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· Republic of the Philippines

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February 4, 1998

... lA~ &.AZNU)OOMt'OUND . lliZALAVIHUII;ITA.CI'IUZ ·". MANILA; rtaUPI'INI!8 TIL ND. 711-IIHO

ADt1INISTRATIVE ORDER · NO. ,3 . s.. HJ98<

··c SUBJECT:i RevisE?<f'Rules: a'nd Reg•ilati.ons and Standard Requirements

fot' Ocoi'i~;•al~ionill Dent<•l Services in the Philippines. . . -· -. . . . . '

Puduan t t.o ·• f.<,brjr Code' on ~fay 1, ·1~74 .. and Administrative Ord<>.t's No. 7 and 30'6 <.;igrled on December: 9, 1976 and August 21, 1078 r-e<.<pectivoJiyx r)n .the Rules. and· Regulations and Standards H<equirements for:Occupat.iC.nal ])ental Health Services prescribed under prev iou(3 9rders · ax:e ·hereby e,men;ded and promulgated for the ,t;r.ict compliance of nll concerned'.

SECTION l TITLE: Th.ese ·rules ;'(rid regulations shall be kno1"n C>S the "Re\•:ic:&d· S.t·-:mclard for Occupational Dental Health :3c•!'V.icen in the Phi U.pp}rle£:". .. ··

·. SECTION 2 ··PURPOSE: These... rules ahd regulations are · p1·omulgatr"d to profect. the r.)ral health· of the workers and· improve

d<.-nl·.:•d ,.::(>t·vices in €{11 9ccupational establishments.

::>ECTIOH 3 'COVERAGE

The st,;tidat~d Re<iqtr.emehts . enumer·ated hereunder shall ·opply .. to .all employers whether operating for profit·. and non~'-pt;q'f~\; indludihg go\ier:nment institutions and aJ'lY of i. to . pbJ;itical ,~;vbdivii-;ions and government-owned and ,:~on tl'olfed-JJbrpora:tions, · which are re<;tuired ·by the. Labor Code to'pr;)~:ide their employees in any locality v.•ith free dent.al ; serv i:i::es and facilities. ·

SECTION. ftEFil-liTION OF TERNS

·The fo1Jow:i.ng t.errris i~hall have. the corresponding meaning imU'-'·af.Eld llei'<~n\ncler Uh1<3ss the conte?:t clearly indicates -~)th(~rwi'~_;e =·:-'

1 , . . Oc,c\JpntJ<mal. Estnbl{s};ments ar•e working jnsu.b,\'.±pns .,!Jethe.r for ·'profit· or non - profit duly ,,,ir..eg'_is.fei·ed . under tl)e . Security and . Exchange

. Ccinl'rii.1isei{oi'l {SEC) and· De'!?itrtnrent. of Trade and Industry. '.'.;--.--:---.-_..,, . ·-' . . -" . -· . . .

2: A)>'"Occupal;ionalD~nfal Service" means a part. of medic:alc an.d dental cl.inic .)1ithin or outside the premises of. •.t,j\1;;: ,,;_,ot,kplace. where. dental personnel,. facilities,

.:r

services and programsorganized eml(lPY\'lr. .f()r. the worker$ ; in requirements of the· Rules. and .the Labor Godeas amended.

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and maintained by the compliance with the

Regulations implementing 3. : Demti~t. · is a graduate of Doctor of Dental l-ledicine a1'ld• has a license to practice General Dentistry. 4. ·. "OcCUJ?~tioniH Dentis~" means dentist employed or engaged in any establishment regardless of whether he . is .. · engageil ·on· full· time pr. on part time basis and has met the Qualification Standard Requirements as stated in Section 4 of this. Standard: · ·

. . .. . - · . .' . ·., ... . 5. · "Workers"' m<'lans all workers employed by an establishment whose· s.ervices are regularly and constantly used and. form as an integraTpart Of or is connected with the ~mployer's business e\;en though said workers are changed from time. to (ime. . · · 6. . ,;Emergency :DChtal Case'; is a person who suffered an· injury · ··or illness ' involving the teeth and the surrounding . ha.rd . and· :sOft. tissues of the oral cavity during office. work< ·

7. "Emergency .. Medic~l .arid · Dental · Treatment" means adequate;,:.: ·in\media'te ::·':and necessary medical and dental treatinent .· Or reln$3d.VCgif€m in case of injury or sudden illriess suffered''by•a worker ·during employment, irrespectiv.e of:t . ..i}ethel'·Or·not SUCh 'injury or illness is· work related 'QefOre nK>re extensive medical and/or cl<':ntal treatment '·Pan •· be. secured. 8. "OrallyF:it" is a itatu~/condition of a worker who is. certified . by the occupational . dentist found to have healthy'gums .,;itii· no?calculus, all unsavable teeth extracted . ancl aJ,l car'ious teeth with . temporary or permanent· fHlings at. tha':t{me. of . eniployment . . '" _ .. _ ,._." :,, ., .. _:_ .. __ . __ , .. ·(·' --:-- --- '

9. "Hazarclotls Work Ar~~{;··Jril;iims working. conditions in envirot1meril7 .abruptly · Or insidiously affect the integrity of the teeth arid' surrounding tis.sues. __ .. ,_._. "<- -.

The foilowing.conditions are deemed a~ hazardous work areas:: .. a. Whei-e the naH.ire of the wOrk exposes the worker to dust, fume, ···. mi~t; fOg, gas, vapor, chemical substances and/or ionizing radia.tions as they may affect tqi;l' oraJ .health . . pf the worker. ::.'-_.-

b. \Vhere : \'idrker~ ~re ... ;l1gaged .in construction worlr, logging, · · • mining, qtla.ttrying, blasting, ·.·. stevedoring, dock . work; de~l? .,ea fi!§liing, and mechanized farming a.s r.h~v :tn~l1' n~u ..... ;...•' _.:..__.~::..;'"'....·._.

l;

: ... -__ ·_·.

c. ,Wher:~ workers are engaged in ·the· · manufacture of explosiyes, dy!'lamite ·'and fireworks {also accident haza~ds). ·· · ··

d. Where.,: ·workers use and/or are exposed to power­driven toois .. and'machines (.also accident hazards)" .. e' Where. the wor)l:ers.are exposed to biologic agents such · as l::>acteria, fungi, viruses, protozoas, nematodes;, al1d other parasites. · 10 .. Non;.;.Hazard6us Work· Areas means. working conditions. J.n .. environment which do not affect the iritegri ty of the te.eth arid surrounding tissues. Where the workers are: not exposed to biologic agents such as bacteria, fungi, viruses, protoioas,. nematodes, parasites ana othiir .· conditions as . stated in the . definition of hazardous work. areas" . . . - ' :- ,·· _. ·<_~::' ·.- : .. - - . ·- .

11. "Occupatioria1Dis~ases of the Hard and Soft Tissues .of Oral. Cavity" refer. t:o ·diseases of the hard and soft t:issues of the 1nouth· produced . after an .individual has been exposed to the occupational hazards· present in his .·· · working environment .whether J.n ·physical· form, as abrasives, irritants, carcirfogenic . substances, equipment, or as chemicals, gas or j;he 'like. · . . ". .- ·. :---· '·.-. :-:.-· . 12. "Non-Occupational Diseases" are those oral diseases and conditions suffered .b;v ,. the .worker during employment which are not due tq . oc<nipational hazards. present in his working environment.< ·. · · · · · ·

13. the other

:- :-? ·.- .. ' . . . ·._. . . -. . ,.. . . . . . . - -- ' . ·.. -· - -. '.

"Dental A;~istant" refers .. to a person who assists d~ntisy' i:r{ .his ... clinical activities and performs dutoi;es delegated by the dentist. - . . - . - ' . . SECTION 5- ORGANIZATION·

<' /.

I1; shall be the duty of ~;he mahageinent among occupa­tional. •establishmen.t:to organize, • Operate and maintain a dental service Sri accordiirice 'with the m1n1mum . standard requirements prescribed / by the Depii.rtment of Health · · through its authorized a.gertcy; the Dental Health Service. The.·. dental service shall· be ,admiriistered by a licensed and qualified dentisj;, The riumbe'r of dentist to be employed by . the occupational establishment and the manner of em,Ployment shall. 'be,,.in ac,c6rclance with the Standards under .· RULE 1960 of the O~cupati<)nal Safety and Health Standards, as amended-pre'scribed by the Bureau of Working Conditions, Department· of Labor and Employment. (See Appendix ) ·· · ·

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SECTION 6- HUMAH RESOURCE REQUIREMENTS: QfJALIFICATIONS; . . DUTIES AND FUNCTIONS

6A Dent,al. Personnel and WOrking Hour Requirements

Ac .· Jiaza.;r;dous Workplace 100 ,-,, 199 Employees

{}01- 2000

B. Non Ha.zar·doi,.\s Workplace.

200 - 600 err,ployees.

601 2000.

20~0 · a.nd' mor·e ·

6. 2·. QfJ~L{FICAfiONS.· .. ··

Part-time dentist 4 ·hours,. 3 x a week

Part-tillle 4 hours; 6 x a week

Full time. 8 hours, 6 x a .week

Par·t-tirne dentist 4 hours 13 x a week

Par·t ~ time 4 hours, 6 x a week

· Fu.ll - time 8 hours, 6 x a >-leek

An· dccupational Dentist shall have· the following mlh inmm .· qua 1 i ficatiohs:

.,, ·.·.. -· . -.... ; ·- i· . . _- -:·

1; Duly ·licensed arid registered dentist in the

3.

Philippines. < ·: .. ··.•··.·· . · . · Must b1,3 ph;>sii::a'};lyand mentally fit certified

· by f.\ny ,g?yel"nll)e~t-' pl:JysiCian ... : f.Jnc!et"goiiei 8I;IY · trf.!,ilJirig course on occupational hemlth.;\ric! safety/ ' .

4. · .. ·.Active /merilber> of' .· the Philippine Dental ·. ·· ils•sodiation 'and ()ther · ];>rofessional/government

organ izcltions.

6. 3 FOr eff~()tive and . efficient delivery of the dental service, i'he occu'pa.tional dentist shall have the f"ollowing dill;ies: ·

1. Plans,· orga~i.ies and 'establishes health· p~&gram · in.t$grating

·nutrition an'd safetor programs oral health Of the w()fk,el:s; ·

a comprehensive dental occupational . health,

to promote and ensure

2. Conducts i::()mplete.arid·thorough oral examination of the workers )n acldi tion. to , .• the required. pre-employment physical ·•e>:aminatiOn · and certifies whether the worker is "orally fitor riot'';

' 3. Conducts oral examination of the ·workers during eliiployment at .least once a year in a non-hazardous

· workplace , ancl periodic oral examination as may be • deemed . necessary upon the re<;~.uest of . supervisors in 'work ,areas Which are hazardous in nature;

4. ·Using X-ray. a11d other diagnostic aids, conducts. a complete .and thorough.oral examination of workers in hazardous' work areas \-i'.ho ,are leaving the company and c'ertifies whether a worker is suffering or not from occupational dise'ases of the hard and soft tissues · of the oral cavity'. . .

· 5 .. Conduct.s oral . examination of worker.;, who have been· treated and . rec:o~iet:ed £rom . c'ontagious oral diseases to eertify. whether . they are fit to return to work or .. not;

6. ·Furnishes · reports ·to company physicians and supervisors for immediate. arid appropriate. action,

. cases of OCClipational oral diseases detecte.d . after . oral examination . · ... during . employment which cannot be attended to by ,the dental service;

7. Attends to emergen,9Y ·dental ;cases so that· the worker can go back to work upon reco\•ery;

. 8. Provid.es . proinpf occupatioriaJ and

i

.. tr~atment . ancl/or non'-occupational oral

referrals diseases;

of

9. In. h£iz~r&icts work areas, it' is the responsibility of the · . oc.cupa;tiqnal;deritist ·to recommend to management that workeir.sh~fi be' provided with suitable protective equipment/devi~es to prote:ct.them- from occupational hazards;. · . · . ·· · · .

10. Gives chair; side· · instructions while ·treating the patients; explains and discusses with him his oral

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condition · and recon1mends positive actions with. emphasis on good oial ,}1ygiene and proper ·nutrition that the w0rker. cafl 'take to, improve. his oral health;

Participa-tes B:ctive'].y tith the health personnel in the preparation. of heaLth 'edvcation materials, as well as disseminating. he'aJ.'th'l.riformation to the workers and thru ·them, to .members ·.;f t.hei,r families;

·.·12. Serves·.as membe.J:" ·of the Health and Safety Committee including inveii;ttgal:.ionof accidents and inspection of

· wo~kplaces; · · · , _,"/X;~<,' ::, , .

13 .. Coorcliriat~s w.i.th the Supply Officer of the establ.i~l1rrient• . iri establishing a regular

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occupational schedule. in

. //~\ ··! . .

the·procuremeritof needed equipment,. dental materials and supplies; ·

14. Submitk fd~ the a;proxalof the Management through the Budget Officer, ·U·cbtidget estimat.es to operate and mainta:in adequate s.taridards of.. dental services· for a r,;eriod of at J.Ei.ast one calendar or fiscal year; . . -· ,• •.·- .·· .

-,; ~- <::' .

15. Complies arid maintains a oomplete record of oral examiriati,;ris, ·. treatment and/or referrals done for each· patient;.:

16. Submits. periodic reports of accomplishments to 'the emplOYE!Z.~ .. ·.· ·

17' · Sublllits dental ... ·reports . to . the . emJ?loyer Regional Health Office;

and the

·. 18, Evaluates. the ':,dJritaJ.- h:~al th service/program of the occupational ef;t;abiJ.shment annually and makes a report of such evalt1ation and .recommendation .. to management;

19. Coordinates hi.~'c~otl~ities with the activities of the other members. of~ the health staff;

20. Performs suchother.duties that may be assigned by his employer.

21. Other Re~~bnsibilities: .

The oc~~pationa{dentist .should know the extent and magnitU<:le: q{ .. th~{::cora:j. pi'oblems of the .workers. This information will· provide him the basis for organizing, plahning, implementing,·.· monitoring and evaluating

· dental' care pr-dgt:ain:s";i its. effects and cost benefits as well as recommending bud~etar;• requirements.

6 .. 4 . For each oocuJ~;~b~al ~entist in the 'dental clinic, one dental.aide;should<bea?siglled to take care of the clinical facili(if!s,. arid ·assist in the dental activities. The fol:lowiqg are· the duties of the Dental Aid~ .

1 .. Clearis.. the clinic a~d arranges dental equipment supplies;

. . ·- - . 2 ~. Sterilizes denta1 instruments;

3. Assists · the occ1.l~at~.onal dentist i.n the dental treatn.lent.; · ·

' -· :.~::::;

process

4. Checks .and ·. k~i~~ deh~ai ·'. e~uipment, supl;:i.l:.efi' • in·, circler:;

materials . -: ... ;·:>:;·,,. ~-·~.,-: "· =><·-''·

and

of

and

· .. ·,.' .

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6.5

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5. Prepa,res' the requisition of dental supplies under the gui4ance of the ocqupational dentist;

6 .. Under•the c!irecti~rlofthe occupational dentist, makes arrangement ·of· apPointments and files records of dental activities,;

7~ Actively participates .in the instruction and demonstration activities.· .·of the health education program; · · · under the guidance and supervision of the occupational dentist.

1. ·Basic' Orfentati'on Training Course

The course is· ·required for occupational dentist entering the. service for the f.irst time and those already in the · ser,;ice but .. have not at tended the course.. The course conteh't is prescribe by the Dental Health Service

. and . conduct,ep by ·the ··Regional Health Office or by any organizatfprLduly accredited by the Department of Health.

Hours· of\T~ain ing . . • · . Forty ( 40) hours Thirty {30) hotp::s for classroom instruction Ten (10) hours for practical exercises -,.·.< )." -~ .

Course cC!f1t~nt: ·

- Laws, Administrative oX:ders, relative to occupational dental health and safety servtces. ·.

Rules· and· Regulations health and occupational

- Standard Re<;tuiremen.ts'for Occupational Dental Services:

Coverage, definitions, organizations, dental personnel, ·· duties, • qualifications and·· tr<d.ning .pequ.irenirents' .. occupational dental health program, · cl.inica.l and techni.ca.l procedures., ..• fa6i.Hties and d€mtal equipment,

·medicines' 'iin\:1 · ~ental .. supplies;. financial regJ.lfrements, .. ·· • r¢cords and- reports,

·regl.strat,iori' · and .. aqcreditation, monitoring ai1d Penal J;•r'ovisions.

- Dental HealtH •EdJdation, Promotion and· advocacy - Diet Cou;Jse'ling · ·• · - Occupa({o'ria.i ()raJ .. Diseases; Prevention and Control. . ,__,. ·£;:.,.- . '

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2. Cqntinuing Edu.cation .· ·

The. occupational dentist is required to attend

reorientation courses. at least once every two years and

shaiL.be ailowed by the employer to attend scientific

seminars· conducted. by . dental societies and duly

accredi.ted organizations to keep abreast with .modern

trend's i.n. odcui?ational .... dentistry. The occupational

establishment ·shall· subs.cribe to dental journals,

·magazinee;, books and articles for the use of occupational

·dentist: . - ---- . .. . . .. ..

3. · Sp€lci~:t ~raining ·on .Ree;earch ·.- -~ '.-

.· .. Occupational est~bli-shments . desiring to conduct

'studies and resear6h oll. occupational oral diseases among

.workers can re41.lest fortechnical assistance from the

Dent.al Health. Service· in ti'ainipg of occupational dentist

on · dental rese.ai'ch me.thods .arid procedures.

'4.Training All~w~l'lce ·

It shall be the duty of .the management of. occupational

establishment to provide reasonable training allowances to

the occupationaldemti-st while attending the required

training qqu:re;es bqpductec! by the Department of Health

and otper, sciep~ific. S~ll}fnars related. to dentistry and.

occupationalhe<>,lth <>,nd safety conducted by .. dental

soc:ietiee; and/or duly ;accredited. organizations/insti tu.tions.

6.6 Rec~mmencled 11il1imum·Sa:J.ar'y

.·To • gu{de qcith. the .·. Manager/Administrator and the

dentist 'of the>establishment, it is suggested that the

recommended .mJ.nJ.mumbasic salary of an occupational

dentist working. s::hour,s a . clay and 5 days a week.

shouldnot be lower than that of government Dentist II

(Central Levei)' •.. Salary Grade 16 under the Salary

Standardizatiop Law .. For .. part-time dentist,it should

be computed .and . fippfdpriated on a daily/hourly basis ..

It is alsO .reques't,ed 'to the· Management/Administrator

that hazard pay shouldbe given to all.dentists working

in hazardous .. areas,., ... ,._.

-.-.-:.--. ·.-. -· ,:;;--,: . "8'

SECTION 7 · ·­Objectives:·

OCCUPATIONAL. DENTAL HEALTH PROGRAM

1. To .. provide aridmaintain.a.high level

of the ·workers . thereby •· improving

efficiency and PJ::Oductive capacity.

of oral their

health working

2. To create ~wareness amo~g the

importance .of oral health as workers on

it relates the to

their total health and well-being.

Five. (5) Basi~ Components

A. Oral Examination

B. Promotive· and Prevemtive Services

· C. Treatment· Services

·D. Rehabilitation

E. Prori1pt Referral and FoHo,~~up

A. Oral.Examl~~{ibn·

Early Detecti()n and Correct Diagnosis of Non

:-Occupational arid Occ)lpa:t.ional Diseases Through Regular

and Per.iodic Oral· Examinations.

1. Pre-employ~nent

The purposep. of ·"the · pre-employment

examination ar~the.following: oral

a; To deterinine a6curate1y the actual condition

of th~ teeth•and surrounding tissues at.· the

star-t· ()f ·. employment and thus protect the

·employer. against ci)rnpE)nsation claims on work ·

connected· <:>n.1l. diseases and conditions.

b. Bas¢d ;chi the f:i.ndings of the oral examination,

the • : occupational.·.·· dentist can give the

necessary .advice to. the worker in order to be

·orally fit pafore starting to.work.

2. During Erriployrnen:t

....• c> . ' . '

An oral e~arnination to detect initial sym}?,toms. and institute prompt treatment of occupational· disea.se among workers· is done p~;>riodiqally . during employment · as such interval. maybe deemed necessary in view of the. risl;:' inherent' of the ·workplace and/or bt}1er .• condi t;i.on under which . work is .Performed. . In case of non-hazardous areas, .the interval should be at least once a year.

·. 3. SeparatJ.on from Ernployment

A' <4orker . leaving employment where .the workp] .. ace .. is considered hazardous is required to undergo · a. thor6tYgh oral e~;aminat~on to determine acqU:ratiiJy.· , the presence. or absent;e of oral manifestations. of. OCC1)pational. diseases and/or conditions for the following considerations:

~Prof-ec~ion of .workers from occupational ·. hi:l.zards affecting the teeth and supporting

t·i:;;sues.

~ Periodic oral.prophylaxis for the . of g'Ingiv it is .· ahd procorsor · di.sea~_es· _

B. Promotive a~td ~I:e.:renti_.:~ Services

prevention periodontal

l.Dental Health EducaGon and D.ie.t Counseling

The ()~cup~tfbn.i\1 dentist shall devote a .. portion · of his· time, using the · chairside or . group'•. approach,. and dental health education •mat.erials, methods and techniques to motivate the workers to assume responsibility. and take

Opositi\re action for his own as well as for his •fa.mily's oral he.alth. This includes the

.,. fol·lowing:

Those which are .the. responsibility of the •·'individual, and can be carried out only· by him; e.g.proper Oral hygiene practices, with pa~ticular • attention to high calcium diet . anct·the avoidance of excessive consumption

.. pf sweet · and . high · carbohydrate foods :especially the sticky kinds- '

10

c.

·.-.·Those ~hic;h a~e the normal responsibilitY;\ of the __ · fa.niily; e.g. regular care of the mouth

·of .children,.·. st'arting from ·the early age p_ossiple, .proPer nutri tiqn -.and eating habits. of .... · tl1e family, pracMce ' of correct .. oral hygiene with family group.

- .The . \<Jorke~s should be taught and encourage tq utilize regulCJ.rly the preventive and tl:'eC\Jment s~rvices available in the oc<mpational establishments.

2. ·.Scaling- and Polishi~g '. ' ·. _. ,'.

This activ"ity. is . done by the dentist to· remove plaques, .•. extrinsic stains and calcular depos·ifs · t_o prevent ··formation of dental caries •'imd ·periodontal diseases.

. . ' ··-' .,,-· _- •' - ' - .--------

Treatmerit Ser'v:i.ces

· 1. Emerg~b~Jy.>t\~ntal Treatment _:,.

To.pr6videimmediat~ relief,-restore working effiCiency and earnirtg capacity of the worker, ·the follow,ing ·. emefg~ncy treatments are . deemed

··necessary: ·

a. Relief of ~cut~.dental .conditions -~-- \

. : . . .

b. Exfia&tion of 1.msavable teeth due to injuries or

acciderits ··'-'-:._

c. Mari~gem:tl~• .0£ hemqrrhage after tooth extraction

dl · Manageme;:;t · of traumatid·. injuries · affecting _the oral cavity• due"to accidents occuring in the workplace. ·· · ' • · ' ·

e .. Estahl j_shin€mt of··· drCJ.·inage · of dentoalveolar

abscess·

f.' ~lanagement. of . ~:f~:r: . debtal emergencies not · ment ioi1e4 c\"bov.i.'

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2. · Protnpf . Treatment · of··.·· Dental Caries and Periodontal· Diseases and its. Sequelae

~'? ;5t:t ~>~·-· ~ ·It f3hal'l 'bE'l•· the · primary duty of the

. occupational· dentist.to·prevent and/or minimize

the:. loss of natural teeth of . workers resulting . from·· advanced . stage ·of dental caries · or periodontal di'sea~e's. This can be done through a regulaf and ·systematic schedule ·of:

a .. Fi~lin~ of aU Jn6ipient ·carious ·lesions detected : upon.·<:oral examination and prompt treatment and

fi:i'J. :l.ng of decayed. • but .· r.estorable teeth.

b.

c;

Gu:•; t';eatment of early signs of gingivitis. and · pe}i<{dontai diseases.

MCI_nagement of other oral diseases detected during. oral e;:amination

. ..

d; .oral Surgery Cases

. c·a§es that need surgical intervention shall

be · attended .··. to,' . .when·. .the occupational estabJ.ishm.ent. has. its own hospital and when there are qualified iOJ:>al surgeons to undertake surgical

repair of debfi:'Ltated conditions of the oral cavity.. > · ·

···<~ "- ..

D. Rehabilitati.on ·

·Rehabilitation' J'r ·• the.· worker by prosthetic appliances to replace . one.· or more. missing teeth

and/or associated parts )nay be provided by the dental service . 'depending upon· the needs of the

·workers · anci · p..ft.er arrangements· regarding payment

· plans have been agreed .updnbetween. employer, worker. at!d occ:uJ;iational dentist .. ,

E. Prompt Referrals and F;{low~up.

The patign~•·~h(),;e needs cannot be met directly

by the dentaL service shall be referred promptly

to othe.r dental>clinics, provided, however that

these. cases are strictly • followed up by the occupational. dentist to be sure that· the workers

actually receive.·. the neoessary treatment that he needs·. · ·"" · · ·

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SECT I ON. 8 ··Jir.<!><;i.:STANDARDVOPERATINGCP~0CEDURES · . .. -.. , ,,_. __ . -~,_.~:-..;-·-·.,.;,.,·f··-·~-_.,,,.>,·::, _; :··-.-:~ .. }:-·;; .... ,; > \ l·-:·:--' -:~>}:~ ~~~ ('*>:;~;).l,?.~.,}_ " . :- ;-~-. ·'- • 1. Infection:·.COntrol·

"' . ' ; ·--.:·' . '. ·.·,· ... ';: ... • .. ,·.• .. ·.' ... ·: •• · .• -''".·.', .. ;: .. - .· :-;. · r'L1.,::-<:.~--f~_~!Jt-:,~:.: · - . ''··t,•T!ie:'' objeCtive .·of. infe.~tion control in the dental .. ·.·. clinic is to prevent the spread of inf€lctions from: patient to dentist, dentist to patient or':ind:i.rec.tly from patient to patient .

. ·. .. Guidelines ··in . Infection Control Observing Universal Pr~cautions · { Refer to ·Infection Control Guidelines .Manual p1Iblished .by OOH-DHS, Manila >.

2. Clinic.al and Technical Procedures

a. Oral Examination

Refer ·to Section . , No.7

As far as it'is considElred necessary, the oral examination shall -·include the use of. diagnostic facilities. and equipment such as X-ray apparatus, pulp tester and other.· special· laboratory examinations· deemed ·inclisJ?ensable owing to the particular nature of the employment.

b. Oral PrOphylaxis···

c.

Refer to Se.ction ' No·. 7

Filling of Savaole Teeth .-·-~:'<<.::.-'~ -~>-:·:.

1. Cavity times be

prepal:'atiori foi> flllirig should at all done. to pl'ovide .. extension· for prevention. ·- -- -- ' _.,,., .. :.- ·- .-., ... - .

2. In Class. II pav{t£es, convergent walls, cervico­occlusally ·shoiild he prepared properly for adequate retentio!l. • of filling. Matrix and gingival w.edges.s}:lould be u.;,ed. in the filling of all Class II cayiti~i;; - ...

3 .. In all· deep ~f?ated ·, f_~yities, the pulp should be protected by calciuiriol)ydroxide and base cement lining. · . ;r .•>·:.:;·

4. Sedative reduced to

·, : . . ·

dressing:; ih• t€lhlporary the .minimum .. ·

filling should be

,. ;

' f. I

t

'. :_:_

5. Dryness of the tee{h should be maintained during

the treatme_rit an.d fill:irtg of cavities ..

·. '·h:·~: .. > _ .. ·_. ' ··,. -__ -·- .. ': 6. Mixing;{ .... insepting and condensing of filling

material shall be observed within specified time.

! -''

A. si'i\rer: Amalgam •

1. St~~ai~d Material - Silver alloy and

U.S::J?:• that will meet ·No. 1 'and

. spec-ifications. of the American

Association.

mercury No. 6

Dental

2. Metfi()d . Trituration may be done either by

ll1or-taf.· and pes:Ble of mechanically using

fi;,/e(5) parts of silver alloy to eight (8)

\?arts of mer'cury. Condensation may be done

·· ·~ither by · mecharii.cal or . hand pressure

methods.Polishing of restoration 'should be

dqne aj:, subsequent;<ippointments .

. B .. C()ffi'p~sites, resins,• ~crylic .and other types of

fiHlng:mci.:terials (See respective lit.erature for

propel:- manipulationfi, e,tc. ) . .

d. -Ex'tFaqtion

1. c8ticiu9'6on .. and. infiltration anae.sthesia should

ah?ay.s<be ·used whenever indicated to control pain

duiirig ·extractions; · ': <·-- .·,:-

2; :fi~~~an,~nt tooth,thai:.cannot be successfully saved

.).:>Y:' opEdative or-endodontic tpeatment should be

·extr_acted, Excepti.ons are allowed when the

:Pr:ofessional . judg€Hnent of the attending dentist.

' :indicates another course of action. ··_.' . _: ' .· .

3; :~J:i surgical prdced,ureE; including extraction of

teeth of persons.with·history of rheumatic fever

,shcl:ll ... first be referred to the physician for·

clearance ·using·.,, proper referral slip and

pertinent informatf0p.

4. · Aft.er extraction,·. the person ·should be given

wri ttem instruction..concerning post~operative

atten.tion; ·· 'in_ additi'on .to the oral instructions

. ;.-_;· ..

given.

'· ..

e.

( ...

Other Procedures

Promotion and

... - ·· or:ai: health instruction provided concurrently

: .... d1.1ril1g t-reatment is the best opportunity to give

in13tiuction and advi.ce on the employees's oral health..·. · ·

Lectures/ demonstration on oral hygiene and

de'~ii~ble ·oral health and nutrition habits and

.Practices given by dentist·. to organized groups of

·female and male ·workers. •

Distrib~tion of poE!ters, leaflets and other

materials on . oral. health for dessimination.

'and'utilization to improve ora.l health practices. '•" > -- -' '

2. Referrals· an~ Follow-up ( Two'-way Referral

System >

. . . Cases that cannot b~ ·attended to directly . by

the dental service sh'a:ll be referred immediately

to other dental clinic's ·for prompt treatment but

should be foUC>wedup by the occupational dentist

to be sure.that theworkep receives the. treatment

that·· he nee.ds. Thi3"p.rivate dentist record the

treatment done dn/.th'e'i·r'e:ferral slip, affixes his

signature and sends .. i.t back to the occupat.ional

dentist conce~ned: .. The duly accomplished referral

slip shaH.becbmei•a l?C3.rt of the workers dental

health recorci.··(($ee'Ap~rlcti~ :t) -- - -..... ' - ,' "' '- -.·

SECTION 9 FAcrLrTiks .. ~D DENTAL EQUIPMENT

1.

·>

For effective arid efficient operations of the

dental servlce;•:it shal.l be the responsibility . of

the management ,of cccui>'a.h()nal establishment to provide

Personnel facilities > ./equipment and supplies for

dental · clini6s :in a:ccor.dari'Ce with the following

standard requirel1leiitB': · ·

Physical Fa:J'ili tie~ The derita.l' c'llni~; should have sufficient space

to allow. (;olllfort' and' e''a:se both to the operator. and

to the patient; It should have good . .ventilation with

sufficient lfg})tancl:ade<;tuatewater supply. Whether

the dental .clipic: · .. is irjside or outside the

workplace, it:) · should.: .· b.e within reasonable

accesibiliJ;,y ,to the wqrkers to minimize waste of

productive· hours;

I

2 . Physiqal Arrang~ment •..

, . T:he , physical arrangement of dental clinic shopld 'af3 ~uch as possible be in accordance with the

,standax;'dsarrangement plan as illustrated in Appendix: ? .; ·

. ,, - ·-"

.3' · De~t~l Equipment

. At the initial set-up of .the dental service, it shall 'l:>e • the responsib:Uity .. of ·the ·occupational est~blJshmemt to provide the minimum standard dental equipment and instruments prescribed inAppendix 3.

4 . Care of Dental Equipment

.·Gar~ of de.ntal equipment' is the responsibility of .. the'fP.ental' aide while supervision rests on the occupa.tional • dentist. 'A suggested schedule for maintenance of equipment .... is recommended to be observed regularly. (Se'e Appendix 4)

5 Dental GaM.nets · •'' _-. . -·

. .·: Wh~r~ cabinets are available, an instrument . medicine :ar'r<'lngement plan is recommended. · (See AJ?:Pen<hx s > · · ·

SECTION 10\ / .

and

·."

. ;,lhoc:dupational establishments,· complete and up-to-date records. are vf3ry important not only to the workers but also to the company. In cases cif. compensation ·claims.due to dental and oral . coridit£on~ ·which may be at.tributed to<occupational hazards present. in.,tn:e•wor~place, it is well that dental records are kept and maintained.accurately. · · ·

.. •. -,'·-·--o.:., ... , .. _,

The:fg1lowing standard procedures on recording and reporting <of dental · · dise'ases and dental health services are prescribed .b§ .the<;Derital He.alth Service.

-,_.. : , __ ·.-:•.--···

10 · ~ •. :rf8.gg.~t~1fintal ~~~lt~e~1~~~dF~~~ · F~~~~di vidual Dental

· Health Records :see.attached DHS revised Form 1 with instructions·.! (~ppendix'.'6)

. I

16.

j i ' 1 J '

10.1.2.

./

10.:L3

10. 2. RECORIHN<J

.. :JA ••

· · • -DHS • ·Form · · 2 • Occupational Dental

·· Diseafies.and Service. Report

··. s~e attacl;1ed DHS. Form 2 with instruc­

tions i /(Appendi:s: 7)

DHS F~im 3 ~Registration Form for

Ocqupational Establishments.

see attached DHS Form 3 (Appendix·8)

····.~

· ..•.. :'Tpe ocpupational dentist shall record findings. of

oral examination andderitalservices rendered to the patient

in DHS revised Form l. Gi'iteria and method of recording in

the said· form shail be in accordance . with administrative

order 44 s .. 1~96.J?~€Jscrl.bed by the Dental Health Service.

10.3 REPORTIN~ OF CONSOLI~ATED REPORTS ..

. 10.3:1

10.3.2

10.3.3'

The . occupational dentist shall

accomplish the DHS Form 2 monthly and

· subm:i.t the · · consolidated . report

quarterly i.n three (3) copies - one

·copy for. file, one copy to be

·· · si:J.bmitted. to . the manager or head of

'of'fice ..... and one copy to be submitted

to the provincial health officer or

the city · health officer of the

pr9vince or . city where the

. ocbupational establishment is located

not' .later than 5th day . of the

suceeqJrig 'month of the said. quarter.

• All ··dental . report of occupational·

.establishments received by the

· · provincial health office· or city

l{eal th off,ice during the quarter are

consolidated· by the senior dentist in

three . (3) copies using the same DHS

Form 2. One copy of it is to be

svbmittecl to. the Hegional Health

· (J:f:ffce not lat.er than the 10th day of

th.e s\lceeding month.

. R;~~onal Consolidated Reports of

·. Occupational Dental Services shall be

a·ccomplished in three ( 3) copies; one

<;:opy for file and two copies to .be

submitted .. to the Regional Health

Director not later that the 20th day

. oi t.he month of the said quarter. The

17

;- ,-:,

· · ••original copy of the consolidated

.. ;. reports of the. occupational dental

• . serviCes together with the

. consolidated reports of otber

categories of dental services are

submitted. to the director> Dental

Health Service, Central Office not

lat~r ·than the 25th day of the

· suceeding month of the said quarter ..

SECTION 11 . MEDIGINE J\ND DENTAL SUPPLY

1.

3

. ·.Requisit-ion Pl:''ocedu~·es .

1. -Atthe ini.t'ial ·set-up of the· dental service,

the · medfcj-'ries and dental supplies . to be

t'equisitioned by the occupational dentist

should .· coti:f9rm with tbe m~m.mum standard

requiremerits as listec! .i.n Appendix .9; .. -, '- >--- ,:: . .· .

2. For Sl.tbseq_,;ent operations and maintenance of

dental servic:e, 'the. occupational dentist

shall ... subini t to the Supply· Officer of the

est,abl i.shment · . one month. in advance a

reqtiisitfon ·.of> needed.· medicines, dental

niat:ei'ials •and supplies to last for at least

t-hree· .. Cs) niont:lls. ·

The. •:·Supply. '''Officer ··• of.· the occupational

establishment in ~odrdination with the occupational

dentist stlall estabJ.isJ:va regular schedule for the

procurcme'qt -:of ·rned:i.ci-nes•;< dental materials and

supr:·lies<·:·as .. reqthsitioned ·.by. the occupational

dentl,;t · n16rder that these are always available to

t.he dentt:;'(t·: .in the efficient ·performance of his

duties.

Report of'tl~di'2\Ae's, Den.tai Materials and Supplies __ ,<

.•.,--_._. .. --

A: :~.~r'drt • of medic'ines; dental materials and

suppli~s·.fE'lceiyed and consumed for three (3) months

shall pe< submitted to the. Supply Officer of the

. occupationg;,l:. estaplishmen.t for his. information and

guldanc~, .nP~t;', le~ter tl:Jan: the 25th day of the

succeeding)fsmrth ·month.

18

SECTION 12 • ;,, ' ' .••••... ·FINANCIAL. REQUIREMENTS

L Iri:i..ttal Set-up of. the Dental Clinic

.. !'Af!tl:te init,ial set up of the dental clinic, it

shall ;be the responsibility of the occupational

establ1.ahJxient to set ias:ide adequate funds for the

purcnase.,'of pr,escribed'standard facilities and dental

~qUiPi'!~Ilt;;

•,'' ·' '·-. :-: '· ,;<:;',

: ... -~ .- ·. ' _-.·_· ; ~- :·· '•, ..

2. · ·.Maintenance and Operations

.. , The . o~cvp~tional ·establishment . shall . set

asic1e, C>n a. yearly. basis and/or consistent with the

· budgetary · . procequres ' of the occvpational

est.abi:l,shments. ·.separate f)lnds .•.. for . salaries and

inq:\,dental. e>~penses pf dental. personne 1, and for

maintenance and. operations .ofthe dental services .

SECTION 13 . REGISTMTIONANDACCREDITATION .. . .

Every oocl~pat,:l,orial establishment shall register with

the·•• Department pf.Health through its .. authorized

agency., the D€mt'al ·Health' Service in accordance with

the reqlii.rements'.6f tlri~ Section. _.,_ .-

1. ·· Registration ·

. DHS Form 3,..1 {Registration Form) prescribed by

the Dental Hea~th Service and available at the Regional

Health Offices shall be, accomplished in three (3)

copies, receipt'6fnot:i.ce and/or witnin 30 days before

the ini tia.'l' sef;#,up of the dental service and S'llbmi tted

to .. the. Regional::' loiecilth Office wl!ere · the occvpational

establishment is located .. A registration fee of TI~O

HUNDRED PESOS (P200. 00) shall be charged to. the

occupational ~stablishment payable to the Department of

Health, Central Office· for · occvpational establishment

located within ·Me,,tro . Manila and/or to the Regional

Health Office. where the occupational establishment is

located. The amount·herein collected shall be officially

receipted: Reg:i.stl:'aU.ori shall be valid for the lifetime

of the dental: service except when any of the following

. coridi tlons exis"t;s/. ,in .. which case, a new registration

. shall be . accompristed>.' : ..

L When ari.ew'd.en1::istis employed;

' ; -:

19

. . . .

,z_, When the nat,ure ~f workplace is changed form

.· '· ' ' non-'-hazard()US t() haz'ardous;

'--' • 3:, w}~~h £):\~ address is changed; and

. , , .. 4. · Ch~ltge of o;.nershi.p · · or ·:Previoi.ls closing,· ·

~· ·- -" -'' -- _, -~ ·-'---·- . .

re-opening after

.. _ .. _-_ intfl1;1~;~ in the registration form is a.

checklist< to · indicate.ihat the occupational

estabhsh:meint has complfed with_the minimum or. above

standa'fd- _·requirements prescribed by the Dental

· Health' :servi~ei .. The Regional Dental Staff shall

inspeqt i ,within 60 . daYs upon receipt of · the

registra:t,;l.on form . to verffy if .• the .. occupational

establishment. concernE)d has . complied _ with .· the

presc:ribed i:-e<auirem.eints.,•· Tne.-_-_registration form, duly

veriLi~g -, e;}lallbe· submitted 'py the Regional __ Dental

. Staff' within fifteen ><15) 'days after inspection to

the Regional Health J)irector, to_ be· submitted within

fifteen ( 15) days to the DentaL Health Service with

his recommendation fo~· accreditation .

. 2 . Accredi.t~~£on A Cer~~1:1~<it€l;'6£<A.dcr~dltatio;l shall be· issued

by the J)epartment/ of -·'Health to the occupational

establishmEn'lt comJ?l.ying ·. with standard requirements

upon the rebomrrH3hdation of· the Director, Dental

Health Servfce within. thirty .· ( 30) days upon receipt

of the. registr~t{on form •· from the Regional Health

Office. · ·· ·· ·•·

3. Registry of Accredited Occupational Establishments

The D~n.tal Health .Service shall keep a complete

and updated '.rEoi~istry ;pf ·.··· accr_edited· occupational

establishments by re'g:ional· distribution. .

4. . Inspection of __ Accredited Occup<').tional Establishments

.. -. .-::,:_,_: __ ;.;:;.'-'. :-::.:/;:-:0~::~-)>-: ·::· .. /~ .. . · _,._ . _.; - . All duly ··accredited' occupational establishments

.. ,shall be subjElct to regUlar inspection by authorized

J?ersonnel of the Department of Health to determine

compliance ·. · with · _ •- the · prescribed standard

requirements. ,Thi;! Secpetary of Health or his duly

authorized repre~e"ht;'il.ti"e from the · Dental . Health

20

.,.'<,

' '

5.

Service, ' J includ'ing but not ·restricted to the

a,uthorized .per~onnel of: the Regional Hea,lth Offices

shall: ·hav~ , access to .the employer-s records and

premises• at'' any tim~ of .the inspection and the right

·to copy therefrom,:. to question .. any employee and to

invei:;tigate any· fact, condition. or matter which may

. be necessary t<) determ.}rie compliance with or to aid

in the enforqemeht o:(Standarcl for Dental Services

set .forth by the.DentaL Health Service of the.

Department'of Health. _see ·znspectiC?Jl Report Form , .

·\•)·' --~'··' ,_,. · ' · · . · · · ... · .. (App. endix 10)

, ...... ,.,, .... -·· "· .

· , " Revocation ·of Certificate . . '

·· The CertifiCate·. of Accreditation may be revoked

'by the Secietary of Health upon the recommendation of

the Regicina1 · Health:. O:ff:i.ce and the Dental Health

Servi.qe . only : when the .occupational establishment

willfully refuses to . Comply with the Standard

Requirements pr'escribed ·bY the· Dental Health Service

after three , (3) 0arl1ings i,ssued by the Regional

Health Directe>r 'arid a report shall be submitted to

the Department of Labor and Employment.

SECTION lA MONITORING• AND SUPERVISION OF DENTAL SERVICES

For eff~•2nve en.for~~ment of minimum standard

requirements ·on · •.dental services in occupational

es.tablishments . .· an<:l for proper implementation of

occupational· dental hl;!al th program, the· following

are duties'o:f.theRegional Dental Sta:ffc

1. The 'Regioria1 Dental: h~ff is a/are member/s of

techriic?-l~tat':(of ,the Regional Health Office

serves.• as adviser,···.-in all matters pertaining

occupa,ti()nal :cieritai services in his area·

jui;isd'iction;

the and· to of

Interprets. poiL::ies,guidelines. and

occupational· dental health services standards on tn the region;

3. Provide~t~cl:i'l'lica1Fassist0nce

evalu«tion 'o:f th~.,occupational in planning and

dental.health program;

-1. Upon receipt o:f Application for Registration from

occupat£.onal 'r:establishment, . he conducts

insJ;iecti6n c< df'c dental · services to ·. verify

compl].ance' with. E;taridard re,c,tuirements as stated

th<;>t;¢Jn , <.\p~c.subn\its recommendations . thereof to

the· •Regional Health Director, furnishing a copy

·to 'the Mani:\gei? of t.he occupational establishment

or'Hea<;l of.Offic . .;;; ..

21

5. Conducts· regular ·inspection of . duly accredited ·.· occupa'ti<:)rial ·. establishment to insure compliance

to 'the prescribed minimum standard requirements .. · .. pfithe.Dental Health Ser.vi~e,

·:·e. ~~~ori:ends ·appropriate action to the Regional Heal'th Director . on erring occupational

· .. esfal)lishments who willfully refuses to comply with mj.nimum .standard requirements prescribed by

· the Dental Health Se,rvice;

7 .• Ini(ri~~.s,• plans, organizes and submits reports of. 'training courses conducted for occupational dent,i.~.ts In close coordination with the Regional Heal.th Training Center and the Labor Regional Office;' and

8. Submits. requtre<:l r.e~or.ts of O.ccupationa.l <:!ental servi.ces · tq the Regional Health ·Director to include .. · .. tabulation; analysis and recommendation

·and .(Jther, r.eports as·may be. required ·by the . Regipnal Hea1 th Office ..

SECTION 15 B:ENAL PROVISIONS

Al.l' vio'la:tions of ·the provisions of this Standards · shall .. b~ subject to the applicable penalties. proyl.d.ed Jbr' ,in the .Labor Code of the PhUippi~1es (P.D. A42)'as amended.

PENAL PROVISIONS AND LIAE1ILITiE~ ART. · 278. "rENALT,IE$ ·. Except . as otherwise provided in

thi.s <:;ode, anyviolationO(the.provisions of.this code declared. to be unlawful· or. ·penal in. nature or. of the rules and regulations issued ther·eunder shall. be puilished.'wi th'' a Hne of not less than. on0 thousr.nd pesos nor.lilore<than, teri' thousand and/or imprisonment for the duration of the viP.lati·ori or non-compliance or until such time th!).t recti.fic,ati6n of the vio:J.ation has been made, at the cl irecti6l) ·· of appropriate authority. (as amended by Presidential Decree No. 570-A Section 62) · ·

ART. 279. Who ·ar~' 'if£]'):l:e 'when commit ted by · other than·

.If the offense is·66mmitted by a corporation, trust, fl rm, partnersj1ip, associ at :iOn or any other entity, the penalty. shall be i.inposecl upori the guilty officer or . officers of such corporation, trust, firm; ,J?ar:tnership, -association or entity. (As. amended b;' Presidential D~cree No: 570-A Section 63)

22

SECTION 16. REPEALING CLAIJSE

All o.the.r previous orders inconsistent this ordel\ ,c a:r~~' hen::eb~ resbiJ1,ded,' or aocordingiy:~f}i

with the provision of otherwise amended

·' :---· ·--<(,-::::~:::.x:- : _· ·:·: ·, Thi.,; A(ilninistrative Orde;. shall take effect immediately.

23