Recently, OSHA has updated their requirements for dental laboratories in regards to Silica and Beryllium dust. Over a multiple year study, dental labs have been found to have a higher occurrence of lung cancers and heavy metal poisoning, not only in the employees but also their family members at home. The tasks that are associated with this increased risk of beryllium and silicate exposure are casting, sandblasting, grinding porcelain, and cleaning/maintenance processes. The main culprit with these tasks are the materials used, they most commonly contain beryllium and silica dust. The particles are 1000x smaller than a grain of sand, allowing for them to become airborne and inhaled very easily. Poor ventilation, respiratory protection, and barrier PPE increase the risk of inhalation. This fine particulate dust also settles on our uniforms, which if brought home, is then inhaled by family members. This significantly increases our family member’s potential to develop respiratory issues, cancers, and chronic health issues. OSHA has implemented regulations that are aimed at protecting dental lab employees and the secondary exposure victims. These regulations are coming under stricter enforcement measures within dental labs and adjacent dental practices. For more information on this please visit https://www.osha.gov/SLTC/beryllium/index.html, this outlines the OSHA findings to include how family members are affected by respirable silica and beryllium dust.
The final rule was published in June of 2017 after a few months delay by the current presidential administration. However, compliance is mandatory and will be rolled out for enforcement in the very near future. The timeline is as follows:
|General Industry and Maritime|
|Comply with all obligations of the standard, except the action level trigger for medical surveillance||June 23, 2018|
Offer medical examinations to employees exposed above the PEL for 30 or more days a year
|June 23, 2018|
|Offer medical examinations to employees exposed at or above the action level for 30 or more days a year||June 23, 2020|
What this means is that the time is NOW, to begin implementing programs to reduce or eliminate exposures. You can be sure that dental practices and labs that have exposure potential will be audited very heavily. This is due to the fact that these issues not only affect those directly involved, but also second-hand exposures are very likely as well. An excellent resource that breaks this down even further is at http://news.nilfiskcfm.com/2016/08/silica-dust-glance-answers-7-faq-oshas-new-rule/.
Without proper respiratory protection, the particles are inhaled into the lungs where they cause scar tissue to build up, reducing the lungs ability to function. This is a condition known as Silicosis and along with chronic heavy metal exposure and poisoning (from the beryllium used in the materials). This condition eventually develops into kidney damage, lung cancer, and tuberculosis. Silicosis is an incurable disease that will cause chronic respiratory issues for the rest of the employee’s life, which will be shortened due to the development of other chronic exposure incidents. Even if the exposure is stopped, Silicosis can, and usually does, get worse. Silicosis is a preventable condition through the use of exposure controls, ventilation systems, and appropriate PPE.
How do we protect ourselves in regards to silicates and beryllium? The most effective method of control is through substitution. If we can eliminate materials that contain crystalline silicates and beryllium for sandblasting, then the main source of silicosis will no longer be present. A common replacement is aluminum oxide, however there are many acceptable replacements available. If substitution is not possible, we have to focus on ventilation at the production source as a primary mitigation method. With an effective ventilation system in place, any dust that becomes airborne is evacuated before it is inhaled or caught on surfaces. In addition to appropriate ventilation, respirators are also required in case any stray dust is not captured. Respirators require proper FIT testing programs to be in place, either by a qualified member of the team or outsourced to a third party (approved testing methods are outlined by OSHA at https://www.osha.gov/laws-regs/federalregister/2003-06-06-0 ). At a minimum the filters on properly fitting air-purifying respirators must be N-100 type as defined in CFR 42 Part 84.179.
In addition to the above control methods, some specific housekeeping procedures will help reduce the chances of exposure. Wet mopping, wet wiping, or vacuuming with a HEPA filter is highly recommended to keep dust from becoming airborne. DO NOT use a compressed air duster, this will significantly increase the airborne particulates in both quantity and trajectory.
With the increased awareness on respirable silicate dangers in regards to dental settings, we can develop protocols and programs to decrease the exposure. Most importantly, we can help to ensure all members of our dental teams, and their families, have a safe work environment and continued quality of life.
Some additional sources of information pertaining to silicates and beryllium: