Participatory ergonomics intervention in an industrially developing country--a case study

In industrially developing countries, a few ergonomists have directed great efforts towards developing ergonomics awareness among managers and workers in organizations. There is little research on the degree of their success, though. Furthermore, access of organizations to ergonomics knowledge is usually very difficult, especially in industrially developing countries. Thus, building ergonomics awareness is certainly the first phase of the process. Three companies from one industry (44 people: 14 females and 30 males) participated in a project aimed at improving their work system. At the beginning, we needed to create a common goal and ensure participation with appropriate ergonomics tools. The findings of this study were the key issue for the ergonomics intervention (i.e., a shared vision, awakened need of change and learning). Further, to build ergonomics awareness and develop a continuous learning process in the company, it was necessary to use more ergonomics tools through workers' participation in different workplaces.

Resistance of medical gloves to permeation by methyl methacrylate (MMA), ethylene glycol dimethacrylate (EGDMA), and 1,4-butanediol dimethacrylate (1,4-BDMA)

Gloves afford hand protection by minimizing skin contact. The effectiveness of medical gloves to protect against permeation of the monomers, methyl methacrylate (MMA), ethylene glycol dimethacrylate (EGDMA), and 1,4-butanediol dimethacrylate (1,4-BDMA), was assessed focusing on permeation rates and degradation of glove materials caused by monomer contact. Fifteen different brands of gloves were tested using a European Standard procedure. Surface images of glove materials before and after exposure to the monomer mixture were obtained using a scanning electron microscope. The standard is not applicable as the only method for estimating the safety of gloves, but it is useful as guideline together with the cumulative permeation of acrylic monomers. Monomer contact on the outside resulted in substantial swelling of most glove materials, and structure changes of the inside surface.

Permeability of different types of medical protective gloves to acrylic monomers

Dental personnel and orthopedic surgeons are at risk when manually handling products containing methyl methacrylate (MMA). Dental products may also contain cross-linking agents such as ethylene glycol dimethacrylate (EGDMA) or 1,4-butanediol dimethacrylate (1,4-BDMA). Skin contact with monomers can cause hand eczema, and the protection given by gloves manufactured from different types of material is not well known. The aim of this study was to determine the breakthrough time (BTT, min) as a measure of protection (according to the EU standard EN-374-3) for a mixture consisting of MMA, EGDMA and 1,4-BDMA. Fifteen different gloves representing natural rubber latex material, synthetic rubber material (e.g. nitrile rubbers), and synthetic polymer material were tested. The smallest monomer MMA permeated within 3 min through all glove materials. A polyethylene examination glove provided the longest protection period to EGDMA and 1, 4-BDMA (> 120 min and 25.0 min), followed by the surgical glove Tactylon (6.0 min and 8.7 min) and the nitrile glove Nitra Touch (5.0 min and 8.7 min). This study showed that the breakthrough time (based on permeation rate) cannot be regarded as a 'safe limit'. When the permeation rate is low, monomers may have permeated before BTT can be determined. Using double gloves with a synthetic rubber inner glove and a natural rubber outer glove provided longer protection when the inner glove was rinsed in water before placing the outer glove on top.

Cytotoxicity of liquids and powders of chemically different dental materials evaluated using dimethylthiazol diphenyltetrazolium and neutral red tests

The purpose of this study was to assess and compare the cytotoxicity of liquid and powder components of chemically different dental materials using 2 basic unspecific cell culture methods. Three chemically cured glass ionomers (Fuji II, Lining cement, and Ketac Silver), 1 light-cured glass ionomer (Fuji II LC), and 2 chemically cured acrylates (Swedon and Super Bond) were tested. The liquids were diluted 1:10 in cell culture medium. The liquids from chemically cured acrylates were further diluted 1:100, 1:1000, and 1:10000. Extracts were made by incubating the powders in cell culture medium for 24 h at 37 degrees C according to the ISO standard 10993-12. The cytotoxicity was assessed in transformed mouse fibroblasts (L-929) using two viability assays, dimethylthiazol diphenyltetrazolium (MTT) and neutral red (NR). Severe cytotoxicity was observed when testing powder extracts of Swedon, Fuji II, and Lining cement, whereas powder extracts of Ketac Silver, Fuji LC, and Super Bond induced slight to non-cytotoxicity. All of the 1:10 liquid dilutions were severely cytotoxic in the MTT assay. In the NR assay, however, four 10% dilutions were severely cytotoxic and 4 moderately cytotoxic. Further dilution of the liquids of the chemically cured acrylates reduced the toxicity, while the Super Bond catalyst was severely cytotoxic even as the 1:100 dilutions.

Permeability of medical gloves to mono- and dimethacrylate monomers in dental restorative materials

Dental personnel manually handle methacrylate-based restorative materials, which can cause skin irritation and allergies. The protection given by different types of medical gloves is not well known. Breakthrough time (BTT, min) was used as a measure of protection according to a European standard, using 2 test mixtures consisting of respectively 3 and 5 monomers. Fourteen gloves representing natural rubber latex, synthetic rubber, and synthetic polymeric material were tested. The BTT ranged from some minutes to more than 2 hrs for the 4 monomers with a molecular mass less than 300. The longest protection was recorded for Nitra Touch (nitrile rubber), Tactylon (synthetic rubber), and Metin (PVC).

Users' demands regarding dental safety glasses. Combining a quantitative approach and grounded theory for the data analysis

Eye infections are common among dentists and many are concerned, but few are using proper eye protection. To understand users' demands behind the low use of safety glasses, all dental teams in Sweden were asked which factors they found most important when choosing dental safety glasses, and rate the importance of 31 statements regarding ergonomic aspects of dental safety glasses in a questionnaire. Data were analysed using the Grounded Theory and a quantitative approach. Results showed that dentists ranked the visual aspects as most important and chair assistants the protective aspects. The highly visual demanding work performed by dentists requires safety glasses that are not yet available on the market, which might explain the low use.

Cytotoxicity of dental glass ionomers evaluated using dimethylthiazol diphenyltetrazolium and neutral red tests

The purpose of this study was to assess the cytotoxicity of some commonly used glass ionomers. Three chemically cured glass ionomers (Fuji II, Lining cement, and Ketac Silver) and one light-cured (Fuji II LC) were tested. Extracts of mixed non-polymerized materials and polymerized specimens were prepared in accordance with ISO standard 10993-12. The polymerized specimens were cured and placed either directly in the medium (freshly cured), left for 24 h (aged), or aged plus ground before being placed in the medium. The cytotoxicity of extracts was evaluated on mouse fibroblasts (L, 929), using dimethylthiazol diphenyltetrazolium (MTT) and neutral red (NR) assays. Further, the concentrations of aluminum, arsenic and lead were analyzed in aqueous extracts from freshly cured and aged samples, and the fluoride levels analyzed in aqueous extracts from freshly cured samples. All extracts except that of non-polymerized Ketac Silver were rated as severely cytotoxic in both assays. Extracts of polymerized material were significantly more cytotoxic than extracts of non-polymerized material. All freshly cured glass ionomers released aluminum and fluoride concentrations far above what is considered cytotoxic (aluminum >0.2 ppm and fluoride >20 ppm). Extracts from freshly cured Lining Cement contained the highest concentrations of aluminum and fluoride (215 ppm and 112 ppm). Extracts from freshly cured Ketac Silver had the lowest concentrations of aluminum and fluoride but the highest of lead (100 ppm). It can be concluded that all extracts from non-cured, freshly cured, and aged glass ionomers contained cytotoxic levels of substances. Curing did not reduce the toxicity significantly.

Evaluating the potential occupational hazard of handling dental polymer products using the HET-CAM technique

The irritation potencies of 8 dental polymer products, used as dental restorative materials, adhesives, or temporary constructions, were tested using the HET-CAM (hen's egg test-chorioallantoic membrane) technique. Liquid and powder components, and extracts of cured and freshly mixed non-cured materials of 5 glass ionomers, 1 bonding, 1 composite, and 1 cold-cured acrylate were examined. Results showed that the liquid component of all products had a strong irritation capacity but powder suspensions and extracts from cured and freshly mixed non-cured materials had no effect on the CAM. Thus, dental personnel who handle liquid and powder manually are exposed to components with a high irritation potential, in contrast to patients who are exposed to the cured and mixed non-cured materials with low irritation potential. This illustrates the importance of safe handling procedures and practices for dental personnel who handle non-cured polymers manually.

Hand dermatitis and symptoms from the fingers among Swedish dental personnel

Hand dermatitis among dental personnel has been an issue in recent years. Dental personnel manually handle polymer materials which are known to irritate skin, and also cause allergy. In addition, dental personnel wash their hands frequently, and use latex gloves, and are therefore at risk to develop hand dermatitis. To survey the occurrence of hand dermatitis among dental personnel, questionnaires were sent to all dental teams (dentist + chair assistant) working in the two northern Swedish counties. Referents were; researchers, teachers, and secretaries from a university and high schools, from the same geographical area. The response rate was 76% for dental teams, and 66% for referents. The results show that male dentists reported a significantly higher prevalence of hand dermatitis than male reference. In contrast to chair assistants and referents, dentists (both male and female) reported a higher extent of hand dermatitis on the left than on the right hand. There was an association between hand dermatitis among dental personnel and; age, eczema in childhood, and hay fever but, not with; sex, asthma, frequent washing of the hands, and glove use. Whitening of the fingers increased with increasing age among dental personnel. Pricking was also associated with frequent glove use. Pricking of the fingers was associated with sex, and 3.5 times more common among female dental personnel than male dentists. Numbness of the fingers, and finger pain was reported by more dentists than chair assistants and referents.

Adverse health reactions in skin, eyes, and respiratory tract among dental personnel in Sweden

Dental personnel manually handle products that contain monomers. Several studies have documented adverse health effects after exposure to such products. Gloves made of vinyl or latex are easily penetrated by monomers. Ordinary glasses, or visors, do not protect against vapour from polymer products. Dental face masks filter out about 40% of respirable particles. To survey the prevalence of asthma, atopic dermatitis, conjunctivitis, hay fever/rhinitis, and hand eczema among dental personnel, a questionnaire was distributed to all dental teams in Northern Sweden. Referents were researchers, teachers, and secretaries from the same geographical area. The response rate was 76% for dental teams, and 66% for referents. The results show a significantly higher prevalence of conjunctivitis, and atopic dermatitis among dentists, both male and female. Hypersensitivity to dental materials was reported by significantly more dental personnel than by referents.

The Correlation Between Symptoms, Frequent Use of Dental Polymers, and Evaluation of Health Risk

Dental personnel are at risk as they manually handle polymer products containing monomers and additives that cause irritation and induce allergy. Gloves and face masks can be easily penetrated by monomers. A total of 587 dental personnel and a referent group (585) in the 2 most northern regions of Sweden were included in a questionnaire study (response rate 76%). Questions were asked regarding symptoms of atopy, asthma, conjunctivitis, atopic dermatitis, hand dermatitis, and hay fever/rhinitis. The dental personnel were asked to give the name of polymer products used in their practice and the frequency of use. They were also asked to risk evaluate 5 different types of polymer materials on a scale from 1 to 5. Analysis was done to find if the occurrence of a symptom was associated with a high risk evaluation of a polymer material, or with frequent use of a certain polymer product. Significantly more dentists reported symptoms of atopic dermatitis and conjunctivitis compared to referents and chair assistants. Results show that dental personnel with symptoms risk evaluated most materials significantly higher than dental personnel without symptoms. Further, the occurrence of some symptoms was associated with frequent use of 8 polymer products.

Use of polymer materials in dental clinics, case study

Dentistry uses a variety of different polymer materials. Dental polymer materials are based on methacrylate, its polymer, and polyelectrolytes. The setting of restorative materials and adhesives is initiated chemically by mixing two components or by light. In both cases, polymerisation is incomplete and monomers, not reacted, release. Studies have documented that monomers may cause a wide range of adverse health effects such as irritation to skin, eyes or mucous membranes, allergic dermatitis, asthma, parenthesise in the fingers, and disturbances from central nervous system such as; headache, pain in the extremities, nausea, loss of appetite, fatigue, sleep disturbances, irritability, loss of memory and changes in blood parameters. Dental personnel are occupationally exposed when handling the non reacted monomers. The use of gloves do not give enough protection as monomers, released from the material, easily penetrate all gloves used in dentistry. Face masks do not prevent inhalation of monomers. Ordinary glasses do not protect the eyes against vapor from monomers. The result from this study demonstrate the need for the development of ergonomic procedures and practices for safe handling of such materials in dental clinics.

Amalgam in Dentistry A Health Hazard for Dental Personnel?

In a cross sectional study done in 1993 among dental personnel in Norrbotten, self-reported prevalence of muscular pain, headache, tremor, insomnia, irritation, impaired memory and depression, as well as information regarding different mercury exposures were collected Mercury exposures were determined as "number of amalgam fillings in teeth," "years in practice," "insufficient ventilation at work," "total number of amalgam removed, produced and polished per day," and "working in dental clinics." As controls, physicians and nurses from the same geographical area were selected. The correlation between symptoms and different mercury exposures was calculated using logistic regression. The results suggested a higher prevalence of muscular fatigue and tremor for female dental personnel compared to controls Controls reported a lower prevalence of symptoms with increasing number of amalgam fillings in teeth. There was no correlation between the number of amalgam fillings handled per day and symptoms for dental personnel. Male dental personnel associated muscular fatigue headache, impaired memory, and depression with increased handling of amalgam in the clinic' whereas the female dental personnel associated the same symptoms with the number of amalgam fillings in teeth. The strongest correlation was found between symptoms and insufficient ventilation at dental clinics for dental personnel.

Dental clinics--a burden to environment?

To estimate environmental burden of mercury from dental clinics, a survey was conducted in 1993 at dental clinics in northern part of Sweden. Factors regarding amalgam separators, maintenance and disposal of collected sludge, age of clinics, cleaning of waste pipes, and sorting and handling of amalgam contaminated products were investigated. The result showed that many were not familiar with maintenance of the amalgam separator. A majority, 68%, were working in clinics older than 10 years, but only 9% reported that waste pipes had been cleaned or changed. Classification of amalgam contaminated products as high-risk and low-risk waste differed a lot, as well as handling of waste products. The result shows that there is need for more information and attention to all individuals working in Dental Care on how to reduce environmental burden of mercury from dental clinics.