Assessing Knowledge and Awareness of Occupational Hazards and Preventive Measures among Dentists and Final-year Students in Two Dentistry Hospitals, Kabul, Afghanistan

Introduction

The high incidence of workplace safety hazards is a worldwide phenomenon that is particularly significant in developing countries. Working in a dangerous environment can have a negative impact on many employees’ physical and mental health, which can impact their households and close social networks. An occupational hazard is an illness or injury brought on by one’s job or the environment in which one works.^1–3 The recognition of occupational risks dates back to the 18th century, when Bernardino Ramazzini, known as the ‘Father of Occupational Medicine’, first described the connection between occupation and the dynamics of health and disease. Over time, this understanding has expanded, leading to an increased awareness of various hazards in different professions, including dentistry.^4–8

Occupational hazards in dentistry encompass a range of risks faced by dental professionals, including noise pollution, psychological stress, chemical exposure, infections, and musculoskeletal disorders. These hazards can significantly affect the health and well-being of dental practitioners, necessitating awareness and preventive measures to mitigate their effects.^9,10 Physical and mechanical threats in dentistry include projectiles that cause eye injuries, cutting objects, and puncture wounds from needles or other sharp instruments. These injuries can also lead to the transmission of infectious diseases. Additionally, harmful radiation can damage various body cells, and prolonged exposure to noise and vibration from high-speed and low-speed handpieces, high-volume suction, and ultrasonic instruments can contribute to hearing issues. Musculoskeletal problems, such as wrist pain, lower back pain, and neck discomfort, often arise from repetitive motions and maintenance of fixed working positions. Chemical hazards include inorganic substances such as mercury, organic solvents, resins, and gases, as well as caustic chemicals such as formaldehyde. Allergic reactions such as contact dermatitis from latex gloves are also a concern. Biological hazards, including allergens, infections, toxicity of dental materials, and the risk of cross-contamination, pose additional threats. Lastly, psychological risks, such as stress, excessive workload, job dissatisfaction, professional burnout, and medicolegal concerns can significantly impact mental health.^11,12

The prevalence of occupational hazards in dentistry is a significant concern, studies report an alarming prevalence of musculoskeletal disorders among dentists, and ranging from 68% to 100%, with common issues including back pain (29% to 94.6%) and neck pain (26% to 92%).¹³ Exposure to hazardous materials such as mercury and the risk of cross infection are notable with, 44% of dental students reporting mercury toxicity and 40.4% concerned about aerosol infections.¹⁴ Stress is prevalent, with 63.5% of dental professionals citing it as a major concern, often linked to patient interaction and financial pressures.¹⁵

Awareness of occupational hazards in dentistry is crucial to ensure the safety of dental professionals. Various studies have highlighted the prevalence of different hazards including noise pollution, sharp injuries, chemical exposure, and blood-borne infections. Despite some awareness, a significant gap remains in the knowledge and preventive measures among dental practitioners and students. A study found that 85% of dentists perceived noise as an occupational hazard, yet only 57.1% were aware of permissible noise levels.¹⁶ In a recent study conducted in Saudi Arabia, awareness of sharp injuries was satisfactory among 64.3% of dental students, but 31.3% reported exposure in the past two years.¹⁷ Similar findings were also observed in another study, which demonstrated approximately 48.12% of dentists in Korea had a serious perception of occupational hazards, with 77.3% experiencing them.¹⁸ Likewise, awareness of bloodborne pathogens and post exposure protocols was low in a recent study, with only 18% correctly following treatment guidelines after exposure.¹⁹ Understanding these work-related threats is essential to raise awareness among dentists.²⁰ Effective safety practices in dental workplaces include the establishment of an infection prevention program, proper maintenance of work areas, implementation of education and training on physical hazards, and the correct use of personal protective equipment.²¹

Although awareness of occupational hazards is improving, many dental professionals still lack comprehensive knowledge and adherence to safety protocols. Reviewing the literature, we found that in the context of Afghanistan, only one study has been conducted on occupational hazards in Afghanistan, which primarily focused on the occurrence and types of these hazards.²² However, it did not address the knowledge and awareness of individuals regarding this topic, and no research has been conducted in this regard. In light of these considerations, the objective of the current study was to assess the level of awareness regarding occupational hazards and the preventive measures taken by both dentists and final-year students at the Stomatology Teaching Hospital and the National Stomatology Curative and Specialized Hospital in Kabul, Afghanistan.

Material and methods

This study was a cross-sectional, survey-based research conducted at the Stomatology Teaching Hospital and National Stomatology Curative and Specialized Hospital, Kabul, Afghanistan. These two hospitals are major dentistry healthcare facilities in Kabul City. Convenience sampling was used to recruit participants. The study included all dentists and final-year dental students from the aforementioned hospitals, who agreed to participate. In total, 198 participants were included in this study. Inclusion criteria included all dentists and final-year dental students working at the Stomatology Teaching Hospital and National Stomatology Curative and Specialized Hospital, Kabul, who agreed to participate. Exclusion criteria were individuals who declined to participate or had incomplete responses.

A self-designed questionnaire was developed to assess the knowledge and awareness of occupational hazards and preventive measures in dentistry. It was initially written in English, reviewed, and modified based on feedback from senior dentistry instructors and then translated into Dari for participant convenience. A pilot study was conducted with ten final-year dental students to evaluate the clarity and reliability of the questionnaire. Based on feedback from the pilot study, necessary modifications were made before full-scale data collection.

The questionnaire consisted of three main sections: Part A gathered socio-demographic information (QA1-QA5), including questions related to the participants’ age, gender, education, work experience, and position within the dental field. Part B assessed knowledge and awareness regarding occupational hazards in dentistry (QB1-QB23), covering topics such as risks from dental materials, radiation exposure, sharp injuries, and infectious diseases. Part C focused on knowledge and awareness of preventive measures for occupational hazards (QC1-QC24), addressing topics such as personal protective equipment (PPE), sterilization protocols, infection control, and safe handling practices. Each question in Parts B and C offered three response options: “Yes,” “No/Not Established,” and “I Don’t Know.” The “No/Not well established” and “I don’t know” options were included to capture the lack of prior exposure or knowledge regarding occupational safety culture. It is possible that some final-year students or practicing dentists have never received formal training in this area.

Before data collection, data collectors were comprehensively trained to guide participants in completing the questionnaire and ensuring that all the questions were answered. All potential respondents were informed about the study’s objectives, procedures, and their rights, including confidentiality and voluntary nature of their involvement. Participation was entirely voluntary and anonymous. Written informed consent was not obtained due to the minimal-risk nature of the study, which involved non-selective data collection through anonymous, self-administered questionnaires. Requiring written consent would have introduced unnecessary administrative burden, particularly in clinical and educational settings. Therefore, verbal informed consent was obtained, and the completion and return of the questionnaire was considered as implied consent. This approach was reviewed and approved by the research committee of the Kabul University of Medical Sciences.

The collected data were entered, systematically coded, cleaned, and analyzed using SPSS version 25. To ensure data quality, a random selection of questionnaires was compared to the data entered at the end. Correct answers to each question were assigned 1 point, while incorrect answers and ‘I do not know’ responses were assigned 0 points. The proportion of correct answers was calculated for each participant separately for Parts B and Part C. The average proportion of correct responses was then calculated across all participants for Part B (occupational hazards knowledge), Part C (preventive measures knowledge), and overall (Parts B and C combined). Awareness levels were categorized based on proportion scores following previously published guidelines for knowledge and awareness assessment: 0.00–0.20 (Very Low), 0.21–0.40 (Low), 0.41–0.70 (Moderate), 0.71–0.90 (High), and 0.91–1.00 (Very High).²³

The Mann-Whitney U test was used to compare awareness levels between male and female respondents and between final-year dental students and practicing dentists. The effect size was measured using rank-biserial correlation (r). The study was approved by the Research Committee of the Kabul University of Medical Sciences on 24/4/1403 (14/7/2024), protocol 6, agenda no. 3.

Results

A total of 198 dental professionals participated in this study, including 106 males (53.5%) and 92 females (46.5%). The majority of respondents (90.9%) were aged between 21 and 30 years. Regarding their professional status, 131 (66.2%) were final-year dental students and 67 (33.8%) were dental practitioners. Most participants (80.8%) were affiliated with the Stomatology Teaching Hospital, whereas others were from private dental clinics or academic settings ( Table 1).

Awareness of occupational hazards among participants was assessed using a set of 14 questions. The mean proportion of correct responses was 0.73, which reflected a high level of general awareness. Several questions demonstrated a particularly high awareness. For instance, 97% of respondents correctly recognized that high-intensity light used during dental procedures can cause eye damage, and 93.4% acknowledged the harmful effects of X-ray radiation exposure. Furthermore, 97.5% were aware that diseases such as Herpes Simplex Virus (HSV), Hepatitis B (HBV), HIV, and Tuberculosis (TB) can be transmitted during dental procedures. However, certain areas revealed notable gaps in their knowledge. Only 14% of participants correctly identified carpal tunnel syndrome as a common occupational hazard in dentistry. Additionally, a significant proportion (62.1%) mistakenly believed that mercury in dental amalgam was carcinogenic. Awareness of other hazards, such as the effects of poor posture on musculoskeletal health and noise-induced hearing loss, showed moderate levels of understanding, with correct response rates ranging from 50% to 70% ( Table 2).

The section on preventive strategies consisted of 11 questions, with participants achieving a mean correct response rate of 0.69, indicating a slightly lower awareness than the hazard-focused questions. High levels of awareness were evident in some areas: 93.9% of participants recognized the importance of taking a detailed medical history to prevent adverse reactions, and 93.4% emphasized the need for protective eyewear during dental procedures. Moreover, 90.9% believed that managing stress by spending time with family was an effective coping strategy for psychological well-being. Nonetheless, other responses indicated critical gaps in knowledge. Only 8.1% correctly understood the inverse square law in radiation protection and 19.7% were aware of the correct use of safety boxes for disposing of sharp instruments. Similarly, only 31.8% answered correctly regarding the use of the scoop technique to prevent needle stick injury. While awareness of the benefits of proper lighting, regular breaks, and ergonomic seating was moderate, some areas related to safe handling and disposal practices were clearly under recognized ( Table 3).

The combined mean proportion of correct responses across both sections (Parts B and C) was 0.71 ( Table 4), reflecting an overall high level of awareness among participants. However, the variability in responses suggests that while some topics are well understood, others, particularly those involving technical or procedural details, require further emphasis in training and continuing education programs.

To determine differences in awareness by gender and professional status, the Mann-Whitney U test was used. The results revealed a statistically significant difference in awareness scores between the male and female participants, with females showing significantly higher awareness levels (p = 0.000) ( Table 5). In contrast, no statistically significant difference was found between the final-year students and dental practitioners (p = 0.575), suggesting that both groups had comparable levels of knowledge regarding occupational hazards and preventive measures ( Table 6).

Discussion

This study assessed the knowledge and awareness of occupational hazards and their preventive measures among dentists and final-year dental students at two dentistry hospitals in Kabul, Afghanistan. The overall awareness level was high (0.73) for hazards, and medium (0.69) for preventive measures, resulting in a combined awareness level of 0.71. It is important to note that some respondents answered ‘No/Not well established’ or ‘I don’t know’ to certain questions. These responses indicate areas where knowledge gaps exist and may have affected the overall awareness scores. Addressing these gaps is critical for designing effective educational interventions and ensuring comprehensive occupational safety awareness among dental professionals. However, specific knowledge gaps have been identified particularly regarding the risks from electrical devices, mercury exposure, and certain musculoskeletal conditions. Notably, female participants had significantly higher awareness than male participants, while no significant difference was observed between final-year students and practicing dentists. These knowledge gaps may partly reflect the current delivery of occupational safety and health content in the dental curriculum. In Afghanistan, as in many LMICs, occupational safety and health is not consistently emphasized within the dental curriculum. Training is often limited to theoretical lectures with little structured practical exposure, and topics such as ergonomics, radiation safety, and chemical hazards receive minimal attention. This limited curricular integration may partly explain the persistence of knowledge gaps observed in our study. Strengthening and systematizing the curriculum with a focus on practical occupational safety and health training could significantly improve awareness and preparedness among future dental professionals.

To the best of our knowledge, no study has used a specific methodology to assess occupational hazard awareness among dental professionals in Afghanistan. However, the findings from existing studies offer valuable insights and provide a context for understanding the results of our study.

Studies involving dental students have reported high levels of awareness regarding needlestick injuries (NSI), with 89.23% of students demonstrating knowledge of NSI and their management in one study.²⁴ Similarly, 89% of students in another study were aware of post exposure prophylaxis for accidental NSI. In our study, a high level of awareness was observed in response to QB15, where 96.0% of respondents correctly identified the dangers of cross-contamination from sharp objects like needles and scalpels, resulting in a proportion of 0.96. This finding suggests that awareness of NSI is strong among dental professionals in Afghanistan, similar to findings in other regions.

One study found that 98% of dental practitioners were aware of the risk of noise-induced hearing loss (NIHL), in contrast to only 34% of dental students.²⁵ In our study, when exploring the potential for devices such as high-speed handpieces and suction machines to cause hearing loss (QB5), the awareness level was moderate (0.69). While this is lower than the awareness found in practitioners in other studies, it highlights an important area where further education can improve understanding, especially among dental students and new professionals.

Another study found that general dentists were more likely to recognize X-rays as a risk factor than specialists.²⁶ Our study found that awareness of the harmful effects of X-ray radiation without protective measures (QB7) was very high (0.93). However, awareness slightly decreased in QB8, which assessed knowledge of the life-threatening risks posed by prolonged X-ray exposure, resulting in a proportion of 0.89, which is still classified as high. This decrease may reflect the complexity of understanding long-term risks even among those who are aware of immediate hazards.

A study assessing ergonomic awareness has generally found that women are more likely to recognize their importance than men.²⁷ Similarly, one study reported that 75.8% of female dentists had an idea of what the term ergonomics meant compared to 52.6% of male dentists, with a statistically significant difference (p < 0.05).²⁸ Our study also found a gender difference, with female participants demonstrating a higher overall awareness. This difference may be explained by several factors. Previous research suggests that female dental professionals are more likely to recognize and report musculoskeletal symptoms, which may heighten their sensitivity to ergonomic practices. Biological factors, such as lower muscle strength and a greater susceptibility to musculoskeletal strain, could also make women more cautious about posture and preventive strategies. Moreover, behavioral and sociocultural influences, including greater adherence to health and safety recommendations, may further account for the higher awareness observed among female participants in our study.

A study assessing basic knowledge of theoretical ergonomics, the ISO 11226 standard, and ways to improve undergraduate ergonomics training found that most students had an average level of knowledge of dental ergonomic principles.²⁹ In our study, the proportion of correct responses to three key questions—whether a balanced body position (0.80), taking short breaks (0.89), and regular physical exercise (0.82) help prevent musculoskeletal disorders—was categorized as high. While the data may not be directly comparable due to differences in questioning, our findings suggest a strong awareness of practical ergonomic principles among the participants.

While no significant difference was found in awareness levels between final-year dental students and practicing dentists, this result could be partly explained by the composition of the sample. With 131 final-year students out of 198 total participants, a large proportion of students may have introduced a bias, as these individuals are currently undergoing extensive training in clinical settings, likely acquiring knowledge about occupational hazards and preventive measures at a similar rate as practicing professionals. As a result, both groups may have had relatively similar exposure to occupational health and safety education, which could account for the lack of a significant difference.

Moreover, the absence of a substantial difference could suggest that formal education on occupational hazards provided during the students’ academic curriculum might be sufficient to ensure an awareness level comparable to that of practicing dentists. It is also possible that further practical experience in the field might not drastically change awareness if foundational knowledge imparted during education is strong.

The consequences of occupational hazards extend beyond physical injury. Lack of awareness can lead to psychological issues, such as anxiety, depression, and post-traumatic stress disorder (PTSD). When healthcare workers experience repeated exposure to hazardous situations without proper knowledge and support, their mental health deteriorates, leading to burnout and decreased job satisfaction.^1,30 Inadequate awareness can not only affect the overall productivity of healthcare workers, but also compromises patient safety and outcomes.^31,32

Furthermore, inadequate awareness has a substantial economic impact. Increased healthcare costs due to injuries, loss of productivity, and the need for additional training or recruitment can limit healthcare budgets. In low- and middle-income countries (LMICs), where resources are already limited, this becomes a critical issue affecting the sustainability of health services.^32,33

Our study identified several clear gaps in the knowledge regarding occupational hazards and preventive measures, which may contribute to these broader consequences. Notably, there is insufficient awareness about the risks posed by electrical devices, mercury in dental amalgams, and specific musculoskeletal conditions such as carpal tunnel syndrome. Similarly, gaps were evident in the understanding of radiation safety measures, including the importance of wearing lead-protective gowns, applying the inverse square law, and the use of safety boxes for sharp instruments. Addressing these knowledge gaps is essential not only for individual safety, but also for improving mental well-being, reducing economic burdens, and enhancing overall healthcare sustainability.

These gaps highlight the need for regular and effective training on occupational hazards and preventive measures. Studies indicate that healthcare workers LMICs, including dental professionals, often lack adequate training, resulting in insufficient knowledge about critical risks, such as blood-borne pathogens and ergonomic hazards. Addressing these deficiencies requires ongoing educational intervention to improve awareness and safety practices.

Support from health organizations through counseling services and workplace health programs can play a pivotal role in enhancing awareness. Additionally, analyzing the history of workplace incidents can help identify weaknesses in safety protocols, which can then be used to tailor more effective training programs. It is critical to build and sustain a strong safety culture within dental workplaces, as this has been shown to positively influence employee behavior and adherence to safety protocols. A culture of safety reinforced through continuous education and leadership support can significantly reduce the risks associated with dental practice and improve the well-being of dental professionals.

Creating a safe work environment is essential to reduce occupational hazards. Many healthcare workers are exposed to various types of hazards, as mentioned before in this study, which can be mitigated through proper safety protocols.^34,35 The current study did not collect data on participants’ daily working hours which may influence both exposure to occupational hazards and related stress levels. Previous research has shown that extended working hours are associated with increased occupational risk and reduced adherence to preventive measures.^31,36 Future studies should incorporate work-hour documentation to more accurately assess correlations between exposure, awareness, and risk perception.

Regular and effective training on occupational hazards and preventive measures is critical. Studies show that healthcare workers in LMICs often lack adequate training, leading to insufficient knowledge about risks, such as blood-borne pathogens and ergonomic hazards. Support from organizations through counseling services and health programs can enhance awareness, and analyzing the history of workplace incidents can help identify safety weaknesses and improve training programs. A strong safety culture within the workplace significantly impacts employee behavior and adherence to safety protocols.^37,38

This study had certain limitations. The use of a self-made questionnaire may have impacted the validity and reliability of the findings, as it was not pre-validated against standardized measures. Additionally, the convenience sampling method limits the generalizability of the results, as the participants may not be fully representative of all dental professionals in Kabul. Future research should consider using a validated questionnaire and randomized sampling approach to improve the robustness of the findings.

Future research could explore intervention-based approaches, such as training programs, to assess whether targeted education might enhance awareness of lesser-known occupational hazards. Additionally, conducting a larger multicenter study involving different regions of Afghanistan could offer a more comprehensive understanding of awareness levels nationwide. By addressing these issues, future studies may contribute to further enhancing the safety and well-being of dental professionals.

Conclusion

This study demonstrates that dental professionals and final-year students in Kabul exhibit a relatively high awareness of occupational hazards and preventive measures. However, specific knowledge gaps persist, particularly regarding risks associated with electrical devices, mercury exposure, radiation safety, and musculoskeletal conditions. Addressing these gaps through structured educational interventions continuous professional training, and reinforcement of occupational safety curricula is essential. Enhancing knowledge and awareness is crucial not only for individual safety but also for improving mental well-being, reducing the risk of burnout, and ensuring patient safety. Dental professionals and students must be actively aware of and willing to prevent various occupational hazards such as noise, light exposure, ergonomic positioning, sharp instrument handling, and biological risks. Regular training programs and a strong workplace safety principle can significantly improve adherence to preventive measures and overall occupational health.

Ethics approval and informed consent

The study was approved by the Research Committee of the Kabul University of Medical Sciences on 24/4/1403 (14/7/2024), protocol 6, agenda no. 3. Verbal informed consent was obtained, and the completion and return of the questionnaire was considered as implied consent.