October 1, 2014
Article Title: Assessment of Noise Exposures in a Pediatric Dentistry Residency Clinic
Author: K Jadid, DDS, et al.
Journal: Pediatric Dentistry
Date: July-August 2011 (Volume 33)
Major Topic: Occupational Noise Exposure
Main Purpose: To compare typical noise exposures in a pediatric dental clinic to the OSHA action level (AL = 80 dBA) and permissible exposure limit (PEL = 90 dBA) as well as to measure the daily combined noise level that was produced by dental instruments and young children and to which one resident was exposed in a pediatric dentistry residency clinic.
Over 6 weeks, noise dosimetry samples were obtained for 31 standard workdays of a pediatric dentistry resident in a hospital-based program. During those days, the resident performed procedures that are typically done by pediatric dentists on a daily basis. A comprehensive noise dose, time weighted average (average of the sampled sound over 8 hours), and average noise exposure levels for each of these 31 days were obtained. The average recording time per day was 7.6 hours. The resident was also responsible for keeping a daily exposure logbook with information about his clinical activities and specific encounters of noisy events (ex: 10;15am, screaming during a lap exam, etc). The noise dosimeter was calibrated before and after each day’s use to ensure accurate results. Noise spikes that could not be mated with noisy activities in the exposure log were excluded from the analysis. The data were analyzed to determine the frequency of days during which the maximum noise levels exceeded 90dBA and whether daily noises exceeded the OSHA action level, PEL, and/or NIOSH reference limits.
On any particular day during the sample period, the OSHA AL and PEL were never exceeded, however the average sound levels of noise produced when children cried during lap exams, papoose board treatments, and during unsuccessful sedations were 88.3, 90.1, and 86.3 dBa, respectively. The high-pitched sounds of children in the dental operatory routinely reached maximum levels in excess of 98dBA.
During some days, the noise exposure exceeded 50% of the OSHA and NIOSH standards for exposure. Some values recorded were higher than the noise levels produced by dental instruments, including ultrasonic scalers. This suggests that the potential for hazardous noise exposure exists, especially if working for extended shift durations or if a greater number of crying/screaming patients are encountered or if episodes of crying/screaming are extended. The maximum sound level sampled never exceeded the OSHA ceiling limit of 115dBA. Even moderate levels of noise, however, potentially contribute to a stress reaction, interfere with sleep, lower morale, reduce efficiency, create annoyance, interfere with concentration, or result in premature fatigue. The data suggest that pediatric dentists may be at risk for incurring these non-auditory noise effects. The study also suggests that dentists who predominantly treat children are exposed to overall higher noise levels than other dentists because children themselves produce significant sound in addition to the noise of dental instruments. As a consequence, when exposed for extended periods of time, these providers are potentially at a higher risk for auditory side effects – tinnitus, temporary hearing loss, and permanent hearing loss (all noise induced hearing loss – NIHL).
Given the study’s results, I think that it is important to raise awareness to reduce the risk for NIHL. We should consider strategies to reduce noise exposure during the workday as well as after hours to minimize it’s adverse health effects.