Occupational dermatitis in dental personnel: contact dermatitis with special reference to (meth)acrylates in 174 patients

Between 1995 and 1998, 174 dental personnel were referred as patients to the Department of Occupational and Environmental Dermatology, Stockholm. After clinical examination, 131 were patch tested with the Swedish standard series and 109 with a dental screening series. Furthermore, 137 were tested for IgE-mediated allergy to natural rubber latex (NRL). Hand eczema was diagnosed in 109/174 (63%), 73 (67%) being classified as irritant contact dermatitis and 36 (33%) as allergic. Further diagnoses included other eczemas, urticaria, rosacea, psoriasis, tinea pedis, bullous pemphigoid or no skin disease. 77/131 (59%) had positive reactions to substances in the standard series and 44/109 (40%) to substances exclusive to the dental series. 24/109 (22%) patients had positive reactions to (meth)acrylates, the majority with reactions to several test preparations. Reactions to HEMA (2-hydroxyethyl methacrylate), EGDMA (ethyleneglycol dimethacrylate) and MMA (methyl methacrylate) were most frequent. 9 of the 24 were positive only to (meth)acrylates, the remaining 15 also had reactions to allergens in the standard series. 23 of these had hand eczema and 1 facial eczema. In 17 of the 24 allergic to (meth)acrylates, the dermatitis had started in 1995 or later, in 15 within the previous 12 months. Of 8 who had been sick-listed, 7 also had a history of atopy and 6 were allergic to nickel. The most frequent allergens besides (meth)acrylates were nickel, cobalt, palladium, fragrance mix, colophonium and thiuram mix. Allergy to natural rubber latex was diagnosed in 14/137 (10%). In conclusion, irritant hand dermatitis was the dominant diagnosis. Contact allergy to (meth)acrylate was seen in 22% of the patch tested patients, with reactions to 3 predominant test substances. 1/3 of the patients with allergy to (meth)acrylates had been sick-listed for dermatitis, but in all these cases the (meth)acrylate allergy was seen together with atopy and/or further contact allergies.

Prevalence and risk factors of hand problems and carpal tunnel syndrome among dental hygienists

PURPOSE

Recent research indicates a growing presence of hand problems and carpal tunnel syndrome (CTS) in dental professionals, especially among dental hygienists. This study was designed to determine the prevalence of hand problems and CTS among dental hygienists and identify risk factors for these conditions.

METHODS

As part of a study that surveyed more than 5,000 army dental personnel, 177 dental hygienists were analyzed in great detail. Because of the magnitude of the overall study, which included all types of dental professionals, it was not only possible to identify the prevalence and risk factors of hand problems and CTS affecting dental hygienists, but also the prevalence rates as compared to other dental personnel.

RESULTS

While the overall response rate for all dental personnel was 81%, dental hygienists responded at nearly 92%. Seventy-five percent of dental hygienists reported having hand problems, and 56% exhibited probable or classic symptoms of CTS. By logistic regression, the data revealed that dental hygienists whose practice comprised a majority (> 50%) of patients with heavy calculus were 2.3 times more likely to develop hand problems than those treating fewer patients with heavy calculus. Those who had practiced more than 10 years were also 1.9 times more likely to manifest symptoms associated with CTS than those with fewer years in the profession.

CONCLUSION

The prevalence of hand problems and CTS among dental hygienists was the highest among army dental personnel, with the exception of dental therapy assistants. Risk factors for both hand problems and CTS are multifactorial, and dental hygienists should be particularly aware of those factors that can be prevented.

Occupational exposures to blood in a dental teaching environment: results of a ten-year surveillance study

Evaluation of occupational exposures can assist with practice modifications, redesign of equipment, and targeted educational efforts. The data presented in this report has been collected as part of a ten-year surveillance program of occupational exposures to blood or other potentially infectious materials in a large dental teaching institution. From 1987 to 1997, a total of 504 percutaneous/non-intact skin and mucous membrane exposures were documented. Of these, 494 (98 percent) were percutaneous, and 10 (2 percent) were mucosal, each involving a splash to the eye of the dental care worker (DCW). Among the 504 exposures, 414 (82.1 percent) occurred among dental students, 60 (11.9 percent) among staff, and 30 (6 percent) among faculty. One hundred ninety-one (37.9 percent) exposures were superficial (no bleeding), 260 (51.6 percent) were moderate (some bleeding), and 53 (10.5 percent) were deep (heavy bleeding). Regarding the circumstances of exposure, 279 (54.5 percent) of the injuries occurred post-operatively (after the use of the device), and most were related to instrument clean-up; 210 (41.0 percent) occurred intra-operatively (during the use of the device); and 23 (4.5 percent) occurred when a DCW collided with a sharp object in the dental operatory (eight cases involved more than one circumstance). The overall exposure rate for the college was 2.46+/-0.11 SD per 10,000 patient visits. The average rate for the student population was 4.02+/-0.20 SD per 100 person-years, with the highest rates being observed among junior year students. The observed rates of occupational exposures to blood and body fluids in this report are consistent with published reports from several other educational settings. Dental teaching institutions are faced with the unique challenge of protecting the student and patient populations against bloodborne infections. Educational efforts must go beyond mere teaching of universal precautions and should include the introduction of safer products and clinical procedures that can minimize the risks associated with the hands-on aspects of the students' learning process.

Musculoskeletal pain: prevalence, prevention, and differences among dental office personnel

Data regarding the presence and specific region of musculoskeletal pain were collected as part of a study that surveyed more than 5,000 dental personnel, dentists, and dental auxiliaries. The magnitude of the overall study, which included all types of dental professionals, made possible identification of the prevalence of musculoskeletal pain and comparison of regions of pain among the different dental professionals.

Musculoskeletal symptoms among dental personnel; - lack of association with mercury and selenium status, overweight and smoking

Our objective was to describe the occurrence of musculoskeletal symptoms and how they affect the daily life of three different occupational groups of dental personnel. A cross sectional-study was performed among 268 dental staff members and 111 referents. Female dental hygienists and female dentists showed, compared with their referents, higher prevalence of symptoms during the past 12 months from neck, shoulders and hands/wrists. Both dental groups also had higher frequencies of combined symptoms from these body regions, as well as longer duration of symptoms in neck and shoulders during the past 12-month period. Male dentists had higher frequencies of neck and shoulder symptoms compared with their referents. Female dental assistants did not deviate from their referents. The symptoms from each single body region, or the occurrence of symptoms from multiple regions in a subject, did not show any statistically significant association with mercury (whole blood and urinary levels) or selenium (plasma level) status, neither with smoking habits nor overweight (Body Mass Index). The high frequency of musculoskeletal disorders probably reflects the specific work load in dentistry, with high demands on vision and precision and fine manipulative hand movements and work with unsupported, elevated arms. The symptoms might impair work capacity and the future possibility to stay in the profession. Further studies are needed to verify this.

Dental establishment business activity in New York State counties

Bureau of the Census reports for 1997 were used to develop business data for "average" dental establishments in each of the countries in New York State. On average, during the mid-1990s, when compared to nationwide information, the number of New York State dental establishments increased at a slower rate, had a smaller resident population per establishment, reported lower gross receipts, had fewer employees and paid lower salaries to employees.

Results of the recent TDA member survey

This article fully outlines active TDA members' responses to the various questions posed by the recent membership survey. Every effort was made to ensure the accuracy of the results. To this end, a professional research firm was employed to cross tabulate answers and analyze the data. A thorough reading will provide you with the TDA members' perspective on a wide range of important dental issues.

A survey of private prosthodontic practice

The data from a survey of private prosthodontic practitioners are reported in this article. The author provides a brief look at employment status, number of employees, time spent in the office, number of patient visits per week, gross billings, net income, and practice expenses of prosthodontic practices. In addition, the author has developed a profile for a median prosthodontic practice and practitioner.

[A preliminary study on dental-manpower forecasting model of Miyun County in Beijing]

OBJECTIVE

To explore the dental-manpower forecasting model of Chinese rural region and provide references for Chinese dental-manpower researches.

METHODS

Chose rural Miyun County in Beijing as a sample, according to the need-based and demand-weighted forecasting method, a protocol WHO-CH model and corresponding JWG-6-M package developed by authors were used to calculate the present and future need and demand of dental-manpower in Miyun County. Further predications were also calculated on the effects of four modeling parameters to the demand of dental manpower.

RESULTS

The present need and demand of oral care personnel for Miyun were 114.5 and 29.1 respectively. At present, Miyun has 43 oral care providers who can satisfy the demand but not the need. The change of oral health demand had a major effect on the forecast of the manpower.

CONCLUSION

Dental-manpower planning should consider the need as a prime factor but must be modified by the demand. It was suggested that corresponding factors of oral care personnel need to be discussed further.

Solo general practitioners and specialists

A solo practitioner is the sole owner of and the only dentist in a dental practice and also is the most common type of dental practitioner in the United States. The authors provide a brief look at solo general practitioners' and specialists' characteristics, including employment status, number of employees, time spent in the office, number of patient visits per week, gross billings, net income and practice expenses.

A survey of dental professionals' health and well-being

Past research has indicated that working within dentistry may offer a considerable threat to health. However, no data have previously been published regarding the general well-being and lifestyles of dental personnel. This descriptive study, which was undertaken by the BDA, aimed to examine the self-perceived health and well-being of people working in dental surgeries and to describe their health related behaviours.

Prevalence of HCV infection in health care workers of a UK dental hospital

OBJECTIVE

To determine the prevalence of hepatitis C virus (HCV) antibodies in a group of dental health care workers (DHCW).

DESIGN

Retrospective cross sectional study.

SETTING

A UK dental hospital.

SUBJECTS AND METHODS

The sera of 167 unselected DHCW were tested for the presence of IgG antibodies to HCV using two, third-generation enzyme-linked immunosorbent assays (ELISA). HCV viremia was determined by reverse transcription polymerase chain reaction (RT-PCR) analysis.

RESULTS

Two (1.2%) of the serum samples were found to be anti-HCV positive; one was also viremic. The two antibody-positive subjects were a qualified dental nurse and a student dental nurse, both females, without any known risk factor for HCV acquisition. No dentist was HCV seropositive.

CONCLUSIONS

Since the prevalence of HCV infection in the UK general population varies between 0.08% and 0.55%, these results suggest that DHCW, and auxiliary staff in particularly, may have a slightly increased risk of HCV infection.

Fostering employee involvement

Every year, the ODA's Economics of Practice Committee, with the help of an independent consulting firm, carries out the Cost of Practice Monitor which tracks the various costs of running a dental practice in Ontario. This article is the result of a joint ODA-Arthur Andersen initiative to provide members with detailed information from the Monitor. Over the next year, there will be a series of articles published under the heading "Best practises for Ontario's Dental Practices." The article featured in this issue focuses on wage expenses in dental practices and how to foster employee involvement as a means of addressing cost-productivity issues. Furthermore, information relating to wage expenses may be used by practitioners to benchmark their practice against the average Ontario dental practice. Appendix C was developed for this purpose. Through benchmarking, the practitioner may gain insight into ways of evaluating their practice and in addressing issues that could improve the management of the practice. For a long time, concepts of best business practises were applied only to manufacturing organizations or large multi-national corporations but experience has demonstrated that these activities are universal to all organizations, including service companies, schools, government and not-for-profit organizations.

Accidental exposures to blood and body fluids among health care workers in dental teaching clinics: a prospective study

The authors evaluated accidental exposures to blood and body fluids reported to a hotline or to health officials at four dental teaching clinics. The authors used a standard questionnaire to solicit and record data regarding each exposure. During a 63-month period, 428 parenteral exposures to blood or body fluids were documented. Dental students and dental assistants had the highest rates of exposure. Syringe needle injuries were the most common type of exposure, while giving injections, cleaning instruments after procedures and drilling were the activities most frequently associated with exposures.

[Implications in terms of costs and manpower of using the Scandinavian dental care model in Brazil]

The implications in terms of dental manpower and costs of applying the Scandinavian system of dental care in Brazil are specified and analysed. Two societies were chosen for study: those of Sweden, in Scandinavia and Santa Catarina, State in southern Brazil. The theoretical analysis of the implications was undertaken on the basis of an estimate of dental and auxiliary manpower required to deal with the high levels of oral disease and needs (caries, teeth needing extraction, periodontal diseases and the need for full dentures) in Santa Catarina. This estimate was undertaken by means of the World Health Organization-Fédération Dentaire Internationale (WHO-FDI) Model "Health Through Oral Health" (1989). The implications in costs, taking the total Swedish expenditure per dentist as a basis, were calculated and applied to the manpower calls for by the WHO-FDI model. The high costs resulting showed that the application of the Swedish model of dental care to Santa Catarina would be unrealistic. The implications in terms of manpower were calculated by applying the manpower ratios considered desirable in Sweden to Santa Catarina. In order to achieve the Swedish dentist: population ration, Santa Catarina would need 85% more dentists that it had in 1990. Regarding auxiliary personnel, the Brazilian State of Santa Catarina would need to train a large number of new personnel in order to attain the Swedish auxiliary: dentist ratio. In the light of the findings of this study, the adoption of the Swedish model of providing dental care by Santa Catarina in terms of costs and manpower is not feasible. Therefore, alternative approaches for the improvement of oral health in Santa Catarina and in the rest to Brazil should be sought. These approaches should take consider political, cultural and socio-economic aspects of Brazilian society into consideration.

Musculoskeletal symptoms among dentists in a dental school

A cross-sectional study of symptoms from the musculoskeletal system among employees in a school of dentistry was performed. A questionnaire was answered by 139 dentists, dental auxiliaries and office workers, e.g. 68% of the employees. The answers from the dentists were compared to the answers from all the other employees. No significant differences in musculoskeletal symptoms between the dentists and the other employees were found. Female dentists reported more musculoskeletal symptoms than did male dentists. No difference was found comparing the occurrence of musculoskeletal symptoms among female dentists and females in the reference group. This indicates that the symptoms are not related to the work as a dentist, but to female working conditions in general or to factors outside work.

Dental practice in New York State counties. 10-year economic analysis

Results from a series of Federal reports indicate a continuing up-turn in dental economics in New York State through the early 1990s. A review of dental practices at the state and county level document these developments.

Sero-prevalence of hepatitis B infection among dental professionals

Dental employees in government institutions in a State in Peninsular Malaysia were screened for exposure to hepatitis B virus (HBV) in 1989. Almost all (96.8%) of the 217 employees responded. One quarter (24.8%) was positive for at least one serological markers to HBV; 2.4% had hepatitis B surface antigen (HBsAg) and 22.4% had anti-body to HBsAg (anti-HBs). The presence of HBsAg was unrelated to age, sex, ethnicity, geographical locality and occupations of the subjects. The prevalence of anti-HBs increased with age and was highest for ethnic Chinese (53.6%), followed by Indians (25%), compared to Malays (14.9%) (p less than 0.001) and were increased among dentists (53.1%) and assistant nurses (33.3%). The overall prevalence of HBsAg and anti-HBs were similar to the situation in the community. However, dentists and their chairside assistant nurses, with a higher proportion of Chinese, had higher anti-HBs prevalences compared with that of the general population.

Dental health care workers' response to the HIV epidemic

Random samples of Minnesota DHCWs were surveyed in late 1989 regarding HIV-related and infection control KAPs. Response rates were: dentists 69% (438/631); hygienists 73% (439/603); and assistants 56% (384/691). More than 50% of DHCWs said they did not have sufficient information to safely and effectively provide care for HIV-infected patients. Use of infection control techniques varied considerably. Parenteral injuries were relatively high, but only 5% of DHCWs believed they could have been exposed to HIV from these occurrences, and few DHCWs sought medical evaluation. Less than 45% of offices had a blood/body fluid exposure staff protocol, and few offices had a policy for HIV-infected staff. Nearly twice as many DHCWs said offices have an ethical versus a legal duty to treat HIV-infected persons. Low percentages of DHCWs believed the private practice dental office is the best place to treat HIV-infected patients, but approximately 50% said they would provide care. Twenty percent indicated that a diagnosed HIV-infected person had been seen at their office. Seventy-six percent said staff had been uncomfortable treating HIV-infected patients, 14% said staff had refused to treat, and 10% said referrals were difficult. DHCWs exhibited substantial improvements in their HIV-related KAPs compared to previous surveys. Nevertheless, additional cognitive and behavioral changes are necessary to ensure that all DHCWs provide care with the highest technical, legal, and ethical standards for all patients.