Chemical factors of the working environment in the work of a dentist. Dangerous and harmful production factors and measures to protect against them by profession dentist Physical hazards in the work of dentists
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Sakhanov Anton Anatolievich 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: dissertation ... candidate of medical sciences: 14.00.21 / Sakhanov Anton Anatolievich; [Place of defense: GOUDPO "St. Petersburg Medical Academy of Postgraduate Education"]. - St. Petersburg, 2009. - 256 p.: ill.
Introduction
Chapter 1 Literature Review 8
Chapter 2 Materials and methods of research 34
2.1 Hygienic methods for studying the factors of the labor process 36
2.2 Microbiological research methods 40
2.3 Sociological research 41
Chapter 3 The results of studies at the workplaces of dentists of various specialties 42
3.1 The results of studies of the conditions and nature of work at the workplace of dentists and therapists at the therapeutic department 42
3.2 The results of research on the conditions and nature of work at the workplaces of pediatric dentists in the children's department 53
3.3 The results of studies of the conditions and nature of work at the workplaces of orthopedic dentists in the orthopedic department 66
3.4 The results of studies of the conditions and nature of work at the workplace of dentists and surgeons at the surgical department 81
3.5 The results of microbiological studies at the workplaces of dentists, therapists and orthopedists. 89
3.6 Results of sociological research 93
Chapter 4. Discussion of research results 99
Conclusion 107
References 115
Appendix 130
Introduction to work
The urgency of the problem. The complex relationship between working conditions and the health status of dentists has been studied by domestic and foreign scientists for a long period of time (Danilova N.B., 2004). Dentists are one of the most numerous categories of medical workers, who rank third in terms of occupational morbidity, among them the number of dentists is 65%. The negative impact of a number of factors of the working environment on the body of dentists-therapists was 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 are no data on a comprehensive assessment of working conditions and the health status of dentists-therapists. At the present stage, adjustments are being made to their practical activities due to the introduction of the latest achievements of the dental industry and the results of healthcare reform. In addition, the problem is of even greater interest due to the widespread introduction of the new specialty "general dentistry". The new specialty "general dentistry" includes expanding the scope of patient care by one specialist to include clinical activities inherent in other specialties. But the main work is done to help the patient in the framework of therapeutic dentistry. Thus, this calls for a more thorough and comprehensive assessment and study of a number of factors in the working environment of dentists-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:
To give a comprehensive hygienic assessment of working conditions and the nature of the work of dentists-therapists in comparison with dentists of other specialties;
Determine and study the quality and quantity of harmful factors present in the workplace of dentists-therapists, including the severity and intensity of the labor process in comparison with dentists of other specialties;
Based on the comprehensive assessment, identify the main harmful factors affecting the health of general dentists, in comparison with dentists of other specialties;
Based on the study of the nature of work activity, determine the likelihood of developing professionally caused diseases among general dentists;
Develop and implement a set of measures aimed at reducing occupational risk and maintaining the health of dentists-therapists.
Scientific novelty of the research:
For the first time, the level of risk of occupational diseases among dentists-therapists was determined and a comprehensive assessment of the conditions and nature of labor activity in certain medical dental specialties was 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 the performance of labor activities in the specialty therapeutic dentistry in comparison with the specialties of orthopedic dentistry, surgical dentistry and pediatric dentistry.
The theoretical significance of the study lies in the identification of the main factors and patterns that form 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 aimed at preventing the risk of occupational diseases and, therefore, preserving the health of dentists-therapists has also been developed.
Defense provisions.
In the course of their work, dentists-therapists are exposed to the complex effects of harmful and dangerous factors of the working environment: physical (microclimate, light, noise, vibration), chemical, microbiological
The most pronounced and common for dentists-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).
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 labor process.
The main aggravating indicator in assessing the severity of the work of general dentists, as well as for doctors of other dental specialties, is an uncomfortable fixed posture.
The practical significance of the work.
Based on the proven provisions, with the introduction of recommended measures, it seems possible to reduce the impact of harmful factors on the health of general dentists, 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 "Topical issues of clinical and experimental medicine". St. Petersburg (2006).
Structure and scope of work.
The dissertation consists of 4 chapters, 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.
Hygienic methods for studying the factors of the labor process
In industrial premises at workplaces, such hygienic factors as microclimate, noise, infrasound, ultrasound, vibration, illumination, air pollution with aerosols and bacterial contamination, as well as the severity and intensity of the labor process, were evaluated.
Hygienic studies provided for a comprehensive approach to assessing the working conditions of dentists in a comparative aspect, taking into account the influence of physical, chemical and biological production factors on the body. The assessment of working conditions was carried out in 33 rooms using modern equipment, informative generally accepted methods and in accordance with the currently existing methodological recommendations and regulatory documents (GOST, SN, SanPiN, MU).
As part of the assessment of architectural and planning solutions, the engineering and technical support of the premises and the compliance of the area of the rooms with the number of dental units located in them (one, two or more) were subject to examination, in accordance with the sanitary rules “Arrangement, equipment, operation of outpatient dental institutions, labor protection and Personal Hygiene of Personnel” No. 2956-83.
The microclimatic conditions of dental offices were determined by indicators of temperature, humidity, air velocity and thermal radiation. Microclimate studies in dental offices were carried out in accordance with GOST 12.1.005-88 "General sanitary and hygienic requirements for the air of the working area" and SanPiN 2.2.4.548-96 "Hygienic requirements for the microclimate of industrial premises".
The measuring instruments were: meteometer MES-2 (certificate of state verification No. 0162091 dated 02.09.2003); humidity and temperature meter TKA-TV (test certificate dated 10.10.2003).
The study included 495 measurements. The main source of acoustic vibrations of the infrasonic range, noise and local vibration in dental offices at workplaces are turbine units (which include dental compressors).
Instrumental measurements of the main parameters of industrial noise at the workplaces of dentists were carried out in accordance with GOST 12.01.050-86 "Methods for measuring noise at workplaces", "Guidelines for conducting, measuring and hygienic assessment of noise at workplaces" No. 1844-78. The analysis and evaluation of the results obtained was carried out in accordance with SN No. 2.2.4/2.1.8.562-96 "Noise at workplaces, in the premises of residential and public buildings and in residential areas."
Measurements and hygienic assessment of industrial infrasound were carried out in accordance with SN No. 2.2.4/2.1.8.583-96 "Infrasound at workplaces, in residential, public buildings and in residential areas." Acoustic changes were carried out by sound level meter t. As part of the study, 800 measurements were carried out.
Measurements and evaluation of local vibration parameters were performed in accordance with GOST 12.1.043-84 “Vibration. Measurement methods at workplaces in industrial premises”, GOST 12.1.012-90 “Vibration. General safety requirements”, “Guidelines for measurements and hygienic assessment of industrial vibration” No. 3911-85, SN 2.2.4/2.1.8.566-96 “Industrial vibration, vibration in residential and public buildings”. As part of the study, 600 measurements were carried out.
The noise and vibration measuring equipment used for instrumental measurements corresponded to GOST 17187-81 “Sound meters. General technical requirements and test methods”, GOST 17168-82 “Electronic octave and third octave filters” and GOST 12.4.012-83 SSBT Vibration. "Means of measurement and control of vibration at workplaces". Vibrometer "Robotron" vol. 00042 No. 61090, filter FE-2 No. 418, vibration sensor KS-50 No. 5024 (certificate of state verification No. 2/0013801 dated January 27, 2004) served as the measuring instrument. As part of the study, 1269 measurements were taken.
The assessment was carried out in various situational conditions: - included one dental unit; two; three or more (in an office with appropriate equipment); - during operation of the turbine handpiece: at idle and during mechanical processing of hard dental tissues; - when the micromotor is idling and during the processing of hard tooth tissues.
The parameters of noise and vibration generated by equipment of domestic (US-30) and imported (HIRADENT, SIEMENS) production were measured.
Identification of low-frequency acoustic oscillations of the infrasonic range, as well as establishing the degree of severity of infrasound relative to noise, was carried out by using the level difference on the scales "Linear" and "A".
Lighting of dental offices is carried out by combined and combined lighting. To assess the illumination, the following regulatory materials were used: SNiP 23-05-95 "Natural and artificial lighting", SanPiN 2.2.1.1278-03 "Hygienic requirements for natural, artificial and combined lighting of residential and public buildings", GOST 24940-96 "Buildings and structures. Illumination measurement methods”, GOST 26824-86 “Buildings and structures. Methods for measuring brightness”, Methodological recommendations “Hygienic requirements for illumination (brightness) for precise visual work” No. 3863-85, MU OT RM 01-98 / MU 2.2.4.706-98. Measuring instrument: digital photometer (luxmeter-luminance meter) TKA-04/3 No. 01021 (certificate of state verification No. 0118167 dated 09/23/2003). The study included 345 measurements.
The results of studies of the conditions and nature of work at the workplace of dentists and therapists at the therapeutic department
The dentist-therapist, leading the duty reception, works in 2 shifts with two regulated breaks. The day (morning) shift is 5.5 hours and the evening shift is 5.5; with a six-day work week. His main duties include: admission of patients with acute pain, diagnosis, treatment of dental caries, treatment of complicated forms of dental caries with temporary fillings, examination of the oral cavity with the issuance of certificates of sanitation and referral of patients for X-ray examination, to a dental surgeon and others. specialists, as well as maintaining medical and reporting documentation (filling out medical records, a sheet for registering patients of retirement age, a sheet for daily employment records, a summary sheet, etc.).
The workplace is located in an office with an area of 15m, the ceiling height is 3.2m, the volume of the room is 48m. There is only one doctor in the office. The workplace is equipped with a lifting and swivel chair, an EMO “Volgograd” unit, a dental chair for a patient, tables for instruments and for documentation. The dentist-therapist, leading the duty reception, works with a nurse serving two doctors (in different rooms). Uses a set of sterile dental instruments (probe, intraoral mirror, trowels, tweezers weighing 20-27g) and tips for a drill weighing up to 115g and dental burs weighing up to 5g. For treatment, the doctor uses the following drugs: devitalizing paste (arsenic-free), Dentin paste, 3% hydrogen peroxide. The tips are treated with 70% alcohol, the used burs are soaked in a solution: lysoformin 1.5%, blanisol 0.5%.
Work is carried out sitting or standing, periodically in an uncomfortable position (fixed posture with the body tilted and keeping the hands on weight). The operations are performed by the doctor sequentially: recording data in the registration log, questioning the patient (collecting complaints and anamnesis), adjusting the position of the chair, lamp, processing hands or latex gloves, examining the oral cavity and recording the dental formula, followed by diagnosis and determining the scope of work. In case of acute pain in a patient, depending on the diagnosis, the doctor performs instrumental and drug treatment of the carious cavity, the application of a devitalizing paste and temporary filling, or instrumental and drug treatment of the root canal. The daily workload of a dentist-therapist who is on duty is 20-25 patients per shift. The duration of admission of one patient depends on the complexity of the work and is 15-30 minutes in the treatment of complicated caries with the installation of a temporary filling, and when examining the oral cavity with the issuance of certificates and referrals to other specialists - 5-10 minutes.
According to the results of the research, the work shift time was distributed as follows: examining the patient's oral cavity and recording the dental formula, collecting and recording complaints, making a diagnosis occupied 35%; processing of hands, adjusting the position of the chair, talking with patients and work distractions - 17%; formation and filling of a carious cavity - 14%. Documentation took 34%. On average, the time the doctor performs the main operations that require concentrated attention is 75% of the working time. Physical dynamic load when moving goods at a distance of up to 1 m does not exceed 10 kgm. Mass (one-time) of goods moved manually constantly during the shift, up to 0.2 kg. The number of performed stereotypical working movements with a regional load with the predominant participation of the muscles of the hands and fingers is up to 12,000 movements. Static load when holding loads and applying efforts with one hand 1000 kgf s per shift. Working posture "standing" - up to 30% of the time, periodically fixed, uncomfortable up to 59%, body tilts at an angle of more than 39 single. Movements due to production needs, up to 0.5 km.
According to the results of the research, the severity of the work of a dentist-therapist conducting an on-duty appointment is assessed as class 3 - harmful work of the 1st degree, the indicator determining the class is the working posture.
As for the intensity of labor, it, in accordance with R 2.2.2006-05, approved. 01.11.2005 “Guidelines for the hygienic assessment of the factors of the working environment and the labor process. Criteria and classification of working conditions ”is determined by intellectual loads associated with solving complex problems using well-known algorithms, perceiving information with subsequent comparison and final assessment of parameter values, checking the completed task, working in conditions of increased responsibility for the final result. Sensory loads are characterized by the duration of concentrated observation up to 75% of the time with the size of the discrimination object of 1-0.3 mm for no more than 50% of the shift. The number of production facilities for simultaneous monitoring is up to 5. The density of signals and messages received on average for each hour of operation is not more than 75. There is no work with optical devices and monitoring of the screens of video terminals. The load on the auditory analyzer is determined by the intelligibility of words 100-90%, on the vocal apparatus - no more than 16 hours per week. The emotional load is due to the responsibility for the functional quality of the final work in the absence of a risk to one's own life and the presence of responsibility for the safety of patients. The monotony of loads is characterized by the number of steps necessary for the implementation of repetitive operations, more than 10 and the duration of their execution for more than 100 seconds. Time of active actions 90%. Work mode in 2 shifts without a night shift (day shift 5.5 hours, evening shift - 5.5) with two regulated breaks with a total duration of 7.7% of the shift time. The intensity of the work process of a dentist-therapist conducting a duty appointment is assessed by the sum of 22 indicators (the results of the studies are presented in the relevant protocols and in the certification card in Appendix No. 1) as 3rd class, 1st degree.
Along with the assessment of work regimes, hygienic factors were studied at the workplace: the levels of noise, local vibration, illumination, microclimate parameters and air pollution with aerosols and microorganisms were measured.
The equivalent noise level is 60 dBA (with a remote control of 60 dBA, taking into account the severity and intensity of work), the equivalent adjusted level of local vibration is 100 dB with a remote control of 126 dB. "Noise at workplaces in the premises of residential and public buildings and in residential areas." SanPin 2.2.412.1.8.562-96.
The air temperature in the room during the study period was within 23.8-24.2C at a relative humidity of 39-40% and a speed of 0.04-0.07 m/s.
The results of studies of the conditions and nature of work at the workplaces of pediatric dentists in the pediatric department
In the children's department, an assessment of working conditions and certification of 8 workplaces of pediatric dentists was carried out, of which: one is the leading duty reception and one is the leading outpatient reception serving children with temporary teeth.
The conditions and nature of the work of a pediatric dentist leading an outpatient appointment on duty A pediatric dentist leading an on-duty appointment works in 2 shifts (5.5 hours in the morning and 5.5 in the evening), a six-day working week. The main duties of a doctor include receiving children with acute pain, making a diagnosis, treating caries with temporary fillings, examining children for issuing certificates of oral sanitation, and referring patients to specialists. The total area of the cabinet is 32m, the ceiling height is 3.2m, the volume of the cabinet is 102.4m. There is only one doctor in the office. The workplace is equipped with a lifting and swivel chair, an EMO "Volgograd" unit without automatic shutdown of the compressor, a dental chair for the patient, tables for instruments and for documentation. The doctor uses a set of sterile instruments (mirror, probe, excavator, trowels, tweezers) weighing 20-27g and tips for a drill weighing up to 115g. The following drugs are used for treatment: Stomafil, Compa-dent, Silicia, Kemfil, Ketakmolyar, NON ARSENIC, Depulpin. The tips are processed with a 70% alcohol solution, the used burs are soaked in a solution: lysoformin 1.5%, blanisol 0.5%.
The work is performed mainly in the “sitting” position, periodically, when servicing patients, in an uncomfortable, fixed position with the body tilted and keeping the hands on weight. The main operations are performed sequentially in several stages: questioning, collecting an anamnesis and complaints, adjusting the position of the chair, lamp, processing hands or latex gloves, examining the oral cavity, followed by determining the amount of work. In the treatment of caries, the doctor performs the formation of a carious cavity, mechanical and drug treatment of the cavity and the installation of a temporary filling. Registration of documentation includes filling out sanitation cards, registers, sheets of daily employment records and a summary sheet.
The average daily workload of a doctor is 30-40 patients. The duration of the reception of 1 patient during examination and issuance of certificates is on average 3-5 minutes, in the treatment of caries with the installation of a seal - from 20 to 30 minutes. The working shift time was distributed approximately as follows: examination of the oral cavity occupied 28%, instrumental and medical treatment of carious cavities with subsequent filling - 20%, documentation - 28%, hand treatment, adjustment of the position of the chair and conversations with patients and work distractions occupied 25% . On average, the time a doctor performs major operations that require concentrated attention is at least 77% of a shift.
Physical dynamic load when moving goods at a distance of up to 1 m does not exceed 10 kgm. Mass (one-time) of goods moved manually constantly during the shift, up to 0.2 kg. The number of stereotyped working movements with a regional load with the predominant participation of the muscles of the arms and shoulder girdle is up to 5000 movements; with local load - with the participation of the muscles of the hands and fingers - up to 20,000 movements. Static load when holding loads and applying efforts with one hand - 1000 kgf per shift. The working posture is predominantly “sitting”, periodically fixed, uncomfortable up to 48%, body inclinations at an angle of more than 30 are single. Movements due to production needs, up to 0.5 km.
Based on the foregoing, the severity of the work of a pediatric dentist conducting an on-duty appointment is assessed as 3 class 1 degree, the class indicator is the working posture.
The intensity of labor is determined by intellectual loads associated with solving complex problems using well-known algorithms, perceiving information with subsequent comparison and final assessment of parameter values, checking the task being performed, and working under conditions of increased responsibility for the final result. Sensory loads are characterized by the duration of concentrated observation up to 77% of the time with a size of the object of distinction of 1-0.3 mm for no more than 50% of the shift. The number of production facilities for simultaneous monitoring is up to 5. The density of signals and messages received on average for each hour of operation is not more than 75. There is no work with optical devices (microscopes, magnifiers, etc.) and there is no monitoring of the screens of video terminals. The load on the auditory analyzer is determined by the intelligibility of words 100-90%, on the vocal apparatus - no more than 16 hours spoken per week. The emotional load is due to the responsibility for the functional quality of the final work in the absence of a risk to one's own life and the presence of responsibility for the safety of others. The monotony of loads is not expressed. Time of active actions 90%. Work mode for 5.5 hours in 2 shifts without a night shift, with two regulated breaks with a total duration of 7.7% of the shift time.
The intensity of the work process of a pediatric dentist conducting an on-call appointment is assessed by the sum of 22 indicators as grade 3, grade 2, the research results are presented in the relevant protocols and in the certification card in Appendix No. 4. This is due to the reception of a large number of patients, compared with outpatient doctors.
Hygienic factors were assessed at the workplace of a pediatric dentist on duty, the levels of noise, local vibration, illumination, microclimate parameters and air pollution with aerosols were measured when working with a dental unit.
The equivalent noise level was 65 dBA per shift with a remote control of 60 dBA, taking into account the severity and intensity of the labor process (with the compressor located directly in the treatment room).
The equivalent corrected level of local vibration was 109 dB at 126 dB MPC.
The air temperature in the room was in the range of 21.3-21.5C at a relative humidity of 20-21% and an air velocity of 0.03-0.07 m/s.
Natural lighting is represented by side window openings, KEO - 1.5%. Combined artificial lighting: illumination of working surfaces from the general lighting system 410-560 lux with a normalized 200 lux for this category of visual work; from the local - 10,000-13,000 lux with a normalized 750 lux.
The concentration of aerosol in the breathing zone of a dentist when working with a drill was 0.3 - 0.9 mg/m at MPC - 4.0 mg/m.
Thus, according to the totality of indicators, the working conditions of a pediatric dentist who is on duty are assessed as harmful - 3rd class, 2nd degree. The research results are presented in the table (Table 4) and in Appendix No. 5.
The results of studies of the conditions and nature of work at the workplaces of orthopedic dentists at the orthopedic department
In the orthopedic department, an assessment of working conditions and certification of the workplaces of orthopedic dentists, including the head of the orthopedic department and the orthopedic doctor on duty, was carried out.
Head of the orthopedic department, works in 1 shift for 5.5 hours in the head's office. The working day begins with the preparation of the work program for the current day. Then he walks around the department and checks the preparation for work and equipment. From 10 o’clock he begins to receive patients for a consultation, draws up documents for orthopedic treatment of patients, resolves controversial issues that have arisen at the department, fills out “refusal” cards, if necessary, directs patients for a consultation with an allergist, draws up a schedule and a report card for a month on social prosthetics. Prepares monthly and quarterly reports.
Within 2 hours, he receives patients in the treatment room. The area of the treatment room is 75m2, the ceiling height is 3.2m, the volume is 240m. There are 5 dental units in the office. At the same time, he performs all operations related to orthopedic treatment. The workplace is equipped with a swivel chair, Chirodent unit, dental chair for the patient, tables for instruments and for documentation. Uses a set of tools - a mirror, a probe, spatulas, tweezers, tips for a drill and preparations Unifas-2, Stomafil, Temp-bond, Fuji I, Provicol, etc. The tips are treated with 70% alcohol, the used burs are soaked in a solution: lysoformin 1, 5%, blanisol 0.5%. The doctor performs the preparation of teeth using a dental unit for 5 to 30 minutes, depending on the amount of preparation of hard tissues of the teeth. To make an impression, the doctor puts 1-2 measured spoons of the impression alginate mass into a rubber container, dilutes it with a small amount of water, mixes it and puts the finished mass on the impression tray, inserts it into the oral cavity and holds until the impression mass is completely polymerized. Then he removes the impression tray and sends it to the dental laboratory.
The most time-consuming work during prosthetics was observed during prosthetics with metal-ceramic structures. Within 0.5 hours, the tooth is processed under the crown. In the presence of teeth with intact pulp, anesthesia was preliminarily performed. When making an impression for the manufacture of metal-ceramic structures, the technique of two-layer silicone impressions and a retraction thread is used, this operation takes up to 1 hour. Then the shade of the ceramic mass is selected in natural light. The patient visits the doctor several times. Checking the design of a metal-ceramic prosthesis can be performed in the presence of a dental technician, then the prosthesis is pre-fixed for 1-2 weeks with Provicol temporary cement, after which repeated adjustments are possible using a dental unit. Then the final fixation of the prosthesis is performed. The doctor works sitting or standing, periodically in an uncomfortable, fixed position with an inclination of the body and holding hands on weight.
The physical dynamic and static load of the doctor is insignificant. Mass (one-time) of goods moved manually, up to 1 kg. The number of stereotyped movements with a regional load with the predominant participation of the muscles of the arms and shoulder girdle is up to 10,000 movements; with local load - with the participation of the muscles of the hands and fingers - up to 20,000 movements. The main working posture is "sitting", "standing" - up to 30% of the time, periodically fixed, uncomfortable up to 25%, single body inclinations at an angle of more than 30 are possible. Transitions due to production needs, up to 2 km.
Based on the foregoing, the severity of the work of an orthopedic dentist, head of the orthopedic department is assessed as class 2 - average physical activity.
The intensity of work is determined by intellectual loads associated with the sole leadership in difficult situations, the perception of information with subsequent comparison and comprehensive assessment of interrelated parameters, control and preliminary distribution of tasks to subordinates, work in conditions of increased responsibility for the final result. Sensory loads are characterized by the duration of concentrated observation up to 75% of the time with a size of the object of distinction of 0.3-1 mm for no more than 50% of the shift. The number of production facilities for simultaneous monitoring is up to 10. The density of signals and messages received on average for each hour of work is up to 175. The load on the auditory analyzer is determined by the intelligibility of words 90-100%, on the voice apparatus - up to 18 hours per week.
The emotional load is due to the responsibility for the functional quality of the final work in the absence of risk to one's own life and the presence of responsibility for the safety of patients. The monotony of loads is characterized by the number of steps necessary for the implementation of repetitive operations - 9-6 and the duration of their execution for more than 100 seconds. Time of active actions - 80%. Work mode in one shift without a night shift for 5.5 hours with two regulated breaks with a total duration of 7.7% of the shift time.
The intensity of the labor process of the head of the orthopedic department was assessed by the sum of 22 indicators as class 3 - hard work of the 2nd degree, the results of the studies are presented in the relevant protocols and in the workplace attestation card in Appendix No. 11.
Hygienic factors were assessed at the workplace, taking into account the severity and intensity of labor, while at the workplace of the head of the orthopedic department and at other workplaces, the levels of noise, local vibration, illumination, microclimate parameters and air pollution by aerosol were measured.
Poselyanova, Irina Vladimirovna Chugaeva, Uliana Yurievna
Volgograd Medical Academy
Department of Therapeutic Dentistry
PROFESSIONAL HAZARDS
IN THE WORK OF A DENTIST
AND PREVENTION OF CONSEQUENCES
THEIR IMPACTS
(EDUCATIONAL - METHODOLOGICAL AID)
Volgograd, 1998.
Compiled by:
cand. honey. Sciences, Associate Professor V. F. Mikhalchenko, Doctor of Medicine Sciences, Associate Professor E. S. Temkin, Ph.D. honey. Sciences, assistant N. M. Morozova, clinic. intern 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.
Teaching aid
approved at the cyclic methodological commission
Faculty of Dentistry VMA.
Professional hazards in the work of a dentist and prevention of the consequences of their impact: 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 the rules of occupational health, which entail undesirable consequences. At the same time, the health of the doctor is exposed to many dangers. Minor deviations from normal working conditions from year to year accumulate and lead to consequences that make it difficult or impossible for a doctor to continue his professional activity.
A person's ability to work during the working day is not the same. At the beginning of work, the working capacity is relatively low. During work, the functional ability of the body and labor productivity naturally change throughout the work shift. Changes in working capacity during the working day have several phases:
1.Workability or increasing performance. 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 working capacity. It is characterized by high labor indicators. The duration of this phase 2 - 2.5 hours or more, depending on the degree of neuro-emotional stress, physical severity and hygienic working conditions.
3. Decay phase manifested by a decrease in attention, the appearance of unnecessary movements, erroneous reactions.
The internal order of work is especially important. If a doctor, having crossed the threshold of the office, examines one patient after another at a frantic pace, leaving himself not a minute of rest, then he not only loses human contact with patients, their trust, but also harms himself. Increasing from day to day "race" easily becomes the working norm of the doctor. A large load leads to a huge expenditure of energy, fatigue, which sometimes can be somewhat suppressed by the use of stimulating medications and other means, but not overcome.
Fatigue is a condition accompanied by a feeling of fatigue, decreased efficiency, attention, caused by intense and prolonged activity, expressed in the deterioration of quantitative and qualitative indicators of work and ending after rest.
I. M. Sechenov showed that fatigue does not occur 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.”
IP Pavlov believed that the inhibition that occurs during fatigue in the central nervous system is limited - by limiting the performance of the cortical cells of the brain, it preserves nerve cells from overstrain and death.
Neglecting fatigue, volitional or otherwise overcoming fatigue, more and more plunges us into a state of chronic overwork, characterized by a number of symptoms: fatigue, lethargy, indifference, poor ability to concentrate, memory loss, constant haste in actions, irritability, poor sleep.
An overworked person's movements become slow and poorly coordinated. Labor productivity is declining to a large extent, both qualitatively and quantitatively. The general condition is characterized rather not by drowsiness, but, on the contrary, by increased excitability. As a result of the altered reactivity, a typical picture of neuro-circulatory dystonia appears, various functional disorders (stomach, intestines, blood vessels and skin). As a result of circulatory disorders, oxygen deficiency occurs and diseases such as coronary artery 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 cause of increased irritability is the constant haste and tension at work. In haste, all normal ideas are shifted: insignificant little things gain sudden weight, small failures take on the character of a catastrophe. Having lost inner balance, we lose the ability to see clearly, the hand ceases to obey the brain. If this condition lasts for several years, it can cause the severe consequences described above. To avoid them, you must follow some rules:
1) in order to evenly enter the work, it is not advisable 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 - 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, relax, in the second half, walk and make active movements, thereby increasing blood circulation.
WORKING CONDITIONS AND
DENTIST'S PERFORMANCE
The workplace of a doctor is of great importance for labor productivity. Rational distribution of furniture, frequent airing of the premises during the working day provide 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 the well-being of a person.
It is necessary to strive for access to natural light in the office. Windows should face north or east. Walls and ceiling should be painted in light colors. Preferred colors: light blue, light green, light gray, beige.
Furniture, devices, 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
THE DENTIST, THE REASONS FOR THEIR APPEARANCE,
ELIMINATION METHODS, PREVENTION
A dentist spends most of his working time manipulating instruments. It is generally accepted that irrationally thin tool handles lead to overexertion and muscle spasms (Fig. 1).
When holding a thin instrument, the muscles are tense, 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. The fingers should rest freely on the instrument (Fig. 2.3).
Often there is an inconvenient shape of tips for a drill. The absence of a swivel head forces the doctor to twist his arm while working. Sharp edges on the body contribute to the formation of calluses and cause pain in the fingers, there is a curvature of the third finger of the hand: on the left - due to the uncomfortable 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 repeatedly move towards each other with effort;
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. Clenching your fist, slowly take out your thumb.
Dupuytren's contracture
This disease develops in people who constantly work with hard tools, cleavers, axes, hammers. It is often observed in dentists, because most of the tools (forceps, tips) constantly press on the same place on the palm.
On the middle, ring finger or on the little finger, rope-like knotted thickenings of the palm appear, 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 
Treatments include hot air showers, hot palm baths, paraffin wax, ozocerite, passive stretching, or overnight splints. Brüne proposed a cuff - a steel tape 2 cm wide is sewn into a tight belt and placed on the palm or back of the hand (Fig. 7.8).
Thanks to the steel band, 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 that to unload the right hand, train the left for all work associated with high stress.
tendovaginitis
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 as a very serious disease. When the first signs of it appear, you should take a break from work. Then it will be possible to avoid pain in the hands and other unpleasant consequences of tendovaginitis. The combination of tendovaginitis with Raynaud's disease leads to occupational disability. Fingers become cold, bloodless, pale. In severe cases, gangrene occurs.
Especially often tendovaginitis and circulatory disorders occur in dentists who work 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 relieved of loads that exceed his physiological capabilities.
Treatment of tendovaginitis. Conservative treatment: thermal procedures, lidase or ronidase electrophoresis, massage, resting the affected hand. In severe cases, surgery is indicated, which consists in dissection of the tendon sheath and excision of the annular ligament.
If the main etiological factor is not eliminated - the systematic overstrain of the finger, then the process progresses, does not lend itself to conservative treatment, even in young people.
The impact of vibration on the body of a dentist
Vibration sources include manual mechanized rotary machines: a drill and directly a dental handpiece.
Prolonged exposure to vibration, combined with a complex of adverse factors (static muscle loads, noise, emotional overstrain) can lead to persistent pathological disorders in the body of workers, the development of a vibration disease.
The pathogenesis of vibration disease is not well understood. It is based on a complex mechanism of neuro-reflex and neurohumoral disorders, which lead to the development of congestive excitation with subsequent persistent changes in the receptor apparatus and the central nervous system. Direct mechanical traumatization, primarily of the musculoskeletal system (muscles, ligamentous apparatus, bones and joints), is not excluded.
Vascular disorders are one of the main symptoms of vibration disease. Most often they consist in violation of peripheral circulation, changes in capillary tone. Doctors complain of sudden attacks of whitening of the fingers, which are more likely to occur when washing hands with cold water or when the body is generally cooled.
Polyneuropathic symptoms are manifested by aching, aching, pulling pains in the hands. Pain is accompanied by paresthesia, increased chilliness of the hands. Pain and temperature sensitivity suffers.
Therapeutic and preventive measures:
1) reduction of vibration intensity due to design improvements;
2) control over the serviceability of the equipment, since a pronounced increase in vibration occurs during operation and wear;
3) compliance with the regime of work and rest;
4) medical - preventive and general health measures
a) thermal procedures for hands in the form of hydroprocedures (baths);
b) massage and self-massage of hands and shoulder girdle;
c) industrial gymnastics;
e) vitamin prophylaxis and other restorative procedures - a psychological unloading room, an oxygen cocktail, etc.
Diseases associated with prolonged static load
Under the static load, which leads to overload diseases, we understand any work that requires the adoption and retention of 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 - the process of contraction of the muscles necessary to maintain the body or its parts in space. In the process of labor, static work is associated with fixing objects in a stationary state, as well as with giving a person a working posture.
With a static effort, from the point of view of physics, there is no external mechanical work, however, in a physiological sense, work is available. Static work is more tiring than dynamic work, since muscle tension lasts continuously, without pauses, without allowing them to rest. In addition, blood circulation in the working muscles is difficult, there is a decrease in blood flow, a decrease in oxygen consumption and a transition to anaerobic energy supply with the accumulation of a large amount of lactic acid. Immediately after the cessation of static work, oxygen consumption rises sharply and blood flow increases (Lingard's 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, poor visibility makes doctors take an uncomfortable, unnatural position, which they are forced to maintain for a long time. Static disorders affect ligaments and muscles. With a long unilateral load, the muscles first get tired, then they stretch and, as a result, the joints are weakened and the bones are displaced. There are so-called stress skeletal muscle diseases. Fatigue develops during work, pain during movement and spontaneous pain at rest. Muscles and joints are painful on palpation.
A shift in the knee joint leads to a displacement of the hip and a change in the contact of the femoral head and acetabulum. The position of the lower leg changes, injuries to the ankle joint and foot occur. Many dentists turn their feet outward to get as close to the patient's chair as possible. In this case, the weight of the body 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, the position of the thigh or the entire pelvis changes, the entire musculature of the pelvis shifts upward (Fig. 9). This leads to curvature of the spine.
The doctor leans forward, his arms tensed. This additionally overloads the occipital and dorsal muscles. In this position, the blood rushes to the legs. The blood pressure in the arteries of the legs and feet is twice as high as in the supine position. This leads to redistribution of blood. Dizziness, fainting, diseases of the pelvic organs occur, menstruation intensifies in women. When a person leans while standing, the weight of the body is more on one leg and one hip. The ribs approach each other on one side, 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 the bile ducts, bile flow worsens and stones appear (Fig. 11). In women, the dome of the uterus shifts away from the midline, and the intestinal loops move accordingly. Prolonged tilt of the body to the side causes neuroasthenic disorders and neuroses of the liver and intestines. Compression of the abdominal organs leads to enteroptosis, dyspepsia, gastritis, neurovegetative dystonia, which often affects dentists.
Pain in the shoulder and arm are caused by irritation of the nerve roots in spondylosis of the lower cervical vertebrae. Headaches that occur in the sockets behind the eyes appear due to overexertion of the occipital muscles.
Some doctors have a bad habit of holding their breath and raising their shoulders high when performing difficult and complex work in the oral cavity. By doing this, the doctor is trying to somehow facilitate and compensate for difficult access to the object. There is a shift in the center of gravity and the distribution of the load on the legs is disturbed. There is fatigue of the feet, pain in the Achilles tendons and calf muscles. Pain can spread to the muscles of the thigh and buttocks, mimicking rheumatism.
Occupational stress, metabolic
and neurohumoral 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 thought processes, and the emotional sphere. The work of medical workers is associated with constant contacts 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, and increased body temperature. Mental work associated with neuro-emotional stress causes an increase in the activity of the sympathetic-adrenal, hypothalamic-pituitary, and cortical systems. With emotional stress, there is an acceleration of the exchange of catecholamines, an increase in the release of norepinephrine in the sympathetic ganglia, an increase in the blood levels of adrenaline and glucocorticoids. The optimization of mental work should be aimed at maintaining a high level of efficiency 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 the continuation of mental activity in a given direction. After the end of work, the “working 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- the nervous pathway, when the reaction of the hypothalamus to stress is regulated by higher nerve centers in accordance with the intensity and nature of the stress. Second the path 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 these are particularly important: the sympathetic-adrenal system, which secretes catecholamines, and the pituitary-adrenal cortex, which secretes corticosteroids.
The immediate reaction of the neuro-endocrine system to stress leads to the activation of the sympathetic-adrenal system. The most important catecholamines are released: epinephrine and norepinephrine. Catecholamines are the most important regulators of adaptive 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 are released from the adrenal cortex, acting in stressful situations: mineralocorticoids, glucocorticoids, and androgens.
In conditions of constant psycho-emotional stress, the secretion of adrenaline increases, which is important for the activation of 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.
In conditions of psycho-emotional stress in stressful situations, the following functional disorders may occur:
Muscular symptoms: tension and pain;
Gastrointestinal symptoms: dyspepsia, vomiting, heartburn, constipation;
Cardiovascular symptoms: palpitations, arrhythmia, chest pain;
Respiratory symptoms: shortness of breath and hyperventilation;
CNS symptoms: neurotic reactions, insomnia, weakness, fainting, headaches.
Of the cardiovascular symptoms, coronary insufficiency and arterial hypertension are the most common.
Elimination and prevention of violations that have arisen.
To avoid these phenomena, it is necessary to abandon excessively tense body positions and replace them with more comfortable ones. The main reasons forcing the 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 the lack of time, doctors regret the few seconds and movements required to give the chair the desired position. Sometimes only illness or severe 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.
The effectiveness of the professional activity of doctors is largely determined not only by their qualifications and the 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 terms of number (8.1%) after diagnostic laboratory assistants (9.4%), pediatricians (14.8%), general practitioners (21%) and specialized doctors (28.1%) .
The daily practice of a dentist is associated with the presence of a large number of risk factors that entail negative consequences, leading to a deterioration in the health of a specialist and the inability to perform their professional duties in a quality manner. Among them: an increase in neuro-emotional stress, a forced working posture, irrational lighting, the 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 study of 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 the noise (and vibration) that accompanies the operation of high-speed dental equipment, doctors are more likely to develop disorders of the nervous system and occupational unilateral hearing loss. Often, to increase the power of the dental unit, it is equipped with an additional aspiration system. Despite the noise isolation of these pumps, they emit monotonous loud noises that adversely affect the hearing aid and make it difficult for the interaction between the doctor and the patient, and the assistant and the doctor at the dental appointment.
Electromagnetic radiation (a professional computer, a lamp from a dental unit, a telephone, a microwave oven, a refrigerator, etc.) when exposed to the body can negatively affect the organs of the reproductive system, leading to adverse long-term effects. We should also not forget about the detrimental effect of electromagnetic radiation on the hematopoietic organs (bone marrow), the central nervous system and, of course, on the eyes, where a long-term damaging effect will lead to serious vision problems (cataracts, changes in the retina by the type of angiopathy, sclerosis of retinal vessels, in some cases, the formation of dystrophic foci in the macular region).
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 in working with x-rays can lead to:
1. Blood disease - hemolytic anemia; 2. The occurrence of cataracts; 3. An increase in the incidence of oncology; 4. Rapid aging; 5. Reduced 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 found in the air of dental rooms all year round in concentrations that exceed the MPC (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 are: nausea, repeated vomiting, headache, noise in the head, dizziness, thirst, weakness, drowsiness leading to loss of consciousness, hypotension and the development of epileptiform convulsions. Chronic inhalation exposure to MMA in high concentrations in the air of the working area contributes to the development of intoxication, accompanied by dysfunction of the nervous system.
2. Biological factors (pathogenic microorganisms).
Various patients, including those with chronic infectious diseases (pulmonary tuberculosis, venereal diseases, etc.), who are carriers of pathogenic bacteria and viruses, such as hepatitis B, hepatitis C, meningitis, and HIV infection, seek to see a dentist.
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 pathogens.
3. Psychophysiological factors.
The main psychophysiological factors affecting the health of a dentist are:
1. Posture while working, standing or sitting for a long time; 2. Static load on the hands; 3. Visual tension.
Dentists - surgeons work most of their working time standing, in an inclined position. Prolonged work in this position contributes to the curvature of the spine and legs, pelvic deformities, flat feet, varicose veins of the lower extremities.
It is generally recognized that it is irrational - thin tool handles cause overstrain and spasm of the muscles of the hand. Often, dentists develop Dupuytren's contracture, because. most tools (forceps, tips) constantly press on the same place in the palm during the work shift. In addition, prolonged, often repetitive tension of individual muscle groups in a forced position contributes to the development of tendovaginitis.
In the process of work, the doctor performs constant visual control, since working in the oral cavity with a cutting tool rotating at a speed of up to 450 thousand revolutions per minute, near soft tissues, is quite dangerous and can lead to negative consequences. With difficulty in accessing the working field, the doctor brings his gaze as close as possible to the working area, this leads to a contraction of the lens muscles and an increase in its curvature.
The dentist works in a combination of natural and artificial lighting. Artificial lighting sources include incandescent lamps, fluorescent lamps, xenon reflectors that can cause the development of visual and general fatigue, working myopia due to the intense work of the direct internal muscles of the eye, and spasms of accommodation. The daylight we see in its spectrum contains part of the 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 not able to stop the ultraviolet stream emitted by the halogen lamp, which leads to the impact of ultraviolet radiation on the retina. The photoreceptors of the eye are affected, which leads to loss of sensitivity of individual cells, and then to the loss of visual fields.
The assistant plays a significant role, it makes the work of a dentist less stressful and reduces the amount of time spent. However, 60% of doctors work without an assistant, which reduces the convenience of working 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 in reducing the efficiency 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 judicial and pre-trial instances, defend queues, waste money and time. All this will lead to an increase in the doctor's nervousness (stress), an increase in fatigue, which will ultimately affect the state of immunity.
With a decrease in the activity of immunity, we become more susceptible to various kinds of diseases, including the exacerbation of existing chronic diseases. This is of particular importance in winter, where against the background of reduced immunity (lack of sunlight, which means a lack of vitamin D), immunity is weakened even more, which increases the likelihood of a dentist getting acute respiratory viral infections, adenovirus, and also increases the likelihood of contracting various types of diseases. from patients directly at the dental appointment.
1. The work of a dentist is associated with the impact of a number of professional risk factors leading to a deterioration in the health of a specialist;
2. Organization and development of preventive measures to create optimal working environment conditions is the key to improving health and improving the efficiency of dentists.
Bibliography
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The technological process in the main premises of the dental laboratory includes work on heat treatment of crown sleeves, wax melting, gold casting, drying of denture parts before soldering, whitening of metal dentures in acid solutions, grinding of dentures, etc. As a result, the dental technician is exposed to carborundum dust, plastics and metals, which is formed during the processing of stainless steel prostheses, low-melting metals, as well as lead, mercury and acid fumes that are released during the production of prosthesis blanks.
For the manufacture of denture bases, Fluorax is used, which is a hot-curing plastic based on fluorine-containing acrylic copolymers of the powder-liquid type. Fluorax prostheses have increased strength, elasticity, and their color and translucency harmonize well with the soft tissues of the oral cavity. The basis in this compound is methyl methacrylate, which is a highly effective toxic substance. Its content in the breathing zone of a dental technician (without the use of a fume hood) significantly exceeds the permissible concentration.
At the workplace of a dental technician, when grinding a prosthesis on corundum stones and processing a metal prosthesis, broadband noise appears, which is 83-84 dB, which exceeds the permissible sound pressure levels.
Vibration on the surface of a plastic prosthesis, in the places of its contact with hands during processing on a grinding wheel, exceeds the permissible vibration velocity values by 2 dB in an octave of 63 Hz.
Prevention . To reduce noise and vibration levels at the workplace of a dental technician, it is necessary, as when working with turbine drills, to monitor the technical condition of the noise-vibrating mechanism. Grinders must be mounted 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. There should be strict control over the state of the grinding stone, to prevent its wear, potholes, etc. It can be recommended that dental technicians, when performing technological operations associated with noise, use personal hearing protection: anti-noise phones and the so-called "Earplugs", which are inserted into the external auditory canal and are designed for single use.
The dental laboratory has a number of production facilities, each of which is designed to perform certain ancillary work and is distinguished by various occupational hazards.
In the plaster cast, gypsum is sifted, models are cast, denture parts are gypsumed into cuvettes and the dentures are released from the plaster mold. In the soldering room, individual parts of the prostheses are soldered using a soldering machine, after their preliminary cleaning with acids from scale. In the molding and polymerization, all processes for the manufacture of plastics are carried out, including polymerization, which requires prolonged boiling in water. In polishing work is done on grinding and polishing prostheses. In the foundry, parts of dentures are cast from various metal alloys in special melting machines.
In this regard, the following occupational hazards are observed in industrial premises:
1) in gypsum - gypsum dust;
2) in the soldering room - vapors of nitric and hydrochloric acids, metals to be soldered, solder material, dust of carborundum, pumice, silicon dioxide
3) in the molding and polymerization - water vapor, acrylates, volatile wax components;
4) in the polishing room - dust of abrasive materials (carborundum, pumice, pastes) and prosthesis materials;
5) in the foundry - pairs of various metals that are used to make metal dentures (gold, silver, copper, platinum, cadmium, zinc, chromium, nickel, titanium, manganese, palladium, tin, lead, bismuth, iron, etc.) .
The surface of dentures is usually infected. Constant contact with prostheses during their manufacture and correction leads to contamination of the hands of dental technicians with various microbes, including pathogens. So, in the work of dental technicians there is a danger of infection by contact, which requires the widespread use of modern methods of disinfection and sterilization.
Prevention . To ensure the proper sanitary condition of the air in the premises of the dental laboratory, it is necessary to have a rational system of central artificial ventilation, as well as the obligatory arrangement of local mechanized exhaust ventilation in the form of fume hoods, exhausts, umbrellas, which ensure the removal of dust, vapors and gases directly from the places of their formation. To protect dental technicians from the harmful effects of acrylic plastics, it is recommended to wear a mask on the face and goggles on the eyes.
As a manuscript
SAKHANOV
Anton Anatolievich
CLINICAL AND HYGIENIC FEATURES OF THE INFLUENCE OF HARMFUL AND DANGEROUS FACTORS IN THE WORK OF A DOCTOR WORKING IN THE SPECIALTY OF THERAPEUTIC DENTISTRY, PREVENTION MEASURES
14.00.21 – dentistry
14.00.07 – hygiene
for the degree of Candidate of Medical Sciences
SAINT PETERSBURG
The work was performed at the Department of Therapeutic Dentistry of the State Educational Institution of Additional Professional Education "St. Petersburg Medical Academy of Postgraduate Education of the Federal Agency for Health and Social Development"
Scientific supervisors:
Official opponents:
doctor of medical sciences professor Ivanova Galina Grigoryevna
Doctor of Medical Sciences Professor Chashchin Valery Petrovich
Lead organization:
GOU VPO "St. Petersburg State Medical University. acad. I.P. Pavlov of the Federal Agency for Health and Social Development"
The defense will take place on "__" "__" 200 at ___ hours at a meeting of the dissertation council D 208.089.03 at the State Educational Institution of Additional Professional Education "St. Petersburg Medical Academy of Postgraduate Education of the Federal Agency for Health and Social Development" (195196, St. Petersburg, Kirochnaya street, 41)
The dissertation can be found in the fundamental library of the State Educational Institution DPO St. Petersburg MAPO Roszdrav (195196, St. Petersburg, Zanevsky pr., 1\82).
| Scientific Secretary of the Dissertation Council Doctor of Medical Sciences | O.V. Mironenko |
general description of work
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 a long period of time. Dentists are one of the most numerous categories of medical workers, who rank third in terms of occupational morbidity, among them the number of dentists is 65%. The negative impact of a number of factors of the working environment on the organism of dentists was 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 working conditions and the health status of dentists. At the present stage, adjustments are being made to their practical activities due to the introduction of the latest achievements of the dental industry and the results of healthcare reform. In addition, the problem is of even greater interest due to the widespread introduction of the new specialty "general dentistry". The new specialty "general dentistry" includes expanding the scope of patient care by one specialist, with the inclusion of clinical activities inherent in other specialties. But the main work is done to help the patient in the framework of therapeutic dentistry. Thus, this calls for a more thorough and comprehensive assessment and study of a number of factors in the working environment of dentists.
Purpose of the study: development of medical, preventive and hygienic measures to improve working conditions and preserve the health of a dentist therapist.
To achieve this goal, the following tasks:
- To give a comprehensive hygienic assessment of working conditions and the nature of the work activity of dentists and general practitioners in comparison with dentists of other specialties;
- To determine and study the quality and quantity of harmful factors present at the workplace of dentists and therapists, including the severity and intensity of the labor process, in comparison with dentists of other specialties;
- Based on the comprehensive assessment, highlight the main harmful factors affecting the health of general dentists, in comparison with dentists of other specialties;
- Based on the study of the nature of work activity, determine the risk of developing occupational diseases among dentists and general practitioners;
- Develop and implement a set of measures aimed at reducing occupational risk and maintaining the health of dentists and general practitioners.
Scientific novelty of the research:
For the first time, the level of risk of occupational diseases among dentists and general practitioners was determined and a comprehensive, comparative assessment of the conditions and nature of work in certain medical dental specialties was 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 the performance of labor activities in the specialty therapeutic dentistry in comparison with the specialties of orthopedic dentistry, surgical dentistry and pediatric dentistry.
Theoretical significance of the study is to identify the main factors and patterns that form the risk of occupational diseases of general dentists in comparison with dentists of other specialties, namely dental surgeons, orthopedic dentists and pediatric dentists. A system of measures aimed at preventing the risk of occupational diseases and, therefore, preserving the health of dentists and therapists has also been developed.
Defense provisions.
- In the course of their work, dentists and therapists are exposed to the complex effects of harmful and dangerous factors of the working environment: physical (microclimate, light, noise, vibration), chemical, microbiological, hygienic
- The most pronounced and common for dentists and 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).
- 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 the severity of the labor process.
- The main aggravating indicator in assessing the severity of the work of dentists, therapists, as well as for doctors of other dental specialties, is an uncomfortable fixed posture.
All studies were carried out by the author or with his direct participation: collection and analysis of literary sources, certification of workplaces of dentists, measurements of noise, vibration, illumination, dustiness, determination of the severity and intensity of labor, collection of material for microbiological studies, statistical processing with analysis of the data obtained.
The practical significance of the work.
Based on the proven provisions, when implementing the recommended measures, it seems possible to reduce the impact of harmful factors on the health of dentists, general practitioners, as well as doctors of other dental specialties.
Approbation of work.
The results of the work were tested: at the "XI International Conference of Maxillofacial Surgeons and Dentists" St. Petersburg (2006); at the scientific-practical conference of young scientists "Topical issues of clinical and experimental medicine". St. Petersburg (2006).
Publications.
Implementation of the results of scientific research into practice.
Theoretical and practical data obtained as a result of the study were implemented in the practice of the City Dental Clinic No. 31 of the Nevsky District of St. Petersburg, the Safir Medical Center, the Mezon Medical Center, the Center Dental Production Cooperative. In the course of the study, the results were included in the training program for dentists at the postgraduate training cycles of the Department of Therapeutic Dentistry No.
Structure and scope of work.
The dissertation consists of 4 chapters, conclusion, conclusions, practical recommendations, a list of references, applications of 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.
MATERIALS AND RESEARCH METHODS
The objects of the study were the working conditions in the dental offices of state medical institutions in St. Petersburg (city dental clinics Nos. 3, 12, 22, 29, 31). The objects of observation were general dentists and dentists of other specialties (therapists, surgeons, orthopedists, pediatric dentists), aged from 25 to 61 years. (Total 365 people) Dental offices were equipped with different types of dental units (imported and domestic production) and their number (from one to six in each office), while using various treatment technologies and filling materials of different types.
To achieve this goal, modern informative hygienic, physiological, chronometric and sociological methods were used in the work. A summary assessment of the working conditions of therapeutic, orthopedic, surgical and pediatric dentists working in state medical and preventive institutions was carried out in accordance with the principles set forth in the guide R 2.2.2.006-05 “Guidelines for the hygienic assessment of factors in the working environment and the labor process. Criteria and classification of labor”. And it was evaluated on 33 indicators.
When determining the classes of harmfulness and danger, we proceeded from the hygienic criteria and principles of labor classification, the latter are divided into 4 classes, each of which can be interpreted in terms of assessing the risk to the health of workers as follows (R 2.2.2.006-05 "Guidelines for the hygienic assessment of working factors environment and labor process. Criteria and classification of labor"):
- Class 1 - optimal - such conditions under which the health of workers is maintained, but prerequisites are created to maintain a high level of efficiency
- Class 2 - permissible working conditions - are characterized by such levels of environmental factors and the labor process that do not exceed the established hygienic standards for workplaces, but functional changes are possible that are restored during regulated rest or by the beginning of the next shift
- Class 3 - harmful working conditions - are characterized by the presence of harmful production factors that exceed hygienic standards and have an adverse effect on the body of the worker, are divided into 4 degrees of harmfulness:
- Grade 3 1 degree (3.1) are characterized by such deviations from hygiene standards that cause functional changes in workers that are restored with a longer (than by the beginning of the next shift) interruption of contact with harmful factors
- 3 class 2 degree (3.2) - working conditions with such levels of production factors that can cause persistent functional disorders, leading in most cases to an increase in morbidity with temporary disability, an increase in the frequency of general morbidity, the appearance of initial signs of occupational pathology
- Grade 3 Grade 3 (3.3) - working conditions characterized by such a level of harmful factors that lead to the development, as a rule, of occupational diseases of mild and moderate severity, including increased levels of morbidity with temporary disability
- Grade 3 Grade 4 (3.4) - working conditions under which severe forms of occupational diseases can occur, there is a significant increase in the number of chronic diseases and high levels of morbidity with temporary disability
- Class 4 - dangerous (extreme) working conditions - characterized by such production factors, the impact of which during the work shift creates a threat to life, a high risk of severe forms of acute occupational injuries
Statistical processing of the received data was carried out on a personal computer using the Microsoft Office 2003 application package (standard statistical and mathematical functions of Microsoft Excel). To determine the significance of the difference in the results, the values of the criteria were used: Student, Wilconson-Mann-Whitney and Rosenbaum. Correlation analysis was carried out to identify links between indicators.
A total of 3904 studies were performed, of which: hygienic - 3509, timekeeping - 619.5 hours, sociological - 288, 207 microbiological studies of the working environment were performed.
Hygienic methods for studying the factors of the labor process.
In industrial premises at workplaces, such hygienic factors as microclimate, noise, infrasound, ultrasound, vibration, illumination, air pollution with aerosols and bacterial contamination, as well as the severity and intensity of the labor process (33 indicators in total) were assessed.
Hygienic studies provided for a comprehensive approach to assessing the working conditions of dentists in a comparative aspect, taking into account the influence of physical, chemical and biological production factors on the body. The assessment of working conditions was carried out in 33 rooms using modern equipment, informative generally accepted methods and in accordance with the currently existing methodological recommendations and regulatory documents (GOST, SN, SanPiN, MU).
As part of the assessment of architectural and planning solutions, the engineering and technical support of the premises and the compliance of the area of the rooms with the number of dental units located in them (one, two or more) were subject to examination, in accordance with the sanitary rules “Arrangement, equipment, operation of outpatient dental institutions, labor protection and Personal Hygiene of Personnel” No. 2956 – 83.
The microclimatic conditions of dental offices were determined by indicators of temperature, humidity, air velocity and thermal radiation. Microclimate studies in dental offices were carried out in accordance with GOST 12.1.005-88 "General sanitary and hygienic requirements for the air of the working area" and SanPiN 2.2.4.548-96 "Hygienic requirements for the microclimate of industrial premises".
The means of measurement were:
- meteometer MES-2 (certificate of state verification No. 0162091 dated 02.09.2003);
- humidity and temperature meter TKA-TV (test certificate dated 10.10.2003).
The study included 495 measurements.
The main source of acoustic vibrations of the infrasonic range, noise and local vibration in dental offices at workplaces are turbine units (which include dental compressors).
Instrumental measurements of the main parameters of industrial noise at the workplaces of dentists were carried out in accordance with GOST 12.01.050-86 "Methods for measuring noise at workplaces", "Guidelines for conducting, measuring and hygienic assessment of noise at workplaces" No. 1844-78. The analysis and evaluation of the results obtained was carried out in accordance with SN No. 2.2.4/2.1.8.562-96 "Noise at workplaces, in the premises of residential and public buildings and in residential areas."
Measurements and hygienic assessment of industrial infrasound were carried out in accordance with SN No. 2.2.4/2.1.8.583-96 "Infrasound at workplaces, in residential, public buildings and in residential areas." Acoustic changes were carried out by sound level meter t. As part of the study, 800 measurements were carried out.
Measurements and evaluation of local vibration parameters were performed in accordance with GOST 12.1.043-84 “Vibration. Measurement methods at workplaces in industrial premises”, GOST 12.1.012-90 “Vibration. General safety requirements”, “Guidelines for measurements and hygienic assessment of industrial vibration” No. 3911-85,
SN 2.2.4/2.1.8.566-96 "Industrial vibration, vibration in premises of residential and public buildings". As part of the study, 600 measurements were carried out.
The noise and vibration measuring equipment used for instrumental measurements corresponded to GOST 17187-81 “Sound level meters. General technical requirements and test methods”, GOST 17168-82 “Electronic octave and third octave filters” and GOST 12.4.012-83 SSBT Vibration. "Means of measurement and control of vibration at workplaces". Vibrometer "Robotron" vol. 00042 No. 61090, filter FE-2 No. 418, vibration sensor KS-50 No. 5024 (certificate of state verification No. 2/0013801 dated January 27, 2004) served as the measuring instrument. As part of the study, 1269 measurements were taken.
The assessment was carried out under various situational conditions:
One dental unit included; two; three or more (in an office with appropriate equipment);
During operation of the turbine handpiece: at idle and during mechanical processing of hard dental tissues;
When the micromotor is idling and during the processing of hard tooth tissues.
The parameters of noise and vibration generated by equipment of domestic (US-30) and imported (HIRADENT, SIEMENS) production were measured.
Identification of low-frequency acoustic oscillations of the infrasonic range, as well as establishing the degree of severity of infrasound relative to noise, was carried out by using the level difference on the scales "Linear" and "A".
Lighting of dental offices is carried out by combined and combined lighting. To assess the illumination, the following regulatory materials were used: SNiP 23-05-95 "Natural and artificial lighting", SanPiN 2.2.1.1278-03 "Hygienic requirements for natural, artificial and combined lighting of residential and public buildings", GOST 24940-96 "Buildings and structures. Illumination measurement methods”, GOST 26824-86 “Buildings and structures. Methods for measuring brightness”, Methodological recommendations “Hygienic requirements for illumination (brightness) for precise visual work” No. 3863-85, MU OT RM 01-98 / MU 2.2.4.706-98. Measuring instrument: digital photometer (luxmeter-luminance meter) TKA-04/3 No. 01021 (certificate of state verification No. 0118167 dated 09/23/2003). The study included 345 measurements.
The sufficiency of general, local (created by local dental lamps of various types) and combined lighting was assessed at the level of the patient's oral cavity (and the areas of the lateral and frontal groups of teeth were delimited), and on the working (instrumental) table of the dentist.
The assessment of indicators of the severity and intensity of labor was carried out in accordance with the requirements of the manual R 2.2.2006-05, approved. 01.11.2005 “Guidelines for the hygienic assessment of the factors of the working environment and the labor process. Criteria and classification of working conditions. Method of measurement: chronometric observations of the severity and intensity of labor in the workplace. During the study, 619.5 hours of chronometric studies were carried out.
The conditions and nature of the work of dentists at the workplace were assessed in accordance with Guideline R 2.2.2.006-05 “Guidelines for the hygienic assessment of factors in the working environment and the labor process. Criteria and classification of labor”, relevant regulatory documents, based on time studies, job descriptions and expert assessments.
Microbiological research methods.
The air environment was studied in accordance with GOST 12.1.005-88 "General sanitary and hygienic requirements for the air of the working area." Guidelines "Control of the content of foreign substances in the air of the working area" No. 3936-85, Guidelines, "Methods for determining harmful substances in the air of the working area", GN 2.2.5.1313-03 "Maximum permissible concentrations (MPC) of harmful substances in the air of the working area ", Hygienic standards GN 2.2.6.709 - 98 "Maximum permissible concentrations (MPC) of producing microorganisms, bacterial preparations and their components in the air of the working area. 207 sowings completed.
To obtain samples of air microflora, the Krotov apparatus, model 818, 1985, was used. No. 1581. The mechanism of trapping microflora is based on the impact-cutting action of a jet of air, which passed through a narrow wedge-shaped slot and hit the moist surface of the nutrient medium at high speed. As a result of the impact, airborne aerosols, including dust particles and droplets containing bacteria, adhered to the surface of nutrient media. During air sampling, the Petri dish with the nutrient medium rotated, and the air passed at a speed of 25 liters per minute, due to which a uniform contamination of the surface of the nutrient medium with air microflora was achieved. In accordance with the order of the Ministry of Health of the USSR No. 720 1983. sampling to determine the total microbial number was carried out for 4 minutes on plates containing meat-peptone agar, Staphylococcus aureus - for 10 minutes on plates with yolk-salt agar. Additionally, to determine the content of molds and yeasts in the air, samples were taken on plates containing Sabouraud agar. In addition, taking into account the specifics of the microflora of the oral cavity, where streptococci predominate, which do not form colonies on a nutrient medium that does not contain blood, samples were taken on 5% blood agar to count microorganisms with hemolytic activity. Samples were taken in the working area during the treatment of patients' teeth; to assess the background contamination, samples were taken at a distance of at least 1.5 m from the dentist's workplace.
Sociological research.
For a sociological survey of dentists, a special questionnaire was developed and the method of anonymous questioning was applied. The data of the questionnaire survey conducted with 288 dentists were analyzed and statistically processed on a personal computer using Microsoft Excel 2003.
A wide range of questions included in the questionnaire made it possible to analyze the structure of this group of medical workers, their state of health and subjective assessment of well-being in the process of performing professional activities.
Research results.
A comprehensive hygienic assessment of working conditions at the workplaces of dentists and therapists made it possible to assess working conditions at workplaces in accordance with the accepted classification, which is presented below, Table. 1.
Table 1.
Comprehensive hygienic assessment of working conditions at the workplace of dentists and therapists
| Factors/Workplace | Dezh. | Self-supporting | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 |
| Dust | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 |
| Noise | 2 | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 | 2 | 3,1 | 2 | 2 | 2 | 2 |
| local vibration | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
| Microclimate | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
| illumination | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 |
| The severity of labor | 3,1 | 3,2 | 3,2 | 3,2 | 3,2 | 3,2 | 3,2 | 3,2 | 3,2 | 3,1 | 3,1 | 3,1 | 3,1 |
| Labor intensity | 3,2 | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 | 3,1 | 2 | 2 | 2 | 2 |
| General assessment of working conditions | 3,2 | 3,2 | 3,2 | 3,2 | 3,2 | 3,2 | 3,2 | 3,2 | 3,2 | 3,1 | 3,1 | 3,1 | 3,1 |
A comprehensive hygienic assessment of working conditions at the workplace of dentists and dentists of other specialties made it possible to compare working conditions in accordance with the accepted classification, Table. 2.
Table 2.
Comprehensive hygienic assessment of working conditions at the workplace of dentists, therapists and dentists of other specialties
| Factors / Specialty of the dentist | therapist | Children's dentist | orthopedist | surgeon |
| Dust | 3,1 | 2 | 3,1 | No measurements taken |
| Noise | 3,1 | 3,1 | 3,1 | 3,1 |
| local vibration | 2 | 2 | 2 | No measurements taken |
| Microclimate | 2 | 2 | 2 | 2 |
| illumination | 2 | 2 | 2 | 2 |
| The severity of labor | 3,2 | 3,2 | 2 | 3,1 |
| Labor intensity | 3,2 | 3,2 | 3,1 | 3,2 |
| General assessment of working conditions | 3,2 | 3,2 | 3,1 | 3,2 |
Studies were conducted on the appealability of dentists for qualified medical care. The method of questioning was chosen due to the low number of doctors seeking qualified and specialized assistance and the execution of proper medical documentation when the first signs of a particular disease appear.
According to the results of the study, this fact was confirmed. It was found that only 12.50% of the doctors surveyed seek qualified and specialized care and proper medical documentation at the first sign of a disease. The majority of respondents (70.14% of the doctors surveyed) seek qualified and specialized care and proper medical documentation if the disease lasts more than three days. 17.63% of respondents do not seek qualified and specialized assistance and proper medical documentation at all, Table. 3.
Table 3
Table of application for qualified specialized medical care and registration of a disability certificate
When analyzing the incidence among dentists of different age groups, an increase in the incidence of hypertension depending on age was revealed, which, apparently, is associated with the constant impact on the dentist of such a factor as labor intensity, which, as was established during a comprehensive assessment working conditions, rated as harmful (grade 3) 1 or 2 degree (depending on the specific specialty), Figure 1.
Rice. 1. Dependence of the incidence of hypertension among dentists of different age groups in %
According to the results of the survey, it was determined that the incidence of the musculoskeletal system increases among dentists depending on age. Such an increase is associated with the constant impact on the dentist of such a factor as the severity of work, which is assessed as harmful (grade 3), 1 or 2 degrees (depending on the specific specialty). As it was established during a comprehensive assessment of working conditions, the main indicator that determines the "harmfulness" of this factor is an uncomfortable fixed posture, fig. 2.
Rice. 2.Dependence of the incidence of the musculoskeletal system among dentists of different ages (in %)
When analyzing the incidence of the musculoskeletal system among dentists of various specialties and the time spent by the doctor in an uncomfortable fixed position, some features were identified. Namely, among pediatric dentists, with a high rate of staying in an uncomfortable fixed position per shift (63%), the incidence of the musculoskeletal system is significantly lower (47.37%) than among orthopedic dentists (59.38%) and therapists (66.67%). This difference is probably due to the fact that the determining factor is not how much time the doctor spends in an uncomfortable fixed position per shift, but the length of time for which the dentist takes an uncomfortable fixed position, Fig. 3.
Rice. 3. The ratio of the incidence of the musculoskeletal system and the time spent by the doctor in an uncomfortable fixed position per shift
When analyzing the incidence of the upper respiratory tract and lungs among dentists of various age groups, an increase in the incidence with age was found. However, there was a decrease in the incidence in the group of 51 years and older, which is apparently associated with a decrease in the reactivity of the organism and a decrease in the response to the effects of external pathogenic factors in this age group, Fig. 4.
Rice. Fig. 4. Dependence of the incidence of the upper respiratory tract and lungs among dentists of different ages (in %)
The relationship between the incidence of the upper respiratory tract and lungs in dentists of various specialties was established (Table 4). The table shows that the incidence is higher among dentists and general practitioners.
Table 4
The dependence of the incidence of the upper respiratory tract and lungs in dentists of various specialties (in %)
It was found that the concentration of aerosol in the air of the working area of orthopedic dentists was higher than that of general dentists and pediatric dentists (Table 5). This is due to the fact that the orthopedic dentist conducts a more intensive treatment of the hard tissues of the teeth in the mouth of patients, compared with dentists of other specialties.
It is customary to associate the incidence of the upper respiratory tract and lungs in dentists with such an indicator as the concentration of aerosols in the inhaled air. However, it was found (Table 5) that the concentration of aerosols at the workplaces of dentists and the incidence of the upper respiratory tract and lungs among dentists do not have a direct relationship.
Table 5
The concentration of aerosols in the air of the working area, at the workplace of orthopedic dentists, general practitioners and pediatric dentists
When analyzing the contamination of the air environment at the workplace of dentists, orthopedists and therapists, Fig. 5, a clear predominance of contamination in the workplace of a dentist-therapist was revealed, which explains the higher incidence of upper respiratory tract and lungs among dentists-therapists.
Rice. 5. Comparison of AP ST with AP SS, AP ST with 1.5 m from AP SS, AP TS with 1.5 m from AP SS, 1.5 m from AP ST with 1.5 m from AP SS using Mann criteria -Whitney, median chi-square, Kruskal-Wallace revealed significant differences for these pairs (P<0,001 для всех критериев).
At the workplaces of doctors, dentists and surgeons, studies of the dust content in the air of the office were not carried out, since they do not have drills at their workplaces, and they do not perform mechanical processing of hard dental tissues with the formation of fine particles and aerosols.
Thus, the studies conducted at the workplaces of general dentists in comparison with dentists of other specialties made it possible to identify the main "aggravating" factors and determine the risks of developing occupational diseases among general dentists and orthopedic dentists, surgeons and pediatric dentists.
CONCLUSIONS:
- Based on the data obtained, in a comparative analysis and in accordance with the accepted classification, the working conditions of dentists, therapists, as well as surgeons and pediatric dentists working on an outpatient appointment in state medical institutions using modern technologies were assessed as harmful (grade 3) 2 degrees , and the working conditions of orthopedic dentists as harmful (grade 3) 1st degree.
- 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 factors:
- Harmful (grade 3) 2 degrees: the severity of work at the dentist's therapist, pediatric dentist, the intensity of work at the dentist's surgeon;
- Harmful (harmful) 1 degree: labor intensity at the dentist's therapist, orthopedic dentist, equivalent noise level at doctors of all specialties, the severity of work at the surgeon's dentist, orthopedist's dentist, biological factor at the therapist's dentist;
- Permissible (grade 2): local vibration, microclimate, illumination in dentists of all specialties.
- Equip medical institutions with centralized compressor systems to reduce noise levels in treatment rooms.
- Increase control over the use of personal protective equipment for the upper respiratory tract by dentists.
- Organize occupational gymnastics during regulated breaks for dentists and therapists, which help relieve local fatigue of individual muscle groups of the shoulder girdle and arms, in accordance with the developed set of exercises.
- Organize blood pressure monitoring among dentists older than 30 years, for 2 weeks with an interval of 6 months.
- To reduce the load on the visual analyzer, include in clinical practice the use of color-coded instruments, head-mounted optical systems and dental handpieces with fiber-optic illumination.
- Increase the frequency of ventilation from 2 to 4 times in the offices where dentists, therapists and orthopedists work
- To introduce more widely the use of rubber dams for the prevention of respiratory diseases of doctors, dentists, therapists and patients.
- Revise the standards of time parameters and workload for dentists and therapists.
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- Dubeykovskaya L.S. Working conditions and health status of dentists. / L.S. Dubeykovskaya, M.I. Kiryanova, Yu.N. Sladkova, L.I. Salagina, A.A. Sakhanov // Proceedings of the All-Russian Congress "Profession and Health". - Issue. 1. - M., 2006. - S. 135.
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List of used abbreviations.
SanPiN - Sanitary norms and rules
GOST - State Standard
SN - Sanitary standards
MPC - maximum permissible concentrations
PDU - maximum permissible levels
MoH - Ministry of Health
