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OSHA Dental – Dentistry 

Dental professionals may be at risk for exposure to numerous biological, chemical, environmental, physical, and psychological workplace hazards. These hazards include but are not limited to the spectrum of bloodborne pathogens, pharmaceuticals and other chemical agents, human factors, ergonomic hazards, noise, vibration, and workplace violence.

OSHA Dental – OSHA Dentistry Standards

There are currently no specific standards for dentistry. However, exposure to numerous biological, chemical, environmental, physical, and psychological workplace hazards that may apply to dentistry are addressed in specific standards for the general industry. This page highlights OSHA standards, directives (instructions for compliance officers), and standard interpretations (official letters of interpretation of the standards) related to dentistry.

 

Hazard Recognition - OSHA Dental – OSHA Dentistry

Many dental care professionals are at risk for occupational exposure to a variety of hazardous chemicals and situations. Being unaware of the potential hazards in the work environment makes them more vulnerable to injury. The following references aid in recognizing hazards in the workplace.



 

OSHA Issues Hazard Information Bulletin for Exposure to Beryllium in Dental Labs

A new Hazard Information Bulletin issued by the Occupational Safety and Health Administration alerts dental laboratories on how to prevent exposure to beryllium, which can cause chronic beryllium disease (CBD), a debilitating and often fatal lung disease, or lung cancer.

 

"Inhaling Beryllium dust at some concentrations is extremely hazardous-sometimes deadly," said OSHA Administrator John. Henshaw. "We are concerned that dental lab technicians are continuing to contract the disease associated with Beryllium exposure. This bulletin informs dental labs and workers of the potential hazards and offers effective methods to prevent exposure to beryllium."

 

The Hazard Information Bulletin presents a case of CBD recently diagnosed in a dental lab technician and recommends the types of engineering controls, work practices, training, personal protective equipment and housekeeping procedures that can be used to reduce beryllium exposure and the risk of CBD. It also provides information on a health surveillance tool that can be used to identify workers with CBD, or beryllium-sensitized individuals, who are at a high risk of progressing to CBD.

 

Dental laboratory technicians can develop CBD if they inhale dust containing beryllium when working on items such as dental crowns, bridges, and partial denture frameworks made from dental alloys containing beryllium. CBD may develop within months after initial exposure to beryllium or may have a very slow onset and not develop until years after exposure to beryllium has occurred.

 

Not all dental alloys contain beryllium. Dental laboratories and technicians should inquire about the contents of the alloys they are using. Information about the contents of dental alloys can be found in the Material Safety Data Sheets (MSDS) that accompany these products to the dental laboratory.

 

Under OSHA's current beryllium standard employees cannot be exposed to more than 2 micrograms of beryllium per cubic meter of air for an 8-hour time-weighted average. Recent information suggests that compliance with this exposure limit is not adequate for preventing the occurrence of CBD. The Hazard Information Bulletin calls for, to the extent feasible, the use of improved engineering controls and work practices.  

OSHA Dental - OSHA Dentistry Control and Prevention 

Preventing Adverse Health Effects From Exposure To Beryllium In Dental Laboratories

Purpose

This Hazard Information Bulletin (HIB) is to inform employers and employees about the risk of dental laboratory technicians developing chronic beryllium disease (CBD). It also provides information on the ways in which beryllium exposures can be reduced, the type of protective equipment which can be worn to reduce exposure, and on the type of medical surveillance procedures that can be used to identify workers who may be sensitized to beryllium, or who may be in the early stages of CBD.

Background

Chronic Beryllium Disease Caused by Working With Dental Alloys Containing Beryllium:
The Occupational Safety and Health Administration (OSHA) is concerned that cases of chronic beryllium disease (CBD) are continuing to occur among dental laboratory technicians working with dental alloys containing beryllium. CBD is a serious lung disease that can be disabling and even fatal. CBD has been reported among dental laboratory personnel in the past, and a recent letter to OSHA indicates that these cases continue to occur.

Workers exposed to beryllium in dental laboratories are covered by the current OSHA Permissible Exposure Limits (PELs) for beryllium. The OSHA PELs for beryllium allow exposure to 2 micrograms per cubic meter of air (2 µg/m³) as an 8-hour time-weighted average (TWA), between 5 µg/m³ and 25 µg/m³ exposure for up to 30 minutes at a time, and 25 µg/m³ as a maximum peak limit that can never be exceeded. Several studies and reports have questioned whether the current 2 µg/m³ PEL for beryllium in the workplace is adequate to prevent the occurrence of CBD among exposed workers.

The Bulletin presents a case report of a dental laboratory technician who was recently diagnosed with CBD. It also offers information on the types of engineering controls, work practices, training, personal protective equipment and housekeeping procedures that can be used to reduce beryllium exposure and the risk of CBD to individuals involved in casting, sprue cutting, grinding, polishing and finishing of dental alloys containing beryllium. This Bulletin also provides information about a health surveillance method that can be used to identify beryllium-sensitized individuals.



Case Report

Beryllium Dental Alloy Exposure and Work Practices:
A 53-year-old woman who had worked as a dental laboratory technician for 13 years was diagnosed with CBD in May 2000. From 1987 to 1995, her daily work involved sandblasting beryllium dental alloy, cutting the metal sprue from the alloy with a high-speed grinder, removing the bubbles with a hand-held electric grinder and deburrer, and setting the restoration to make sure it fit the die. While performing this work, the worker wore a surgical-type paper mask. Although a household-type wall vacuum system with movable hoses was available for cleanup, the laboratory was reported to be very dusty.

Beginning in 1996, the woman worked in a different dental laboratory, where her duties included the grinding of porcelain restorations, sandblasting, metal finishing, and polishing restorations with rouge. The dental technician also was involved in clean-up activities, which included using a household-type dry vacuum, emptying the bag daily by taking it outside and shaking it, washing the bag, and hanging it outside to dry. Shaking the bag produced a dusty cloud. Although this lab used a beryllium dental alloy, it did so much less often than the dental laboratory where this worker had previously been employed. At the second laboratory, work was performed without the use of a mask or hood. Airborne beryllium samples were not taken at either of the dental laboratories where this woman worked.

The Laboratory Technician’s Awareness of the Hazards of Beryllium Exposure: The laboratory technician reportedly received no information from her employers concerning the health hazards associated with beryllium exposure. The OSHA Hazard Communication Standard (29 CFR 1910.1200) requires that manufacturers of hazardous substances such as dental alloys containing beryllium provide a copy of a Material Safety Data Sheet (MSDS) to their customers along with the beryllium dental product. MSDSs must describe the hazards posed by these substances and ways workers can be protected from exposure.

The Hazard Communication Standard also requires employers using hazardous chemicals to train workers on the hazards to which they are exposed and on how to use and work safely with the product. An MSDS for a dental alloy containing beryllium must indicate the health effects of exposure: (1) that beryllium can cause chronic beryllium disease in exposed workers; (2) that acute beryllium disease, which has symptoms resembling those of pneumonia or bronchitis, may occur as a result of exposure to beryllium. Although this form of beryllium disease is now rare, it has been reported in a single case involving the grinding of dental alloys containing beryllium (ref. 15); and (3) that beryllium is classified as a known human carcinogen by the International Agency for Research on Cancer (ref.16).

Diagnosis of Chronic Beryllium Disease and Confusion with Other Lung Disease: In 1997, the laboratory technician was diagnosed as having sarcoidosis. CBD can be mistaken for sarcoidosis when the diagnosis is based on clinical observation or x-rays alone. The worker was correctly diagnosed with CBD in May 2000. The diagnosis was based on the results of additional diagnostic procedures that identified a positive beryllium lymphocyte proliferation test result and abnormal lung pathology, physiology and function. She is currently experiencing symptoms of CBD including dry cough, decreased energy, shortness of breath after walking up one or two flights of stairs or after walking rapidly on a horizontal surface.

Identification of Dental Alloys That Contain Beryllium
Not all dental alloys contain beryllium. Dental laboratory technicians need to inquire about the contents of the alloys they are using. Information about the contents of dental alloys can be found in the MSDSs that accompany these products to the dental laboratory. The synonyms and trade names for some beryllium-containing dental alloys and products are listed in the Appendix to this document.

Chronic Beryllium Disease
CBD primarily affects the lungs. CBD may occur among dental laboratory technicians when they inhale dust containing beryllium when working on items such as dental crowns, bridges, and partial denture frameworks made from dental alloys containing beryllium. CBD may develop within months after initial exposure to beryllium or may have a very slow onset and not develop until years after exposure to beryllium has occurred. The amount or length of exposure to beryllium necessary to cause a specific individual to develop CBD is not known, but recent information suggests that even short exposures (weeks or months) to levels of beryllium below OSHA’s PEL of 2 µg/m³ averaged over an 8-hour day may lead to CBD in some workers.

Beryllium Sensitization: Only workers who have become sensitized to beryllium are believed to develop CBD. A sensitized worker is one who has developed an allergic-type reaction to beryllium. Some workers may become sensitized within weeks or months of exposure on the job, while others may not become sensitized until after leaving a job where there has been beryllium exposure, and some workers never become sensitized. Beryllium sensitization may be detected through the use of a blood test called the BeLPT, which stands for Beryllium Lymphocyte Proliferation Test. This test measures how specific white blood cells called lymphocytes react to beryllium. Positive test results mean that a worker is sensitized. In some cases, persons with CBD do not have a positive blood lymphocyte test, but do have a positive response to beryllium using other diagnostic tests. Sensitization is believed to occur through inhalation of beryllium dusts or fumes. Particles containing beryllium that become lodged under the skin can cause skin lesions and may have the potential to induce sensitization. There are no known symptoms associated with sensitization to beryllium. It is not known whether everyone who is sensitized will eventually develop CBD, however, between 46% and 100% of surveillance-identified workers with beryllium sensitization already have CBD at the time of initial clinical assessment for the disease. It is currently estimated that individuals with beryllium sensitization, but without CBD, have about a 10% chance per year of progressing to CBD.

Signs and Symptoms of Chronic Beryllium Disease: Workers with CBD may not be aware that they have the disease or may have no or only mild symptoms. Workers with clinical evidence of CBD may have one or more of the following signs or symptoms: unexplained cough; shortness of breath, especially with activity; fatigue; weight loss or loss of appetite; fever; or night sweats. Workers having CBD, but no symptoms can be diagnosed today because of advances in medical testing. Because the disease may develop slowly over a period of many years, workers may have the disease for a long time without knowing it. The individuals with CBD, who do not have clinical symptoms of disease are generally referred to as having asymptomatic CBD, or subclinical CBD.


 
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