HIV: infection control issues for oral healthcare personnel

AIM: To present the essential elements of an infection control/exposure control plan in the oral healthcare setting with emphasis on HIV infection. METHODS AND MATERIALS: A comprehensive review of the literature was conducted with special emphasis on HIV-related infection control issues in the oral healthcare setting. RESULTS: Currently available knowledge related to HIV-related infection control issues is supported by data derived from well-conducted trials or extensive, controlled observations, or, in the absence of such data, by best-informed, most authoritative opinion available. CONCLUSION: Essential elements of an effective HIV-related infection control plan include: (1) education and training related to the etiology and epidemiology of HIV infection and exposure prevention; (2) plans for the management of oral healthcare personnel potentially exposed to HIV and for the follow-up of oral healthcare personnel exposed to HIV; and (3) a policy for work restriction of HIV-positive oral healthcare personnel. CLINICAL SIGNIFICANCE: While exposure prevention remains the primary strategy for reducing occupational exposure to HIV, knowledge about potential risks and concise written procedures that promote a seamless response following occupational exposure can greatly reduce the emotional impact of an accidental needlestick injury.     

Partnering globally and acting locally for infection control in Nepal

AIMS: To describe the process and outputs of an international collaborative oral health promotion project to develop a national infection control policy and training programme for oral health care workers in the low income country of Nepal between April, 2003 and May, 2004. METHOD: The project process was implemented in phases: 1) extensive review of national and international infection control documents; 2) development of draft infection control policies and protocols; 3) development of instruments to assess knowledge, attitude and behaviour and infection control practices; 4) baseline survey to assess these factors; 5) development of training programmes and training of oral health care providers; 6) revision of infection control policies and protocols, survey questions, assessment instruments, and training programme. OUTPUTS: Project outputs include a national infection control policy and protocols, infection control assessment instruments, infection control training materials and programmes, and oral health care providers trained in infection control. SUMMARY: The results of the project to develop a national infection control policy and training programme for oral health care workers in dental clinics, dental education institutions and the Nepal Primary Health Care System, required the collaboration of policy makers, health professionals, health managers, oral health care providers and educators from the government sector, private sector, Non-Government Organisations (NGOs) and International Non-Government Organisations (INGOs).     

Microbiological hazard analysis in dental technology laboratories

Dental technicians are trained in a range of skills involved in the fabrication of prostheses used in the mouth and facial region. Items entering the dental laboratory are essentially inert materials which have been in contact with the patient's mouth, saliva, and possibly blood. Appliances leaving the laboratory are then returned to the clinician to be tried/inserted in the patient's mouth. Relatively little attention has been paid to infection control policy within dental laboratories, perhaps due to perceived and/or actual remoteness from patients, lack of appropriate training, and lack of relevant research. More controlled studies are desirable, in order to identify any potentially hazardous procedures, and to make an assessment of risk for these procedures.     

Management of needlestick injuries in general dental practice.

The objective of this paper is to advise on the development of practical policies for needlestick injuries in general dental practice. Policies for dealing with occupational exposure to chronic blood borne viruses, namely, hepatitis B, C and HIV are evolving. This article was particularly prompted by recent changes in post exposure prophylaxis for HIV infection. A flow chart is also included which should be of possible use in general dental practice. Needlestick injuries are of increasing concern to healthcare workers. Successful prophylaxis requires careful planning in advance. Whilst all practices should have a policy for sharps injuries, prevention of needlestick injuries remains the best policy.     

Controversies in infection control

Dentistry has made great strides in infection control over the past 10 years. An effective asepsis program is part of "the standard of care" in dental practice as we approach the twenty-first century. Several areas of dental infection control are undergoing change as new information is obtained, thereby providing points for discussion and some controversy. An effective vaccine to protect against hepatitis B viral infection is available but has met with indifference on the part of many. This readily available protection should be obtained by all health care providers. Surface disinfection is another area of controversy. A variety of chemical agents with differing properties are available for use in dentistry. Many of these are effective as disinfectants but have limited cleansing action, and this must be considered in their application. The practice of prosthodontics also presents numerous opportunities for cross-contamination. The sterilization and disinfection of dental impressions, prostheses, appliances, and a variety of plastic and wooden items provide a challenge for future research as newer products and techniques are developed. Infection control has literally been placed in the hands of health professionals. We, our patients, and families will continue to benefit from our positive efforts in this area.     

Current prosthodontic practice: A dental laboratory survey

A survey was distributed to dental laboratory owners at the 1988 annual meeting of the Minnesota Dental Laboratory Association. Current laboratory practice in infection control, the use of nonprecious alloys, the amount of time devoted to complete removable prosthodontics, and complete denture laboratory techniques were surveyed. Responses indicate a moderate level of awareness and compliance with infection control techniques recommended by the American Dental Association, a declining demand for removable prosthodontic services, a high percentage of use of nonprecious alloys, and a very high rate of porcelain occlusion requested by dental practitioners. Comparisons with other laboratory surveys and the implications of these results for undergraduate education in prosthodontics are discussed.     

Infection control of in-office dental laboratories

The importance of observing a sound infection control program in the dental laboratory is clear. Personnel should not be expected to work in an unsafe environment. Many of the reasons for ignoring proper disinfection control procedures are unfounded. Infection control procedures do not adversely affect either laboratory personnel or dental prostheses when carefully executed.     

Infection control: a survey of UK special care dentists and dental care professionals.

AIM: To determine attitudes to and practice of infection control among practitioners involved in special care dentistry. METHODS: A questionnaire on the issues of decontamination and infection control was sent to all 680 members of the British Society for Disability and Oral Health. RESULTS: The response rate was 63.5%. Almost all respondents (95%) reported having a local infection-control policy; most (97%) had local protocols for the management of inoculation injuries; most (81%) gave new staff training in infection-control procedures and most (74%) provided updates for established staff. Most respondents 'usually' or 'always' provided eye protection for patients (95%) and themselves (93%). Virtually all routinely wore gloves, and nearly all (94%) 'always' changed gloves between patients. The majority 'usually' or 'always' disinfected or disposed of surface coverings between patients (98%), sterilised all non-disposable instruments that had been set out for the patient (99%), and disinfected laboratory work (96%). CONCLUSIONS: There was high awareness of infection-control issues, and good reported compliance among these dental workers.     

Occlusal refinement of mounted casts before crown fabrication to decrease clinical time required to adjust occlusion

STATEMENT OF PROBLEM: An inordinate amount of time is often required to adjust the occlusion of a newly fabricated crown. PURPOSE: This study determined whether the procedure of "cast adjustment" significantly decreases the time necessary to clinically adjust the occlusion of a newly fabricated crown. MATERIAL AND METHODS: Thirty-eight crowns were fabricated by a commercial dental laboratory for patients of senior dental students at the University of the Pacific School of Dentistry. After master casts were returned from the laboratory and then mounted on semiadjustable articulators by the students, the cases were divided randomly into 2 groups: (1) the control group, for which no further work was performed before fabrication of the restoration; and (2) the experimental group, in which casts were occlusally adjusted by a certified laboratory technician until there was at least 1 cusp tip to flat surface centric contact on each posterior tooth in maximum intercuspation position. After the crowns were delivered, the students filled out a survey. One question on the survey asked the student for the time required to adjust the occlusion on the crown. RESULTS: Of the 19 crowns in the control group, 6 crowns required more than 1 hour for occlusal adjustment. Of the 19 crowns in the experimental group, 1 crown required more than 1 hour for occlusal adjustment. CONCLUSION: Performing a "cast adjustment" before fabricating a single unit casting can significantly decrease the chance of a lengthy clinical occlusal adjustment.     

Infection control update: beware of the ragwheel

Previously, concern about infection control in dentistry emphasized the handpiece, operator safety, barrier technique, and patient protection in the dental operatory. As current knowledge of infection control increases an expanded understanding of other sources of disease transmission is indicated. Often overlooked is the dental laboratory of which particular interest focuses on the lathes used in preparing prosthetic appliances, castings, orthodontic appliances, and surgical stents. Specifically, the potential threat of the ragwheel to the patient and operator is significant. Ragwheels and pumice samples were collected and cultured, the results of which mandate the need for infection control guidelines for the dental laboratory.     

Routine HIV testing in dental practice: can we cross the Rubicon?

The latest Centers for Disease Control and Prevention (CDC) guidelines recommend routine HIV screening for a large segment of the population, given that the individual understands that an HIV test will be performed unless he or she declines testing (opt-out testing). The CDC recommendation calls for the elimination of formalized requirements for written consent and pretest counseling to encourage more Americans to voluntarily accept testing. Knowledge of HIV infection can increase early access to care and treatment and reduce further transmission. A rapid non-invasive test for HIV infection (OraQuick Advance) from oral fluid has recently become available. It offers two distinct advantages: 1) results are available within twenty minutes, thereby eliminating a long waiting period; and 2) it has high sensitivity and specificity comparable to blood testing. A preliminary positive test result must be confirmed with a Western Blot by an outside laboratory or physician. Important ethical and legal issues must be resolved before the successful implementation of HIV testing in the dental setting. An educational emphasis on broader coverage of HIV testing is also needed within the dental school curriculum. The integration of HIV testing into dental practice is discussed as well. A policy of screening patients in dental offices will contribute to a major advance in public health.     

Determinants of Iranian dentists’ behaviour regarding infection control

Aim: To evaluate the determinants of Iranian dentists’ behaviour regarding infection control (IC). Design: A cross-sectional questionnaire survey. Setting: Iranian general dental practitioners (GDP) participating in a national dental congress. Methods: The GDPs filled in a self-administered questionnaire containing questions regarding their attitudes towards and their behaviour on several aspects of IC. Background factors included GDP’s year of birth, gender, and work-related factors. Statistical evaluation employed the Chi-square test, Cronbach alpha, and regression analysis. Results: In total, 479 GDPs returned the questionnaire. Their mean age was 38.6 years (SD = 9.4) and 53% were men. The vast majority of the GDPs had positive attitudes towards the inquired after IC criteria with no statistical difference based on the GDP’s background characteristics. Of all respondents, >70% reported that they inform the laboratory about the infection status of the sent items, disinfect impressions before sending to the laboratory, and wash patients’ mouths before working with high-speed or ultrasonic devices. Adherence to all the studied IC criteria was reported by 10% of the respondents; more frequently by younger GDPs and those with fewer experience years (P < 0.05). Conclusion: Greater emphasis on infection control programmes in dentists’ education is called for especially in continuing education.Key words: Infection control, general dental practice, Iran     

Clinical results with exposed polyglactin 910 resorbable membranes for guided tissue regeneration.

Three cases are presented where early exposure of a resorbable membrane occurred during guided tissue regeneration therapy. An antimicrobial regimen was selected to determine whether infection of exposed membranes could be controlled to the point of achieving acceptable clinical results without membrane removal. The results suggest that with the use of the antimicrobial regimen: (1) exposure is compatible with successful clinical results, and (2) removal is not necessary.     

Felty's syndrome.

An unusual case is presented in which a patient complained of oral ulceration and soreness of the mouth and throat. The results of clinical and laboratory investigations are reported and it was concluded that these oral symptoms were associated with Felty's Syndrome. After treatment of oral infection and a dental clearance the patient was virtually symptom-free for five months. The patient had a relapse and was admitted to hospital for treatment of overwhelming infection. Splenectomy was performed without sustained benefit and the patient died six weeks later.     

Diamond microelectrodes for use in biological environments

The response sensitivity, precision and stability of a diamond microelectrode for the measurement of catecholamines is reported on and compared with a carbon fiber microelectrode. The comparison was made (i) before and after exposure of the bare microelectrode to the laboratory atmosphere and to biological tissue, and (ii) during the in vitro measurement of norepinephrine (NE)-release from a test animal’s mesenteric artery. The surface-sensitive redox system, $\mathrm{Fe}(\mathrm{CN}{)}_6^{-3/-4}$, was also used to probe the electrode response. The diamond microelectrode exhibited a low, stable and pH-independent background current over a wide potential range; good sensitivity and response reproducibility for NE; and resistance to deactivation and fouling during exposure to the laboratory atmosphere and biological tissue. In contrast, the carbon fiber microelectrode exhibited a pH-dependent background current response with evidence for electroactive surface carbon–oxygen functional groups, and deactivated irreversibly during laboratory air exposure and contact with tissue. The same diamond electrode properties that are responsible for the deactivation and fouling resistance (e.g., the non-polar, H-terminated surface with no extended π electron system) are also responsible for the more sluggish catecholamine electrode reaction kinetics (e.g., absence of molecular adsorption on the hydrogen-terminated sp³-bonded carbon surface). In addition, the bare diamond microelectrode provided excellent response characteristics during the in vitro measurement of NE-release from the mesenteric artery of a laboratory test animal. The results confirm that this new microelectrode is useful for sensitive, reproducible and stable electroanalytical measurements in complex biological environments.     

Infection Control in a Prosthodontic Residency Program

Awareness of the need to incorporate an effective infection control program within a prosthodontic practice requires the faculty of a prosthodontic residency program to present a clear and workable model that will allow the flexibility necessary to accommodate the changes in infection control procedures and materials. The use of the barrier system to insulate the operatory, resident, faculty, and dental laboratory is discussed. Current disinfection and sterilization methods used to maintain the barriers are recommended.     

Evaluation of the barrier system, an infection control system for the dental laboratory

An experimental system of laboratory infection control was tested, using 76 dentures from 40 volunteer patients. The dentures were cleansed on entering and again on leaving the laboratory. To evaluate the effectiveness of disinfection, the dentures were cultured as they were received from the patient, after the first cleansing, after polishing, and after the second cleansing. The disinfection of the prostheses involved scrubbing them with Hibiclens skin cleanser, rinsing, disinfection in one of three disinfectants (1:16 Sporicidin solution, full-strength Sporicidin solution, and 5.25% sodium hypochlorite [undiluted Clorox]), and finally rinsing. Full-strength Sporicidin solution was significantly more effective than diluted Sporicidin solution, but no statistically significant difference was found between full-strength Sporicidin solution and sodium hypochlorite, or between sodium hypochlorite and 1:16 Sporicidin solution. All three solutions were effective in reducing or eliminating culturable aerobic bacteria.     

Periodontal disease and systemic disease. Clinical information for the practicing dentist

The relationship between periodontal and systemic disease, previously called the "focal infection theory" or "focus of infection," has become an exciting area of clinical and laboratory research. Periodontal disease has been reported to influence diabetes mellitus, cardiovascular disease, osteoporosis, and respiratory disease. It also can influence the course and duration of pregnancy. This article reviews some of these associations and proposed mechanisms by which periodontal disease and systemic conditions influence each other. We also discuss clinical implications for our daily practice in dentistry.     

Infection control in North American dental schools

A questionnaire concerning infection control issues was sent to all North American dental schools in 1987. The results were compared with a similar survey conducted by the same authors in 1982. The purposes of the survey were to identify changes that have occurred in dental school infection control policies in the past six to seven years, and to study strengths and weaknesses of current policies. The results of the survey indicate a much greater emphasis on instrument sterilization and the use of barriers during dental treatment than in 1982. Compliance with the policy is not always satisfactory, however. It also shows some inconsistency and confusion in areas dealing with hepatitis B and HIV carrier patients and dental school personnel. Several respondents included written infection control protocols with the questionnaire. Information gained from the survey and the enclosures were used to develop guidelines to help schools improve and update their infection control policies.     

Occupational hazards to dental staff

Dental professionals are predisposed to a number of occupational hazards. These include exposure to infections (including Human Immunodeficiency Virus and viral hepatitis); percutaneous exposure incidents, dental materials, radiation, and noise; musculoskeletal disorders; psychological problems and dermatitis; respiratory disorders; and eye insults. Percutaneous exposure incidents remain a main concern, as exposure to serious infectious agents is a virtual risk. Minimizing percutaneous exposure incidents and their consequences should continue to be considered, including sound infection control practices, continuing education, and hepatitis B vaccination. Basically, for any infection control strategies, dentists should be aware of individual protective measures and appropriate sterilization or other high-level disinfection utilities. Strained posture at work disturbs the musculoskeletal alignment and leads to stooped spine. The stooped posture also involved certain groups of muscles and joints. This may lead to diseases of the musculoskeletal system. Continuous educating and appropriate intervention studies are needed to reduce the complication of these hazards. So, it is important for dentists to remain constantly up-to-date about measures on how to deal with newer strategies and dental materials, and implicates the need for special medical care for this professional group.