Work safety of dentists – how to improve it?

Cite: Szymanski P. Work safety of dentists – how to improve it? Nowy Gabinet Stomatologiczny; 2/2025

High-risk environment

These specific working conditions significantly increase the risk of cross-contamination with pathogens such as HBV, HCV, HIV, as well as airborne microorganisms including tuberculosis (TB), pertussis, Staphylococcus aureus, Streptococcus species, and herpesviruses (e.g. HSV, VZV). Due to constant exposure near the dental chair and the formation of the so-called aerosol cloud, dental professionals are among the most at-risk medical workers.

The COVID-19 pandemic further highlighted this problem, prompting in-depth scientific analyses of how viruses and pathogens spread in clinical settings.

It has been established that—unlike in other medical offices or operating rooms—the aerosol cloud in a dental office is an excellent carrier of airborne pathogens. Not only is it inhaled by those working in the room, but more worryingly, it settles and covers all surfaces in the dental operatory. Of course, the dentist and assistant can protect themselves by using personal protective equipment, but once the aerosol cloud descends, it deposits onto everything present in the operatory. This should prompt a change in how the dental practice is organized and possibly lead to a rethinking of the entire workflow system.

The dental operatory should be treated like an operating theater, where only the instruments and materials required for a single procedure are present. Tools and materials intended for other patients should be kept in a separate room and stored in such a way that they are not exposed to the aerosol cloud. Keeping boxes of gauze, cotton rolls, microbrushes, or disposable wipes on an open assistant’s trolley near the dental unit is clearly not a good idea. We now understand this, which is why many practices have completely phased out the use of such trolleys.

For this reason, modern practice designs should include, apart from treatment rooms, staff areas, sterilization rooms, and consultation rooms, a dedicated storage area for instruments and materials. This storage space does not necessarily have to be a separate room. It can consist of cabinets located in the clean area of the sterilization room (for sterilized tools and procedure materials) or in other designated areas where fast-rotating or disposable supplies can be stored.

In the past, dentists kept everything in drawers close to the dental unit, so that the assistant could quickly reach for them if needed. This approach was justified by the principles of ergonomic work. Today, in light of the latest research, we know this is no longer the best solution. Each procedure should be carefully planned in advance, and all materials and tools should be counted and prepared accordingly. There is no longer a need to furnish the treatment room with numerous medical cabinets—just a few are sufficient. Everything else should be stored outside of the operatory. A treatment room should not serve as a storage room. Yet, in many multi-operatory clinics, each treatment room still functions as a separate storage area, because under such an organizational model, all necessary tools and materials must be kept on hand within that room.

Epidemiological Risks in Dental Practice

The instrument preparation process involves multiple stages: transporting used instruments, cleaning, disinfecting, packaging, sterilizing, and storage. Handling contaminated instruments poses significant risks, particularly for staff involved in disposal. Improperly processed medical supplies also endanger subsequent patients via cross-contamination. Strict adherence to safety protocols at every stage is essential to protect both staff and patients.

Imperfections in the sterilization and disinfection process of instruments can be a major factor leading to infections. Often, too many duties and stress related to the need to serve many patients during the day cause staff to rush through disinfection activities. In such conditions, any error in handling, storing or transporting instruments can have far-reaching consequences for the health of staff and patients.

Moreover, needlestick injuries, cuts while working with sharp instruments or contact with aerosol generated during procedures are everyday hazards in dental offices. Reducing these risks requires a conscious approach to work organization and the introduction of procedures that minimize exposure to pathogens.

Workplace ergonomics – the key to reducing risks

Workplace ergonomics are the basis for safe and efficient operation of a dental office. A well-designed workplace not only reduces the risk of epidemiological infections, but also improves the comfort of doctors and staff. Proper arrangement of tools and materials allows to limit unnecessary movements, reduces the risk of accidents and speeds up the performance of daily activities.

An example of the application of ergonomic principles is the arrangement of equipment in such a way that the doctor can reach the tools he needs without having to distract the patient. All elements of the office equipment should be within reach, which not only shortens the time of performing procedures, but also minimizes the risk of accidental contact with infected surfaces.

This is all correct, but how to do it in practice without disrupting the current work system?

Process automation is another key aspect of ergonomics. Tools such as trays, drill organizers or cassettes for storing equipment allow for safe transport and organization of tools. For example, the use of closed trays with transparent covers eliminates the risk of contamination of tools during transport between areas of the office. Such equipment also protects staff from accidental stabbing or cuts. Today, in the office, dental materials and tools are located in many places: in magazines, cabinets, drawers and assistants, which causes a lack of real control over them and provokes various stressful situations. All procedure trays should be stored in a designated place, e.g. in the sterilization room, a separate room or in the office, and replenished from the main warehouse according to a set schedule: between shifts, at the end of the day or week. It all depends on the number of procedures performed, the number of offices and patients. Making such changes will not be difficult.

Office Design and Its Impact on Safety

Designing a dental office is the art of combining functionality with safety. Optimal space planning enables effective management of the flow of tools, materials and personnel, which is key to minimizing the risk of cross-contamination.

One of the most important aspects of designing a sterilization room is the division into clean and dirty zones. The dirty zone should be equipped with disinfection and sterilization devices, such as autoclaves or ultrasonic washers and thermodisinfectors. In contrast, the clean zone should contain ready-to-use tools, stored in hygienic conditions. This is where you can set up a warehouse for ready-to-use tool and material packages. This warehouse can be, for example, a properly designed cabinet.

Storing instruments in appropriately marked cassettes and trays is an important element of work organization. A color system can be extremely helpful here - for example, yellow trays can be designated for scaling procedures, and green for endodontic procedures. This approach allows for quick recognition of the contents and eliminates the need to open many drawers or containers during the procedure.

Transport of instruments from the office to the sterilization zone should take place in hygienic conditions. Lockable trays with transparent covers ensure safety and allow easy identification of instruments without having to open the container. Such a system significantly reduces the risk of accidental contact with infected instruments.

Organizing Tools by Color

Organizing tools and materials using color coding is one of the most practical and effective solutions for dental offices. The 16-color system, introduced by Zirc, is based on a simple assumption: each procedure is assigned a specific color, which allows for intuitive resource management and optimization of staff work. Of course, you don't have to use all the colors. Before introducing the system, you need to determine how many and what types of procedures you perform in the office and it may turn out that a four- or six-color system will be enough.

The color-coding system has many advantages that make the organization of work in the office more efficient. First, it allows for quick recognition of the tools and materials needed for a specific procedure. For example, subgingival scaling tools can be stored on a yellow tray, and composite filling materials on a blue tray. Such a division eliminates the need to search through drawers and containers, because it saves time and reduces stress during work.

Another advantage is the improved safety of work. Color-coded trays and cassettes are closed with lids, which allows safe transport of instruments between different areas of the dental practice. This ensures that instruments remain hygienic and the risk of accidental contact with contaminated objects is minimized.

The color system also has a significant impact on the process of training new staff. Clear and intuitive markings make it easier for new employees to quickly understand the rules of work organization. Thanks to this, the process of introducing new people to work in the office becomes less time-consuming and more effective.

Examples of color system applications

In dental practice, the color system can be used in many ways. Each procedure is assigned a specific color, for example:

• " green - endodontics,
• " yellow - hygiene,
• " blue - composite fillings,
• " orange – prosthetics.

Instruments and materials designated for a specific procedure are stored in appropriately marked trays or tubs.

When we need to prepare the office for a given procedure, all we need to do is bring a tray and a bathtub in the appropriate color. The treatment tray will contain all the necessary tools, drills and possibly disposable items for one patient, and the tub will contain the main and auxiliary materials. When the medical procedure is completed, all used materials, such as saliva ejectors, gauzes, needles, etc., should be removed to baskets. By removing them at this stage, we will save time and avoid cuts during disinfection. After the procedure is completed, the instruments and tools should be placed back in the cassettes, and the drills or files in the appropriate stands. Instruments arranged in this way will allow us to save a lot of time during cleaning and sterilization. Let's close the lid of the tub, disinfecting its surface. We finish the whole process by disinfecting the remaining equipment in the treatment room and removing all used protective agents. The assistant takes the material tub to its storage place and the treatment tray for sterilization. The system seems trivially simple and, most importantly, it is safe from an epidemiological point of view.

Central warehouse and unified storage system

An innovative approach to organizing materials in dental offices is the introduction of a central warehouse and a unified storage system. Instead of storing all the tools and materials in individual offices, you can create a central place where sets dedicated to specific procedures will be prepared. Such sets, packed in tubs and trays, are ready to use and intuitive to pick up, thanks to the color system.

The central warehouse allows for effective management of inventory levels, control of material expiration dates and elimination of waste. As a result, supply costs are much lower and work organization is more efficient. The benefits of implementing a central warehouse include:

1. improvement of logistics – all necessary materials are in one place, which makes them easier to collect and replenish;

2. cost reduction – centralization allows avoiding excess orders and better utilization of inventories;

3. standardization of procedures – uniform sets of tools facilitate the implementation of new employees and facilitate the staff rotation process;

4. increased safety – materials are stored in controlled conditions, outside the contaminated zone.

The introduction of a color system to a dental office brings many benefits – first and foremost, it saves time. The staff does not have to search for tools because everything is stored in an orderly manner.

Safety is increased – closed trays and tubs protect against contamination and accidental needle sticks. The office gains a professional image in the eyes of patients. A well-organized work system builds patient trust. And above all, it generates less stress, because order and clear rules of work organization mean that everyday duties are performed more efficiently.

The color system is not only an organizational tool, but also an investment in the quality of work and safety in the dental office.

Practical solutions to implement immediately

Implementing modern organizational solutions in a dental office can bring immediate benefits. Here are some steps you can take right away:

1. Inventory in drawers. Let's arrange all materials of the same type next to each other, and throw out the outdated and unnecessary ones. It may turn out that we have the same materials open in several different drawers.

2. Conducting a procedure analysis. Let's make a list of all the procedures performed in the office, let's assign them all the tools and materials needed to perform them. Then let's assign colors to the procedures. We have 16 colors at our disposal. This is the basis for implementing the color system in practice.

3. Organization of space. The introduction of color-coded cassettes, trays and tubs allows for better management of tools and materials.

4. Staff training. The introduction of a colour system and standardisation of tools and materials facilitates and significantly speeds up the training of new employees.

5. Regular inspection and replenishment. Monitoring the status of materials and tools, replenishing supplies, and regular maintenance of equipment.

6. Standardization of processes. Standardization of procedures throughout the dental practice allows for more efficient management and better use of resources, and shortens the time of performing procedures.

Summary

Safety and ergonomics of work in a dental office are crucial for the health of doctors, staff and patients. Implementing solutions such as a colour system, ergonomic equipment of workstations or appropriate sterilisation procedures helps to minimise the risk of infections and errors. By taking care of the organisation of work, dentists can not only improve the quality of services provided, but also improve the comfort of their daily work.