As Karin and Peter Arsenault (both 94) prepared to host Thanksgiving in 2023, they faced an unusual task.
Before their guests arrived, the couple, who are dentists, dismantled a makeshift lab they had set up in their living room to study how fluids and other debris get into patients’ eyes during dental visits.
Their setup simulates what might happen when a dentist uses a handpiece, or what most of us think of as a drill. Using a mannequin head to represent the patient, they sprayed colored dye from the oral area toward the eye at various angles to simulate dental procedures.
Their results suggest that even when wearing recommended protective eyewear, patients can face risks to their eyes and vision when undergoing dental work. Their findings were published last fall in the Journal of the Massachusetts Dental Society.
The findings didn’t surprise the Arsenaults, both of whom teach at Tufts University School of Dental Medicine (TUSDM). Karin Arsenault is the Hilde H. Tillman, D49, professor of geriatric dentistry, public health and community services, and director of the dental school’s geriatric dentistry program. Peter Arsenault is a professor and chief of surgery in the Department of Integrated Nursing.
Peter Arsenault has previously studied eye safety risks for dental health care workers, focusing on the protective “floor gap”—the space or opening between the bottom edge of protective eyewear, such as safety glasses, and the wearer’s face.
This gap is critical because it allows debris, aerosols or splashes common in dental procedures to bypass the protective eyewear and enter the eye. They hypothesize that patients may be at similar risk.
“If patients undergo routine dental procedures, such as cleanings, fillings or crowns, they may be exposed to debris such as projectiles, aerosols and splashes,” Karin Arsenault says.
“Our study suggests that even if patients are wearing protective eyewear, they may not be fully protected against debris and splashes that may enter through the floor gap.” The Arsenaults recommend that you consult your dentist about the proper eyewear.
Peter Arsenault began the early research after he sustained an eye injury during a procedure at his private dental practice in 2016.
“I was wearing all my protective gear, including proper goggles and a mask, and a piece of filling popped out from under my glasses and into my eye,” he says. “I panicked.”
A few months later, something similar happened again, and he decided to find out how common the experience was among dentists. “It turns out that 70% of dentists have experienced some degree of eye trauma during their career,” Peter Arsenault says.
He and Karin Arsenault conducted spray studies on a mannequin head (a medical term for a model) representing the spatial relationship between a patient and a provider to understand how and where debris, spatter, and aerosols might travel and potentially enter a dental provider’s eye during a procedure.
The study showed that while safety glasses were effective in protecting health care workers from vertical trajectories, side shields were also effective in preventing lateral trajectories. But for dental professionals, “the real weakness in our time is the gap in the floor,” says Peter Arsenault.
The National Institute for Occupational Safety and Health (NIOSH) endorsed the research, consulted with Peter Arsenault, and conducted high-level testing to validate his findings.
The research led to the development of a new eye safety standard specifically for dentistry, which has been adopted by the American Dental Association (ADA). As a result, dentists are now required to wear safety glasses or masks that provide floor gap protection.
The Arsenaults’ recent research has revealed similar floor gap issues in dental patients. “We found that floor gaps do exist and can potentially cause damage or harm to the eyes of dental patients,” says Peter Arsenault.
The Arsenaults are currently working to raise awareness of the importance of eye protection for patients. Karin Arsenault emphasizes that this is a public health issue for patients, especially those with compromised immune systems.
These risks include not only common contaminants such as bacteria, viruses and fungi, but also chemicals and physical debris. Petre Arsenault says projectiles such as tooth fragments and dental drill bits (similar to small drill bits) can fly out of a drill or a patient’s mouth at speeds of up to 50 mph, posing a serious threat to a patient’s eyes. In severe cases, such exposure can cause permanent vision loss.
While the American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC) recommend that dental teams provide patients with safety glasses, “there are no official standards requiring dental patients to wear protective eyewear,” Peter Arsenault says, “and no governing body mandates it.”
“We hope to continue consultation with NIOSH, the ADA, and the CDC,” says Peter Arsenault. “Our goal is to bring attention to this issue, support further research, and ultimately promote legislation to protect patients.”
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