by: Michelle Strange, MSDH, RDH

When we think about controlling exposures to occupational hazards in dentistry, the first thing that comes to our mind is often PPE (Personal Protective Equipment). Although the role of PPE is crucial in a dental practice, we should recognize that it only serves as the last control when all other measures fail to protect against possible contaminations.

To optimally protect any workplace, a hierarchy of controls needs to be determined. The concept behind this hierarchy is that the control methods at the top are the priority as they are much more effective than those at the bottom. By following this hierarchy, the risk of contamination, illness, or injury reduces substantially.

1. Elimination and Substitution

Elimination and substitution are the most effective strategies to reduce any risk in the workplace. Clearly, when we remove the original source of hazard, the accompanying risk will practically disappear or substantially be reduced. Unfortunately, these measurements are often the most difficult ones to establish. A dental practice is limited in the flexibility of its workplace, and some equipment or actions are just inevitable.

Examples

• Calling patient before they arrive at their appointment to confirm their health
• Asking employees who are feeling unwell or potentially contagious to stay home
• Choosing to handscale versus using an ultrasonic device on a patient with a contagious disease
• Using silver diamine fluoride on a patient with caries lesions instead of utilizing a dental handpiece

2. Engineering Controls

Less effective than elimination or substitution as engineering controls do not totally remove the risk from the workplace. However, thanks to smart engineering solutions, they try to remove the hazard at the source. The initial cost can be higher than administrative controls or PPE, but are more effective and in the long term could be more cost-effective.

Examples

• High Volume Evacuation to reduce spatter, spray, or aerosols to reach the clinician
• Sharps containers at point-of-use to reduce percutaneous injuries
• Instrument cassettes to hold dental instruments and prevent injuries when transporting
• Ultrasonic baths to remove bioburden during the cleaning process vs. hand scrubbing

3. Administrative Controls and PPE

As a last resort, administration controls and PPE protect when all other controls fail or where taking other measurements is not possible. Their protective role is still beneficial, particularly during a pandemic, but it is crucial to realize its priority on the hierarchy of controls.

Examples

• Not eating or drinking in clinical areas
• Using the engineering controls like the HVE for all aerosol generating procedures (AGP)
• Wearing utility gloves during instrument and operatory reprocessing
• Wearing protective eyewear when there is potential for chemical or infectious hazards

In dentistry, eliminating the source is not always possible. Engineering and work practice controls then become the highest priority. Therefore, training personnel with the correct safety procedures is essential.

Providing your dental practice with high-quality devices such as good HVE to reduce the aerosols during patient care can be essential to protect against infections too. Air Techniques Mojave Dry Vacuum System delivers more flow and the highest suction power of any dry vacuum system available resulting in effective aerosol capture with your HVE use. Administrative controls cover processes and standard operating procedures (SOPs) to reduce risk further.

Implementing a hierarchy of controls diminishes the risk of possible hazards in the workplace. However, although the controls at the top of the pyramid get the highest priority, it is the smart implementation of the right combination that will truly have the greatest impact.