Hazard

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Hazards of Laser

Hazardous effects of laser depend on:


 Duration of exposure
 Power density value of laser beam
 Spot size
 Laser operation type

Laser Operation Types


 Continuous wave:
- Energy is emitted as long as the laser is activated.
- Example: CO2/ Diode laser.
- Corrected by: gated or chopped pulsing of continues output.
 Free running
- Like flash lamp where true pulses emit from the device.
- Example: Nd: YAG, Er: YAG.
- more hazardous

Classification of lasers and associated hazards( ANSI & OSHA ) :


Associated Hazards
1- Ocular damage:
 Cause: direct exposure of the unprotected eye or diffuse reflection from
mirror like surface.
 Site of injury depend on the absorption of wavelengths by specific
structures of the eye i.e. pigmented epithelium of the retina and choroids
layer.
 1ry ocular injury result from laser accident is a retinal or corneal burn.
 Retinal injury possible with even low intensity because of focusing effect
of the lens and cornea.
 Retinal burn may cause permanent blindness due to conversion of the
radiation to heat.
 Other injury to sclera, aqueous humor and cataract.
2- Tissue damage:
 Laser induced damage to skin and other non-target tissue (Oral tissue) can
result from thermal interaction of radiant energy with tissue proteins.
 Elevation of temperature above 37⁰C causes cellular enzymes and proteins
destruction and coagulation necrosis which affect the metabolic process.
 Final result is Thermal necrosis of the tissues.
3- Respiratory or Environmental hazards:
 It is also called “Non-beam Hazards” as it is not resulting from direct
exposure to laser beam.
 It involves the potential inhalation of air borne biohazards materials that
may be released as a result of surgical application of lasers.
 This aerosols by-products may contain viruses, bacteria or chemicals.
 Example: chemical hazards.
 Chemical hazards may be due to:
- Escape of toxic chemicals and gases from laser itself i.e. fluorine,
hydrochloride gases, toxic dyes and solvent.
- Surgical instruments generate surgical debris containing chemicals i.e.
during composite removal small amounts of methacrylate free monomer are
released.
 Symptoms:
- Eye irritation.
- Nausea and vomiting.
- Breathing difficulties.
- Transfer of infective bacteria and viruses.

4- Combustion hazards:
 In the presence of flammable materials laser may pose other significant
hazards.
 Flammable solids, liquids and gases used within dental surgical setting can
be easily ignited if exposed to laser beam.

5- Electrical hazards:
 Most laser systems involve high current electrical supplies.
 There are several hazards that may be potentially lethal such as:
- Electrical shock hazards.
- Fire or explosion hazards.
 Insulation, shielding, grounding and housing of high voltage electrical
components provide adequate protection from electrical injury.

Laser hazards control measures


Four categories for control measures are:
1- Personal Protective Equipment (PPE)
2- Engineering control
3- Administrative control
4- Environmental control
1- Personal Protective Equipment (PPE):
Some factors should be considered:
 Wave length of emission.
 Degradation of absorbing filter.
 Optical density of eye wear.
 Need for corrective lenses.
 Comfort and fit.
 Care must be taken when cleaning laser eyewear and side shields so that
their protective coating is not destroyed.
 should be washed with antibacterial soap and dried with a soft cotton cloth
in between procedures and patients.
 Disinfecting solutions generally applied to dental surfaces are too caustic
and should be avoided.
 must be inspected frequently to determine whether there is any breakdown
(lifting / cracking / flaking) of the protective material that would render the
eyewear to be useless.

2- Engineering control:
 Engineering controls are normally designed and built into the laser
equipment to provide for safety.
 Some of the engineering controls recommended in the ANSI standard are
detailed as follows:
A. Protective Housing:
- Laser should have enclosure around it that limits the access to the laser
beam or radiation at or below the applicable MPE level.
B. Master Switch Control:
- The switch can be operated by a key or computer code.
- When disabled (key or code removed), the laser cannot be operated.
- Also Cover foot switch prevent the accidental operation.
C. Beam Stop:
- Class IV lasers require a permanently attached beam stop which can reduce
the output emission to a level at or below the appropriate MPE level when
the laser system is on "standby.“
D. Laser Activation Warning System:
- An audible tone or bell and/or visual warning (such as a flashing light) is
recommended as an area control for Class IIIB and IV laser
3- Administrative control:
 Establishing written Standard Operating Procedures (SOPs) for the dental
practice, as required by national standards as they may apply.
 Supervises the education and training of the dental team.
 Assists with evaluation when a new laser is needed.
 Understands the operational characteristics of the laser(s) in the practice.
 Ensures the laser is being operated by authorized personnel only.
 Knows the limitations of device output.
 Ensures laser maintenance, beam alignment, and calibration of the laser
device.
 Supervises medical surveillance and incident reporting.
 Keeps a log of recorded laser use and parameters employed.

4- Environmental control:
 Determines the controlled area and the potential hazard and non hazard
zones.
 Ensures proper test-firing of the laser prior to admission of the patient into
the operatory.
 Use of carbonized (don’t absorb heat) or non-reflective instruments during
procedure.
 Floor of operating room should be dry to avoid electrical hazards.
 Keep away all the flammable materials from the laser source.

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