Laser Safety: Is Your Dental School Ready? William Leavitt, D.D.S., - PowerPoint PPT Presentation

Laser Safety: Is Your Dental School Ready? William Leavitt, D.D.S., M.P.A. University of Nevada at Las Vegas School of Dental Medicine Scott Benjamin, D.D.S. Midwestern University, Glendale, AZ College of Dental Medicine

Disclosure: William Leavitt , D . D . S ., M . P . A . • UNLV, School of Dental Medicine • Associate Professor Department of Clinical Services • Laser Safety Officer • Board-Recognized Laser Educator for the State of Nevada • ADEA’s Lasers in Dentistry Special Interest Group (LiD-SID) • Chairman

Disclosure: Scott D. Benjamin , D . D . S . • Midwestern University CODM, Glendale, AZ • Adjunct Professor • ANSI Standards Committee Z136 on Laser Safety • Dental Representative & Voting Member • ADA Standards Committee on Dental Products • Chairman of Working Group 6.58 on Dental Lasers • Academy of Laser Dentistry • Past-President • Laser and Health Academy • Clinical Lecturer • Compendium of Continuing Dental Education • Technology Section Editor • Dentsply Sirona Dental Inc., Charlotte, NC • Consultant and Director of Laser Education • National Dental Inc., Barrie, ON, Canada • Clinical Director

Program Objectives: 1. Define laser classifications & laser terminology. 2. Appling best practices to a comprehensive dental laser safety program. 3. Describe of the role and responsibilities of a • Laser Safety Officer (LSO) . • Deputy Laser Safety Officer (DLSO). • Laser Safety Site Contact (LSSC).

Laser Safety Standards ANSI Standard Z136.1 for Safe Use of Lasers The parent document that defines terminology and measurements. It addresses the general safety aspects of laser use, which includes but are not limited to industry, defense, home use, and healthcare. American National Standard (ANSI) for the Safe Use of Lasers Z-136.1-2014 Laser Institute of America; Publisher

Laser Safety Standards ANSI Standards Z136.5-2009 Safe Use of Lasers in Education Institutions Standards ANSI Z136.3-2011 (USA) & CSA Z386-2013 (Canada) Safe Use of Lasers in Health Care Safe Use of Lasers in Health Care Safe Use of Lasers in Health Care Safe Use of Lasers in Education Institutions ANSI Z136.3-2011 CSA Z386 (Canada) ANSI Z136.5-2009

Common Laser Safety Acronyms “The Alphabet Soup of Lasers” AEL -Accessible Emission Limit ANSI -American National Standards Institute CSA -Canadian Standards Association CW -Continuous Wave DLSO -Deputy Laser Safety Officer Er,Cr:YSGG –Erbium, Chromium: Yttrium Scandium Gallium Garnet Er:YAG -Erbium: Yttrium-Aluminum Garnet FLPPS -Federal Laser Product Performance Standard HCF -Health Care Facility HCLS -Health Care Laser System HCP -Health Care Personnel HeNe -Helium-Neon American National Standard (ANSI) Hz -Hertz (Pulses per Second) Symbol: F for the Safe Use of Lasers Z-136.1-2014 Laser Institute of America; Publisher J -Joule (Watts per Second) J/cm2 -Joules/Square Centimeter (Fluence) LCA -Laser Controlled Area (NHZ) LGAC -Laser Generated Airborne Contaminants LIA -Laser Institute of America

Common Laser Safety Acronyms “The Alphabet Soup of Lasers” LPE -Laser Protective Eyewear LSO -Laser Safety Officer LSSC -Laser Safety Site Contact LTCA -Laser Treatment Controlled Area (NHZ) MPE -Maximum Permissible Exposure Nd:YAG - Neodymium: Yttrium Aluminum Garnet NEMA -National Electrical Manufacturers’ Assoc. NHOD -Nominal Ocular Hazard Distance NHZ -Nominal Hazard Distance nm -Nanometer (1 Billionth of a Meter) OD -Optical Density Symbol(s): D( λ), D λ, PPE -Personal Protective Equipment American National Standard (ANSI) PRF -Pulse-Repetition Frequency (Hertz) Symbol: F for the Safe Use of Lasers Z-136.1-2014 Laser Institute of America; Publisher SOP -Standard Operating Procedure TL -Threshold Limit TRT -Thermal Relaxation Time W/cm2 -Watts per Square Centimeter (Irradiance) WL -Wavelength of Light Energy Emitted

ANSI Laser Classifications Class 1 Laser Systems Any laser or laser system containing a laser that cannot emit laser radiation at levels that are known to cause eye or skin injury during normal operation. Class 1M Laser Systems Considered incapable of producing hazardous exposure unless viewed with Collecting optics. Class 2 Laser Systems Visible lasers considered incapable of emitting laser radiation at levels that are known to cause skin or eye injury within the time period of the human eye aversion response (0.25 seconds). Class 2M Laser Systems Emits in the visible portion of the spectrum, and is potentially hazardous if viewed with collecting optics. Class 3R Laser Systems A laser system that is potentially hazardous under some direct and specular reflection viewing condition if the eye is appropriately focused and stable. Class 3B Laser Systems Medium-powered lasers (visible or invisible regions) that present a potential eye hazard for intrabeam (direct) or specular (mirror-like) conditions. Class 3B lasers do not present a diffuse (scatter) hazard or significant skin hazard expect for higher powered 3B lasers operating at certain wavelengths.

ANSI Laser Classifications Class 4 Laser Systems • “High-powered lasers (visible or invisible) considered to present potential acute hazard to the eye and skin for both direct (intrabeam) and scatter (diffused) conditions. Also have potential hazard considerations for fire (ignition) and byproduct emissions from target or process materials.” • “Is a hazard to the eye or skin from the direct beam, may pose a fire hazard or diffuse reflection hazard, and may also produce laser generated air contaminants (LGAC) and hazardous plasma radiation.”* All Dental and Medical Surgical Laser Systems *American National Standard (ANSI) for the Safe Use of Lasers Z-136.1-2014 Laser Institute of America; Publisher

American National Standard Requirements for Lasers by Classification* Laser Safety Control Engineering Training Officer Class Measures Controls (LSO) Not Required Not Required Not Required Not Required 1 Application Application Application 1M Required Dependent Dependent Dependent Not Required Not Required Not Required Not Required 2 Application Application Application 2M Required Dependent Dependent Dependent Not Required Not Required Not Required Not Required 3R Required Required Required Required 3B Required Required Required Required 4 *American National Standard (ANSI) for the Safe Use of Lasers Z136.1-2014 Table 1-1; 3 Laser Institute of America; Publisher

Other Safety Concerns & Considerations (Non-Beam Hazards) • Electrical Hazards • Respiratory Hazards • Fire Hazards • Human Factors • Control Measures • Engineering Controls / Safety Mechanisms • Infection Control

Respiratory Hazards - Laser Plume Laser Generated Airborne Contaminants (LGAC) • Laser Generated Airborne Contaminants (LGAC) are the biological hazard of gas fumes created when tissue is ablated (vaporized), also referred to as the Laser Plume or Surgical Smoke. • LGAC can contain vital strains of the Human Papilloma Virus (HPV) and other organisms. • High Volume Evacuation (HVE) should Always be used with-in 2 inches of the emission point of the laser to remove the laser plume. • Surgical masks must be worn.

The Dental School is Considering Incorporating Its First HCLS / Laser into the School’s Curriculum What Laser Safety Considerations Need to Be Addressed Before Acquiring a HCLS / Laser? Consideration #1: • What University/Institution’s laser policies are presently in place? • Does the institution already have a laser safety committee? • Does the dental school have a member of the committee? • Does the dental school need its own laser safety committee? • Does the institution already have a Laser Safety Officer (LSO)? • Who will be the dental school’s LSO or DLSO? • Will each clinic or simulation lab need to have a specified Laser Safety Site Contact (LSSC) and if so, who?

Laser Safety Officer’s (LSO) Responsibilities • The institution’s “expert” on the care, maintenance, & safe operation of the lasers. • Verifying the classifications of the lasers and laser systems (HCLS) used. • Ensuring that appropriate protocols have been established & are properly followed. • Overseeing & ensuring that all personnel are appropriately trained on the laser’s use and safety. • Controlling & managing the passwords or keys for activating the laser. • Ensuring that all of the required labels and signs are appropriate and are in place. • To ensure that the laser protective eyewear & devices are in good condition. • To periodically inspect the functionality of the laser systems & safety features. • Reporting any significant laser related injury to the laser manufacturer. • Assuring the necessary records required government regulations are maintained. (Documenting: maintenance programs, training records, audits, SOP, etc.) • Overseeing the Deputy Laser Safety Officer (DLSO) and Laser Safety Site Contact (LSSC), if those positions are deemed necessary.