Dangerous factors in the work of the dentist. Harmful production factors among employees of medical institutions
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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 correspondence of the area of the rooms to 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 clinics of the dental profile, 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 sequentially by the doctor: 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 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, perception of information with subsequent comparison and final assessment of parameter values, verification of the completed task, 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 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 is 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 an on-call 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 (at the maximum control level of 60 dBA, taking into account the severity and intensity of labor), the equivalent adjusted level of local vibration is 100 dB at the maximum control level 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 work 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 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 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-duty 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, noise levels, 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 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 places 1-2 measuring spoons of the impression alginate mass in 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%, individual 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 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 - 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
According to the current legislation, specialists of the dental clinic are granted the right to additional leave and a shorter working day (Resolution of the State Committee for Labor of the USSR and the Presidium of the All-Union Central Council of Trade Unions of October 25, 1974 No. 298 / P-22). And according to the results of the certification of workplaces, it turned out that there is no reason to provide additional leave to the main staff of dentists, dental technicians, and paramedical personnel.
Question: What is the duration of additional leave can be set for a dentist and what should be the length of his working day? Is there an additional payment for harmful working conditions to a dentist and what factors of harmfulness are taken into account?
QUESTION: What is the duration of additional leave can be set for a dentist and what should be the length of his working day?
ANSWER: In accordance with the List of industries, workshops, professions and positions with harmful working conditions, work in which gives the right to reduced working hours and additional leave, approved by the Decree of the State Committee of the Republic of Belarus on Labor and Social Protection of the Population dated July 29, 1994 No. 89, with amendments and additions (hereinafter - List No. 89), section XL "Health", subsection "Dental clinics, departments and offices", p.1.
Harmful working conditions for dentists
The work of a dentist is considered harmful and therefore we had a shortened working day in state clinics (one hour less nurses). But the technicians were given milk for harm.
When etooo. Byyyloo. In the time of the USSR, maybe, but right now, from morning to. This "TO" is not known. And different Mr. "Yellowmouths" - they also need to be fed.
In Soviet times, doctors were also given milk for harmfulness by 0.5 liters per day, and the working day was 6 hours, and 24 workers were on vacation.
Hygienic assessment of the work of a dentist.
As a summary of the above, I would like to evaluate the work of a dentist according to the “Hygienic criteria for assessing and classifying working conditions in terms of harmfulness and danger of factors in the working environment, the severity and intensity of the labor process” Unfortunately, within the framework of such a study, this is almost impossible to do. The results of measurements of noise, illumination at workplaces, concentrations of chemicals, timing data, without which it is impossible to correctly assess working conditions and the labor process, are very variable.
Hygienic assessment of working conditions and the risk of health disorders of medical workers of the dental profile
Artificial lighting of the offices was created by 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 indicators of combined illumination (871.3±3.9 lx) were also below the normative values.
Additional payment of 15% to a pediatric dentist
Order of the Federal Medical and Biological Agency of September 3, 2008 No. 305 “On the introduction of new wage systems for employees of federal budgetary institutions subordinate to the FMBA of Russia
3.3. Payment to employees engaged in hard work, work with harmful and (or) dangerous and other special working conditions is established in accordance with Article 147 of the Labor Code of the Russian Federation (Collected Legislation of the Russian Federation 2002, No.
Occupational health and safety (Minsk, Belarus)
In the clinic, 0.5 of the rate of a dentist-orthodontist has been introduced, is it necessary to carry out certification of the workplace according to working conditions? If a dentist will work 0.5 rate as an orthopedic dentist (he has compensation under the conditions of certification according to 3.1 biological factor) and 0.5 rate as an orthodontist, i.e. the whole working day is in harmful working conditions, will he retain the established compensation based on the results of the attestation of the workplace of a dentist-orthopedist?
If the combination is carried out within the same category of employees, then we are talking about combining positions.
Supply of food products for workers employed in jobs associated with harmful working conditions (dentists, orthopedists).
Municipal budgetary educational institution "Secondary school of the village of Khvatovka, Bazarno-Karabulak municipal district of the Saratov region"
Municipal state preschool educational institution kindergarten of a general developmental type with priority implementation of activities for the artistic and aesthetic development of children No. 2 "Rodnichok" of the city district
Ministry of Transport of the Russian Federation
Federal Agency for Railway Transport
Federal state budget educational
institution of higher professional education
"Far Eastern State University of Communications"
Department: "Technosphere safety"
Course work
Discipline: "Life safety"
Topic: "Dangerous and harmful production factors and measures to protect against them in the profession" 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 dentistry 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 Occupational 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 a decrease in working capacity.
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 in health.
MPC (maximum permissible concentration) - the established safe level of a substance in the air of the working area (possibly in soil, water, snow), compliance with which allows you to maintain the health of the employee during the work shift, normal work experience and upon retirement. The negative consequences are not passed on to subsequent generations.
PDU (maximum permissible level) - a characteristic applied to physical dangerous and harmful production factors. The meaning is reflected in the concept of MPC.
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 (OHPF) are divided into: ) physical - electric current, increased noise, increased vibration, low (high) temperature, etc. ) chemical - substances harmful to humans, subdivided according to the nature of the impact (toxic, irritating, carcinogenic, mutagenic, etc.) and the ways 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 strain, monotony of work, etc. By the nature of the impact on a person, OVPF can be associated with the labor process or with environmental exposure. The state of working conditions, in which the impact on workers of dangerous and harmful production factors is excluded, is called labor safety. Life safety in production conditions has another name - labor protection. At present, the latter term is considered obsolete, although all special domestic literature published before about 1990 uses it. Occupational safety was defined as a system of legislative acts, socio-economic, organizational, technical, hygienic and therapeutic measures and means that ensure safety, health and performance in the process of work. Being a complex discipline, "Labor protection" included the following sections: industrial sanitation, safety, 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 on workers of harmful production factors. Safety precautions - a system of organizational measures and technical means that prevent the impact on workers of hazardous production factors. Fire and explosion safety is a system of organizational and technical means aimed at the prevention and elimination of fires and explosions, limiting their consequences. Legislation on labor protection is part of the labor legislation. 1.3 Occupational diseases Occupational diseases - diseases in the occurrence of which the decisive role belongs to the influence of adverse factors of the working environment and the labor process. 2. Profession dentist 1 Description of the profession of a dentist It is probably difficult to find a person who has never had a toothache. Therefore, the demand for the profession of dentist 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 deals with the treatment of teeth, jaw, soft tissues and other organs of the oral cavity. This profession is a fairly broad concept, therefore, dentists are distinguished by narrower specializations: · therapist dentist. This doctor treats caries, pulpitis, periodontitis, puts various fillings, and restores teeth. A specialist in this field carries out general treatment of inflammatory processes in the oral cavity, root canals, etc.; · dentist-surgeon. A doctor in this area diagnoses a disease of the teeth with the help of x-rays. It is such a specialist who removes those teeth that are not subject to conservative treatment. Also, his duties include the removal of cysts, bone grafting, etc.; · orthopedic dentist, in other words - a prosthetist. It restores teeth and prevents the further development of various diseases of the oral cavity and deformation of the teeth. He takes casts of patients' teeth. According to them, the dental technician makes prostheses, bridges, implants, crowns, which the orthopedic dentist fixes in the patient's mouth; · pediatric dentist. His patients are children and adolescents up to 17 years of age. When treating young clients, the doctor must take into account all age characteristics, since the jaws and teeth of children at this age are just being formed. Therefore, a pediatric dentist can not only treat the caries that has appeared, but also help the child correct the malocclusion. In addition to the above specializations, dental technicians, orthodontists, and periodontists work in clinics and dental offices. But whatever the profile of the doctor, he can not do without the help of a dental assistant, who is his right hand. The responsibilities of this assistant include: · sterilization of dental instruments and dressings, disinfection; · carrying out physical and therapeutic procedures; · assistance to the doctor in the treatment of diseases of the teeth and oral cavity of various nature; · preparation of the office and the necessary tools for accepting patients; · assistance to the doctor in the maintenance and execution of documentation, etc. There are more pros than cons in being a dentist. This specialty is in demand in the labor market, and this work is highly paid. But the negative side in this kind of activity can be considered the fact that the dentist often has to spend his entire working day in the same position, sometimes standing idle for several hours in a row. 2 Personal qualities A person who has chosen the profession of a dentist should be distinguished by calmness, poise, perseverance, patience, accuracy, observation. A good dentist treats each of his clients with great attention and kindness. A professional doctor is restrained, 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 after graduating from a medical academy or a university of medicine and dentistry. After training, you must complete an internship, after which a certificate is issued. 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 overexertion 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. The fingers should rest freely on the instrument. 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, a curvature of the third finger appears: 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. 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 repeatedly move towards each other with effort; ) the thumb slides with effort from the base of the finger to its tip (do for all fingers); ) fold your fingers into a fist, thumb inside. Clenching your fist, slowly take out your thumb. 3.1 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. At the same time, the fingers bend, sometimes so much that the nails grow into the palm Hot air showers, hot palm baths, paraffin wax, ozocerite, passive stretching or overnight splints are used for treatment. Brune proposed a cuff - a steel band 2 cm wide is sewn into a tight 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 to unload the right hand to train the left for all work associated with high tension. 2 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. 3 The impact of vibration on the body of a dentist dentist doctor vibration tendovaginitis 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 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 trauma, 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: ) reduction of vibration intensity due to design improvements; ) control over the serviceability of the equipment, since a pronounced increase in vibration occurs during operation and wear; ) observance of the regime of work and rest; ) therapeutic and 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. 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 one-sided 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 diseases of the skeletal muscles. 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. 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, hypertrophy of the back muscles on the right. As a result of pressure on the bile ducts, bile flow worsens and stones appear. 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. 5 Occupational stress 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 sympathoadrenal, 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 finishing work working dominant does not completely fade away, causing more prolonged 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. The first is the neural 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. The second way 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 neuroendocrine 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: mineralocorticoid, glucocorticoid 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: 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. Of the cardiovascular symptoms, coronary insufficiency and arterial hypertension are the most common. 6 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, tilt back and headrest 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 hindered to some extent by the lack of support for the right elbow. For the correct installation of the chair, the following points must be considered: ) proportions of the patient (height, physique); ) doctor's proportions; ) visual acuity of the doctor; ) lighting conditions. The doctor’s position is considered correct, in which the head, neck, chest and abdomen are on the same vertical line and the main burden falls on the bone frame, while the muscles and ligaments are loaded to a minimal extent. In this position, the functions of the respiratory, circulatory, and digestive organs are in favorable conditions. Occupational foot diseases in dentists It has long been proven that a dentist should work while sitting most of the working time. Standing work, not accompanied by various muscle movements, disrupts venous outflow, causes blood stasis in the veins of the lower extremities. The veins expand, their valves do not function enough, blood flow slows down and, as a result, circulatory disorders occur in the vessels not only of the limbs, but also of the abdominal organs. Occupational injuries of the foot appear: curved, flat or splayed feet due to prolonged maintenance of the vertical position of the body. 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 develops with a protruding inner ankle. Inflammation of the mucous sac between the Achilles ligament and the calcaneus 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, grabbing and lifting a handkerchief from the floor with the toes, walking on 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. Pre-do a warm foot bath. Massage movements are carried out to relax the ankle joint, to relax and tense the arch of the foot, massage the toes, relaxing massage of the lower leg. It is useful to walk barefoot on a hard, wet sandy beach, stand or run on a beach covered with small pebbles. While sitting, the correct position of the legs is important. The feet should be comfortable and the entire surface should be in contact with the floor. The muscles are relaxed, nothing interferes with blood circulation. It is recommended to put your feet on your toes and alternate this position with the correct one. This promotes good blood circulation and relaxation of the leg muscles. Occupational diseases of the spine in dentists The need to maintain a certain position of the body for a long time with the inclination of the torso has an effect on the spine. The vertebrae shift and diverge, the spine acquires an atypical configuration. Sprain is accompanied by compression of the intervertebral discs, vessels and nerves on the side of the resulting lordosis. There are vague pains in the neck, shoulders, back, sacrum, passing into the limbs. Occipital and neck pain, brachial plexus neuralgia, intercostal neuralgia, Scaleus syndrome, neck immobility, backache and back pain, sciatica. The nerve structures of the spine and internal organs are connected in the intermediate canal. Radicular, motor, sensory and vegetative disorders develop. For example, a feeling of fear, angina pectoris, difficulty breathing, tension in the neck, often associated with cervical syndrome. An increase in the 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, which interferes with the movements of the forearm and hand. There is a deforming syndrome of the cervical spine or, according to Askey's classification, shoulder-forearm-hand syndrome with neuralgic disorders. Dentists often suffer from this disease. It develops when the musculature of the shoulder girdle receives a unilateral load, which leads to unilateral stress and functional disorders of the apparatus of the discal ligaments in the cervical and thoracic spine. The smallest pulls 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. Leube-Diecbee massage, warm baths and therapeutic gymnastic exercises are used for treatment. With a protrusion (prolapse) of the discal ligaments, surgical intervention is possible. The main ways to deal with fatigue: ) rational organization of the workplace and furniture; ) exercise and training; ) rational modes of work and rest; ) industrial physical culture; ) room for physiological unloading. More than 80% of the working time, the dentist must work while sitting. With prolonged standing work, redistribution of blood occurs, blood circulation deteriorates, and occupational pathology occurs on the part of the lower extremities (varicose veins, thrombophlebitis, swelling of the legs, flat feet). In the sitting position, it is possible to perform work that requires precision of movement (preparation, endodontic work, canal filling), but during prolonged sitting, static tension of the muscles of the neck, shoulder girdle, and back is observed. A change in posture leads to a redistribution of the load on muscle groups, an improvement in blood circulation conditions, and limits the elements of monotony. Exercise (improving skills and habits as a result of repetitive activities) is an important means of preventing fatigue. The exercise is based on the principle of learning skills. It proceeds according to the type of formation of conditioned reflexes to a combination of external and internal stimuli. It is impossible to achieve high performance without training. Exercise underlies the development of labor skills and industrial training. A rational mode of work and rest is such a ratio and content of periods of work and rest, in which high labor productivity is combined with high performance without signs of excessive fatigue. The more intense the load during work, the less should be the load during outdoor activities in order not to exceed the maximum limits of excitability of brain cells. These limits are individual. Age, type of nervous system, fitness, physique and general condition play a role. Complete relaxation and rest gives sleep. It is a vital compensation of 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 means that reduce stress. Recommended bath with water temperature 35 - 36? C for 10 - 15 minutes. Valerian, horsetail can be added to the water. After the bath, it is important to keep your feet warm (use a blanket, heating pad). The bed should not be too soft, the blanket light and not hot. Allergic diseases of the skin of the hands in dentists In dental practice, doctors, nurses, dental technicians have to come into close contact with various allergens: drugs and chemicals, including novocaine, antibiotics, various polymers, synthetic materials, etc. The most common allergic skin diseases are contact dermatitis and eczema. These also include toxicoderma, urticaria, dermatoconiosis. Epidermitis (dry skin) resulting from frequent contact with water and degreasing agents is considered an allergic predisposition. Among patients with occupational dermatoses, young and middle-aged women (21-40 years) predominate. In persons with a short work experience, the percentage of morbidity is higher than in persons who have been working as dentists for a longer time. Mixed-use dentists are more likely to experience dry skin, followed by dermatitis and eczema. Prevention of eye diseases in dentists Daily and seasonal fluctuations in natural light require the use of artificial light instead of natural light or in addition to it. In central Russia, from the second decade of December to the second decade of February, artificial light is used most of the time. The sources are 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 (mucosa, teeth, skin). As a result, conditions for diagnostic errors are created and the quality of the treatment is reduced. At a low level of illumination, 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 direct internal muscles of the eye. This entails the development of working myopia. Fluorescent lamps give a monotonous noise, which manifests itself when they fail. Noise has a negative effect on the nervous system. Since the work of a dentist in a polyclinic requires a lot of eye strain, the illumination of the rooms 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 acquire eye diseases after ten years of practice. The largest number of people with myopia is observed at the age of 31 to 40 years, with hypermetropia - from 41 to 45 years. Physicians are at high risk of developing conjunctivitis. When preparing teeth and removing dental deposits, it is recommended to wear protective goggles. List of used sources and literature 1. Internet resource "Diagram" Free Library/Articles/Occupational safety. Authors of the article: Volkhin S.N., Petrova S.P., Petrov V.P. 2. Internet resource "Teach" Articles / Professions / Dentist. Vartikhovsky A.M. On the influence of production factors on the health status of dentists (for the Moldavian SSR). Dentistry, 1973, No. 2 p. 83 - 84 Kataeva V.A. Allergic skin diseases in medical workers of dental clinics. Dentistry, 1979, v. 63 No. 2 p. 79 - 80. Kataeva V.A. Hygienic assessment of the state of vision of dentists. Dentistry, 1979, v. 58 No. 2 p. 69 - 72.
The state of labor protection, the level of occupational injuries and occupational morbidity of healthcare workers is a serious socio-economic problem of the industry, which directly affects the provision of medical care to the population of the country. Those working in health care institutions are affected by the same factors as in any other industry - morbidity, conditions and nature of work, etc. However, medical personnel, more than in other industries, are influenced by the characteristics of their professional activities. The work of medical workers is difficult to compare with the work of other specialists. Physicians experience great intellectual stress, are responsible for the life and health of other people, daily come into contact with a wide variety of human characters, this profession requires urgent decision-making, self-discipline, the ability to maintain high performance in extreme conditions, high stress and noise immunity. Often, treatment and diagnostic, resuscitation, and surgical interventions are carried out at night, which greatly complicates the work of medical personnel. Scientific and technological progress, which has led to an increase in the technical equipment of medical institutions, the introduction of more advanced technical processes, equipment, tools, the use of new drugs and the development of new methods of diagnosis and treatment, poses new problems for occupational medicine that require a speedy solution.
The concept of "Health worker" includes representatives of quite diverse categories of health workers - these are heads of medical institutions, heads of departments, doctors of all specialties, nurses, laboratory assistants, junior and support staff, whose activities, along with common features, have many significant differences. The incidence of healthcare workers is one of the highest in the country.
Reliable statistics on occupational diseases of doctors do not exist. Doctors, as a rule, self-medicate or receive medical care at the place of work, for which the statistical data on their incidence are obviously lower than the true ones.
In the structure of occupational diseases among physicians, the first place is consistently occupied by infectious diseases (from 75.0% to 83.8%, on average - 80.2%), the second - by allergic diseases (from 6.5% to 18.8%, in on average - 12.3%), intoxication and diseases of the musculoskeletal system are in third place. In recent decades, indicators of the health status and life expectancy of medical workers have moved away from the average in an unfavorable direction.
The above factors together determine a significantly shorter life expectancy for doctors, compared with patients, reducing it by 10-20 years. All this puts on the agenda the problem of developing versatile measures to improve the working and living conditions of this category of specialists.
Occupational hazards- factors of production and labor processes that can have a harmful effect on health and the ability to develop occupational diseases.
Manufacturing processes in medicine - technical treatment (all methods by which, when exposed to a patient, one can achieve his recovery).
Labor processes- processes of human interaction with the subject of labor (patients).
Classification of occupational hazard factors.
Factors of occupational hazard of medical personnel of various profiles can be classified into:
Mechanical (physiological): forced position of the body or tension of individual organs and systems.
Physical: ionizing radiation; non-ionizing radiation; electric and electromagnetic fields; laser radiation; ultrasound; noise, vibration; high atmospheric pressure, high temperature and humidity; inappropriate lighting.
Chemical: anesthetics; antibiotics; hormones, chemicals of an irritating, toxic, allergic nature in various combinations.
Neuro-emotional: intelligent voltage; emotional stress; tension of attention, memory; the need to make decisions in an emergency situation; the need to maintain high performance during shift work; work with cadaveric material.
Mechanical factors include the forced position of the body or the tension of individual organs and systems. This group of factors is especially relevant to the medical staff of the surgical profile (surgeons, obstetrician-gynecologists, operating sister, anesthetist, physiotherapists and massage therapists). Almost the entire operating team is standing, leaning over the operating table, with their hands extended forward, with their heads bowed, and their backs rounded. Prolonged static muscle tension is accompanied by tonic and clonic muscle contractions. A forced posture changes the configuration of the spinal column, causes changes in the intervertebral discs, which may result in complaints of pain in various parts of the spine, shoulder girdle, limbs. With prolonged standing during the operation, stagnation of blood is observed in the lower extremities, the volume of the lower leg increases by almost one centimeter, and the foot area - by almost 5%, which leads to the development of varicose veins of the lower extremities and thrombophlebitis, and stagnation of blood in the pelvic area - to development of hemorrhoids.
During the operation, unfavorable microclimatic conditions are often observed in the area of operation of surgeons, which do not provide a normal level of heat exchange between the body and the environment and comfortable heat sensations.
Surgeons complain about the "heating" microclimate and significant moisture loss. The combined effect of the microclimate and psycho-emotional stress is accompanied by increased sweating during surgical interventions. The amount of moisture loss in surgeons varies depending on the air temperature in operating rooms; so at an air temperature of 21-22 ° C, it is 0.75 g / min., And when it rises to 25-26 ° C - 2.7 g / min. Violation of the body's thermoregulation can contribute to the lengthening of the operating day, as well as the constant accumulation of heat in the body.
The disadvantages of operating clothing, in particular, are aggravated by its frequent washing, autoclaving, ironing, which significantly reduces the breathability and hygroscopicity of the fabric. Replacing ordinary clothes with clothes made of more breathable fabric significantly improves heat sensation and reduces sweating in surgeons.
The work of certain categories of medical specialists is characterized by visual strain - work with laboratory, operating microscopes, microsurgery, dentistry, otorhinolaryngology (small sizes of objects of distinction), that is, it belongs to the category of visual work of the highest accuracy. The load on the eyes in this case is stipulated by sharp contrasts between the light source and the illuminated object, the inaccessibility of these objects, and the darkness of the surrounding space. All this creates a high load on the eye accommodation system, which leads to a deterioration in visual functions, which is manifested by an accommodation disorder, a decrease in visual acuity, light sensitivity and stability of color discrimination. Changes in the vision of health workers (myopic refraction of the eye) increase as the length of service increases.
From physical factors can be called: x-rays, radionuclides, ultrasound, ultraviolet radiation, laser (coherent) radiation, currents and fields of microwave, UHF, HF, high pressure, high temperatures, aerosols, noise from apparatus and instruments that can cause: radiation sickness, local radiation defeat; vegetative-vascular dystonia, asthenic, asthenovegetative, hypothalamic syndromes, local tissue damage by laser radiation, vegetative-sensory polyneuropathy of the hands, cataracts; neoplasms, skin tumors, leukemias. Microwave radiation has an adverse effect on the blood (centimeter and millimeter range), the cardiovascular system (millimeter range fields), on the central and peripheral nervous system, in particular, it causes an amnesic effect (decimeter waves).
Those who serve X-ray rooms, radiological laboratories, as well as some categories of surgeons - X-ray surgical teams, are more inclined to the action of ionizing radiation than others. The biological effect of ionizing radiation is most clearly manifested in actively peripheral tissues (lymphatic, hematopoietic, etc.). It is a potentially causative factor in the development of such occupational diseases as radiation sickness, local radiation injuries, neoplasms, skin tumors, leukemia. The risk of developing occupational diseases is influenced by the defeat of the so-called target organs by one or another carcinogen (for example, the skin of radiologists). This also affects the duration of action of the carcinogen.
The mutual penetration of medical sciences has led to the fact that recently surgeons, anesthesiologists, traumatologists, resuscitators and paramedical personnel are involved in diagnostic and therapeutic manipulations under the control of x-rays along with radiologists. At the time of x-ray examinations, physicians may be exposed to scattered x-ray radiation or even be in the zone of direct action of the rays. The levels of exposure at the workplaces of these specialists, as well as the doses of X-ray radiation received by them, in some cases exceed the doses received by radiologists and laboratory assistants.
An example of the effect of non-ionizing radiation on surgeons is the use of laser scalpels of sufficiently high power. Surgeons and staff may be exposed to both direct and adverse effects of laser radiation, as well as its reflection from biological tissues and instruments. The possibility of getting laser radiation on the hands of surgeons is not ruled out. The degree of potential danger of laser radiation depends on the power of the source, wavelength, pulse duration and purity of its following, environmental conditions, reflection and scattering of radiation. In addition to exposure to laser radiation, other hazards arise. Light energy from pulsed pump lamps can be harmful to the eyes. In addition, the emission spectrum of flash lamps contains long-wavelength ultraviolet rays, which can additionally cause a specific eye reaction. The dangerous factors that arise during the operation of laser systems include: high voltage of chargers that feed a battery of larger capacitors; pollution of the air environment by chemicals formed during the discharge of pulsed pump lamps; intense noise that occurs during the operation of some lasers; x-ray radiation when laser radiation is focused in a gas.
More often, physical factors are not found in pure form, but in combination with each other and with factors of other groups: with a forced position and overstrain of individual organs and systems, with chemical, biological and psychogenic factors. Such combinations of groups of factors are best traced when using the method of hyperbaric oxygenation (HBO), in which many factors potentiate the adverse effects of each other, for example, even air nitrogen under high pressure begins to exhibit a narcotic effect, and oxygen under pressure, in combination with static electricity of synthetic materials, making them flammable and explosive. During compression and decompression, medical workers experience dysbarism - ear, sinus and toothaches appear. Women very quickly developed dysmenorrhea - menstrual irregularity, which turns into menorrhagia - extremely violent incessant bloody menstruation - and algomenorrhea - painful menstruation. And also, for example, the adverse effect of acoustic noise on the hearing organs is significantly enhanced under the influence of the ototoxic action of aminoglycoside antibiotics. At the same time, sensorineural hearing loss develops 3-5 times more often than under the action of noise alone.
From the impact of high-frequency vibrations in female dental personnel, neuropathy develops (deterioration of vibrotactility and sensitivity, strength, motor performance). Noise and vibration during prolonged exposure, even at the level of maximum permissible parameters, lead to damage to receptors in the cochlea.
to chemical factors occupational hazard in medicine can be attributed to a huge arsenal of products of the chemical and pharmaceutical industries, such as: anesthetics; antibiotics; hormones; narcotic substances, especially the inhalation route of administration into the body, various disinfectants, canned products and various drugs, organic solvents, acids and alkalis.
The most common adverse factor in the working environment of medical workers is air pollution of working premises with aerosols of medicinal substances, disinfectants and narcotic drugs, which can exceed the permissible sanitary standards in pharmacies, operating rooms, treatment rooms and other industrial premises of medical institutions by dozens of times. Air pollution of working premises with medicinal substances, especially antibacterial drugs, antitumor drugs, which are highly dangerous substances and give an immunosuppressive, cytotoxic, sensitizing effect on the body, can cause the development of allergic diseases in medical workers, toxic lesions, occupational dermatosis, dysbacteriosis; there is evidence of manifestations of the harmful effects of cytostatics.
Antitumor antibiotics are causally significant allergens for the development of occupational dermatoses in persons in contact with them. The concentration of ether in the blood of the anesthesiologist during the operation is only 1.5-3 times lower than in the operated patients. Biochemical studies of the blood of anesthesiologists indicate a violation of pigment metabolism, phenomena of diffuse liver damage (halothane anesthesia).
Many medicinal substances are at the same time industrial poisons, for example, camphor, bromine, iodine, arsenic, nitroglycerin and others, that is, under certain conditions, they can cause acute and chronic intoxication. The cause of occupational allergies can be not only drugs, but also chemicals, disinfectants and detergents, as well as latex contained in gloves, disposable syringes, infusion systems. The staff of chemotherapy departments revealed a high level of diseases of the gastrointestinal tract, cases of eczema, baldness, and a dependence of hematological changes on the experience of working with chemotherapy drugs was also revealed. In recent years, there has been an exponential increase in the number of immediate allergic reactions in healthcare workers, partly due to the use of latex gloves.
Biological and psychogenic factors occupational hazards in medical personnel of various profiles, although less diverse, but more significant and significant, since their action occurs much faster and is more pronounced.
The work of doctors is accompanied by great associated with responsibility for the life of patients, the need to urgently make a decision, a large number of stressful situations, contact with patients with nervous and mental diseases, psychogenic effects due to an unfavorable outcome of treatment, which leads to a significant tension of emotional and intellectual forces.
Significant fatigue that develops in the process of hard work negatively affects the functional state of the central nervous, autonomic, cardiovascular and other systems. The work of a medical worker for his mental health is 2.5-3.0 times more risk than in other professions in the social sphere.
Psycho-emotional stress against the background of chronic overwork contributes to the occurrence of premorbid conditions and somatic diseases. Significant psycho-emotional stress can lead to the appearance of all profiles of burnout syndrome in doctors.
One of the features of the professional activity of doctors is shift work (daily and night shifts), which carries an additional psycho-emotional and physical load, significantly depleting the body's adaptive capabilities. As a result, there are deviations in the functioning of the nervous cardiovascular systems, the digestive tract. Already from the first years of work, complaints of fatigue, irritability, and sleep disturbance may appear. When comparing changes in blood pressure rhythms in doctors on duty, compared with doctors working during the day, a significant daily increase in blood pressure was recorded on the day of duty. An additional load is exerted by work for one and a half - two rates due to the low wages of doctors.
An important aspect of labor protection in health care is the working and living conditions of women, who make up about 80% of workers in the industry. The work of women in a number of medical professions can lead to violations of the menstrual cycle, the course and outcomes of pregnancy, changes in reproductive function, and impaired health of offspring.
At present, a categorization scale has been developed in accordance with the indicators of the severity of labor, according to which all medical specialties are assigned to four main categories (from fifth to second). The highest (5th) category of labor severity includes the specialties of a surgeon, anesthesiologist, resuscitator, emergency doctor, endoscopist, radiologist, pathologist, forensic expert. In the 4th - district doctors, dentists, therapeutic specialists working in a hospital, dermato-venereologists, otorhinolaryngologists, obstetricians-gynecologists, bacteriologists, doctors of functional diagnostics. To the 3rd - doctors of polyclinics, laboratory doctors, epidemiologists, hygienists, physiotherapists. Up to the 2nd - statistics and valeologists. In each of the listed categories of doctors, the significance of various factors varies.
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 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. Do not forget about the harmful effects of electromagnetic radiation on the blood-forming 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, retinal 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), which is 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, turn to the dentist for an appointment.
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 rectus 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.
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