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Shining the light on laser safety: 4 steps to keep your practice compliant

One of the most important components of all laser education courses is laser safety education, compliant with the American National Standards Institute (ANSI) standards, ANSI Z136.1 "Safe Use of Lasers" (2014) and ANSI Z136.3 "Safe Use of Lasers in Health Care Facilities" (2014). Understanding and adhering to these guidelines will keep both patients and practitioners safe when lasers are used in the dental practice. Compliance with these regulations is extremely important but does not have to be complicated. Compliance can be broken down into four simple steps, so ANSI standards for laser safety can be implemented easily in every dental practice.

Know the standards

ANSI sets the general and clinical standards that define the requirements for the safe use of all types of lasers (Z136.1) and the safe use of lasers specific to health-care facilities (Z136.3). The Laser Institute of America (LIA) serves as the secretariat for the ANSI Laser Safety Committee and publishes the required laser standards and documents. Although ANSI provides laser safety recommendations, it does not have any regulatory powers to enforce these guidelines. The Occupational Safety and Health Administration (OSHA), however, has general authority to regulate workplace safety, and it relies on the recommendations described in ANSI Z136.1 and ANSI Z136.3. The objective of the standards is to provide reasonable and adequate guidance for the safe use of lasers in general and the safe use of lasers in health-care facilities such as dental offices.

The ANSI standards classify lasers and laser systems according to their relative hazards and specify appropriate controls for each classification (table 1).

Lasers used in dentistry for bacterial decontamination or ablation techniques are Class 4 lasers. Class 4 lasers are high-powered and can pose a hazard to the eye or skin from direct-beam exposure. ANSI Z136.3 defines key safety protocols to be followed to keep all laser operators, auxiliaries, and patients in the dental office safe.

Identify a laser safety officer

In compliance with ANSI Z136 standards, any facility where a Class 4 laser is in use requires a laser safety officer (LSO) to oversee the laser safety program. The LSO is the one person in each facility who has been trained in laser safety and is responsible for the laser safety program. The LSO's primary responsibility is to monitor the control of laser hazards and ensure compliance with the guidelines established by ANSI Z136.3. The LSO is accountable for ensuring that all team members, including front-office staff, have received the recommended training.

The LSO does not necessarily have to be a clinician; any team member can perform the duties with the required training. However, choosing a highly engaged team member is always best. Some states require that all Class 4 lasers and associated LSOs be registered with the state.

Arrange training for everyone in the office

Perhaps the most important consideration for the safe use of lasers in the dental office is appropriate training for clinicians and team members. Many organizations offer different levels of training for implementation of lasers in the dental practice, and many state boards specify training guidelines and proficiency levels, as well as organizations recognized to teach laser education. For clinicians seeking laser certification courses, programs that are didactic, hands-on, and device-specific are highly recommended. Online courses that do not allow for hands-on experience do not meet the standard of education necessary for clinicians to achieve basic proficiency in operating lasers.

Maintain a nominal hazard zone when lasers are in use

The nominal hazard zone (NHZ) is defined as the area where the level of direct, reflected, or scattered radiation poses a hazard to the skin and eyes during normal laser operation. Simply put, it is the area around the patient where proper safety protocols must be followed. The NHZ differs for all lasers and is dependent upon laser wavelength, laser fiber size, and beam divergence. Information relative to a laser's specific NHZ can be found in the manufacturer's laser manual or "Information for Use" guide. The NHZ should be restricted to only the patient and necessary personnel. For most lasers, the entire dental operatory becomes the NHZ. Within the NHZ, the following actions must be taken to comply with ANSI standards: (1) Appropriate laser safety eyewear must be worn by all; (2) proper signage must be posted on each NHZ entrance; (3) precautions must be taken to prevent fire hazards; and (4) laser plume must be managed.dental laser tips

All people within the NHZ must wear appropriate laser safety eyewear specific to the laser in use. Laser safety eyewear is labeled with its optical density and the wavelengths it will protect against.

Every entrance to the NHZ must also be marked with an appropriate sign. In January 2014, ANSI adopted an updated laser safety sign that is marked "warning" (figure 1). The sign also indicates the laser's classification, wavelength, and maximum power, as well as the required optical density for the laser safety eyewear (figure 1). The laser safety sign is typically provided by the laser manufacturer with purchase.