Physical hazards in the work of dentists. 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, preventive measures

480 rub. | 150 UAH | $7.5 ", MOUSEOFF, FGCOLOR, "#FFFFCC",BGCOLOR, "#393939");" onMouseOut="return nd();"> Dissertation - 480 RUR, delivery 10 minutes, around the clock, seven days a week and holidays

Sakhanov Anton Anatolyevich. 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 Anatolevich; [Place of defense: State Educational Institution "St. Petersburg Medical Academy of Postgraduate Education"]. - St. Petersburg, 2009. - 256 p.: ill.

Introduction

Chapter 1. Literature Review 8

Chapter 2. Materials and research methods 34

2.1 Hygienic methods for studying labor process factors 36

2.2 Microbiological research methods 40

2.3 Sociological research 41

Chapter 3. Results of studies in the workplaces of dentists of various specialties 42

3.1 Results of studies of the conditions and nature of work in the workplace of dentists and therapists at therapeutic department 42

3.2 Results of studies of working conditions and nature of work in the workplaces of pediatric dentists in the children's department 53

3.3 Results of studies of working conditions and nature of work at the workplaces of orthopedic dentists and orthopedic surgeons in the orthopedic department 66

3.4 Results of studies of working conditions and nature of work at the workplaces of dentists and surgeons in the surgical department 81

3.5 Results microbiological research 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

List of used literature 115

Appendix 130

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

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

To achieve this goal, the following were decided tasks:

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

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

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

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

Develop and implement a set of measures aimed at reducing occupational risk and preserving the health of dental therapists.

Scientific novelty of the research:

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

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

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

Provisions submitted for defense.

During their work, dental therapists are exposed to the complex effects of harmful and dangerous factors in the working environment: physical (microclimate, lighting, noise, vibration), chemical, microbiological

The most pronounced and common for dental therapists, as well as for doctors of other dental specialties, is the tension 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 work process.

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

Practical significance of the work.

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

Approbation of work.

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

Structure and scope of work.

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

Hygienic methods for studying labor process factors

In production premises at workplaces, such hygienic factors as microclimate, noise, infrasound, ultrasound, vibration, illumination, pollution were assessed air environment aerosols and bacterial contamination, as well as the severity and intensity of the labor process.

Hygienic studies included an integrated 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 currently existing methodological recommendations and regulatory documents(GOST, SN, SanPiN, MU).

As part of the assessment of architectural and planning solutions, the inspection was subject to the engineering and technical support of the premises and the compliance of the area of ​​the offices with the number of dental units located in them (one, two or more), in accordance with the sanitary rules “Design, equipment, operation of outpatient dental clinics, labor protection and personal hygiene of personnel" No. 2956 -83.

The microclimatic conditions of dental offices were determined by temperature, humidity, air speed 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: MES-2 meteorometer (state inspection certificate No. 0162091 dated September 2, 2003); humidity and temperature meter TKA-TV (inspection certificate dated 10.10.2003).

The study included 495 measurements. The main source of acoustic vibrations in the infrasound range, noise and local vibration in dental offices and 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 on the conduct, measurement and hygienic assessment of noise in workplaces" No. 1844-78. Analysis and evaluation of the results obtained were carried out in accordance with SN No. 2.2.4/2.1.8.562-96 "Noise in workplaces, in residential, public buildings and in a residential area."

Measurements and hygienic assessment of industrial infrasound were carried out in accordance with SN No. 2.2.4/2.1.8.583-96 “Infrasound in workplaces, in residential and public buildings and in residential areas.” Acoustic changes were carried out with a sound level meter t.2203 No. 226166 (certificate of state inspection No. 0003206 dated January 14, 2004). As part of the study, 800 measurements were taken.

Measurements and assessment of local vibration parameters were carried out in accordance with GOST 12.1.043-84 “Vibration. Methods of measurement at workplaces in industrial premises", GOST 12.1.012-90 "Vibration. General requirements safety", "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 taken.

The noise vibration measuring equipment used to carry out instrumental measurements complied with 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. “Measurements and vibration control at workplaces.” The means of carrying out the measurements were the “Robotron” vibration meter No. 00042 No. 61090, the FE-2 filter No. 418, and the KS-50 vibration sensor No. 5024 (certificate of state inspection No. 2/0013801 dated January 27, 2004). The study included 1,269 measurements.

The assessment was carried out in various situational conditions: - one dental unit was turned on; two; three or more (in an office with appropriate equipment); - during operation of the turbine handpiece: at idle speed and during mechanical processing of hard dental tissues; - when the micromotor is idling and during processing of hard dental tissues.

The parameters of noise and vibration generated by domestic (US-30) and imported (HIRADENT, SIEMENS) equipment were measured.

Identification of low-frequency acoustic vibrations in the infrasonic range, as well as establishing the degree of severity of infrasound relative to noise, was carried out by using the difference in levels on the “Linear” and “A” scales.

Lighting of dental offices is carried out using combined and combined lighting. To assess 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. Methods for measuring illumination", GOST 26824-86 "Buildings and structures. Brightness measurement methods", Guidelines“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-brightness meter) TKA-04/3 No. 01021 (state inspection certificate No. 0118167 dated September 23, 2003). The study included 345 measurements.

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

The dentist-therapist leading the duty appointment 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 responsibilities include: receiving patients with acute pain, diagnosis, treatment of dental caries, treatment of complicated forms of dental caries with the placement of 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 other specialists, as well as maintaining medical and reporting documentation (filling out medical records, a sheet for recording 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 ​​15 m, the ceiling height is 3.2 m, the volume of the room is 48 m. There is only one doctor in the office. The workplace is equipped with a lift-and-swivel chair, a Volgograd EMO unit, a dental chair for the patient, tables for instruments and for maintaining documentation. The dentist-therapist, leading the duty appointment, works with a nurse serving two doctors (in different offices). Uses a set of sterile dental instruments (probe, intraoral mirror, smoothers, tweezers weighing 20-27g) and drill tips 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. Handpieces are treated with 70% alcohol, used burs are soaked in a solution: lysoformin 1.5%, blanisol 0.5%.

The work is carried out sitting or standing, periodically in an uncomfortable position (fixed position with the body tilted and arms held in the air). Operations are performed by the doctor sequentially: recording data in a registration log, interviewing the patient (collecting complaints and medical history), adjusting the position of the chair, lamp, treating hands or latex gloves, examining the oral cavity and recording the dental formula, followed by making a diagnosis and determining the scope of work. In case of acute pain in a patient, depending on the diagnosis, the doctor performs instrumental and medicinal treatment of the carious cavity, application of a devitalizing paste and temporary filling, or instrumental and medicinal treatment of the root canal. The daily workload of a dentist-therapist conducting an appointment on duty is 20-25 patients per shift. The duration of an appointment with one patient depends on the complexity of the work and is 15-30 minutes when treating complicated caries with the installation of a temporary filling, and 5-10 minutes when examining the oral cavity with issuing certificates and referrals to other specialists.

According to the research results, the work shift time was distributed as follows: examining the patient’s oral cavity and recording the dental formula, collecting and recording complaints, and making a diagnosis occupied 35%; hand washing, chair adjustments, conversations with patients and work distractions - 17%; formation and filling of carious cavities - 14%. Documentation took 34%. On average, a doctor's time performing basic operations that require concentrated attention is 75% of his working time. Physical dynamic load when moving loads over a distance of up to 1 m does not exceed 10 kgm. Weight (one-time) of goods moved manually constantly during a shift, up to 0.2 kg. The number of stereotypical working movements performed under 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 force with one hand is 1000 kgf s per shift. The working position is “standing” - up to 30% of the time, periodically fixed, uncomfortable up to 59%, body tilts at an angle of more than 39 units. Movements due to production needs, up to 0.5 km.

According to research results, the workload of a dental therapist conducting an on-duty appointment is assessed as class 3 - hazardous work 1st degree, the class-determining indicator is the working posture.

As for labor intensity, it, in accordance with R 2.2.2006-05, approved. 01.11.2005 “Guide to the hygienic assessment of factors in the working environment and the labor process. Criteria and classification of working conditions" is determined by intellectual loads associated with solving complex problems using known algorithms, perceiving information with subsequent comparison and final assessment of parameter values, checking completed tasks, and 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 object of discrimination being 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 no more than 75. There is no work with optical instruments and monitoring of video terminal screens. 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 caused by 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 techniques required to implement repeatedly repeated operations, more than 10, and the duration of their execution, more than 100 seconds. Time active actions 90%. The work schedule is 2 shifts without night shifts (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 an appointment on duty is assessed by the sum of 22 indicators (research results are presented in the relevant protocols and in the certification card in Appendix No. 1) as class 3, degree 1.

Along with the assessment of working conditions, hygienic factors in the workplace were studied: noise levels, local vibration, illumination, microclimate parameters and air pollution by aerosols and microorganisms were measured.

The equivalent noise level is 60 dBA (at MPL 60 dBA, taking into account the severity and intensity of work), the equivalent corrected level of local vibration is 100 dB at MPL 126 dB. “Noise at work places in residential and public buildings and in residential areas.” SanPin 2.2.412.1.8.562-96.

The air temperature in the room during the research period was in the range of 23.8-24.2C with a relative humidity of 39-40% and a movement speed of 0.04 - 0.07 m/s.

Results of studies of the conditions and nature of work at the workplaces of pediatric dentists in the children's 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 was the leading duty reception and one was the leading outpatient reception serving children with temporary teeth.

Conditions and nature of work of a pediatric dentist conducting an outpatient duty appointment. A pediatric dentist conducting an on-duty appointment works in 2 shifts (morning 5.5 hours and evening - 5.5), six-day work week. The main responsibilities of a doctor include receiving children with acute pain, making a diagnosis, treating caries with temporary fillings, examining children to issue certificates of oral sanitation, and referring patients to specialists. The total area of ​​the office is 32 m, the ceiling height is 3.2 m, the volume of the office is 102.4 m. In the office, medical work is carried out by one doctor. The workplace is equipped with a lift-and-swivel chair, a Volgograd EMO unit without automatic shutdown of the compressor, a dental chair for the patient, tables for instruments and for maintaining documentation. The doctor uses a set of sterile instruments (mirror, probe, excavator, smoothers, tweezers) weighing 20-27g and drill tips weighing up to 115g. The following drugs are used for treatment: Stomafil, Compa-dent, Silicium, Kemfil, Ketamolar, NON ARSENIC, Depulpin. Handpieces are treated with a 70% alcohol solution, used burs are soaked in a solution: lysoformin 1.5%, blanisol 0.5%.

The work is performed primarily in a “sitting” position, periodically when serving patients - in an uncomfortable, fixed position with the body tilted and arms held in the air. Basic operations are performed sequentially in several stages: interview, collection of anamnesis and complaints, adjustment of the position of the chair, lamp, treatment of hands or latex gloves, examination of the oral cavity with subsequent determination of the amount of work. When treating caries, the doctor performs the formation of a carious cavity, mechanical and medicinal treatment of the cavity and installation of a temporary filling. Documentation includes filling out rehabilitation cards, accounting logs, daily employment records and a summary sheet.

The average daily workload of a doctor is 30-40 patients. The duration of an appointment with 1 patient for examination and issuance of certificates is on average 3-5 minutes, for the treatment of caries with the installation of a filling - from 20 to 30 minutes. The work shift time was distributed approximately as follows: examination of the oral cavity occupied 28%, instrumental and medicinal treatment of carious cavities with subsequent filling - 20%, documentation management - 28%, hand treatment, adjusting the position of the chair and conversations with patients and work distractions occupied 25%. . On average, a doctor's time performing basic operations that require concentrated attention is at least 77% of the shift.

Physical dynamic load when moving loads over a distance of up to 1 m does not exceed 10 kgm. Mass (one-time) of loads moved manually constantly during a shift, up to 0.2 kg. The number of stereotypical working movements under 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 force with one hand - 1000 kgf per shift. The working position is predominantly “sitting”, periodically fixed, uncomfortable up to 48%, the body is tilted at an angle of more than 30. Movements due to production needs, up to 0.5 km.

Based on the above, the severity of the work of a pediatric dentist conducting an on-duty appointment is assessed as class 3, degree 1, the determining indicator of the class being the working posture.

Labor intensity is determined by intellectual loads associated with solving complex problems using 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 the size of the object of discrimination being 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 work is no more than 75. There is no work with optical instruments (microscopes, magnifying glasses, etc.) and monitoring of video terminal screens. 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 caused by 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 others. The monotony of the loads is not expressed. Active action time 90%. The work schedule is 5.5 hours in 2 shifts without night shifts, 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-duty appointment is assessed by the sum of 22 indicators as class 3, degree 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 to doctors conducting outpatient visits.

Hygienic factors were assessed at the workplace of a pediatric dentist conducting an on-duty appointment; noise levels, local vibration, illumination, microclimate parameters and air pollution by aerosols were measured when working with a dental unit.

The equivalent noise level for a shift was 65 dBA with a PDU of 60 dBA, taking into account the severity and intensity of the work process (with the compressor located directly in the treatment room).

The equivalent corrected local vibration level was 109 dB with an MCL of 126 dB.

The air temperature in the room was in the range of 21.3-21.5 C with a relative humidity of 20-21% and an air speed of 0.03-0.07 m/s.

Natural lighting is provided by side window openings, KEO - 1.5%. Combined artificial lighting: illumination of working surfaces from the general lighting system 410-560 lux with a standardized 200 lux for this category of visual work; from local - 10,000-13,000 lux with the normalized 750 lux.

The aerosol concentration in the dentist's breathing zone when working with a drill was 0.3 - 0.9 mg/m with a maximum permissible concentration of 4.0 mg/m.

Thus, based on a set of indicators, the working conditions of a pediatric dentist conducting an on-duty appointment are assessed as harmful - class 3, degree 2. The research results are presented in the table (Table 4) and in Appendix No. 5.

Results of studies of the conditions and nature of work at the workplaces of orthopedic dentists and orthopedic surgeons in 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 conducting the duty appointment, were carried out.

Head of the orthopedic department, works 1 shift of 5.5 hours in the director’s office. The working day begins with the preparation of a 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 consultation, draws up documents for orthopedic treatment of patients, resolves controversial issues that have arisen in the department, fills out “refusal” cards, if necessary, refers patients to a consultation with an allergist, draws up a schedule and a monthly report card for social prosthetics. Prepares reports for the current month and quarter.

Within 2 hours he receives patients in the treatment room. The area of ​​the treatment room is 75 m2, ceiling height is 3.2 m, volume is 240 m. The office has 5 dental units. At the same time, he performs all operations related to orthopedic treatment. The workplace is equipped with a lift-and-swivel chair, a Chirodent unit, a dental chair for the patient, tables for instruments and for maintaining 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, used burs are soaked in a solution: lysoformin 1, 5%, Blanisol 0.5%. The doctor prepares the teeth using a dental unit for 5 to 30 minutes, depending on the volume of preparation of the hard tissues of the teeth. To make an impression, the doctor places 1-2 measuring spoons of impression alginate mass in a rubber container, dilutes it with a small amount of water, mixes it and applies the finished mass to an impression tray, inserts it into the oral cavity and holds it until the impression mass is completely polymerized. Then he removes the tray with the impression and transfers it to the dental laboratory.

The most labor-intensive work during prosthetics was observed during prosthetics with metal-ceramic structures. The tooth is treated for a crown within 0.5 hours. In the presence of teeth with intact pulp, anesthesia was preliminarily performed. When making an impression for the production of metal-ceramic structures, the technique of two-layer silicone impressions and 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. The design of a metal-ceramic prosthesis can be checked 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 the body tilted and arms held in the air.

The physical dynamic and static load of the doctor is insignificant. Weight (one-time) of loads moved manually is up to 1 kg. The number of stereotypic movements under 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 position is “sitting”, “standing” - up to 30% of the time, periodically fixed, uncomfortable up to 25%, occasional body tilts at an angle of more than 30 are possible. Transitions due to production needs, up to 2 km.

Based on the above, the workload of an orthopedic dentist or head of an orthopedic department is assessed as class 2 - average physical activity.

Labor intensity is determined by intellectual stress associated with sole leadership in difficult situations, 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 the size of the object of discrimination being 0.3-1 mm for no more than 50% of the shift. The number of production facilities for simultaneous observation 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 spoken per week.

The emotional load is caused by 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 the loads is characterized by the number of techniques required to implement repeatedly repeated operations - 9-6 and the duration of their execution of more than 100 seconds. Active action time - 80%. The work schedule is one shift without night shifts for 5.5 hours with two regulated breaks with a total duration of 7.7%) of the shift time.

The intensity of the work process of the head of the orthopedic department was assessed by the sum of 22 indicators as class 3 - intense work of the 2nd degree, the research results are presented in the relevant protocols and in the workplace certification card in Appendix No. 11.

Hygienic factors were assessed at workplaces, taking into account the severity and intensity of work, while at the workplace of the head of the orthopedic department and at other workplaces, noise levels, local vibration, illumination, microclimate parameters and aerosol air pollution were measured.

Poselyanova, Irina Vladimirovna Chugaeva, Ulyana Yurievna

CHAPTER 1. Literature review

CHAPTER 2. Materials and research methods

2.1 Hygienic methods for studying labor process factors

2.2 Microbiological research methods

2.3 Sociological research

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

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

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

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

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

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

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

LIST OF ABBREVIATIONS USED IN THE WORK:

MPL - maximum permissible level

MPC - maximum permissible concentrations

KEO - natural light coefficient

CFU - colony forming unit

MMA - methyl methacrylate

SanPiN - Sanitary rules and regulations

GOST - State standard

CH - Sanitary standards

MOH - Ministry of Health

ZD ST - breathing zone of the dentist-therapist

ZD CO - breathing zone of the orthopedic dentist

Recommended list of dissertations

• Occupational hygiene of orthopedic dentists in medical institutions of various forms of ownership 2004, Candidate of Medical Sciences Degtyareva, Elina Petrovna

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

• Hygienic assessment of working conditions and the risk of health problems for dental medical workers 2009, Candidate of Medical Sciences Petrenko, Natalya Olegovna

• Hygienic assessment of quality of life using the example of dentists in a large industrial center 2010, Candidate of Medical Sciences Dyachenkova, Olga Igorevna

• Comprehensive social and hygienic study of the health of dentists and dentists in the Kabardino-Balkarian Republic 2013, Candidate of Medical Sciences Psigusov, Marat Aslambekovich

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

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

• Scientific rationale for optimizing the work process of therapeutic dentists 2004, Candidate of Medical Sciences Danilova, Natalia Borisovna

• Improving the organization of work of orthodontic departments (offices) of dental clinics 2008, Candidate of Medical Sciences Komarova, Ekaterina Yurievna

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

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

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

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

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

Please note that the scientific texts presented above are posted for informational purposes only and were obtained through original dissertation text recognition (OCR). Therefore, they may contain errors associated with imperfect recognition algorithms. There are no such errors in the PDF files of dissertations and abstracts that we deliver.

Ministry of Transport of the Russian Federation

Federal Agency for Railway Transport

Federal state budget educational

institution of higher professional education

"Far Eastern State Transport University"

Department: “Technosphere safety”

Course work

Discipline: “Life Safety”

Topic: “Dangerous and harmful production factors and measures to protect against them in the profession of dentist”

Performed:

Gonchar Olesya Vladislavovna

Khabarovsk

1. Dangerous and harmful production factors

1 General concepts

2 Classification

1.3 Occupational diseases

2. Profession dentist

2.1 Description of the dental profession

2.2 Personal qualities

2 Education (What do you need to know?)

Dangerous and harmful factors of the dentist profession. Causes, methods of elimination, prevention

3.1 Dupuytren's contracture

3.2 Tenosynovitis

5 Professional stress

6 Elimination and prevention of violations that have arisen

3.7 Occupational diseases

1. Dangerous and harmful production factors

1 General concepts

A harmful production factor is a production factor, the impact of which on a worker, under certain conditions, leads to illness or decreased performance.

A hazardous production factor is a production factor, the impact of which on a worker, under certain conditions, leads to injury or other sudden deterioration health.

MPC (maximum permissible concentration) - established safe level substances in the air of the work area (possibly in soil, water, snow), the observance of which allows the employee to maintain health during the work shift, normal work experience and upon retirement. Negative consequences are not passed on to subsequent generations.

MPL (maximum permissible level) is a characteristic applied to physical hazardous and harmful production factors. The meaning is reflected in the concept of maximum permissible concentration.

Harmful working conditions are working conditions characterized by the presence of harmful production factors that exceed hygienic standards and have an adverse effect on the body of the worker and (or) his offspring.

2 Classification

According to GOST 12.0.003-74 SSBT. Dangerous and harmful production factors. Classification , hazardous and harmful production factors (HPF) are divided into:

) physical - electric current, increased noise, increased vibration, decreased (increased) temperature, etc.

) chemical - substances harmful to humans, divided according to the nature of the effect (toxic, irritant, carcinogenic, mutagenic, etc.) and the route of penetration into the human body (respiratory organs, skin and mucous membranes, gastrointestinal tract);

) biological - pathogenic microorganisms and their metabolic products;

) psychophysiological - physical and emotional overload, mental overstrain, monotony of work, etc.

According to the nature of the impact on humans, HFPF can be associated with the labor process or with environmental exposure.

The state of working conditions in which workers are not exposed to hazardous and harmful production factors is called labor safety. Life safety in production conditions has another name - labor protection. Currently, the latter term is considered obsolete, although all specialized domestic literature published before approximately 1990 uses it.

Occupational safety was defined as a system of legislative acts, socio-economic, organizational, technical, hygienic, therapeutic and preventive measures and means that ensure safety, preservation of health and performance during the work process.

Being a complex discipline, “Occupational Safety and Health” included the following sections: industrial sanitation, safety precautions, fire and explosion safety, as well as labor protection legislation. Let us briefly describe each of these sections.

Industrial sanitation is a system of organizational measures and technical means that prevent or reduce the impact of harmful production factors on workers.

Safety precautions are a system of organizational measures and technical means that prevent workers from being exposed to hazardous production factors.

Fire and explosion safety is a system of organizational and technical means aimed at preventing and eliminating fires and explosions and limiting their consequences.

Labor protection legislation forms part of labor legislation.

1.3 Occupational diseases

Occupational diseases are diseases in the occurrence of which a decisive role is played by the influence of unfavorable factors in the working environment and the labor process.

2. Profession dentist

1 Description of the dentist's profession

It is probably difficult to find a person who has never had toothache. Therefore, the demand for the dentistry profession has always been high. This specialty is very important and widespread. Today, young people are increasingly choosing this type of activity.

A dentist is a doctor who treats teeth, jaws, soft tissues and other organs of the oral cavity. This profession is a fairly broad concept, so dentists have narrower specializations:

· dental therapist. This doctor treats caries, pulpitis, periodontitis, places various fillings, and does dental restoration. A specialist in this field provides general treatment for inflammatory processes in the oral cavity, root canals, etc.;

· dentist-surgeon. A doctor in this specialty diagnoses dental disease using x-rays. It is such a specialist who removes those teeth that cannot be conservative treatment. His responsibilities also include removing cysts, replanting bone tissue, etc.;

· orthopedist-dentist, in other words - prosthetist. It restores teeth and prevents the further development of various oral diseases and tooth deformation. He takes impressions of patients' teeth. Using them, the dental technician makes dentures, bridges, implants, crowns, which the orthopedic dentist secures in the patient’s mouth;

· pediatric dentist. His patients are children and adolescents under 17 years of age. When treating young clients, the doctor must take into account everything age characteristics, since the jaws and teeth of children at this age are just forming. Therefore, a pediatric dentist can not only treat existing caries, but also help the child correct a malocclusion.

In addition to the above specializations, dental technicians, orthodontists, and periodontists work in clinics and dental offices. But whatever the doctor’s profile, he cannot do without the help of a dental assistant, who is his right hand. The duties of such an assistant include:

· sterilization of dental instruments and dressings, disinfection;

· carrying out physical and therapeutic procedures;

· assisting the doctor in the treatment of diseases of the teeth and oral cavity of various types;

· preparing the office and necessary instruments for receiving patients;

· assistance to the doctor in maintaining and completing documentation, etc.

There are more pros than cons to being a dentist. This specialty is in demand in the labor market, and this work is highly paid. But the negative side of this type of activity can be considered the fact that the dentist often has to spend his entire working day in the same position, sometimes standing on his feet for several hours in a row.

2 Personal qualities

A person who has chosen the profession of a dentist must be calm, balanced, persevering, patient, accurate, and observant. A good dentist treats each of his clients with great attention and kindness. Professional doctor reserved, tactful and loyal to everyone who comes to him for help. This profession requires excellent vision and well-developed fine motor skills.

You can become a dentist only by obtaining a higher education in the specialty “dentistry”, having graduated medical academy or medical and dental university. After training, you must undergo an internship, after which you will be issued a certificate.

3. Dangerous and harmful factors of the dentist profession. Causes, methods of elimination, prevention

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

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. Your fingers should rest freely on the instrument.

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

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

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

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

) Fold your fingers into a fist, with your thumb inside. Clench your fist and slowly remove your thumb.

3.1 Dupuytren's contracture

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

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

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

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, Brune recommends training the left hand to unload the right hand to perform all work associated with high stress.

2 Tenosynovitis

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

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

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

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

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

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

3 Impact of vibration on the dentist’s body

dentist doctor vibration tenosynovitis

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

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

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

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

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

Therapeutic and preventive measures:

) reduction of vibration intensity due to design improvements;

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

) compliance with the work and rest regime;

) therapeutic, preventive and general health measures

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

b) massage and self-massage of the arms and shoulder girdle;

c) industrial gymnastics;

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

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

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

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

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

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

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

As a result of pressure on the bile ducts, bile secretion worsens and stones appear. In women, the dome of the uterus moves 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 entails enteroptosis, dyspepsia, gastritis, and neurovegetative dystonia, which often affects dentists.

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

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

5 Professional stress

Mental work is associated with the reception and processing of information, which requires primary tension of the sensory apparatus, attention, memory, activation of thinking processes, emotional sphere. The work of medical workers is associated with constant contact with people, increased responsibility, lack of information and time to make decisions. 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 sympathoadrenal, hypothalamic-pituitary, and cortical systems. With emotional stress, there is an acceleration of catecholamine metabolism, an increase in the release of norepinephrine in the sympathetic ganglia, and an increase in the content of adrenaline and glucocorticoids in the blood. Optimization of mental work should be aimed at maintaining a high level of performance and eliminating chronic neuro-emotional stress. But it is necessary to take into account the fact that during mental work the brain is prone to inertia and continuation of mental activity in a given direction. After finishing work 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. In activation defense mechanisms the hypothalamus is involved. The hypothalamic-pituitary system carries out humoral regulation two ways. The first is the neural pathway, when the hypothalamic response to stress is regulated by higher nerve centers in accordance with the intensity and nature of the stress. The second pathway is humoral, thanks to which the pituitary gland constantly interacts with the adrenal glands, thyroid and gonads. In stressful situations, several parts react simultaneously endocrine system regulated by the hypothalamus. Two of them are especially important: the sympathetic-adrenal system, which secretes catecholamines, and the pituitary-adrenal system, which secretes corticosteroids.

The immediate response of the neuroendocrine system to stress leads to activation of the sympathetic-adrenal system. The most important catecholamines are released: adrenaline and norepinephrine. Catecholamines are the most important regulators of adaptation processes in the body. They allow him to quickly move from a state of rest to a state of activity. They stimulate the breakdown of glycogen and lipids, lead to the accumulation of glucose in the blood, and activate oxidation fatty acids, stimulate cardiac activity and muscle activity, excite the central nervous system, stimulate protective and immunological mechanisms.

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

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

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

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

muscle symptoms: tension and pain;

gastrointestinal symptoms: dyspepsia, vomiting, heartburn, constipation;

cardiovascular symptoms: palpitations, arrhythmia, chest pain;

respiratory symptoms: shortness of breath and hyperventilation;

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

The most common cardiovascular symptoms are coronary insufficiency and arterial hypertension.

6 Elimination and prevention of violations that have arisen

To avoid these phenomena, you need to abandon overly tense body positions and replace them with more comfortable ones. The main reasons that force a doctor to adopt an incorrect body position are haste and insufficient attention to the correct fit of the dental chair for each patient. Due to lack of time, doctors regret the few seconds and movements required to give the chair the required position. Sometimes only illness or serious disorders force the doctor to change his habit. Modern chairs with adjustable height, backrest and headrest tilt allow you to give the patient the correct position. The design of the chair can be improved by removing the right armrest. Usually it has a very elongated shape, which prevents the doctor from taking a comfortable position. However, the patient is to some extent hampered by the lack of support for his right elbow.

To properly install the chair, you need to consider the following points:

) the patient’s proportions (height, build);

) doctor's proportions;

) the doctor’s visual acuity;

) lighting conditions.

The correct position for the doctor is one in which the head, neck, chest and abdomen are on the same vertical and the main burden falls on the bone frame, while the muscles and ligaments are minimally loaded. In this position, the functions of the respiratory, circulatory, and digestive organs are in favorable conditions.

Occupational foot diseases among dentists

It has long been proven that a dentist should work while sitting most of the time. Standing work, not accompanied by various muscle movements, disrupts venous outflow and causes stagnation of blood in the veins of the lower extremities. The veins dilate, their valves do not function sufficiently, blood flow slows down and, as a result, circulatory disturbances occur in the vessels of not only the extremities, but also the abdominal organs.

Appear professional injuries Feet: Curved, flat, or splayed feet due to long periods of maintaining an upright posture. Insufficiency of supporting tissues, muscles, ligaments, bones and joints develops.

With prolonged standing and turning of the feet, in addition to flat feet, the so-called valgus foot with a protruding inner ankle develops. Inflammation of the mucous sac between the Achilles ligament and the heel bone causes pain on both sides of the tendon.

For the treatment and prevention of diseases of the legs and feet, a set of exercises has been developed: flexion and extension of the toes, grasping and lifting a scarf from the floor with the toes, walking tiptoe , on heels, walking on river sand, on stones, running on large pebbles in the water, exercises with a stick on wheels, etc. Massage and self-massage of the legs are successfully used. First make a warm foot bath. Conduct massage movements to relax the ankle joint, to relax and tense the arch of the foot, toe massage, relaxing calf massage. Walking barefoot on a hard, wet sandy beach or standing or running on a beach covered with small pebbles can be beneficial.

It is important while sitting correct location legs The feet should be comfortable and their entire surface in contact with the floor. The muscles are relaxed, nothing interferes with blood circulation. It is recommended to place your feet on your toes and alternate this position with the correct one. This promotes good blood circulation and relaxation of the leg muscles.

Occupational diseases of the spine among dentists

The need to maintain a certain body position for a long time with the torso tilted has an effect on the spine. The vertebrae are displaced and diverged, the spine acquires an atypical configuration. Ligament sprain is accompanied by compression intervertebral discs, vessels and nerves on the side of the resulting lordosis. Vague pain appears in the neck, shoulders, back, sacrum, spreading to the limbs. Occipital and cervical pain, brachial plexus neuralgia, intercostal neuralgia, Scaleus syndrome, neck immobility, lumbago and back pain, sciatica.

The nerve structures of the spine and internal organs are connected in the intermediate canal. Radicular, motor, sensory and autonomic disorders develop. For example, feelings of fear, angina pectoris, difficulty breathing, tension in the neck, often associated with cervical syndrome.

Increased load on the intermediate discs and deformation of the vertebrae, muscle tension and pressure on the vessels and nerves cause pain in the shoulder joint, interfering with the movements of the forearm and hand. Deforming syndrome occurs cervical region spine or, according to the Askey classification, shoulder-forearm-hand syndrome with neuralgic disorders. Dentists often suffer from this disease. It develops when the muscles of the shoulder girdle receive a one-sided load, which leads to one-sided tension and functional disorders apparatus of the discal ligaments in the cervical and thoracic spine. The smallest stretches into the lateral root canals can cause compression phenomena. In differential diagnosis, it is necessary to exclude pain such as angina pectoris, reflex projections into the shoulder of pain from the pancreas, gallbladder, stomach and duodenum. For treatment, massage according to Leube - Diecbee, warm baths and therapeutic gymnastic exercises. If there is protrusion (prolapse) of the disc ligaments, surgical intervention is possible.

The main ways to combat fatigue:

) rational organization of the workplace and furniture;

) exercises and training;

) rational work and rest regimes;

) production Physical Culture;

) physiological relief rooms.

More than 80% of the working time, a dentist must work while sitting. When standing for a long time, blood is redistributed, blood circulation deteriorates, and occupational pathology occurs in the lower extremities (varicose veins, thrombophlebitis, swelling of the legs, flat feet).

In a sitting position, it is possible to perform work that requires precision movements (preparation, endodontic work, canal filling), but when working for a long time while sitting, static tension in the muscles of the neck, shoulder girdle, and back is observed.

Changing posture leads to a redistribution of the load on muscle groups, improves blood circulation conditions, and limits elements of monotony.

Exercise (improving skills through repetitive activity) is an important means of preventing fatigue. The exercise is based on the principle of skill formation. It proceeds according to the type of formation of conditioned reflexes to a combination of external and internal stimuli. You cannot achieve high performance without training. Exercise underlies the development of work skills and industrial training.

A rational regime of work and rest is a ratio and content of periods of work and rest in which high labor productivity is combined with high performance without signs of excessive fatigue. The more intense the load during work, the less the load should be during active rest so as not to cross the maximum limits of excitability of brain cells. These boundaries are individual. Age, type of nervous system, fitness, physique and general condition play a role.

Sleep gives complete relaxation and rest. It is a vital compensation for the working day. A dentist, whose work requires a lot of energy, needs 8 hours of sleep.

After a busy day at work, it is necessary to use stress-reducing products. A bath with a water temperature of 35 - 36? C for 10 - 15 minutes. You can add valerian and horsetail to the water. After a bath, it is important to keep your feet warm (use a blanket or heating pad). The bed should not be too soft, the blanket should be light and not hot.

Allergic diseases of the skin of the hands among dentists

In dental practice, doctors, nurses, and dental technicians have to come into close contact with various allergens: medications and chemicals, which include novocaine, antibiotics, various polymers, synthetic materials, etc.

The most common allergic skin diseases are contact dermatitis and eczema. These also include toxicoderma, urticaria, and dermatoconiosis. Epidermatitis (dry skin), resulting from frequent contact with water and degreasing substances, is considered an allergic predisposition.

Among patients with occupational dermatoses, young and middle-aged women (21 - 40 years old) predominate. For people with short work experience, the incidence rate is higher than for people who have worked as dentists for a longer time. Dentists who conduct a mixed practice often experience dry skin, followed by dermatitis and eczema.

Prevention of eye diseases by dentists

Daily and seasonal fluctuations in natural light require the use of artificial light instead of or in addition to natural light. In central Russia from the second ten days of December to the second ten days of February most time you have to use artificial light. The source is incandescent and fluorescent lamps. Artificial lighting has disadvantages that can cause the development of visual and general fatigue, working myopia and spasms of accommodation. In addition, fluorescent lighting makes it difficult or impossible to accurately perceive the true color of healthy and diseased tissues (mucous membranes, teeth, skin). As a result, conditions are created for diagnostic errors and the quality of treatment is reduced.

In low light levels, to increase the angle of view, the doctor needs to get closer to the object in question. As a result, convergence is enhanced due to the intense work of the rectus internal muscles of the eye. This entails the development of working myopia.

Fluorescent lamps produce a monotonous noise, which manifests itself when they malfunction. Noise has a negative effect on the nervous system.

Since the work of a dentist in a clinic requires a lot of visual strain, the illumination of the offices should be increased.

Many doctors associate fluorescent lighting with headaches, irritability from monotonous noise, flicker And transfusion moving objects and note that it gives a deathly color and cyanosis to the mucous membranes and skin.

% of dentists develop eye diseases after ten years of practice. The largest number of people with myopia is observed between the ages of 31 and 40 years, with hypermetropia - from 41 to 45 years. General practitioners are at high risk of developing conjunctivitis. It is recommended to wear safety glasses when preparing teeth and removing plaque.

List of sources and literature used

1. Internet resource “Diagram” Free library/Articles/Labor safety. Authors of the article: Volkhin S.N., Petrova S.P., Petrov V.P.

2. Internet resource “Teaching” Articles/Professions/Dentist.

Vartikhovsky A.M. On the influence of production factors on the health status of dentists (in the Moldavian SSR). Dentistry, 1973, No. 2 p. 83 - 84

Kataeva V.A. Allergic skin diseases among medical workers in dental clinics. Dentistry, 1979, vol. 63 No. 2 p. 79 - 80.

Kataeva V.A. Hygienic assessment of the state of vision of dentists. Dentistry, 1979, vol. 58 No. 2 p. 69 - 72.

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

What hazards may arise in the work of a dentist?

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

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

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

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

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

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

Occupational hazards of a dentist: preventing adverse consequences

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

So how do you do this?

Required in mandatory Visit doctors regularly for medical examinations. Workers of all categories underestimate the importance of this preventive measure, but timely detection of the disease allows it to be cured as quickly as possible.

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

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

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

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

If you find an error, please highlight a piece of text and click Ctrl+Enter.

-- [ Page 2 ] --

Artificial lighting of offices was created through general, local, and most often combined lighting created by incandescent and fluorescent lamps. The levels of general artificial illumination created by fluorescent lamps were clearly insufficient (280±2.4 lux) and did not reach the required values ​​(at least 500 lux). The combined illumination indicators (871.3±3.9 lux) were also below the standard values. Thus, the illumination indicators at dentists’ workplaces can be classified as class 3.1, which corresponds to the harmful class of working conditions of the first degree.

The noise level in dental offices created by dental units (drills) was within 55.02±4.7 dBA. The local vibration parameters from the operation of dental units (drills) were 124.4±8.6 dB, which met hygienic standards.

In the working conditions of dental medical workers, one of the unfavorable factors was bacterial contamination of the air.

Table 1

Characteristics of microbial air pollution

dental offices, (M ± m)

The highest rates of total bacterial contamination were observed in the rooms of the therapeutic department (202.1±9.3 microbial bodies per 1 m3); while the lowest rates were recorded in the offices of the orthopedic department (179.3 ± 9.3 microbial bodies per 1 m3). The highest rate of presence of Staphylococcus aureus in the air was recorded in surgical dentistry (56.05±1.03 CFU), while the lowest rate of presence of Staphylococcus aureus was observed in orthopedic dentistry (30.7±0.44 CFU). At the same time, all premises of dental clinics, according to the effect of biological factors on the dentist’s body, corresponded to the harmful class of working conditions 3.3. by classification

R 2.2.2006 – 05.

The average duration of a dentist's work shift is 6 hours 36 minutes. The main direction in the work of a dentist is the implementation of medical activities (reception of patients). The dentist's responsibilities include examining the patient; carrying out therapeutic procedures; conducting patient consultations to explain the diagnosis and types of treatment procedures; assignment of recommendations; filling out medical records for dental patients.

Depending on their professional group, dentists received from 4 (orthopedic dentists) to 6 (therapeutic dentists and surgeons) patients per work shift. That is, dentists - orthopedists saw one patient for an average of 1.5 hours, dentists - therapists and dentists - surgeons - for 1 hour.

The working conditions of dental medical workers had pronounced specifics. In the process of work, dentists were exposed to various unfavorable factors, including: physical and psycho-emotional stress, significant visual strain, prolonged concentration of attention during treatment, special precision of actions, exposure to bacterial aerosol, unfavorable microclimatic factors.

Studying the structure of the time spent on a working shift of dental medical workers depending on their professional affiliation, we found that dentists-therapists spent more than 50% of the shift time in an uncomfortable working position - “sitting” in a work chair while performing their functional duties. Consequently, the work of dental therapists corresponds to the harmfulness of working conditions 3.2. according to classification R 2.2.2006 - 05 “Hygienic assessment criteria and classification of working conditions according to indicators of harmfulness and danger of factors in the working environment, severity and intensity of the labor process.”

Dentists-surgeons spent 68.18% of their working time in a “standing” position with a slight forward bend and a bend of the spine towards the patient and standing with a strong bend of the body and a bend of the spine, depending on the type of work performed, and 22.7% of the working time, dentists – surgeons performed the procedure in a “sitting” position, filling out registration documentation and carrying out sanitary and educational work with the patient. Taking into account the presented data, the work of surgical dentists can be classified as harmful, intense work of the first degree (3.1).

For orthopedic dentists, the working posture depended on the type of work performed. Orthopedic dentists spent 45.5% of their working time in a “sitting” position and 45.5% in a “standing” position, that is, they are characterized by periodic up to 50% of their shift time in an uncomfortable fixed position. Thus, the work of orthopedic dentists corresponds to the harmfulness of working conditions 3.1.

table 2

Comprehensive assessment of working conditions for dentists (- therapists,- surgeons,- orthopedists)

Based on the totality of the data presented above, the activities of dental medical workers can be classified as class 3, 3 degrees of intensity of the labor process, when the intellectual load occurs with a significant lack of information and the need to create new information, and the emotional load manifests itself in the intensity of factors causing negative emotions: fear for the health of the patient, a sharp lack of time and high responsibility during medical procedures, duration of concentration during treatment, special precision of actions, significant visual strain, exposure to bacterial aerosol.

To provide a sociological characterization of working conditions, a survey was conducted. The results obtained showed the dependence of the working capacity and psycho-emotional sphere of dentists on the working conditions and regime. As a result of the adjustments to the work regime, 37.2% of dentists noted a decrease in fatigue, 29% - an increase in performance and an improvement in general well-being, 41.4% - the absence of chronic fatigue and overwork.

In a comparative analysis of the parameters of the psychophysiological status of the observation group and the control group, a number of differences were identified. Both groups, in general, were characterized by an average level of reactive and personal anxiety; at the same time, the level of reactive and personal anxiety in the observation group was significantly higher (42.7±0.09 points; 44.5±0.06 points) than in the control group (34.02±0.05 points .; 41.8±0.02 points). The results of the Depression Scale test allow us to evaluate the condition of all subjects as being without depression. The level of anxiety in both compared groups did not differ significantly (observation group - 4.74±0.03 points, control group - 4.58±0.02 points).

When studying the state of the psychophysiological status of dental medical workers, depending on their professional affiliation, we found that dentists - therapists and dentists - orthopedists were characterized by an average level of reactive anxiety. However, the level of reactive anxiety among dental therapists is significantly higher (40.2±2.9 points) compared to orthopedic dentists (35.2±2.1 points). Dentist-surgeons were characterized by a significantly higher level of reactive anxiety (51.1±3.2 points) compared to dentists-therapists and dentists-orthopedists.

The indicator of “personal anxiety” among dentists-surgeons was also characterized by a high level of personal anxiety (53.2±4.4 points), and among dentists-therapists - as an average level of personal anxiety (42.6±3.4 points). The results of the Depression Scale test showed that all three groups of dentists were characterized by a state without depression.

When analyzing sensorimotor characteristics according to the “Tapping test” data, by the end of the work shift in the observation group there was a significant increase in the fatigue coefficient and a significant decrease in the individual pace indicator, both in comparison with the beginning of the work shift and in relation to individuals in the control group. The time spent performing work using the “Arrangement of Numbers” method for individuals in the study and control groups at the end of the working day increased by an average of 35.15 s and 7.15 s. respectively (Table 3). However, among dentists 2.1 times (P< 0,05) возросло количество допущенных ошибок, а в группе контроля количество допущенных ошибок достоверно уменьшилось (табл. 3).

At the end of the work shift, dentists, as well as workers in the outpatient clinic group, showed a decrease in the individual rate of sensorimotor activity (by 0.28 beats/sec. and 0.47 beats/sec., respectively) and a significant increase in the fatigue coefficient compared to the beginning of the work shift, which indicated the development of fatigue by the end of the work shift in individuals of both groups (Table 3). However, fatigue was more pronounced in the observation group.

Table 3

Psychophysical indicators of the body of medical workers

at the beginning and end of the working day, (M±m)