The career-ending injury no one talks about

May 30, 2017

Dental professionals need to take extra precaution to protect their eyes during their daily work.

According to the Centers for Disease Control and Prevention (CDC), each day about 2,000 workers in the United States experience a job-related eye injury that requires medical treatment.

About one-third of these injuries are treated in hospital emergency departments, and more than 100 of these injuries result in one or more days of lost work. An estimate from the Occupational Safety and Health Administration (OSHA) states that in the United States each year, thousands of people are blinded from work-related eye injuries that could have been prevented with the proper selection and use of eye and face protection. Eye injuries in the United States alone cost more than $300 million per year in medical expenses, worker compensation and lost production time.

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Data from the CDC indicates that the majority of these eye-related injuries result from small particles or objects striking or abrading the eye. Examples of small particles include metal slivers, dust, cement chips and wood chips that are ejected by tools, wind-blown or fall from above a worker. Larger objects may also come in contact with the eye or face, or a worker may run into an object, causing blunt force trauma to the eyeball or eye socket. Chemical and thermal burns to one or both of the eyes are also common.

Dentistry is not immune to these eye-related injuries. In fact, dental staff members are prone to such eye injuries as particles abrading the eye, chemical and thermal burns, and ocular exposure as a result of inadequate eye protection. In both the health care sector and society as a whole, ocular health is becoming increasingly important because undetected and untreated ocular conditions and injuries can lead to vision loss and blindness.

Conventionally, safety organizations such as Organization for Safety, Asepsis and Prevention (OSAP) and OSHA have judiciously focused on preventing the spread of infection, which has led to marginal education regarding the eye-related injury risks associated with dental practice.

Both OSHA and OSAP have specific guidelines for eye protection to prevent the spread and infection of bloodborne pathogens and diseases, but neither organization has standards acknowledging the risk of eye injuries. Similarly, the CDC recommends the use of protective eyewear for dental and health care professionals to protect the mucous membranes of the eyes from contact with microorganisms, but not against other eye-related injuries. Further consideration is necessary to address eye injuries in dental practice and preventative measures to reduce the number of eye injury incidences.

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Eye injuries in the dental practice

Dental professionals are considered one of the occupational groups that are prone to experience ocular injuries and problems as they perform their daily dental work. A study completed by Arheiam et al. found that eye problems were the third most frequently reported occupational health problem among dentists. In a study of Greek endodontists, 73 percent reported ocular incidences, with amalgam and sodium hypochlorite (NaOCl) as the most frequently associated foreign bodies involved in ocular accidents. Another study completed by Sims et al. found that 43 percent of orthodontists in the United Kingdom reported instances of ocular injury in their practices, with the majority occurring during debonding or trimming acrylic.

In addition to these generalists and specialists, dental laboratory procedures can result in traumatic injuries due to projectiles or exposure to harsh chemicals or heat. Patients can also be susceptible to eye injuries during dental procedures. A 2006 study completed by Hill found that while 84 percent of dental school restorative clinics in the United States had safety glasses available for patients, only 77 percent required usage during restorative procedures.All dental professionals and patients are thus at risk for eye injuries due to the activities involved in dental treatments.

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For example, any dental procedures involving high speed rotary instrumentation (180,000 rpm to 500,000 rpm) generate debris that can travel at high speeds of up to 50 mph. Without protective means, such debris, including amalgam, tooth enamel, calculus, pumice and broken dental burs, may find its way into the eyes of the dental practitioner, team member, laboratory technician or patient. If these small objects are projected and strike the orbit, injuries of varying severity can occur.

Drilling can significantly increase the probability of injuring the eyes of the operator as the foreign body locates itself in the conjunctival sac or the cornea, causing lacrimation, reddening of the eyeball and acute pain.More severely, if the debris deeply penetrates the eye, it may result in a perforation of the cornea and a consequent injury to the lens.

Depending on the type of material, drilling, polishing and finishing can also lead to foreign particles entering the air and potentially the eye. Due to the complex nature of dental materials, these particles can lead to chemical burns in the eye as well.

In addition to debris contacting the eye, exposure to non-ionizing radiation has also become an increasing concern in dentistry because of the use of ultraviolet and blue light to cure or polymerize various dental materials, including composite resin, bonding agents and sealants. Exposure to radiation can also occur during laser treatments and X-rays. Absorbed radiation can lead to phototoxic and photoallergic reactions in the eyes and skin of operators as well as patients. Exposure to these wavelengths can damage the cornea, lens and retina. Protective eyewear is necessary to safeguard the eye from debris, chemicals, radiation and any other foreign bodies that can potentially injure the practitioner, team member or patient. 

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Keeping an eye on preventing injuries

The best practices for preventing eye injuries in the dental practice are safety shields and glasses worn correctly. However, among dental professionals, the use of protective eyewear varies. A study completed by Ajayi et al. revealed that the frequency of using protective eyewear among the dental personnel was 36.7 percent. Another study surveyed general dental practitioners and found that 48 percent had experienced ocular trauma or infection, which occurred during a variety of procedures, and 75 percent of these injuries resulted from not wearing eye protection.Of those surveyed, 87 percent of practitioners reported wearing eye protection routinely, but their choice of protection was not always adequate and not worn for all procedures.

Debris enters the eye using one of three routes: frontal entry, sideways entry or bottom gaps. Frontal entry occurs when debris travels perpendicular to the practitioner’s face, and typically any type of glasses protects the eyes from this route of entry. With sideways entry, debris travels tangential to the face, and side shields on protective eyewear can protect the patient and practitioner from this type of entry.11 Finally, debris travelling vertically or tangential to the face may contact the eye through bottom gap entry or the space between the glasses and the mask of the practitioner.Thus, the current dental mask and eyewear combination for protecting the eyes of the dental care provider is inadequate protection.

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Although some team members and practitioners may use their prescription glasses for protective eyewear, these are not recommended due to the many gaps that give way to potential debris, resulting in eye injury. Appropriate safety goggles or glasses should fit comfortably over street eyewear, providing satisfactory protection without impairing the fit of the prescription glasses. Suitable safety goggles, glasses or shields should have thick frames that cover the side of the face and the top and bottom of the glasses to ensure that debris cannot come in contact with the eye. Face shields are an alternative option that ensure complete protection and avoid the gap between the glasses/goggles and the mask.

Additional protective glasses are necessary for any radiation exposure treatments. The practitioner, patient and dental team members should wear glasses that filter UV light during light curing and polymerization. Various colored plastic glasses and hand shields are available that effectively protect the eyes from UV radiation.Glasses are also available to protect the eyes from laser radiation (i.e., Holmium-YAG lasers, Diode 810nm lasers, etc.). Finally, safety glasses are necessary during radiographs to avoid radiation exposure during X-rays. It is important to notify the patient and dental team members when radiation-specific protective glasses/goggles are necessary to ensure that the patient and dental professionals are adequately protected throughout the treatment.

Eye injuries prevention checklist

  • Clean reusable eyewear between patients and disinfect whenever visibly soiled.

  • Wear protective eyewear with solid side shields during any patient-care activities that can generate debris, radiation, or splashes or sprays of blood or bodily fluids.

  • Educate your patients about why protective eyewear is important and require them to use it during any procedures that can generate debris, radiation or splashes or sprays of blood or body fluids.

  • Utilize radiation specific glasses (i.e., UV light, lasers, radiation) for the patient, practitioner and team member.

Conclusion

Although eye injuries occur every day, utilizing protective glasses, goggles, face shields and radiation-specific eyewear can help to avoid most injuries. Patients in the dental practice must be educated about why protective eyewear is important and when to use it. Team members and dental practitioners must be proactive in maintaining eye protection to avoid eye injuries and their complications.