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Harmful drugs that the dentist works with. Occupational hazards in the work of a dental technician Life activities of students studying in the specialty “Orthopedic Dentistry”

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. To correctly install the chair, you need to take into account the following points: 1) the patient’s proportions (height, build); 2) doctor’s proportions; 3) the doctor’s visual acuity; 4) lighting conditions. The correct position for the doctor is 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). Every dentist At his workplace he must place all auxiliary tools and devices in height and in a horizontal plane in accordance with the height and length of his arms. For work requiring large nervous tension and attention, quick 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 work time must work while sitting. Standing work not accompanied by various muscle movements, disrupts venous outflow, 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 disorders occur in the vessels of not only the limbs, but also the organs abdominal cavity. 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 calcaneus 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 helpful. 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, neuralgia brachial plexus, intercostal neuralgia, Scaleus syndrome, neck immobility, lumbago and back pain, sciatica. Nervous structures The spine and internal organs are connected in the intermediate canal. 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 the 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 of the 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. When standing for a long time, blood is redistributed, 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 indoors and 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. Daily air baths are important. 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. In the morning, it is effective to take a cold shower, after which you should rub your 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, physical activity, and sports are useful. 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 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. The largest number of people with myopia is observed between the ages of 31 and 40 years, with hypermetropia - from 41 to 45 years. General practitioners are at high risk of developing conjunctivitis. It is recommended to wear safety glasses when preparing teeth and removing plaque. 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, general 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 layout of lamps, prohibition of using only local lighting. 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.

CHAPTER 1. Literature Review

CHAPTER 2. Materials and research methods

2.1 Hygienic methods for studying labor process factors

2.2 Microbiological research methods

2.3 Sociological research

CHAPTER 3. Results of studies at the workplaces of dentists of various specialties

3.1 Results of studies of the conditions and nature of work in the workplace of dentists and therapists in the therapeutic department

3.2 Results of studies of working conditions and nature of work in the workplaces of pediatric dentists in the children's department

3.3 Results of studies of the working conditions and nature of work at the workplaces of orthopedic dentists and orthopedic surgeons in the orthopedic department

3.4 Results of studies of the conditions and nature of work at the workplaces of dentists and surgeons in the surgical department

3.5 Results of microbiological studies at the workplaces of dentists, therapists and orthopedists. 89 3.6 Results of sociological research

CHAPTER 4. DISCUSSION OF RESEARCH RESULTS 99 CONCLUSION 107 CONCLUSIONS 112 PRACTICAL RECOMMENDATIONS 114 REFERENCES 115 APPENDIX

LIST OF ABBREVIATIONS USED IN THE WORK:

MPL - maximum permissible level

MPC - maximum permissible concentrations

KEO - natural light coefficient

CFU - colony forming unit

MMA - methyl methacrylate

SanPiN - Sanitary rules and regulations

GOST - State standard

SN - Sanitary standards

MOH - Ministry of Health

ZD ST - breathing zone of the dentist-therapist

ZD CO - breathing zone of the orthopedic dentist

Recommended list of dissertations

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  • Social and hygienic study of working conditions and morbidity among dental doctors 2003, Candidate of Medical Sciences Dzugaev, Vakhtang Kazbekovich

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Introduction of the dissertation (part of the abstract) on the topic “Clinical and hygienic features of the influence of harmful and dangerous factors in the work of a doctor working in the specialty “therapeutic dentistry”, preventive measures”

Relevance of the problem. The complex relationship between working conditions and the health status of dentists has been studied by domestic and foreign scientists for long period time (Danilova N.B., 2004). Dentists are one of the most numerous categories medical workers, which rank third in terms of occupational morbidity, among them the number of dental therapists. is 65%. The negative influence of a number of factors in the working environment on the body of dental therapists has been revealed (Kataeva V.A., 1981; Gvozdeva T.F., 1994; Burlakov S.E., 1998; Kataeva V.A., 2000; Mchelidze T. Sh., 2000; Degtyareva E.P., 2004). However, there is no data on a comprehensive assessment of the working conditions and health status of dental therapists. At the present stage, adjustments are being made to their practical activities due to the implementation the latest achievements dental industry and the results of healthcare reform. In addition, the problem is of even greater interest in connection with the widespread introduction of the new specialty “dentistry” general practice" The new specialty of “general dentistry” includes the expansion of the scope of patient care by one specialist to include clinical activities inherent in other specialties. But the main work is done to assist the patient within the framework of therapeutic dentistry. Thus, this raises the need for a more thorough and comprehensive assessment and study of a number of factors in the working environment of dental therapists.

Purpose of the study: development of medical and preventive (hygienic) measures to improve working conditions and preserve the health of a dentist-therapist.

To achieve this goal, the following tasks were solved:

1. To provide a comprehensive hygienic assessment of working conditions and the nature of work activity of dental therapists in comparison with dentists of other specialties;

2. Determine and study the quality and quantity of harmful factors present in the workplace of dental therapists, including the severity and intensity of the work process in comparison with dentists of other specialties;

3. Based on a comprehensive assessment, identify the main harmful factors affecting the health of dental therapists in comparison with dentists of other specialties;

4. Based on a study of the nature of work activity, determine the likelihood of developing occupationally caused diseases among dental therapists;

5. Develop and implement a set of measures aimed at reducing professional risk and maintaining the health of dental therapists.

Scientific novelty of the research:

For the first time, the level of risk of occupational diseases among dental therapists has been determined and a comprehensive assessment of the conditions and nature of work activity in individual dental specialties has been given.

For the first time, based on the results obtained, proposals have been developed to improve the hygienic classification of working conditions, which are taken into account when assessing the risk of occupational diseases associated with working in the specialty of therapeutic dentistry in comparison with the specialties of orthopedic dentistry, surgical dentistry and pediatric dentistry.

The theoretical significance of the study lies in identifying the main factors and patterns that shape the risk of occupational diseases of dental therapists in comparison with dentists of other specialties, namely dental surgeons, orthopedic dentists and pediatric dentists. A system of measures has also been developed aimed at preventing the risk of occupational diseases and, therefore, preserving the health of dental therapists.

Provisions submitted for defense.

1. In the course of their work, dentists and therapists are exposed to complex impact harmful and dangerous factors of the production environment: physical (microclimate, lighting, noise, vibration), chemical, microbiological

2. The most pronounced and common for dental therapists, as well as for doctors of other dental specialties, is the intensity of the labor process, which is expressed by high psycho-emotional stress, as well as significant loads on the analyzer systems (visual, olfactory, tactile and others).

3. The high prevalence of diseases of the cardiovascular and nervous systems, as well as the musculoskeletal system, is a consequence of the adverse effects of high tension and severity of the work process.

4. The main aggravating indicator when assessing the severity of the work of dental therapists, as well as for doctors of other dental specialties, is an uncomfortable fixed posture.

Practical significance of the work.

Based on proven provisions, with the implementation of recommended measures, it seems possible to reduce the impact of harmful factors on the health of dental therapists, as well as doctors of other dental specialties.

Approbation of work.

The results of the work were tested at: “XI International Conference of Maxillofacial Surgeons and Dentists” St. Petersburg (2006); scientific-practical conference of young scientists “Current issues of clinical and experimental medicine”. St. Petersburg (2006).

Structure and scope of work.

The dissertation consists of 4 chapters, a conclusion, conclusions, practical recommendations, a list of references, applications, documents on implementation in practice. The dissertation is presented on 130 pages, contains 23 tables, 1 figure. The list of used literature includes 139 domestic and 27 foreign authors.

Similar dissertations in the specialty "Dentistry", 14.00.21 code VAK

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  • Development of an integral assessment of the workload of dentists and therapists in public institutions 2009, Candidate of Medical Sciences Bachalova, Eset Ibragimovna

  • Theoretical substantiation and development of mechanisms for increasing the efficiency of dental care to the population 2006, Doctor of Medical Sciences Meshcheryakov, Dmitry Glebovich

  • Clinical expert assessment of errors and complications in the practice of a pediatric dentist-therapist 2006, Candidate of Medical Sciences Abramova, Elena Evgenievna

Conclusion of the dissertation on the topic “Dentistry”, Sakhanov, Anton Anatolyevich

1. Based on the data obtained, in a comparative analysis and in accordance with accepted classification working conditions of dental therapists, as well as surgeons and pediatric dentists working on outpatient visits in state medical institutions using modern technologies, are assessed as harmful (class 3) 2nd degree, and the working conditions of orthopedic dentists as harmful (class 3) 1st degree.

2. A comprehensive hygienic assessment of working conditions at the workplaces of dentists of various specialties made it possible to determine the degree of harmfulness of the factors:

Harmful (class 3) 2 degrees: severity of work at the dentist, pediatric dentist, work intensity for a dental surgeon;

Harmful (harmful) 1st degree: labor intensity for a dental therapist, orthopedic dentist, equivalent noise level for doctors of all specialties, labor intensity for a dental surgeon, orthopedic dentist, biological factor for a dental therapist;

Acceptable (class 2): local vibration, microclimate, illumination for dentists of all specialties.

3. The level of air contamination in the breathing zone of a dentist or therapist is a dominant factor compared to general level dustiness in the development of morbidity in the upper respiratory tract.

4. The leading factor in the development of morbidity of the musculoskeletal system among dental therapists is the duration of the intervals during which the dentist takes an uncomfortable fixed position.

5. Unfavorable working conditions and the health status of dental therapists, established as a result of a comprehensive assessment of hygienic factors and the nature of work activity, indicate the need to improve preventive measures aimed at improving the working environment.

1. Equip medical institutions with centralized compressor systems to reduce noise levels in treatment rooms.

2. Increase control over the use of personal protective equipment for the upper respiratory tract by dentists.

3. Organize industrial gymnastics classes for dental therapists during regulated breaks, helping to relieve local fatigue of individual muscle groups of the shoulder girdle and arms in accordance with the developed set of exercises.

4. Organize monitoring of blood pressure levels among dentists over 30 years of age for 2 weeks with an interval of 6 months.

5. To reduce the load on the visual analyzer, include in clinical practice the use of color-coded instruments, forehead optical systems and dental handpieces with fiber-optic illumination.

6. Increase the frequency of ventilation from 2 to 4 times in offices where dentists, therapists and orthopedists work.

7. To introduce more widely the use of rubber dam for the prevention of respiratory diseases among dental therapists and patients.

8. Review the standards for time parameters and workload for dental therapists.

List of references for dissertation research Candidate of Medical Sciences Sakhanov, Anton Anatolyevich, 2009

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PHYSICAL FACTORS:

Temperature, humidity, air speed, thermal radiation;

Non-ionizing electromagnetic 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 of the 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 overexertion and muscle spasms

When holding a thin instrument, the muscles are tense, 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) the 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 the middle, ring or 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 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. 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.

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 the development of varicose veins, flat feet, the appearance of constipation, congestion 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 pronounced symptoms of tendon damage. Spasms of the hand and finger muscles can be so strong that they force you to stop working.

Dentists and dental paramedics may experience neuroses, neuritis, and tendovaginitis in the area of ​​the hands. Contracture may also develop palmar aponeurosis due to constant pressure on the same place on the palm of the tooth extraction forceps, 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 of 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 with cold water, resulting in the formation of a rather thick aerosol consisting of tiny particles water with an admixture of dusty fragments, fabrics being processed 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 means of protection against airborne infections, especially influenza, are gauze masks, which retain about 95% of the microflora. 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 isolate hands during diagnostic tests and for caring for patients in dentistry, while polyethylene ones protect the hands of medical staff from moisture, contaminants 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 last years For the manufacture of denture bases, fluorax is widely used, which is a hot-curing plastic based on fluorine-containing acrylic copolymers of the powder-liquid type. Fluorax dentures have increased strength, elasticity, and their color and translucency harmonize well with the soft tissues of the oral cavity. The leading compound in this compound is methyl methacrylate, which is a highly 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 should be installed on the work table on rubber shock absorbers so that the points 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” that are inserted into the external auditory canal and are 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, so there is a risk of infection in their work by contact, which requires widespread use 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 protective goggles (close-fitting open and closed with direct and indirect ventilation, non-fitting) 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.

CONTROL 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.

The effectiveness of the professional activities of doctors is largely determined not only by their qualifications and material and technical equipment of medical and preventive institutions, but also by the state of their own health.

Key words: dentistry, occupational hazards, risk factors.

Dentistry is one of the most numerous medical specialties, ranking fifth in number (8.1%) after diagnostic laboratory technicians (9.4%), pediatricians (14.8%), therapists (21%) and specialized doctors (28.1%)

The daily practice of a dentist is associated with the presence large quantity risk factors that entail negative consequences, leading to a deterioration in the specialist’s health and the inability to perform their professional duties efficiently. Among them: increased neuro-emotional stress, forced working posture, poor lighting, risk of infection transmission, contact with allergens and toxic substances, noise, vibration and many others.

Purpose of the work: analysis of literature data on the issue of studying occupational hazards in the work of a dentist.

Occupational hazards affecting the dentist are divided into the following groups:

1. Physical factors (vibration, noise, ultrasound).

Due to exposure to noise (and vibration) associated with the operation of high-speed dental equipment, doctors are more likely to develop nervous system and occupational disorders. unilateral hearing loss. Often, to increase the power of a dental unit, it is equipped with an additional aspiration system. Despite the soundproofing of these pumps, they produce a monotonous loud noise that has a detrimental effect on the hearing aid and impedes the interaction between both the doctor and the patient, and the assistant and the doctor during a dental appointment.

Electromagnetic radiation (professional computer, lamp from a dental unit, telephone, microwave oven, refrigerator, etc.) when exposed to the body can negatively affect organs reproductive system, leading to adverse long-term effects. We should also not forget about the harmful effects electromagnetic radiation on the hematopoietic organs (bone marrow), the central nervous system and, of course, on the eyes, where long-term damaging effects will lead to serious vision problems (cataracts, changes in the retina such as angiopathy, sclerosis of the retinal vessels, in some cases, the formation of dystrophic foci in the macular area ).

In his work, the dentist constantly receives a dose of x-ray radiation. This negatively affects his health. Constant contact with x-rays and non-compliance with safety precautions when working with x-rays can lead to:

1. Blood disease – hemolytic anemia; 2. The occurrence of cataracts; 3. An increase in the incidence of cancer; 4. Rapid aging; 5. Decreased life expectancy – early death; 6. Chemical factors (acute, chronic intoxication).

The compound methyl methacrylate (MMA), widely used in orthopedic dentistry as a material intended for the manufacture of fillings, is contained in the air of dental premises year-round in concentrations that exceed the maximum permissible concentration (10 mg/m3). Acute inhalation exposure to MMA contributes to irritation of the mucous membrane of the eyes and upper respiratory tract.

The main manifestations of intoxication with this substance: nausea, repeated vomiting, headache, noise in the head, dizziness, thirst, weakness, drowsiness leading to loss of consciousness, hypotension and the development of epileptiform seizures. Chronic inhalation exposure to MMA in elevated concentrations in the air of the work area contributes to the development of intoxication, accompanied by dysfunction of the nervous system.

2. Biological factors (pathogenic microorganisms).

Various patients come to see a dentist, including those with chronic infectious diseases (pulmonary tuberculosis, sexually transmitted diseases, etc.) who are carriers of pathogenic bacteria and viruses, for example, hepatitis B, hepatitis C, meningitis and HIV infection.

In addition, in the human oral cavity with inflammatory periodontal diseases and the presence of carious lesions, the number of microorganisms increases many times, including pathogenic ones.

3. Psychophysiological factors.

The main psychophysiological factors influencing the health of a dentist are:

1. Working position, standing or sitting for a long time; 2. Static load on the hands; 3. Eye strain.

Dentist-surgeons work most of their working time standing, in an inclined position. Prolonged work in this position contributes to the occurrence of curvature of the spine and legs, pelvic deformation, flat feet, and varicose veins of the lower extremities.

It is generally accepted that it is irrational - thin handles of tools cause overstrain and spasm of the hand muscles. Dentists often experience the development of Dupuytren's contracture, because Most instruments (forceps, tips) constantly apply pressure to the same place on the palm during the work shift. In addition, prolonged, frequently repeated tension of individual muscle groups in a forced position contributes to the development of tenosynovitis.

During the work, the doctor carries out constant visual monitoring, since working in the oral cavity with a cutting instrument rotating at a speed of up to 450 thousand revolutions per minute, next to soft tissues, is quite dangerous and can lead to negative consequences. If there are difficulties in accessing the working field, the doctor brings his gaze as close as possible to the working area, this leads to contraction of the muscles of the lens and an increase in its curvature.

A dentist works in a combination of natural and artificial lighting. Sources of artificial lighting include incandescent lamps, fluorescent lamps, xenon reflectors, which can cause the development of visual and general fatigue, working myopia due to the intense work of the rectus intrinsic muscles of the eye and spasms of accommodation. The daylight we see in its spectrum contains some ultraviolet rays, but their influence is compensated by the lens, which has an orange tint - a kind of natural filter that prevents the ultraviolet spectrum from reaching the retina. However, the lens is unable to block the ultraviolet radiation emitted by a halogen lamp, which leads to exposure to ultraviolet radiation on the retina. The photoreceptors of the eye are affected, which leads to loss of sensitivity of individual cells, and then to loss of visual fields.

The assistant plays a significant role; it makes the dentist’s work less stressful and reduces the amount of time spent. However, 60% of doctors work without an assistant; this reduces the convenience of work when performing complex manipulations and increases the amount of time spent on one patient. As a result, the break between patients is reduced and by the end of the working day the doctor is in a state of physical and psychological stress.

Another important factor contributing to the decline in the performance of dentists is consumer extremism. Extremist patients, filing lawsuits, expose doctors to chronic stress, as dentists begin to worry about the “current” situation, come to court and pre-trial authorities, stand in lines, waste money and time. All this will lead to increased nervousness of the doctor (stress), increased fatigue, which will ultimately affect the state of the immune system.

When immune activity decreases, we become more susceptible to of various kinds diseases, including exacerbation of existing chronic diseases. It has special meaning in winter, where, against the background of reduced immunity (lack of sun rays, which means a lack of vitamin D), the immune system is weakened even more, which increases the likelihood that the dentist will become ill with acute respiratory viral infections, adenovirus, and also increases the likelihood of contracting various types of diseases from patients directly at a dental appointment.

1. The work of a dentist is associated with exposure to a number of occupational risk factors that lead to deterioration in the specialist’s health;

2. Organization and development of preventive measures to create optimal conditions The working environment is the key to strengthening the health and increasing the performance of dentists.

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