A dental practice that uses formaldehyde, glutaraldehyde or nitrous oxide must familiarize itself with the applicable regulations. The chemicals are all known air contaminants and employers must ensure occupational exposure does not exceed established permissible exposure levels (PEL) or short term exposure limits (STEL). If an employee expresses concern about the levels of an air contaminant, an employer must provide the employee with documentation that contaminant levels are within permissible limits. Permissible exposure levels for all air contaminants are listed in the California Code of Regulations, Title 8 Section 5155.
Cal/OSHA requires each employer in an establishment where formaldehyde is present to monitor employees to determine their exposure. The exception to this requirement is when an employer documents, using objective data, that the presence of formaldehyde or formaldehyde-releasing products in the workplace cannot result in concentrations of airborne formaldehyde that would cause any employee to be exposed at or above the action level (0.5 ppm calculated as an eight-hour time- weighted average concentration) or at or above the STEL under foreseeable conditions of use. Such objective data may
be available from the manufacturer of the sterilizing unit. An employer could also do initial monitoring. If initial monitoring indicates an exposure level higher than either of the above limits, steps to reduce it must be taken. Follow-up monitoring should be conducted every six months, and may be discontinued if two consecutive measurements, taken at least one week apart, record levels below the permissible limits. Refer to the excerpt from Title 8 Section 5217 below. (Reference: § CCR 5217)
Formaldehyde is a known carcinogen and its use must be reported to Cal/OSHA. Request a “Report of Use of Regulated Carcinogens” form via email at [email protected], or by phone at 916.574.2993. The form is not available on the agency’s website. (Reference: § CCR 5203)
Glutaraldehyde solutions are used for cold sterilization and high-level disinfection in the dental and medical fields and the biotechnology industry. Employees should handle glutaraldehyde with care because health assessments indicate the solution can cause occupational asthma and skin sensitization responses such as contact dermatitis. Exposure related symptoms may include one or more of the following: shortness of breath, chest tightness, wheeze, cough, skin rash, hives, and irritation of the nose, throat, skin or eye. Other potential effects of overexposure to glutaraldehyde are headaches, nausea, asthma and allergic reactions.
Required hazard communication training provided to employees should address these health hazards and symptoms along with the measures taken by the employer to evaluate and control exposures that can include medical evaluations, exposure monitoring, ventilation systems, work practices and personal protective equipment. Inform employees of where to report possible health symptoms and where to ask questions, report concerns and receive information about the employer’s evaluation and control measures.
In light of current health information, CDA recommends the following precautions for those using glutaraldehyde:
As with all chemicals used in the workplace, be sure that staff reviews the manufacturer’s safety data sheet, which includes additional health and safety recommendations and chemical data.
Effective scavenging equipment and periodic inspection of equipment should keep nitrous oxide exposures to within acceptable limits. Recommendations for the safe use of nitrous oxide in the dental office are included in articles published in the Journal of the American Dental Association:
Once an employer is notified of a pregnancy, the first obligation is to assess the risks within the workplace for the pregnant employee. CDA recommends:
The U.S. National Institute for Occupational Safety and Health (NIOSH) has online resources:
U.S. Department of Labor - OSHA
CDA does not endorse any one company that provides individual vapor monitors but provides this list for the convenience of members.