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.
