1. OCCUPATIONAL HEALTH HAZARDS IN DENTAL TECHNOLOGY PRACTICES IN NIGERIA: A MATTER OF URGENT ATTENTION FOR BETTER CAREER HARNESSING By Okorie P.C 1, Okeke K.N 2 1. Post Graduate Student, Department of Public Health Technology, School of Health Technology, Federal University of Technology, P.M.B 1526, Owerri, Imo State. Nigeria 2. Department of Dental Technology, School of Health Technology, Federal University of Technology, P.M.B 1526, Owerri, Imo State. Nigeria @ The 2013 National Conference/AGM of the Association of Dental Technologists of Nigeria (ADTN). 10 th – 11 th October, 2013 Held at Michael Okpara Auditorium, Umuahia, Abia State.

2. “C conditions, Objects, Substances, Or Processes, Which Has The Risk Or Potential Of Causing Injury, Damage or Diseases are called Hazards Amadi Nkwa

3. INTRODUCTION Hazards according to Amadi (2011) are conditions, objects, substances, or processes, which has the risk or potential of causing injury, damage or diseases. It is also circumstance of things, which predispose people to, or cause accidents, injury or diseases. Accidents, therefore, occurs as a result of exposure to hazards, and without hazards there would be no accidents. Risk in the other hand is defined as a chance or likelihood that hazards will cause harm (QRSM International, 2012). It is pertinent that every employer in dental technology has to access the risk of harm to employees from the job they do. It is a process known as risk assessment. Risk assessment is a way to think about what could go wrong and how to stop it happening before someone hurts. It is not only good practices but is highly required by law (QRSM International, 2012).

4. STEP BY STEP PROCESS IN RISK MANAGEMENT …… According to Safe work Austrialia (2009), safe and healthy workplace does not happen by chance or guesswork. You have to think about what could go wrong at your workplace and what the consequences could be. Then you must do whatever you can (in other words, whatever is ‘reasonably practicable’) to eliminate or minimise health and safety risks arising from your business or undertaking. This process is known as risk management and involves the four steps set out in this Code (see Figure 1 below): Identify hazards – find out what could cause harm Assess risks if necessary – understand the nature of the harm that could be caused by the hazard, how serious the harm could be and the likelihood of it happening Control risks – implement the most effective control measure that is reasonably practicable in the circumstances Review control measures to ensure they are working as planned.

5. STEP BY STEP PROCESS IN RISK MANAGEMENT ……

6. With the above preambles, Occupational Hazard can be defined as the risk to the health of a person usually arising out of employment. It can also refer to work, material, substances, processes or situations that predisposes or itself causes accidents or disease at work place. (Ramandeep et al, 2011). Occupational Hazard in Dental Technology is then the risk to health of a dental technologist usually arising out of his or her work. The history of Occupational hazard awareness can be traced back to the 18 th century when Bernadino Ramazinni, who is referred to as the “Father of Occupational medicine”, recognized the role of occupation in the dynamics of health and disease (Adebola, 2004 in Ramandeep et al, 2011).

7. AIM OF OCCUPATIONAL HADARDS …… Occupational hazards should aim at the promotion and maintenance of the highest degree of physical, mental and social well – being of workers in all occupations: the prevention amongst workers of departures from health caused by their working conditions; the protection of workers in their employment from risks resulting from factors adverse to health; the placing and maintenance of the worker in an occupational environment adapted by his physiological and physiological capabilities, and, to summarize, the adaptations of work to man and of each man to his job (www.ilo.org, retrieved, 09/09/2013).www.ilo.org The main focus in occupational health is on three different objectives: The maintenance and promotion of workers health and working capacity The improvement of working environment and work to become conducive to safety and health and Development of work organization and working cultures in a direction which supports health and safety at work and in doing so also promotes a positive productivity of the undertaking (Joint ILO/WHO Committee, 2013).

8. RELATIONSHIP BETWEEN WORK AND HEALTH As it is known that for a good work production, there is a good health. Therefore, poor health reduces productivity and workers efficiency thereby resulting to work seems to have both positive and negative effects on each other. Amadi, (2011) states the relationship between work and health under the following headings: Positive effects of work on health Positive effects of good health on work Negative effects of poor health (diseases) on work capacity Negative effects of work on health. POSITIVE EFFECTS OF WORK ON HEALTH Work serves to relief boredom Work provides an avenue for creativity It serve as means of personal (economic) gains and means of livelihood It adds to life satisfaction and happiness

9. RELATIONSHIP BETWEEN WORK AND HEALTH POSITIVE EFFECTS OF GOOD HEALTH ON WORK Good health increases capacity of work Good health increases capacity to enjoy work Capacity to derive satisfaction from work NEGATIVE EFFECTS OF POOR HEALTH (DISEASES) ON WORK CAPACITY Poor health can lead to poor disposition and capacity to work Poor performance Reduces productivity, i.e. low productivity owing to illness. NEGATIVE EFFECTS OF WORK ON HEALTH Hazards in the work environment can threaten the workers health and well being, and result in physical, mental and behavioural disorders in every organ of the human body and even death.

10. OCCUPATIONAL HAZARD IN DENTAL TECH. Dental technology as a profession like every other profession is faced with many hazards and potential hazards. These hazards range from: Physical Hazard Chemical Hazard Radiation Hazard Ergonomic hazards Psychological Hazard Biological Hazard Mechanical hazards PHYSICAL HAZARDS Physical hazards are those hazards found in the physical component of workers environment. Amadi, (2011) made it known that pressure, Humidity, Radiation; Noise and Vibration are not left out in our physical environment.

11. OCCUPATIONAL HAZARD IN DENTAL TECH. Dental technologist and other dental practitioners are exposed to noise of different sound levels while working in dental laboratories and clinics. Dental laboratory machine, dental hand piece etc produce sound at different levels which is appreciable (Ramandeep et al, 2011). It is noted that with the high effects of noise been experienced by the dental technologist in the various laboratories, a negative effect on the extra – auditory system with physical consequences (quickened pulse, increase in blood pressure, constriction of blood vessels etc) and psychical consequences (nervousness, mental fatigue and emotional frustration, low productivity etc) in some individuals. These effects occur especially with noise levels above 80db and dependent on the intensity, the distance to the source, the total duration of the noise, age of the individual and his / her physical condition and sensitivity (Behannan et al, 1993).

12. OCCUPATIONAL HAZARD IN DENTAL TECH. As a result of dust generated during casting, sandblasting, grinding porcelain, cleaning / maintenances a dental technologist can suffer from Silicosis. Silicosis is a disabling and incurable lung disease but is preventable. It is caused by breathing in fine dust containing crystalline silica. Once in the lungs, the dust causes damage that stops the body from using oxygen properly. Breathing of dust containing crystalline Silica has been linked to other disease such as tuberculosis, kidney disease and lung cancer. CHEMICAL HAZARDS They are hazards caused by chemical environment which are made up of the elements, compound and mixture (Amadi. 2011). These chemicals can accumulate in human body and can pose as health problems. It may take up to 10 to 30 years before its total manifestation. Most hazardous chemicals are from dental materials. Acrylic resin monomer though proven safe but can still be hazardous on inhalations. Other dental materials are volatile and may rise to dermatological and respiratory effects (Pohl and Bergman, 1995).

13. OCCUPATIONAL HAZARD IN DENTAL TECH. RADIATION Dental technologists like other Dental personnel are exposed to ionizing and non –ionizing types of radiations. Ionizing radiation is a well – established risk factor for cancer (Kai, et al, 1997). Most metallic elements in the laboratory emit some radioactive elements which can cause harm to the body. ERGONOMICS Ergonomics remains one of the most occurring hazards in the dental technology practices. It includes tool design, equipment design, job design, workstation design and manual handling. Musculoskeletal Disorders (MSD) and Disease of the peripheral Nervous System is a common effect to dental technologist. The muscular pain stays with the dental technologist during their professional practices affecting the spine, neck, shoulders and hands, among others (Cabellero et al, 2010). Musculoskeletal pain, particularly back pain has been found to be a major occupational hazard in dental technology profession (Marshall et al, 1997; Biller, 1946).

14. OCCUPATIONAL HAZARD IN DENTAL TECH. Spine degeneration which leads to back pain syndrome, Neck discopathy which results in cervical pains or cervico – acromial pains are particularly common among dental technologist (Runderantz et al, 1991). PSYCHOLOGICAL It will be noted that workload, dealing with the public, harassment, discrimination and low – level constant noise remains the psychological hazards faced by the dental technologist. Hamida, et al (2009) states that both male and female technologists are exposed to different stress factors; however the highest stress factors for both of them are limited opportunities for career growth, followed by financial worries. He further states that males are suffering significantly higher than females in some stress factors as quality requirements in their relationship with their customers, feeling undervalued and staff problems. Psychologically, Locker et al, (1989); Bader, (1982); Furnham, (1983) and Niu and Locker, (1996) states that dental technologist career is the high stressful job.

15. OCCUPATIONAL HAZARD IN DENTAL TECH. With this effect, in line with this year’s Conference theme, Dental technologists are really faced with psychological hazards in making a nice career due to the salary scale. BIOLOGICAL HAZARDS Viruses, Bacteria and Infections are not left out as part of the hazards encountered by the dental technologist in their various laboratories. Viruses such as Hepatitis A, B and C can be gotten from an unsterilized impression. Viruses and bacteria can equally be spread via unmaintained air conditioning units in the laboratory. In the repairs of Dentures, there may be a cross – infection from the patient to the practitioner which tuberculosis serves as on. MECHANICAL HAZARDS Being hit by moving Dental motors from the trimming machines, polishing machines etc, or being caught by moving parts of dental machinery can cause fractures, bruises, lacerations, dislocations, permanent injuries or death

16. METHODS OF DETECTION OF OCCU. HAZARDS The following, according to many authors has been adopted as the major ways of detecting occupational hazards. Medical Surveillance Environmental monitoring MEDICAL SURVEILLANCE This is an ongoing systematic collection, analysis and determination of diseases data on groups and population. These include: Biological monitoring Medical Examination Radiographic monitoring Analysis of Medical Records ENVIRONMENTAL MONITORING This involves the measurements of the dose of hazardous agent absorbed by the dental technologist at his place of work e.g. Dust measurement in the Dental laboratory.

17. METHODS OF CONTROL OF OCCU. HAZARDS The major aim of this control is to control and minimize the dental technologist exposure to the potential hazards, so that exposure levels will be below what is considered hazardous. These include: Substitution of toxic material Total Enclosure Locally Applied Exhaust ventilation Segregation or Isolation of a process Education on the hazards of the job Limitation of time of exposure General ventilation Wet methods General cleanliness Personal Hygiene Personal protection

18. DENTAL TECHNOLOGIST IN OCCUPATIONAL HAZARD As it is known in the practices of Medicine, all other aspect of medicine and para- medicine are responsible for the treatment of persons involved in occupational related hazards. How does Dental technologist come into play? This question remains one most of the Dental technology practitioners ask? In an event of an accident and there are loss of oral and oro-facial structures, whose duty is to replace them? Dental Technologist of course

19. CONCLUSION It is paramount to note, notwithstanding the various papers presented and despite the numerous advancement, many Dental Technologists are faced with occupational hazards. Occupational hazards remain inseparable in many practices in which Dental technology is one. Dental products such as acrylic resins and polymer materials used in Dental Technology represent a major advance in dentistry. Although these products may act as alleviators to challenges, one should keep in mind that every technology, no matter how beneficial, can exert a negative impact on some members of the population. The reality of Public health will always involve balancing maximum benefit and minimum harm to the public health and well –being. Because allergy is a reality Dental technologist have to deal with.

20. RECOMMENDATIONS We are delighted to recommend the following: The Dental laboratories in the different health sectors must be designed and prepared according to the recommended safety as recommended by Hamida and Mostafa, (2010). Dental technologist should be familiar with the major signs and symptoms of allergies reactions. Dental Technologist Registration Board of Nigeria (DTRBN) should ensure that its members are part of key decision making in Standard organization of Nigeria for quality assurance of products Dental technologist should make it as a point of responsibility to ensure that they are properly sited in a good posture at work. Be aware of cross – sensitivity towards colouring agents of dentures Local exhaust ventilation systems can significantly reduce the peace concentration of acrylate vapour in the breathing zone of the dental technologist. The Association of the Dental Technologists of Nigeria (ADTN) should work in collaboration with the DTRBN to see that the working conditions of members are improved in the different centres.

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24. For comments, further information about this paper and Suggestions, correspondence to: OKORIE PETER CHIDIEBERE Post graduate student Environmental and safety option Department of public health technology School of health technology Federal university of technology Owerri, imo state. Tel: +2348039546036, 07084824579 E-mail : Chidiokorieus@gmail.ComChidiokorieus@gmail.Com