Dental Office Safety Manual

What Should a Dental Office Safety Manual Include?

The contents of a Dental Office Safety Manual should reflect the practice’s actual operations.

A general dental office may need a different combination of programs than an oral surgery practice, pediatric dental office, orthodontic practice, or large multi-provider facility containing extensive sterilization operations, nitrous oxide systems, laboratories, X-ray equipment, and specialized clinical procedures.

Depending on operations, the manual may address:

• Dental office safety responsibilities.
• Hazard assessments.
• Safety inspections.
• Bloodborne Pathogens.
• Exposure Control Plan.
• Universal Precautions.
• Needlestick and sharps prevention.
• Exposure incident response.
• Hepatitis B vaccination.
• Instrument processing.
• Infection-control practices.
• Hazard Communication.
• Dental chemical safety.
• Personal Protective Equipment.
• Eye and face protection.
• Nitrous oxide safety.
• Waste anesthetic gases.
• Dental ergonomics.
• Dental X-ray safety.
• Compressed gas cylinders.
• Electrical safety.
• Emergency procedures.
• Workplace violence.

Programs and procedures should be selected according to the work actually performed, hazards present, equipment used, and applicable safety requirements.

Dental Office Safety Program

An effective Dental Office Safety Program establishes responsibilities and procedures for identifying workplace hazards, preventing employee exposures, safely handling contaminated instruments and sharps, controlling chemical and anesthetic-gas exposures, providing appropriate PPE, and correcting unsafe conditions.

Management should provide employees with the equipment, safeguards, training, PPE, and resources necessary to perform their assigned work safely.

Dentists, managers, supervisors, and other designated personnel should:

• Identify workplace hazards.
• Maintain required written safety programs.
• Evaluate occupational exposure to blood and other potentially infectious materials.
• Maintain the Exposure Control Plan.
• Evaluate safer medical devices.
• Maintain sharps-safety procedures.
• Evaluate chemical hazards.
• Maintain appropriate engineering controls.
• Evaluate nitrous oxide exposure where applicable.
• Provide appropriate PPE.
• Maintain equipment and safeguards.
• Conduct workplace inspections.
• Provide required employee training.
• Correct unsafe conditions.
• Investigate exposure incidents and workplace injuries.
• Maintain required records.

Employees should follow established procedures, use required engineering controls and PPE, report unsafe conditions, and immediately report occupational exposure incidents.

Dental Office Hazard Assessments

Dental-office operations should be evaluated to identify biological, chemical, ergonomic, physical, and other workplace hazards.

Hazard assessments may consider:

• Blood and other potentially infectious materials.
• Needles and sharps.
• Dental instruments.
• Aerosols and splashes.
• Cleaning and disinfecting chemicals.
• Sterilants.
• Nitrous oxide.
• Compressed gases.
• Radiation.
• Dental laboratory materials.
• Electrical equipment.
• Ergonomic stress.
• Slips and falls.
• Workplace violence.

Assessments should be reviewed when procedures, equipment, chemicals, technology, or workplace conditions change significantly.

Dental Office Safety Inspections

Periodic safety inspections can help identify unsafe conditions and verify that established procedures are being followed.

Inspections may include:

• Dental operatories.
• Sterilization areas.
• Instrument-processing areas.
• Laboratories.
• Chemical-storage areas.
• Sharps containers.
• Emergency equipment.
• Nitrous oxide equipment.
• Compressed gas cylinders.
• Electrical equipment.
• X-ray equipment.
• PPE supplies.
• Housekeeping.
• Exit routes.
• Fire-protection equipment.

Identified deficiencies should be documented and corrected in a timely manner.

Bloodborne Pathogens

Dental employees with occupational exposure to blood or other potentially infectious materials should be protected according to applicable Bloodborne Pathogens requirements.

Dental procedures present particular exposure concerns because employees routinely work with sharp instruments in and around the patient’s mouth.

The Bloodborne Pathogens Program should address applicable:

• Exposure determination.
• Exposure Control Plan.
• Universal Precautions.
• Engineering controls.
• Work-practice controls.
• Personal Protective Equipment.
• Housekeeping.
• Hepatitis B vaccination.
• Post-exposure evaluation and follow-up.
• Employee training.
• Recordkeeping.

Employees should understand the procedures they must follow before beginning work involving occupational exposure.

Exposure Control Plan

The dental practice should maintain an Exposure Control Plan when employees have occupational exposure to blood or other potentially infectious materials.

The plan should identify:

• Job classifications with occupational exposure.
• Tasks and procedures involving exposure.
• Methods of compliance.
• Engineering and work-practice controls.
• PPE.
• Housekeeping procedures.
• Hepatitis B vaccination procedures.
• Exposure incident procedures.
• Post-exposure evaluation and follow-up.
• Communication of hazards.
• Training.
• Recordkeeping.

The Exposure Control Plan should be reviewed and updated as required.

Exposure Determination

Exposure determination should be based on reasonably anticipated occupational exposure without considering the use of PPE.

Dental job classifications and tasks should be evaluated individually.

Potentially exposed employees may include:

• Dentists.
• Dental hygienists.
• Dental assistants.
• Sterilization personnel.
• Dental laboratory personnel.
• Other employees whose assigned duties involve occupational exposure.

Administrative employees without occupational exposure should not automatically be included solely because they work in a dental office.

Universal Precautions

Universal Precautions should be observed to prevent contact with blood and other potentially infectious materials.

Employees should treat applicable blood and other potentially infectious materials as potentially infectious regardless of the patient’s known or perceived health status.

Appropriate engineering controls, work-practice controls, and PPE should be used.

Saliva in Dental Procedures

For purposes of occupational exposure control, saliva in dental procedures is treated as other potentially infectious material.

Dental employees should therefore follow applicable Bloodborne Pathogens precautions during procedures where contact with saliva occurs.

Engineering Controls

Engineering controls should be used to eliminate or minimize employee exposure where feasible.

Depending on the procedure, controls may include:

• Sharps disposal containers.
• Needleless systems where applicable.
• Sharps with engineered sharps-injury protections.
• Other safer medical devices.
• Appropriate instrument-handling systems.

Engineering controls should be examined and maintained or replaced as necessary to ensure effectiveness.

Work-Practice Controls

Work-practice controls should reduce the likelihood of occupational exposure by changing the manner in which tasks are performed.

Procedures may address:

• Handling contaminated instruments.
• Passing sharp instruments.
• Needle handling.
• Disposal of sharps.
• Transport of contaminated instruments.
• Instrument cleaning.
• Surface decontamination.
• Specimen handling.
• Cleanup of blood or OPIM.

Employees should follow established procedures rather than improvising when handling contaminated sharps or instruments.

Needlestick and Sharps Prevention

Needles, scalers, burs, wires, blades, and other sharp dental instruments can cause percutaneous injuries.

The dental practice should evaluate tasks involving sharps and implement appropriate engineering and work-practice controls.

Employees should:

• Handle sharps carefully.
• Minimize unnecessary handling.
• Dispose of contaminated sharps promptly.
• Use appropriate sharps containers.
• Avoid reaching into sharps containers.
• Report needlesticks and other exposure incidents immediately.

Sharps-safety practices should be incorporated into employee training.

Safer Medical Devices

Where employees have occupational exposure, the practice should evaluate commercially available safer medical devices as required.

Frontline employees involved in direct patient care should participate in identifying, evaluating, and selecting effective engineering and work-practice controls as applicable.

The Exposure Control Plan should document required consideration and implementation of appropriate safer medical devices.

Needle Recapping

Contaminated needles should not be bent, recapped, or removed except when permitted by applicable requirements.

When recapping or needle removal is necessary for a specific procedure and no feasible alternative exists, the task should be performed using an appropriate mechanical device or one-handed technique.

Employees should receive instruction on the approved method.

Sharps Containers

Contaminated sharps should be placed in appropriate sharps containers.

Containers should be:

• Closable.
• Puncture resistant.
• Leak resistant as applicable.
• Appropriately labeled or color coded.
• Accessible to employees.
• Located as close as feasible to where sharps are used.

Containers should be replaced before overfilling creates an additional hazard.

Hepatitis B Vaccination

Employees with occupational exposure should be offered Hepatitis B vaccination according to applicable requirements.

The vaccination should be made available within the required timeframe after initial assignment unless an applicable exception exists.

Employees who decline vaccination should complete the required declination documentation.

An employee who initially declines may later request the vaccination while remaining occupationally exposed.

Exposure Incidents

Needlesticks, cuts from contaminated instruments, splashes to mucous membranes, and other qualifying exposures should be immediately reported.

The practice should establish procedures for:

• Immediate first aid.
• Reporting the incident.
• Documenting the route and circumstances of exposure.
• Identifying and documenting the source individual when applicable.
• Medical evaluation.
• Laboratory testing as applicable.
• Post-exposure prophylaxis when medically indicated.
• Counseling.
• Follow-up.

Employees should understand that prompt reporting is important following an occupational exposure.

Post-Exposure Evaluation and Follow-Up

Following a qualifying exposure incident, the employer should provide confidential medical evaluation and follow-up according to applicable requirements.

Required information should be provided to the evaluating healthcare professional.

The employee should receive the healthcare professional’s written opinion as required.

Medical information should be maintained confidentially.

Personal Protective Equipment

Appropriate PPE should be provided based on the employee’s anticipated exposure.

Depending on the procedure, PPE may include:

• Gloves.
• Protective clothing.
• Safety glasses.
• Goggles.
• Face shields.
• Masks.
• Other appropriate protection.

PPE should prevent blood or OPIM from contacting the employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under reasonably anticipated conditions.

Gloves

Appropriate gloves should be worn when hand contact with blood, OPIM, mucous membranes, or non-intact skin is reasonably anticipated.

Disposable examination gloves should be replaced when contaminated, torn, punctured, or when their ability to function as a barrier is compromised.

Disposable gloves should not be washed or decontaminated for reuse.

Employees requiring non-latex or other alternative gloves should be provided suitable options as appropriate.

Eye and Face Protection

Dental procedures can generate splashes, droplets, particles, and flying debris.

Appropriate eye and face protection should be used based on the anticipated exposure.

Protection may include:

• Safety glasses with appropriate side protection.
• Goggles.
• Face shields used with appropriate primary eye protection when necessary.

Protective equipment should be cleaned, maintained, or disposed of according to applicable procedures.

Protective Clothing

Protective clothing should be selected based on the task and anticipated exposure.

Depending on the procedure, this may include gowns, clinic jackets, laboratory coats, or other appropriate protective garments.

Contaminated protective clothing should be removed and handled according to established procedures.

Employees should not take employer-provided contaminated protective clothing home for laundering when employer laundering is required.

Instrument Processing

Instrument processing can expose employees to contaminated sharps, blood and OPIM, chemicals, heat, and equipment hazards.

The instrument-processing area should be organized to reduce unnecessary handling and cross-contamination.

Procedures should address:

• Receiving contaminated instruments.
• Transport.
• Cleaning.
• Inspection.
• Packaging.
• Sterilization.
• Storage.

Employees should use appropriate PPE during instrument processing.

Transporting Contaminated Instruments

Contaminated instruments should be transported in a manner that minimizes employee exposure.

Containers should be appropriate for the instruments and hazards involved.

Employees should not carry unprotected contaminated sharps in a manner that creates unnecessary exposure to themselves or others.

Instrument Cleaning

Mechanical cleaning methods should be used where appropriate to reduce unnecessary hand contact with contaminated instruments.

Where manual cleaning is necessary, employees should use appropriate tools and PPE and avoid reaching blindly into containers containing contaminated sharps.

Employees should follow equipment and chemical instructions.

Ultrasonic Cleaners — When Applicable

Employees using ultrasonic cleaners should follow manufacturer instructions and established procedures.

Potential hazards may include:

• Contaminated instruments.
• Cleaning chemicals.
• Splashes.
• Electrical equipment.
• Noise.

Equipment should be maintained in safe condition.

Sterilizers and Autoclaves

Sterilizers and autoclaves can expose employees to heat, steam, hot surfaces, and pressurized equipment.

Employees should:

• Follow manufacturer instructions.
• Use appropriate loading and unloading procedures.
• Allow equipment and materials to cool when necessary.
• Use appropriate PPE.
• Report leaks or equipment defects.
• Avoid opening equipment in an unsafe manner.

Only appropriately instructed employees should operate sterilization equipment.

Infection Control

Dental infection-control procedures should support employee protection from infectious materials and complement applicable Bloodborne Pathogens requirements.

Procedures may address:

• Hand hygiene.
• PPE.
• Respiratory hygiene.
• Instrument processing.
• Environmental cleaning.
• Surface decontamination.
• Sharps safety.
• Waste handling.
• Exposure response.

Clinical infection-control recommendations and applicable occupational safety requirements should be appropriately incorporated into practice procedures.

Environmental Cleaning and Decontamination

Work surfaces and equipment contaminated with blood or OPIM should be cleaned and decontaminated according to established procedures.

Employees should use appropriate disinfectants and PPE.

Broken glass or other contaminated sharp materials should not be picked up directly with the hands.

Regulated Waste

Regulated waste should be handled, contained, labeled, stored, and disposed of according to applicable requirements.

Employees should understand which materials constitute regulated waste and the procedures for handling them.

Containers should be appropriate for the material being discarded.

Dental Chemical Safety

Dental offices may use disinfectants, sterilants, bonding agents, etchants, resins, cleaners, impression materials, laboratory chemicals, and other hazardous substances.

Employees should:

• Follow label and Safety Data Sheet precautions.
• Use required PPE.
• Maintain container labels.
• Follow established handling procedures.
• Store chemicals appropriately.
• Avoid unauthorized mixing.
• Report spills and damaged containers.

Hazard Communication

Employees exposed to hazardous chemicals should receive appropriate information and training.

The Hazard Communication Program should address applicable:

• Chemical inventories.
• Safety Data Sheets.
• Container labeling.
• Employee information and training.
• Non-routine tasks.
• Contractor communication.

Employees should understand how to obtain and use Safety Data Sheets.

Disinfectants and Sterilants

Chemical disinfectants and sterilants should be used according to manufacturer instructions and applicable safety procedures.

Employees should understand:

• Required PPE.
• Dilution procedures.
• Ventilation requirements where applicable.
• Contact hazards.
• Spill procedures.
• Storage requirements.
• Incompatible materials.

Employees should not mix chemical products unless specifically instructed and authorized to do so.

Mercury — When Applicable

Dental practices that handle mercury-containing materials should evaluate potential employee exposure.

Procedures should address appropriate:

• Handling.
• Storage.
• Spill response.
• Waste management.
• Employee training.

Mercury spills should be handled according to established procedures rather than ordinary housekeeping methods.

Chemical Spill Response

Employees should know how to respond to foreseeable chemical spills.

Procedures should identify:

• How to report the spill.
• Appropriate PPE.
• Cleanup materials.
• Ventilation considerations.
• When evacuation is necessary.
• When specialized assistance is required.
• Disposal procedures.

Employees should not attempt to clean a spill beyond their training or available protective equipment.

Nitrous Oxide Safety — When Applicable

Dental practices administering nitrous oxide should evaluate employee exposure to waste anesthetic gas.

Controls should address:

• Delivery equipment.
• Scavenging systems.
• Ventilation.
• Equipment inspection.
• Leak prevention.
• Work practices.
• Maintenance.
• Employee training.

Employees should understand how waste nitrous oxide can enter the operatory and the importance of properly operating exposure-control systems.

Nitrous Oxide Scavenging

Appropriate scavenging should be used to capture waste nitrous oxide during administration.

Equipment should be operated according to manufacturer instructions and established procedures.

The patient interface should fit appropriately to minimize leakage.

Scavenging should remain effective throughout the procedure and during appropriate post-administration periods.

Nitrous Oxide Equipment Inspection

Nitrous oxide delivery and scavenging equipment should be inspected and maintained according to established procedures.

Potential problems may include:

• Worn tubing.
• Cracks.
• Damaged masks.
• Loose connections.
• Leaks.
• Inadequate vacuum flow.

Defective equipment should be repaired or replaced as appropriate.

Nitrous Oxide Leak Prevention

Connections and equipment should be evaluated for leaks according to established procedures.

Employees should promptly report suspected leaks or abnormal equipment conditions.

Cylinder changes and equipment maintenance should be performed only by appropriately trained or authorized personnel.

Ventilation

Dental operatories should have appropriate ventilation for the work performed.

Where local exhaust, scavenging, or other engineering controls are provided, employees should use the systems correctly.

Ventilation systems should not be intentionally disabled or obstructed.

Compressed Gas Cylinders

Oxygen, nitrous oxide, and other compressed gas cylinders should be appropriately stored, secured, handled, and protected from damage.

Employees should use appropriate regulators and connections.

Cylinders should be protected from conditions that could damage valves or cause uncontrolled release.

Damaged cylinders or components should be reported and removed from service as appropriate.

Dental Ergonomics

Dentists, dental hygienists, and dental assistants may spend prolonged periods performing precision work in constrained positions.

Potential ergonomic risk factors include:

• Awkward neck posture.
• Forward bending.
• Twisting.
• Elevated shoulders.
• Repetitive hand movement.
• Pinch grip.
• Static posture.
• Poor patient positioning.
• Prolonged sitting or standing.

Work practices and equipment should be evaluated to reduce unnecessary musculoskeletal stress.

Operator Positioning

Employees should position themselves and the patient to reduce excessive bending, twisting, reaching, and static posture where practical.

Appropriate seating, patient positioning, lighting, magnification, and instrument placement may reduce unnecessary physical strain.

Frequently used equipment should be positioned within convenient reach where practical.

Dental Hygienist Ergonomics

Dental hygienists perform repetitive precision work that may place substantial demands on the hands, wrists, shoulders, neck, and back.

Ergonomic considerations may include:

• Instrument selection.
• Instrument sharpness.
• Grip.
• Wrist position.
• Patient positioning.
• Operator seating.
• Work-rest patterns.
• Task variation.

Employees should report persistent pain, numbness, tingling, weakness, or other symptoms that may indicate a developing musculoskeletal problem.

Repetitive Hand and Wrist Work

Repetitive instrumentation can contribute to hand and wrist fatigue.

Where practical, employees should:

• Maintain neutral wrist positions.
• Avoid unnecessary forceful gripping.
• Use appropriately designed instruments.
• Keep instruments properly maintained.
• Vary tasks or positions when feasible.
• Report symptoms early.

Aerosols and Respiratory Hazards

Dental procedures may generate aerosols, droplets, dust, fumes, or other airborne contaminants.

The practice should evaluate respiratory hazards based on the procedures and materials involved.

Controls may include:

• High-volume evacuation.
• Ventilation.
• Engineering controls.
• Work-practice controls.
• Appropriate PPE.
• Respiratory protection when required.

Respiratory Protection — When Applicable

When respirators are necessary to protect employees from occupational respiratory hazards, the practice should maintain an appropriate Respiratory Protection Program.

Applicable requirements may include:

• Respirator selection.
• Medical evaluation.
• Fit testing.
• Training.
• Inspection.
• Maintenance.
• Program evaluation.

Respirator use should be based on an appropriate evaluation of the workplace hazard.

Dental X-Ray Safety — When Applicable

Dental practices using X-ray equipment should establish procedures for protecting employees from unnecessary radiation exposure.

Procedures may address:

• Safe positioning.
• Restricted access.
• Equipment condition.
• Appropriate shielding.
• Employee training.
• Equipment maintenance.
• Applicable monitoring requirements.
• Applicable state radiation-control requirements.

Employees should follow established radiographic safety procedures during every exposure.

Radiation Safety

Radiation-safety procedures should reflect the type of equipment and applicable regulatory requirements.

Employees should not intentionally remain in an inappropriate location during an exposure.

Damaged or malfunctioning X-ray equipment should be removed from use as appropriate until evaluated.

Dental Laboratory Safety — When Applicable

Dental offices performing laboratory work should evaluate hazards associated with grinding, polishing, trimming, chemicals, dust, heat, sharp tools, and powered equipment.

Procedures may address:

• Local exhaust ventilation.
• Eye and face protection.
• Machine guarding.
• Dust control.
• Chemical safety.
• Hand protection.
• Housekeeping.

The scope of laboratory procedures should reflect the actual work performed in the office.

Beryllium — When Applicable

Certain dental laboratory materials may present beryllium exposure concerns.

Practices performing applicable laboratory work should determine whether beryllium-containing materials are present and evaluate potential employee exposures.

Appropriate substitution, engineering controls, work practices, PPE, housekeeping, and other measures should be implemented where applicable.

Silica — When Applicable

Certain dental laboratory activities may generate respirable crystalline silica or other mineral dust.

Practices performing applicable laboratory work should evaluate materials and processes to determine whether an exposure hazard exists.

Dust should be controlled using appropriate methods rather than relying on uncontrolled dry sweeping or compressed air.

Hand and Power Tools — When Applicable

Dental laboratory and maintenance work may involve grinders, polishers, rotary tools, drills, and other powered equipment.

Tools should be maintained and used according to their intended purpose.

Required guards and safeguards should remain in place.

Appropriate eye, face, hand, hearing, or respiratory protection should be used based on the task.

Electrical Safety

Electrical equipment, cords, plugs, receptacles, and panels should be maintained in safe condition.

Employees should not use damaged electrical equipment.

Electrical panels should remain appropriately accessible.

Employees should report equipment that shocks, sparks, overheats, or otherwise operates abnormally.

Only qualified or otherwise authorized personnel should perform electrical work requiring specialized knowledge or training.

Slips, Trips and Falls

Dental offices should maintain floors, corridors, operatories, laboratories, sterilization areas, and other walking-working surfaces in safe condition.

Potential hazards include:

• Water.
• Chemical spills.
• Cords.
• Equipment.
• Supplies.
• Damaged flooring.
• Clutter.

Spills and other temporary hazards should be promptly corrected or appropriately protected.

Housekeeping

Work areas should be maintained in an orderly and sanitary condition.

Supplies and equipment should be stored securely.

Exit routes, electrical panels, fire extinguishers, eyewash equipment, and other emergency equipment should remain accessible.

Housekeeping procedures should distinguish between ordinary cleaning and cleanup involving blood, OPIM, hazardous chemicals, or regulated waste.

Emergency Eyewash — When Applicable

Where employees may be exposed to corrosive materials requiring immediate flushing, suitable emergency washing facilities should be readily available as required.

Access should remain unobstructed.

Employees should understand the location and proper use of emergency washing equipment.

Fire Prevention

Fire-prevention procedures should address the hazards present within the dental practice.

Potential considerations include:

• Electrical equipment.
• Oxygen and compressed gases.
• Flammable materials.
• Laboratory activities.
• Heating equipment.
• Storage.

Fire extinguishers and other fire-protection equipment should remain accessible.

Emergency Action Plan

Employees should understand procedures to follow during foreseeable dental-office emergencies.

The Emergency Action Plan may address:

• Fire.
• Medical emergencies.
• Chemical releases.
• Gas leaks.
• Severe weather.
• Power failure.
• Workplace violence.
• Evacuation.
• Shelter-in-place.

Employees should understand alarm methods, exit routes, assembly locations, emergency communication procedures, and their assigned responsibilities.

Medical Emergencies

Dental offices should establish procedures for foreseeable medical emergencies involving patients or employees.

Employees should understand:

• How to summon emergency medical assistance.
• Their assigned responsibilities.
• Locations of emergency equipment.
• Communication procedures.
• Incident-reporting procedures.

Employees should perform only those emergency-response activities for which they are appropriately trained and authorized.

First Aid

The practice should maintain appropriate procedures for obtaining prompt medical assistance for employee injuries.

Employees should understand how to report workplace injuries and obtain necessary care.

First-aid supplies should be maintained and readily accessible as appropriate.

Occupational exposure incidents should be handled according to the practice’s Bloodborne Pathogens procedures rather than solely as ordinary first-aid events.

Workplace Violence Prevention

Dental employees may encounter threatening, aggressive, or otherwise unpredictable patients, family members, or other individuals.

Procedures should address:

• Recognizing concerning behavior.
• Obtaining assistance.
• Emergency communication.
• De-escalation where appropriate.
• Reporting threats or incidents.
• Contacting law enforcement.
• Protecting employees during emergencies.

Employees should prioritize personal safety and should not unnecessarily place themselves in danger to protect property.

Waste Handling

Employees should follow established procedures for handling ordinary waste, contaminated materials, sharps, chemical waste, and regulated waste.

Waste containers should be appropriate for the materials being discarded.

Employees should not reach blindly into waste containers or manually compress waste that may contain sharps.

Hazardous Waste — When Applicable

Dental practices generating hazardous waste should identify and manage the waste according to applicable requirements.

Potential wastes may include certain chemicals, mercury-containing materials, pharmaceuticals, laboratory materials, or other regulated substances.

Employees responsible for handling hazardous waste should receive appropriate information and instruction.

Contractor Safety

Outside contractors may perform equipment service, electrical work, HVAC maintenance, construction, renovation, waste handling, or other specialized work within the dental office.

Contractor activities should be coordinated to protect employees, patients, and visitors from work-related hazards.

Relevant hazard information should be exchanged when required.

Dental Office Safety Training

Safety training should reflect each employee’s assigned duties and occupational exposures.

Depending on the practice, training may address:

• Bloodborne Pathogens.
• Exposure Control Plan.
• Sharps safety.
• Exposure incident response.
• PPE.
• Instrument processing.
• Chemical safety.
• Hazard Communication.
• Nitrous oxide.
• Compressed gases.
• Ergonomics.
• Radiation safety.
• Laboratory hazards.
• Fire prevention.
• Emergency procedures.
• Workplace violence.

Training should be provided at required intervals and whenever changes in tasks, procedures, equipment, or exposures make additional training necessary.

New Employee Safety Orientation

New employees should receive appropriate safety orientation before independently performing work that exposes them to workplace hazards.

Orientation may address:

• General office safety.
• Bloodborne Pathogens.
• Exposure Control Plan.
• Needlestick prevention.
• PPE.
• Chemical safety.
• Hazard Communication.
• Emergency procedures.
• Injury and exposure reporting.
• Equipment restrictions.

Employees should receive task-specific training before performing specialized work.

Dental Office JSA/JHA

Dental offices can use JSAs/JHAs to evaluate selected tasks where a step-by-step hazard analysis would improve employee protection.

Potential Dental Office JSAs/JHAs may include:

• Instrument processing.
• Sharps handling.
• Sterilizer operation.
• Chemical handling.
• Nitrous oxide cylinder changes.
• Dental laboratory grinding.
• Chemical spill cleanup.
• Equipment maintenance.

Routine clinical procedures may be more appropriately addressed through clinical protocols, exposure-control procedures, and established work practices rather than creating a JSA for every dental procedure.

Dental Office Safety Meetings

Periodic safety meetings can reinforce safe work practices and address current workplace concerns.

Potential topics include:

• Needlestick prevention.
• Sharps handling.
• Exposure incident response.
• PPE.
• Instrument processing.
• Chemical safety.
• Nitrous oxide.
• Ergonomics.
• Slips and falls.
• Emergency procedures.
• Workplace violence.

Recordkeeping

The dental practice should maintain occupational safety and health records required for its operations.

Records may include:

• Exposure Control Plan reviews.
• Employee training.
• Hepatitis B vaccination documentation.
• Medical records required by applicable standards.
• Exposure incident documentation.
• Respirator records where applicable.
• Safety inspections.
• Equipment evaluations.
• Other required program records.

Confidential medical information should be maintained according to applicable requirements.

Additional Safety Programs

Depending on dental-office operations, additional safety programs may be necessary for:

• Respiratory Protection.
• Ionizing Radiation.
• Compressed Gas Cylinders.
• Ergonomics.
• Laboratory Safety.
• Beryllium.
• Silica.
• Hazardous Waste.
• Spill Prevention and Response.
• Workplace Violence Prevention.
• Working Alone.

These programs should be included when employee activities or workplace hazards make them applicable rather than automatically adding programs unrelated to the practice’s operations.

Building a Dental Office Safety Manual

A useful Dental Office Safety Manual should reflect the actual practice rather than simply combining generic healthcare policies.

A general dentistry practice may require a different combination of procedures than an oral surgery center using extensive anesthetic gases, an orthodontic practice handling numerous wires and sharps, or a dental practice performing substantial laboratory work.

The manual should consider:

• Services performed.
• Employee job classifications.
• Occupational exposure to blood and OPIM.
• Sharps and instruments.
• Instrument processing.
• Chemicals.
• Nitrous oxide.
• Compressed gases.
• X-ray equipment.
• Laboratory activities.
• Ergonomic exposures.
• Emergency procedures.
• Workplace violence risks.

Selecting the appropriate programs creates a manual that is comprehensive without filling it with procedures unrelated to the dental practice.

Customized Dental Office Safety Manuals

A Dental Office Safety Manual can be developed around the specific procedures, employee exposures, equipment, chemicals, anesthetic gases, sterilization methods, laboratory activities, and other hazards of the practice.

The finished manual may incorporate applicable programs for Bloodborne Pathogens, sharps safety, exposure incidents, Hazard Communication, PPE, nitrous oxide, ergonomics, radiation safety, compressed gases, emergency procedures, and other hazards present within the operation.

This provides dental employers with a practical safety manual organized around the work their employees actually perform.