unnecessary movements, saving effort, rational working posture, rational workplace)

13. Diseases of dentists that develop as a result of working with instruments that do not meet ergonomic requirements, prevention.

Unsustainably thin tool handles lead to overstrain and muscle spasms

When holding a thin instrument, the muscles are tense, and the hand loses fine sensitivity. It is advisable to use instruments with a handle that matches the anatomical shape of the hand. Often there is an inconvenient shape of the tips for the drill. The lack of a rotating head forces the doctor to twist his arm when working. Sharp edges on the body contribute to the formation of calluses and cause pain in the fingers, curvature of the third finger of the hand appears: on the left - due to the inconvenient thin handle of the mirror, on the right - due to the irrational shape of the tip for the drill



For the prevention and treatment of emerging arthrosis and curvature of the fingers

1) the fingertips of both hands are folded and the hands are moved repeatedly with force

towards each other;

2) thumb slides with effort from the base of the finger to its tip (do

for all fingers);

3) fold your fingers into a fist, thumb inside. Clench your fist and slowly remove your thumb.

Dupuytren's contracture

Most of the instruments (forceps, tips) constantly press on the same place on the palm. On average, ring finger or on the little finger rope-like nodular thickenings of the palm occur, which lead to contracture of the main and middle joints. In this case, the fingers bend, sometimes so much that the nails grow into the palm

Tenosynovitis

Inflammation inner shell fibrous sheath of the muscle tendon, that is, the synovial membrane. (disease joint capsule at the sites of tendon attachment), which develops due to prolonged, often repeated tension of individual muscle groups in an unnatural, forced position. may become chronic.

When the first signs appear, you should take a break from work. Then it will be possible to avoid pain in the hands and other unpleasant consequences Tenosynovitis. The combination of tenosynovitis with Raynaud's disease leads to professional disability. The fingers become cold, bloodless, and pale. In severe cases, gangrene occurs. Tenosynovitis and circulatory disorders occur especially often in dentists working without a nurse.

It's no secret that the dentistry profession is quite difficult, and in order to master this specialty, you need a lot of skills and abilities. And even if a person is suitable for this job, he will still face unfavorable moments that affect his health. This is precisely what lies in occupational hazards dentist This article will explain what they are and how to avoid them if possible.

What hazards may arise in the work of a dentist?

Researchers have identified several groups of occupational hazards that can affect the work of dentists.

    First of all, these are physical factors. These may include phenomena such as ultrasound and noise that arise during operation. There is no escape from them in the process of work, since the very specifics of the work are associated with them.

    In addition, we can highlight such professional hazards of dentists as chemical factors. They cannot be neglected, because they include sharp and chronic intoxication, which are very dangerous to human health.

    The third group of hazards consists of the so-called biological factors. They are related to hygiene, which doctors do not always carefully monitor during their work. The work of dentists is almost always associated with pathogenic microorganisms, and even with minimal violations of hygiene rules, there is a risk of contracting various infections. Therefore, it is so important to always carefully monitor the cleanliness of medical instruments.

    Researchers also highlight psychophysiological factors. These include a great variety of different circumstances related to the work of a dentist. For example, dentists spend most of their working time standing, and even in an inclined position, which has a negative impact on the spine. In addition, the medical profession involves the manipulation of instruments, which leads to muscle tension, which can also lead to negative consequences. Thus, due to this, Dupuytren’s contracture, which is a disease of the hand, is often classified as an occupational disease for dentists.

Artificial lighting is also a big problem. Of course, we all use it, and the harm from it can extend to any of us. However, the dentist comes into contact with artificial lighting much more, because he gets very close to its source in the process of examining patients. Because of this, the vast majority of dentists experience deteriorating vision after several years of practice.

Occupational hazards of a dentist: preventing adverse consequences

Of course, not everything described above can be prevented, since much of it is inevitable. However, some issues can still be prevented by taking timely care of your health.

So how do you do this?

    It is imperative to regularly visit doctors for medical examinations. Workers of all categories underestimate the importance of this preventive measure, but timely detection of the disease allows it to be cured as quickly as possible.

    You need to exercise regularly and do exercises in the morning. This will have a positive impact not only on the prevention of occupational diseases, but also on health in general.

    During work, it is necessary to take breaks of 10-15 minutes. This will prevent fatigue and stress.

    To prevent diseases of the fingers and hands, it is recommended to perform special exercises, which are not at all complicated and do not require much time and effort.

    It is necessary to do eye exercises to prevent vision deterioration.

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Volgograd Medical Academy

Department therapeutic dentistry

OCCUPATIONAL HAZARDS

IN THE WORK OF A DENTIST

AND PREVENTION OF CONSEQUENCES

THEIR IMPACTS

(EDUCATIONAL MANUAL)

Volgograd, 1998.

Compiled by:

Ph.D. honey. Sciences, Associate Professor V.F. Mikhalchenko, Doctor of Medicine. Sciences, Associate Professor E. S. Temkin, Ph.D. honey. Sciences, assistant N. M. Morozova, wedge. resident N.V. Kalinina, Ph.D. honey. Sciences, assistant A. G. Petrukhin, assistant A. A. Kondratenko.

Reviewer:

head Department of General Hygiene, Doctor of Medical Sciences, Professor

N. I. Latyshevskaya.

Educational and methodological manual

approved by the cyclic methodological commission

Faculty of Dentistry of the Military Medical Academy.

Professional hazards in the work of a dentist and prevention of the consequences of their exposure: Educational and methodological manual / Comp. V. F. Mikhalchenko, E. S. Temkin, N. M. Morozova, N. V. Kalinina, A. G. Petrukhin, A. A. Kondratenko; Volgograd Medical Academy. - Volgograd, 1998. - 26 p.

The work of a dentist is hard and stressful work. Interesting work often completely captivates the doctor, bringing him joy, but at the same time requires a lot of effort. In the daily practice of a dentist, there are unconscious violations of occupational hygiene rules that entail undesirable consequences. At the same time, the doctor’s health is exposed to many dangers. Minor deviations from normal working conditions accumulate from year to year and lead to consequences that complicate or make the doctor’s further professional activity difficult or impossible.

A person's ability to work during the working day varies. At the beginning of work, performance is relatively low. During work, the body's functional ability and labor productivity naturally change throughout the work shift. Changes in performance during the working day have several phases:

1.Workability or increasing efficiency. Depending on the nature of the work and the individual characteristics of the person, this period lasts from several minutes to 1.5 hours.

2.Phase of high stability of performance. It is characterized by high labor indicators. The duration of this phase is 2 - 2.5 hours or more, depending on the degree of neuro-emotional stress, physical severity and hygienic working conditions.

3. Decreased performance phase manifested by decreased attention, the appearance of unnecessary movements, and erroneous reactions.

The internal work routine is especially important. If a doctor, having crossed the threshold of the office, examines one patient after another at a frantic pace, without leaving himself a minute of rest, then he not only loses human contact with the patients, their trust, but also harms himself. The “race” that increases day by day easily becomes working standard doctor A heavy load leads to a huge expenditure of energy and fatigue, which can sometimes be somewhat suppressed by the use of stimulating medications and other means, but cannot be overcome.

Fatigue is a condition accompanied by a feeling of fatigue, decreased performance, attention, caused by intense and prolonged activity, expressed in a deterioration in quantitative and qualitative performance indicators and stopping after rest.

I.M. Sechenov showed that fatigue does not arise in the working organ itself, not in the muscle, but in the central nervous system: “The source of the feeling of fatigue lies not in the muscle, but in the disruption of the activity of the nerve cells of the brain.”

I.P. Pavlov believed that the inhibition that occurs during fatigue in the central nervous system is limited in nature - by limiting the performance of the cortical cells of the brain, it preserves nerve cells from overstrain and death.

Neglect of fatigue, volitional or other overcoming of fatigue increasingly plunges us into a state of chronic overfatigue, characterized by a number of symptoms: fatigue, lethargy, indifference, poor ability to concentrate, memory loss, constant haste in actions, irritability, poor sleep.

The movements of an overtired person become slow and poorly coordinated. Labor productivity decreases to a significant extent, both qualitatively and quantitatively. The general condition is characterized not by drowsiness, but, on the contrary, by increased excitability. As a result of altered reactivity, a typical picture of neurocirculatory dystonia and various functional disorders (stomach, intestines, blood vessels and skin) appear. As a result of circulatory disorders, oxygen deficiency occurs and diseases such as ischemic heart disease, myocardial infarction, gastritis, gastric ulcer, apoplexy develop - diseases that are often observed among our colleagues who work very hard and get irritated too often. The reason for increased irritability is the constant rush and tension at work. In a hurry, all normal ideas are displaced: insignificant little things take on sudden weight, minor failures take on the character of a catastrophe. Having lost internal balance, we lose the ability to see clearly, the hand ceases to obey the brain. If this condition lasts several years, it can cause the symptoms described above. severe consequences. To avoid them, you must follow some rules:

1) in order to get into work evenly, it is inappropriate to plan complex work that requires a lot of time and energy at the beginning of the working day;

2) during the first hour you should do simple and short work;

3) after 2 hours it is advisable to take a break for 10 - 15 minutes;

4) have a two to three minute rest between patients;

5) in the middle of the working day you should take a break for 30 - 60 minutes.

During rest, it is necessary to ventilate the room, make several movements to relieve tension and take 2-3 deep breaths. During the first half of the pause you need to sit and relax, in the second half you need to walk and do active movements, thereby increasing blood circulation.

WORKING CONDITIONS AND

DENTIST'S PERFORMANCE

The doctor's workplace is of great importance for productivity. Rational distribution of furniture and frequent ventilation of the room during the working day ensure acceptable working conditions.

The air temperature in the room should be 18 - 20°C, relative humidity 30 - 45%. The air in the room must move. The accumulation of stagnant warm air adversely affects human well-being.

It is necessary to strive for access to natural light in the office. Windows should face north or east. The walls and ceiling should be painted in light colors. Preferred colors: light blue, light green, light gray, beige.

Furniture, equipment, instruments should be located so that it is convenient for the doctor to use them in his work without additional effort and stress.

OCCUPATIONAL DISEASES

DENTIST, REASONS FOR THEIR APPEARANCE,

METHODS OF ELIMINATION, PREVENTION

The dentist spends most of his working time manipulating instruments. It is generally accepted that irrationally thin tool handles lead to overstrain and muscle spasms (Fig. 1).

When holding a thin instrument, the muscles are tense, and the hand loses fine sensitivity. It is advisable to use tools with a handle that matches the anatomical shape of the hand when the muscles are relaxed and unloaded. Fingers should rest freely on the instrument (Fig. 2,3).

Often there is an inconvenient shape of the tips for the drill. The lack of a rotating head forces the doctor to twist his arm when working. Sharp edges on the body contribute to the formation of calluses and cause pain in the fingers, curvature of the third finger of the hand appears: on the left - due to the inconvenient thin handle of the mirror, on the right - due to the irrational shape of the tip for the drill (Fig. 4, 5).

For the prevention and treatment of emerging arthrosis and curvature of the fingers, the following exercises are recommended:

1) the fingertips of both hands are folded and the hands are repeatedly moved towards each other with effort;

2) the thumb slides with effort from the base of the finger to its tip (do this for all fingers);

3) fold your fingers into a fist, thumb inside. Clench your fist and slowly remove your thumb.

Dupuytren's contracture

This disease develops in people who constantly work with hard tools, cleavers, axes, and hammers. It is often observed among dentists, because most of the instruments (forceps, tips) constantly press on the same place on the palm.

Rope-like nodular thickenings of the palm appear on the middle, ring or little fingers, which lead to contracture of the main and middle joints. In this case, the fingers bend, sometimes so much that the nails grow into the palm (Fig. 6).

D For treatment, hot air showers, hot palm baths, paraffin, ozokerite, passive stretching or night splints are used. Brüne proposed a cuff - a steel tape 2 cm wide is sewn into a thick belt and placed on the palm or back of the hand (Fig. 7,8).

Thanks to the steel tape, excess pressure applied to individual areas of the fascia is evenly distributed over a larger area of ​​the palm. Pathological phenomena disappear after six months. In addition to the cuff, Brüne recommends training the left hand to unload the right hand to perform all work associated with high stress.

Tenosynovitis

Tenosynovitis is a disease of the joint capsule at the sites of tendon attachment, which develops due to prolonged, often repeated tension of individual muscle groups in an unnatural, forced position.

Usually the doctor always tries to continue working despite the pain. His condition worsens, the disease becomes chronic.

Tenosynovitis should be considered a very serious disease. When the first signs appear, you should take a break from work. Then it will be possible to avoid pain in the arms and other unpleasant consequences of tendovaginitis. The combination of tenosynovitis with Raynaud's disease leads to professional disability. The fingers become cold, bloodless, and pale. In severe cases, gangrene occurs.

Tenosynovitis and circulatory disorders occur especially often in dentists working without a nurse. Working without a nurse is not only slow and unprofitable, but also dangerous to the health of the doctor. The specialist must be spared loads that exceed his physiological capabilities.

Treatment of tendovaginitis. Conservative treatment: thermal procedures, electrophoresis of lidase or ronidase, massage, resting the affected hand. In severe cases, surgical intervention is indicated, consisting of dissection of the tendon sheath and excision of the annular ligament.

If the main etiological factor- systematic overstrain of the finger, the process progresses and cannot be treated conservatively even in young people.

The impact of vibration on the body of a dentist

Sources of vibration include manual mechanized rotational machines: a drill and the dental handpiece itself.

Prolonged exposure to vibration, combined with a complex of unfavorable factors (static muscle loads, noise, emotional stress) can lead to persistent pathological disorders in the body of workers, development vibration disease.

The pathogenesis of vibration disease has not been sufficiently studied. It is based on a complex mechanism of neuro-reflex and neurohumoral disorders, which lead to the development of stagnant excitation with subsequent persistent changes in the receptor apparatus and the central nervous system. Direct mechanical trauma cannot be ruled out, primarily to the musculoskeletal system (muscles, ligamentous apparatus, bones and joints).

Vascular disorders are one of the main symptoms of vibration disease. Most often they consist of impaired peripheral circulation and changes in capillary tone. Doctors complain of sudden attacks of whitening of the fingers, which often occur when washing hands with cold water or during general cooling of the body.

Polyneuropathic symptoms are manifested by aching, aching, nagging pain in the hands. The pain is accompanied by paresthesia and increased chilliness of the hands. Pain and temperature sensitivity suffers.

Treatment and preventive measures:

1) reduction of vibration intensity due to design improvements;

2) monitoring the serviceability of equipment, since during operation and wear there is a pronounced increase in vibration;

3) compliance with the work and rest regime;

4) therapeutic, preventive and general health measures

a) thermal procedures for hands in the form of hydro procedures (baths);

b) massage and self-massage of hands and shoulder girdle;

c) industrial gymnastics;

e) vitamin prophylaxis and other restorative procedures - psychological relaxation room, oxygen cocktail, etc.

Diseases associated with prolonged static load

Static load, which leads to overload diseases, is understood as any work that requires taking and maintaining a certain position for a long time, the effect of which is aggravated if the position is taken incorrectly or if it leads to overload.

Static work is the process of contracting muscles necessary to support the body or its parts in space. In the labor process, static work is associated with fixing objects in a stationary state, as well as giving a person a working posture.

With a static force, from the point of view of physics, there is no external mechanical work, however, in a physiological sense, the work is obvious. Static work is more tiring than dynamic work, since muscle tension lasts continuously, without pauses, preventing them from resting. In addition, blood circulation in working muscles is difficult, there is a decrease in blood flow volume, a decrease in oxygen consumption and a transition to anaerobic energy supply with the accumulation of large amounts of lactic acid. Immediately after the cessation of static work, oxygen consumption increases sharply and blood flow increases (Lingard phenomenon). With prolonged maintenance of tension, muscle fatigue, combined with insufficient blood circulation, can lead to the development of diseases of the musculoskeletal system and peripheral nervous system. The work of a dentist combines static work and mental activity.

Insufficient access to the surgical field and poor visibility forces doctors to take an uncomfortable, unnatural position, which they are forced to maintain for a long time. Static disorders affect ligaments and muscles. With prolonged unilateral loading, the muscles first become tired, then they become stretched and, as a result, the joints are weakened and the bones are displaced. There are so-called stress-related diseases of skeletal muscles. Fatigue develops during work, pain during movement and spontaneous pain at rest. Muscles and joints are painful on palpation.

The shift in the knee joint leads to displacement of the femur and changes in the contact of the femoral head and acetabulum. The position of the lower leg changes, damage to the ankle joint and foot occurs. Many dentists, in order to get as close as possible to the patient’s chair, turn their feet outward. In this case, the body weight is transferred to the inner edge of the foot and leads to its flattening and dislocation. In this case, the body weight falls on one leg (right), the leg transfers force to the thigh, and the knee turns inward. inner side, the position of the thigh or the entire pelvis changes, the entire pelvic muscles shift upward (Fig. 9). This leads to curvature of the spine.

The doctor leans over, his arms tense. This further overloads the neck and back muscles. In this pose, blood rushes to the legs. Blood pressure in the arteries of the leg and feet is twice as high as in the supine position. This leads to blood redistribution. Dizziness, fainting, diseases of the pelvic organs occur, and menstruation increases in women. When a person bends while standing, more body weight is placed on one leg and one hip. The ribs come close to each other on one side, and on the other side they diverge. This leads to compression and limitation of the mobility of the chest, the development of scoliosis, and hypertrophy of the back muscles on the right (Fig. 10).

As a result of pressure on bile ducts Bile secretion worsens and stones appear (Fig. 11). In women, the dome of the uterus moves away from midline, the intestinal loops move accordingly. Prolonged tilt of the body to the side causes neuroasthenic disorders and neuroses of the liver and intestines. Organ compression abdominal cavity entails enteroptosis, dyspepsia, gastritis, neurovegetative dystonia, which often affects dentists.

Pain in the shoulder and arm is caused by irritation of the nerve roots due to spondylosis of the lower cervical vertebrae. Headaches that occur in the sockets behind the eyes appear due to overstrain of the neck muscles.

Some doctors have bad habit When performing difficult and complex work in the oral cavity, hold your breath and raise your shoulders high. By doing this, the doctor is trying to somehow facilitate and compensate for difficult access to the object. A shift in the center of gravity occurs and the distribution of the load on the legs is disrupted. Fatigue of the feet, pain in the Achilles tendons and calf muscles appear. The pain can spread to the muscles of the thigh and buttocks, simulating rheumatism.

Occupational stress, metabolic

and neuro-humoral reactions

Mental work is associated with the reception and processing of information, which requires the primary tension of the sensory apparatus, attention, memory, activation of thinking processes, and the emotional sphere. The work of medical workers is associated with constant contact with people, increased responsibility, lack of information and time to make the right decision, which causes a high degree of neuro-emotional stress. This leads to tachycardia, increased blood pressure, ECG changes, increased pulmonary ventilation and oxygen consumption, increased body temperature. Mental work associated with neuro-emotional stress causes an increase in the activity of the sympatho-adrenal, hypothalamic-pituitary, and cortical systems. With emotional stress, there is an acceleration of catecholamine metabolism, an increase in the release of norepinephrine in the sympathetic ganglia, and an increase in the content of adrenaline and glucocorticoids in the blood. Optimization of mental work should be aimed at maintaining a high level of performance and eliminating chronic neuro-emotional stress. But it is necessary to take into account the fact that during mental work the brain is prone to inertia and continuation of mental activity in a given direction. After finishing work, the “work dominant” does not completely fade away, causing longer fatigue and exhaustion of the central nervous system during mental work than during physical work.

In stressful situations, complex mechanisms are activated. The hypothalamus is involved in the activation of protective mechanisms. The hypothalamic-pituitary system carries out humoral regulation in two ways. First- neural pathway, when the response of the hypothalamus to stress is regulated by higher nerve centers in accordance with the intensity and nature of the stress. Second the pathway is humoral, thanks to which the pituitary gland constantly interacts with the adrenal glands, thyroid and gonads. In stressful situations, several parts of the endocrine system, regulated by the hypothalamus, react simultaneously. Two of them are especially important: the sympathetic-adrenal system, which secretes catecholamines, and the pituitary-adrenal system, which secretes corticosteroids.

Immediate neuro-response endocrine system stress leads to activation of the sympathetic-adrenal system. The most important catecholamines are released: adrenaline and norepinephrine. Catecholamines are the most important regulators of adaptation processes in the body. They allow him to quickly move from a state of rest to a state of activity. They stimulate the breakdown of glycogen and lipids,

lead to the accumulation of glucose in the blood, activate the oxidation of fatty acids, stimulate cardiac activity and muscle activity, excite the central nervous system, stimulate protective and immunological mechanisms.

Three types of steroid hormones that act in stressful situations are released from the adrenal cortex: mineralocorticoids, glucocorticoids and androgens.

Under conditions of constant psycho-emotional stress, the secretion of adrenaline increases, which is important for activating the body's defenses. The secretion of norepinephrine also changes under the influence of emotions, although to a lesser extent than adrenaline. A positive correlation was found between the rate of adrenaline excretion, social adaptation and emotional stability.

In addition, noise and vibration affect the level of corticosteroid secretion. Intense noise leads to an increase in the rate of corticosteroid secretion. Vibration, in addition to the other functional disorders described above, leads to an increase in the secretion of catecholamines and corticosteroids.

Under conditions of psycho-emotional stress in stressful situations, the following functional disorders may occur:

Muscle symptoms: tension and pain;

Gastrointestinal symptoms: dyspepsia, vomiting, heartburn, constipation;

Cardiovascular symptoms: palpitations, arrhythmia, chest pain;

Respiratory symptoms: shortness of breath and hyperventilation;

Symptoms from the central nervous system: neurotic reactions, insomnia, weakness, fainting, headaches.

Of the cardiovascular symptoms, the most common are coronary insufficiency and arterial hypertension.

Elimination and prevention of emerging violations.

To avoid these phenomena, you need to abandon overly tense body positions and replace them with more comfortable ones. The main reasons that force a doctor to adopt an incorrect body position are haste and insufficient attention to the correct fit of the dental chair for each patient. Due to lack of time, doctors regret the few seconds and movements required to give the chair the required position. Sometimes only illness or serious disorders force the doctor to change his habit. Modern chairs with adjustable height, backrest and headrest tilt allow you to give the patient the correct position.

Due to lack of time, doctors regret the few seconds and movements required to give the chair the required position. Sometimes only illness or serious disorders force the doctor to change his habit. Modern chairs with adjustable height, tilt of the backrest and headrest make it possible to give the patient the correct position (Fig. 12, 13). The design of the chair can be improved by removing the right armrest. Usually it has a very elongated shape, which prevents the doctor from taking a comfortable position. However, the patient is to some extent hampered by the lack of support for his right elbow. For correct installation chairs, the following points must be taken into account: 1) the patient’s proportions (height, build); 2) doctor’s proportions; 3) the doctor’s visual acuity; 4) lighting conditions. The correct position of the doctor is considered to be one in which the head, neck, chest and abdomen are on the same vertical and the main burden falls on the bone frame, while the muscles and ligaments are minimally loaded. In this position, the functions of the respiratory, circulatory, and digestive organs are in favorable conditions (Fig. 14). Each dentist at his workplace must place all auxiliary instruments and devices in height and in a horizontal plane in accordance with the height and length of the arms. For work that requires a lot of nervous tension and attention, fast and precise hand movements, frequent but short breaks (5 - 10 minutes) are advisable. At the heart of the production physical culture lies the phenomenon of active rest described by I.M. Sechenov: tired muscles rest better, their performance is restored faster not with complete rest, but with the work of other muscle groups. For this purpose, introductory gymnastics, a physical education break, and a physical education minute are used. The psychophysiological relief room is a room in which sessions are held to relieve fatigue and neuropsychic tension. The effect of psycho-emotional relief is achieved through the aesthetic design of the interior, comfortable furniture, broadcasting specially selected musical works, air ionization, taking tonic drinks, simulating a natural environment in the room, showing slides and video programs with views of nature and reproducing the sounds of the forest, sea surf, etc. Occupational diseases feet of dentists It has long been proven that a dentist’s main working hours must work while sitting. Standing work not accompanied by various muscle movements, violates venous drainage, causes stagnation of blood in the veins lower limbs. The veins dilate, their valves do not function sufficiently, blood flow slows down and, as a result, circulatory disturbances occur in the vessels of not only the extremities, but also the abdominal organs. Occupational foot injuries appear: bowed, flat or splayed feet due to prolonged support vertical position bodies. Insufficiency of supporting tissues, muscles, ligaments, bones and joints develops. Irregularly shaped shoes (narrow-toed shoes) cause foot disease. Shoes, stockings and socks should not interfere with blood circulation in the lower leg and foot area. They need to be chosen in such a way that the toes can move freely in them. With prolonged standing and turning of the feet, in addition to flat feet, the so-called valgus foot with a protruding inner malleolus develops (Fig. 15). Inflammation of the mucous sac between the Achilles ligament and the heel bone causes pain on both sides of the tendon (Fig. 16). For the treatment and prevention of diseases of the legs and feet, a set of exercises has been developed: flexion and extension of the toes, grasping and lifting a scarf from the floor with the toes, walking on tiptoes, on heels, walking on river sand, on stones, running on large pebbles in the water , exercises with a stick on wheels, etc. Massage and self-massage of the legs are successfully used. First make a warm foot bath. Massage movements are carried out to relax the ankle joint, to relax and tense the arch of the foot, massage the toes, relaxing massage of the lower leg. Walking barefoot on a hard, wet sandy beach or standing or running on a beach covered with small pebbles can be beneficial. Correct positioning of the legs is important when sitting. The feet should be comfortable and their entire surface in contact with the floor. The muscles are relaxed, nothing interferes with blood circulation. It is recommended to place your feet on your toes and alternate this position with the correct one. This promotes good blood circulation and relaxation of the leg muscles. Occupational diseases of the spine in dentists The need to maintain a certain body position for a long time with the torso tilted has an effect on the spine. The vertebrae are displaced and diverged, the spine acquires an atypical configuration. Sprained ligaments are accompanied by compression of the intervertebral discs, vessels and nerves on the side of the resulting lordosis. Vague pain appears in the neck, shoulders, back, sacrum, spreading to the limbs. Occipital and neck pain, brachial plexus neuralgia, intercostal neuralgia, Scaleus syndrome, neck immobility, lumbago and back pain, sciatica. Nervous structures spine and internal organs are connected in an intermediate channel. Radicular, motor, sensory and autonomic disorders develop. For example, feelings of fear, angina pectoris, difficulty breathing, tension in the neck, often associated with cervical syndrome. Increased load on the intermediate discs and deformation of the vertebrae, muscle tension and pressure on blood vessels and nerves cause pain in the shoulder joint, interfering with the movements of the forearm and hand. There is a deforming syndrome of the cervical spine or, according to the Askey classification, a syndrome of the shoulder - forearm - hand with neuralgic disorders. Dentists often suffer from this disease. It develops when the muscles of the shoulder girdle receive a one-sided load, which leads to one-sided tension and functional disorders apparatus of the discal ligaments in the cervical and thoracic regions spine. The smallest stretches into the lateral root canals can cause compression phenomena. In differential diagnosis, it is necessary to exclude pain such as angina pectoris, reflex projections into the shoulder of pain from the pancreas, gallbladder, stomach and duodenum. Treatment includes massage according to Leube - Diecbee, warm baths and therapeutic gymnastic exercises. If there is protrusion (prolapse) of the disc ligaments, surgical intervention is possible. The main ways to combat fatigue: 1) rational organization of the workplace and furniture; 2) exercises and training; 3) rational work and rest regimes; 4) industrial physical culture; 5) physiological relief rooms. More than 80% of the working time, a dentist must work while sitting. At long work While standing, blood redistribution occurs, blood circulation deteriorates, and occupational pathology occurs in the lower extremities (varicose veins, thrombophlebitis, swelling of the legs, flat feet). In a sitting position, it is possible to perform work that requires precision movements (preparation, endodontic work, canal filling), but when working for a long time while sitting, static tension in the muscles of the neck, shoulder girdle, and back is observed. Changing posture leads to a redistribution of the load on muscle groups, improves blood circulation conditions, and limits elements of monotony. Exercise (improving skills through repetitive activity) is an important means of preventing fatigue. The exercise is based on the principle of skill formation. It proceeds according to the type of formation of conditioned reflexes to a combination of external and internal stimuli. You cannot achieve high performance without training. Exercise underlies the development of work skills and industrial training. A rational regime of work and rest is such a ratio and content of periods of work and rest in which high labor productivity is combined with high performance without signs of excessive fatigue. The more intense the load during work, the less the load should be during active rest, so as not to exceed the maximum limits of excitability of brain cells. These boundaries are individual. Age, type of nervous system, fitness, physique and general condition play a role. Sleep gives complete relaxation and rest. It is a vital compensation for the working day. A dentist, whose work requires a lot of energy, needs 8 hours of sleep. After a busy day at work, it is necessary to use stress-reducing products. A bath with a water temperature of 35 - 36° C for 10 - 15 minutes is recommended. You can add valerian to water, horsetail. After a bath, it is important to keep your feet warm (use a blanket or heating pad). The bed should not be too soft, the blanket should be light and not hot. Methods to combat fatigue Dentists spend their entire working day in indoors, are exposed to heat-emitting light sources. As a result, skin breathing becomes difficult and blood circulation worsens. The person looks pale, tired, and his performance deteriorates. Important have daily air baths. They should be taken everywhere and at any time of the year. In winter, these procedures should be taken in a well-ventilated room. In warmer times of the year - from open window and in the fresh air. Sunbathing has a beneficial effect on the body. But too much sun exposure leads to skin burns and irritates the nervous system. Warm water has a good relaxing effect. Baths with a water temperature of 25 - 30 ° C are considered warm, and hot - 38 - 42 ° C. Warm water dilates the superficial and deep-lying blood vessels of the skin. At the same time, peripheral blood circulation is accelerated. Warm water shifts the metabolism to the alkaline side, having a calming and relaxing effect. Cold has an exciting and revitalizing effect. It is effective to take in the morning cold shower, after which you should rub the body with a glove made of rough linen or a terry towel. After work, in the evening, it is useful to take a warm shower, which relieves fatigue and tension. A light massage is recommended to relax the muscles and nervous system. At the same time it improves capillary circulation, a subjective feeling of freshness arises. Massage has a beneficial effect on the skin, muscles, vascular and nervous systems. Massage also has a reflex effect on internal organs. All types of hardening are useful, motor activity , sports Along with muscle training, the vascular system also trains, breathing becomes more economical, which leads to an increase in the performance of the heart. Allergic diseases of the skin of the hands of dentists In dental practice, doctors, nurses, and dental technicians have to come into close contact with various allergens: medications and chemicals, which include novocaine, antibiotics, various polymers, synthetic materials, etc. The most common diseases of allergic skin nature are contact dermatitis and eczema. These also include toxicoderma, urticaria, and dermatoconiosis. Epidermatitis (dry skin), resulting from frequent contact with water and degreasing substances, is considered an allergic predisposition. Among patients with occupational dermatoses, young and middle-aged women (21 - 40 years old) predominate. For people with short work experience, the incidence rate is higher than for people who have worked as dentists for a longer period of time. Dentists who conduct a mixed practice often experience dry skin, followed by dermatitis and eczema. Prevention of eye diseases in dentists Daily and seasonal fluctuations in natural light require the use of artificial light instead of natural light or in addition to it. In central Russia, from the second ten days of December to the second ten days of February, most of the time you have to use artificial light. The source is incandescent and fluorescent lamps. Artificial lighting has disadvantages that can cause the development of visual and general fatigue, working myopia and spasms of accommodation. In addition, fluorescent lighting makes it difficult or impossible to accurately perceive the true color of healthy and diseased tissues (mucous membranes, teeth, skin). As a result, conditions are created for diagnostic errors and the quality of treatment is reduced. In low light levels, to increase the angle of view, the doctor needs to get closer to the object in question. As a result, convergence is enhanced due to the intense work of the rectus internal muscles of the eye. This entails the development of working myopia. Fluorescent lamps produce a monotonous noise, which manifests itself when they malfunction. Noise has a negative effect on the nervous system. Since the work of a dentist in a clinic requires a lot of visual strain, the illumination of the offices should be increased. Many doctors associate fluorescent lighting with the appearance of headaches, irritability from monotonous noise, “flickering” and “transfusion” of moving objects and note that it gives a deathly color and cyanosis to the mucous membranes and skin. 80% of dentists develop eye diseases after ten years of practice. Largest quantity persons with myopia are observed between the ages of 31 and 40 years, with hypermetropia - from 41 to 45 years. Therapists are at high risk of developing conjunctivitis. When preparing teeth and removing dental plaque, it is recommended to wear safety glasses. Hygienic requirements for industrial lighting In case of insufficient lighting and eye strain, the condition visual functions is at a low functional level, in the process of performing work, vision fatigue develops, overall working capacity and labor productivity decrease, and the risk of injury increases. Low light contributes to the development of myopia. The degree of illumination unevenness is determined by the unevenness coefficient - the ratio of maximum to minimum illumination. If the field of view constantly contains surfaces that differ significantly in brightness, then when moving the gaze from a bright to a dimly lit surface, the eye is forced to re-adapt. Frequent readaptation leads to the development of visual fatigue and makes it difficult to perform work. Prevention: rational scheme placement of lamps, prohibition of the use of local lighting only. Today it is difficult to imagine the work of a dentist without the use of photopolymerizing filling materials. Photocomposites contain photosensitizers and their polymerization occurs under the influence of light radiation in a narrow region of the visible spectrum around 480 nm (blue light). To carry out this process, special devices are used - photopolymerizers. They differ in power, energy luminosity, additional service functions, and design, but the principle of operation and main design components are approximately the same. Worth your time special attention the effects of blue light on the doctor's vision. English scientists have established in an experiment on animals that a total direct 15-minute exposure to polymerizer light on the eyes leads to the appearance of signs of irreversible changes in the retina. It is not uncommon for doctors, after working for a long time with a photopolymerizer, especially without protective equipment, to complain about “fly spots” flashing before their eyes. In this regard, it is necessary to follow certain rules: 1) work only if there are protective hoods or caps on the photopolymerizer; 2) be sure to use safety glasses. LITERATURE: 1. Borovsky E.V., Makeeva I.M., Estrov E.A. New in dentistry, 1996, No. 5 p. 15 - 17. 2. Vartikhovsky A. M. On the influence of production factors on the health status of dentists (in the Moldavian SSR). Dentistry, 1973, No. 2 p. 83 - 84. 3. Ivashchenko G. M., Kataeva V. A. Some current issues of occupational hygiene in dentistry. Dentistry, 1978, No. 4 p. 67 - 69. 4. Kataeva V. A., Alimov G. V. Comparative physiological and hygienic characteristics of dentist work. Dentistry, 1990, vol. 69 No. 3 p. 80 - 82. 5. Kataeva V. A. Allergic skin diseases in medical workers dental clinics. Dentistry, 1979, vol. 63 No. 2 p. 79 - 80. 6. Kataeva V. A. Hygienic assessment of the state of vision of dentists. Dentistry, 1979, vol. 58 No. 2 p. 69 - 72. 7. Psychosocial factors at work and health protection. Edited by R. Kalimo // World Health Organization, Geneva, 1989. 8. Schöbel Rudolf. Ways to improve the performance of a dentist. M., Medicine, 1971, 215 pp.

Occupational hazards dentists are nervous and emotional stress, forced working posture, heating microclimate, sharp fluctuations in illumination, significant eye strain, noise and vibration created by high-speed turbines. They are also adversely affected by narcotic and toxic substances, anesthetics, antibiotics, polymer materials, mainly acrylic plastics and epoxy resins, used for the manufacture of fillings and dentures. , X-ray radiation, microbial factor, there is a danger of infection with AIDS, syphilis, hepatitis.

There are frequent cases of development varicose veins veins, flat feet, constipation, stagnation in the abdominal organs, pelvis, diseases associated with sedentary life, diseases of the nervous system, decreased hearing acuity, which can cause deafness.

When working with instruments, you have to constantly hold the tips of drills and thin handles of instruments with tension, which leads to various painful phenomena: at first, complaints of slight pain in the fingers and hands, in the forearm, fatigue, sometimes a noticeable crunch when moving, appear, then the phenomena gradually progress and lead to spasmodic muscle contractions and other more severe symptoms tendon damage. Spasms of the hand and finger muscles can be so strong that they force you to stop working.

Dentists and dental assistants may experience neuroses, neuritis, and tendovaginitis in the area of ​​the hands. It is also possible to develop contracture of the palmar aponeurosis due to constant pressure on the same place on the palm of forceps for tooth extraction, various other forceps, a “gun”, etc.

A rational working posture is one that is easily maintained with minimal dynamic and static muscle tension, regardless of whether the work is done while sitting or standing. To work properly while standing, it is recommended that the head, neck, chest and abdomen be on the same vertical, then the main burden falls on the bone skeleton, and the muscles and ligaments are unloaded. It is rational to alternate body positions, when sitting work takes 50-60% of the time, and the rest of the time is spent on a standing position and short-term movements associated with work, short breaks. It is recommended to use fairly loose shoes with wide heels 2-3 cm high.

To prevent diseases that arise among dental doctors and paramedics due to the forced position of the body during work, as well as to reduce fatigue, it is recommended physical exercise. It is advisable to spend physical exercise minutes during the working day or after it at home. Mass types of physical culture and sports associated with walking, swimming and other forms of physical dynamic activity, especially outdoors, are also useful. Attention should be paid to hardening with the help of natural factors.

The work of a dentist, especially a specialist in therapeutic dentistry, requires constant and significant visual strain at all stages of examining a patient, when choosing instruments, during treatment and when filling out medical documentation. The visual work of a dental therapist is of the highest precision.

Facilitation and improvement of the quality of visual work of personnel is achieved through rational, natural and artificial lighting dental offices. It is envisaged that the illumination in the workplace should be 500 lux, in the oral cavity - 3000-4000 lux, and the light from electric reflectors at dental chairs should not have a blinding effect on the eyes of the patient and the doctor. The spectral composition of light is important, which should provide the ability to distinguish color shades without changing color skin, mucous membranes and teeth.

Modern high-speed drills facilitate the dispersion of bacterial aerosols. Elimination side effect turbines is achieved through cooling or most often cold water, resulting in the formation of a rather thick aerosol consisting of tiny particles water with an admixture of dusty fragments, processed fabrics carious teeth, lubricating oils and numerous microorganisms. These aerosols can remain in the doctor’s breathing zone for about 30 minutes and spread around a distance of 50-80 cm, presenting a danger to medical personnel.

A good remedy Gauze masks, which retain about 95% of microflora, serve as protection against airborne infections, especially influenza. Before and after seeing each patient, and sometimes during the process of diagnosis and treatment, you must thoroughly wash your hands. To isolate the hands of medical personnel during dental interventions and other procedures that require asepsis, medical gloves are designed to prevent infectious agents from entering the wound from the skin of the hands, and also protect the dentist from infection and the harmful effects of disinfectants and toxic agents on the skin of the hands. substances. Nitrile gloves provide reliable protection against microorganisms, water, weak acids, alkalis and organic solvents. Vinyl ones are used to insulate hands when carrying out diagnostic studies and for patient care in dentistry, and polyethylene ones provide protection for the hands of medical staff from moisture, polluting elements and a number of aggressive chemicals.

Preventive measures aimed at combating noise and vibration in dental offices include technical improvement of equipment. It is necessary to promptly clean and lubricate the rotating parts of drills and monitor the serviceability of individual components and the machine as a whole. The establishment of standards for the speed of rotation of the boron is of great hygienic importance. For offices with conventional drills, noise is normalized within 50 dB.

IN dental laboratory dental technician exposed to carborundum dust, plastics and metals generated during the processing of prostheses made of stainless steel, low-melting metals, as well as lead vapor, mercury and acids released during the production of prosthetic blanks. In recent years, fluorax, which is a hot-curing plastic based on fluorine-containing acrylic copolymers of the powder-liquid type, has been widely used for the manufacture of denture bases. Fluorax prostheses have increased strength, elasticity and their color and translucency - they harmonize well with soft tissues oral cavity. The leading compound in this compound is methyl methacrylate, which is highly active toxic substance, the maximum permissible concentration of which is 0.01 mg/m 3. Its content in the main room in the breathing zone of the dental technician when the fume hood is inactive significantly exceeds the permissible concentration.

The most harmful factor in the plaster room is gypsum dust, in the soldering room - vapors of nitric and hydrochloric acids, metals to be soldered, solder material, carborundum dust, pumice, silicon dioxide, in the molding and polymerization - vapors of water, acrylates, volatile wax components, in the polishing room – dust of abrasive materials and dentures, in the foundry – vapors of various metals used for the manufacture of metal dentures from gold, silver, copper, platinum, cadmium, zinc, chromium, nickel, titanium, manganese, palladium, tin, lead, bismuth, iron . During the heat treatment of materials and metals during the manufacturing of dentures, products of complete (water, carbon dioxide) and incomplete combustion (carbon monoxide) are released into the air.

To reduce noise and vibration levels at the dental technician’s workplace, it is important to monitor the technical condition of the noise-vibrating mechanism; wear and tear of the grinding stone should not be allowed. Grinding machines must be installed on the work table on rubber shock absorbers so that the places where the machine is attached to the table surface do not have direct contact. When performing technological operations associated with noise, you should use individual means hearing protection: anti-noise antiphons and “earplugs” inserted into the outer ear canal and designed for one-time use.

Constant contact with dentures and impression materials, the surface of which is usually infected, leads to contamination of the hands of dental technicians with various microorganisms, including pathogenic ones, therefore, in their work there is a danger of infection by contact, which requires wide application modern methods disinfection and sterilization.

To protect the respiratory system from pathogenic microorganisms and liquid droplets, protective masks are made of hypoallergenic non-woven material, which prevent microbial contamination of the working field by retaining bacteria in the exhaled air flow. A number of masks are equipped protective screen, which protects the eyes from traumatic particles, as well as biological and aggressive chemical liquids. An alternative to a mask is a respirator made from a material that does not irritate the skin.

To protect the eyes from mechanical and thermal damage, use safety glasses (adjacent open and closed with straight and indirect ventilation, non-adjacent) and a screen that protect against contact of biomaterial and aggressive chemicals with the mucous membrane. When working with solar lamps and laser devices, it is necessary to use glasses with light filters to protect the retina.

To ensure the proper sanitary condition of the air in the premises of a dental laboratory, it is necessary to have a rational system of central artificial ventilation, as well as the mandatory installation of local exhaust ventilation in the form of fume hoods, suction, and umbrellas that ensure the removal of dust, vapors and gases directly from the places of their formation.

TEST QUESTIONS

1. Hygienic characteristics of working conditions.

2. Occupational diseases and their prevention.

3. Hygienic characteristics of physical production factors.

4. Hygienic requirements for working on a computer.

5. Hygienic characteristics of chemical production factors.

6. Hygienic characteristics of biological production factors.

7. Hygienic characteristics of psychological production factors.

8. Occupational hygiene of medical workers.

9. Occupational hygiene in dental clinics.