Infection control in dentistry.

The risk of transmission of infection within the dental workplace is low, but recent data have indicated that human immunodeficiency virus transmission between dentist and patient can occur, and that while nosocomial transmission of hepatitis B virus is now less likely, a small but significant number of staff may be at risk of hepatitis C virus and varicella zoster virus infection during dental treatment. Despite these continued risks, shortcomings remain in cross-infection control in the dental workplace. Dental clinicians still fail to take adequate steps to minimize nosocomial infection, inconsistently using appropriate methods of sterilization and not providing ancillary staff with suitable protective clothing. Similarly, although vaccinated against hepatitis B virus, a substantial number of clinicians are reluctant to treat hepatitis B virus- or human immunodeficiency virus-infected patients. Cross-infection control procedures continue to be modified. Of importance, it has been confirmed that protective rubber gloves cannot be reused, as micropunctures develop during rewashing. Sharps injuries are common in dental practice, but there are still no effective measures to prevent postinjury human immunodeficiency virus or hepatitis C virus infection. Instrument sterilization is generally safe and effective, but the contamination of dental unit water supplies remains to be overcome, and while impressions can be placed in disinfectants for up to 1 hour without significant dimensional change, it is not known if infectious agents within the impression material are inactivated by this procedure.     

Hazards of gloves in dentistry

Concerns about AIDS, hepatitis and infection control have increased the use of gloves in medical and dental practice. Though generally assumed to be protective, gloves pose many hazards to the practitioner and patient. This is especially significant in dentistry where a large assortment of materials and manipulative techniques are used as part of treatment. Gloves, with relatively large porosities, are poor barriers to viruses. They can promote bacterial growth, skin lesions, toxic and allergic reactions in patient and staff. Gloves are costly, time consuming to use, reduce sensitivity and dexterity. Gloves do not protect the wearer from penetrating injuries, the leading source of HIV and HBV infections in health care workers. The use of gloves is helpful only in those cases where their advantages outweigh liabilities. Governmental regulations, requiring universal glove-wear compliance, may not be in the best public or professional interest.     

Patient perception of cross-infection prevention in dentistry

A questionnaire survey was conducted among 301 dental hospital and general practice patients in the Glasgow region to assess their perception and awareness of cross-infection preventive methods used in dentistry. Sixty percent of the respondents were aware that dentists have been advised to wear gloves routinely, and a large majority thought that the gloves were for the dentists' own protection. Almost all the respondents did not mind the dentist wearing either gloves or masks during treatment. One third of the total population were ignorant about sterilization methods used in dentistry. One half of the hospital patients and one third of the general practice patients thought that infectious diseases could be contracted via the dentist or his instruments. Although two in three of the respondents surmised that transmission of AIDS in the dental clinic is unlikely, one half of the general practice patients were unwilling to visit the dentist if the latter was known to treat patients with AIDS. This survey indicates that there is a great deal of confusion and fear among the public on cross-infection in the dental clinic, which needs to be rectified by a properly targeted health education campaign.     

Patients' Perception of Cross-infection Prevention in Dentistry in Jordan

Purpose: To explore the public perception of cross-infection prevention methods and their role in disease transmission, among patients attending Jordan University Hospital. Materials and Methods: A systemic random sample of 310 dental patients with a mean (SD) age of 35.1 (14.80) years was selected (42.6% males and 57.4% female). Patients were interviewed prior to dental appointments by a specially trained and calibrated dentist. Responses of the patients were recorded in the structured questionnaire, maintaining their privacy and confidentiality. The data were entered into a Microsoft Excel spreadsheet and analysed using the SPSS statistical package to obtain the prevalence rates of patients' perceptions, which were then cross tabulated with gender, age and other variables. Significant differences were determined using the chi-square test, when appropriate. Results: Of the respondents, 83.5% found it necessary for the dentist to wear gloves, and 65.8% stated the reason was to prevent cross infection from one patient to another. About three-quarters (74.8%) found it necessary for the dentist to wear a mask; when asked about the reason, 52.3% stated prevention of cross infection from dentist to patient. Regarding wearing protective glasses, about three-quarters (73.9%) found it unnecessary for the dentist to do so. The majority (76.8%) stated the method of HIV transmission was by dentists using needles previously used for patients infected with AIDS; 71% knew there is no vaccine against HIV. Only half (49%) reported that hepatitis could be transmitted by blood transfusion. Approximately two-thirds (67.4%) knew there is a vaccine against hepatitis. About 53.5% claimed their knowledge regarding infection transmission was obtained through watching television programmes about cross infection. Conclusion: Dental patients in Jordan need to be equipped with adequate knowledge about cross-infection control, thus education reinforcement is imperative.     

武汉市牙医对爱滋病的态度、知识及在感染控制中的行为调查分析

目的 :研究武汉市牙医对AIDS的态度、知识及在感染控制中的行为。方法 :对武汉市 5 0 0名牙医进行问卷调查和分析。结果 :收到有效问卷 46 7份。其中 6 3.2 %的牙医表示愿意治疗AIDS/HIV 病人。 6 0 .4%牙医认为血液是传播HIV的最危险的体液 ,且大多数牙医错误地认为唾液是传播HIV的媒介。 318名牙医每天戴手套操作治疗病人 ,但其中仅 12 8(40 .3% )名牙医在治疗完病人后更换手套。结论 :本研究表明牙医所掌握HIV传播的知识水平较低。同时牙医也没有提供足够的防护措施来保护自己和病人     

Oral care of HIV infected patients: the knowledge and attitudes of Irish dentists.

As the numbers of people with HIV infection and AIDS increase, so will the contribution required from dental practitioners. A postal questionnaire survey was therefore conducted among dental practitioners in Ireland to determine their knowledge and attitudes towards HIV infection and the issues it raises for them. Although a majority of dentists were aware of the facts related to AIDS and the spread and oral manifestations of HIV infection, there were considerable gaps in their knowledge with regard to dental management. Only 41% were prepared to be engaged in continued care of HIV infected patients while contradicting opinions were expressed on the risk of HIV transmission in dentistry and attitudes towards HIV seropositive patients and staff. Further educational efforts on HIV infection and its implications in dentistry should be directed towards dentists in Ireland.     

Operating gloves. The good and the bad.

The use of gloves in all types of dentistry has been a major benefit to both patients and dentists. However, operating gloves are not without challenges. Tight ambidextrous gloves can produce significant and debilitating hand pain; latex allergies are a problem for many dental personnel and patients; and the disagreeable taste; odor and powder of some brands of gloves has frustrated both professionals and patients. In spite of the challenges that glove use poses, it offers many advantages--foremost among them the protection of patient and dentist alike from infection.     

Evaluation of spatter generation and contamination during instrument cleaning prior to sterilization

Over the past few decades, considerable interest has arisen in improving infection control in dentistry. In particular, concerns over the spread of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) to healthcare workers have energized efforts at improving infection control. This has inspired improved infection control procedures, new federal and state Occupational Safety and Health Organization (OSHA) regulations, and research into infection transmission, all of which have led to attempts to elucidate the basic principles of disease transmission in order to help dental care providers improve infection control in their practices.     

Consumers' awareness of barrier protection in dentistry

Because of the scarcity of printed educational material available to the oral healthcare consumer regarding barrier protection in the dental office, four students at the Fones School of Dental Hygiene conducted a senior project that hypothesized that dental health consumers are poorly informed about barrier protection. Data received from a questionnaire were analyzed to determine the participants' awareness of barrier protection in the dental care setting; specifically, the use of masks, gloves, and protective eyewear. Of the 400 participants, 72% reported that their dentist wore gloves. Of the 321 participants who indicated that their dentist employs a dental hygienist, 76% reported that the dental hygienist wears gloves. And of the 334 participants who indicated that their dentist employs a dental assistant, 65% reported that their dental assistant wears gloves. The percentage of participants who reported the use of protective eyewear and masks is lower. Survey participants who visited offices where dental hygienists and dental assistants are employed were more likely to notice the dentist wearing a mask, gloves, and protective eyewear. Eighty-nine percent of the participants replied that they knew why masks, gloves, and protective eyewear should be worn in the dental setting; 40% replied that they would like more information.     

Factors that affect patient attitudes toward infection control measures.

This study examined how differences in infection control procedures and patients' perceived knowledge of infection control, and how AIDS and hepatitis might affect attitudes toward the use of such measures. Patients receiving treatment at two sites where the methods of infection control and the frequency of their use differed (dental school and private dental practices) were surveyed concerning their approval/acceptance of infection control measures and self-report of knowledge concerning infectious disease and possible transmission of infectious disease during dental treatment. Data were collected from 379 patients, 272 from the dental school and 107 from five private practices. A high percentage (95 percent) of both dental school and private patients felt they were adequately protected, while fewer than 2 percent expressed anxiety about infection control procedures being used in either setting. Factors such as gender, age, and years of formal education did not significantly affect attitudes toward infection control measures, but age and education were correlated with perceived knowledge of infectious diseases. Patients' reported knowledge of infectious disease had a significant effect on their decision to leave a practice if the dentist was HIV positive. A significantly higher percentage of dental school patients felt that barrier infection control techniques should be used routinely. Patients treated where such techniques were not routinely used nevertheless expressed satisfaction with that level of protection, implying that patients tend to accept the level of infection control being practiced where they receive treatment.     

Oral research and dental treatment in HIV infection.

In June 1991, practicing, research, and academic dentists attended a symposium on oral research and dental treatment in HIV infection at Guy's Hospital in London, England. Oral lesions in HIV infection were classified as strongly associated, probably associated, and possibly associated with HIV infection. A speaker stressed that those strongly associated with HIV infection should be of the most interest to general dental practitioners. Another speaker said that chronic erythematous candidiasis has emerged as an oral infection strongly associated with HIV infection in addition to pseudomembranous candidiasis. A dentist mentioned hairy leukoplakia as a new condition strongly associated with HIV infection. Other HIV associated periodontal disease included gingivitis, necrotizing gingivitis, and periodontitis. A speaker noted that AZT increases longevity of AIDS patients and the drugs dideoxyinosine and dideooxycytidine are being tested. Another dentist spoke about the issue of HIV infected dentists citing the example of the dentist in Florida who infected 5 patients. Other speakers addressed the cases and needs of asymptomatic HIV infected people. A survey of dentists showed that only 33% of dentists would provide dental care to HIV infected people and only 20% would if the patients had AIDS. A dentist addressed the problem of a lack of data on prevention and treatment of oral lesions since their etiology and pathogenesis were unknown. Other presentations focused on research on antibodies and DNA probes in reference to saliva and subgingival flora. The symposium revealed the ran ge and depth of research going on in British schools on oral manifestations of HIV infection.     

Patient attitudes to the wearing of gloves by dentists.

Cross-infection control in dentistry is of continuing concern, and this survey provides some timely information on the attitudes of patients to the wearing of gloves by their dentists. A high proportion of the patients questioned felt glove wearing was important, although only half would not attend a dentist who did not wear gloves.     

Infection control practices and beliefs of Minnesota dental hygienists and dental assistants

To obtain comprehensive information about the knowledge, attitudes, and practices of Minnesota dental hygienists and registered dental assistants, a questionnaire was mailed to random samples of both groups in the fall of 1988. Most assistants and hygienists claimed to always wear gloves, but substantially fewer indicated always wearing a mask. Use of eye protection showed even lower compliance, with less than half of either group routinely using protective eyewear or a face shield. Assistants and hygienists reported incurring numerous needlesticks and instrument injuries. A contributing factor may be that many staff were still recapping needles with an unprotected hand. Most people who had not been vaccinated against hepatitis B said that they would be immunized if their employer or health insurance paid for it. Less than one-half of either group felt knowledgeable about infection control. Only one-third of assistants and less than one-half of hygienists claimed to be familiar with the Centers for Disease Control's "Recommended Infection Control Practices for Dentistry." This is consistent with assistants' and hygienists' reported infection control related behaviors. Other than gloving, many recommended infection control measures--masking, wearing protective eyewear and uniforms, hepatitis B immunization, and proper handling of sharps--were not employed by a substantial number of respondents. Many respondents indicated insufficient knowledge to safely and effectively care for patients with hepatitis B, hepatitis B carriers, or individuals infected with the human immunodeficiency virus (HIV). This is reflected in the relatively small percentages of respondents who indicated willingness to treat these patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

An update on the human immunodeficiency virus and infection control

This report is not an attempt to provide a comprehensive review of HIV infection, AIDS, and infection control. Rather it has highlighted some of the medical, ethical and legal aspects associated with the AIDS dilemma which are of significance to the dental profession. There would appear to be few if any valid professional reasons which a dentist may use to avoid treating an HIV infected or AIDS patient. In fact, dentists adopting such an attitude may be subject to litigation. From a research perspective, it is feasible that continuing monitoring of the oral manifestations of AIDS and its associated diseases will contribute much information regarding the responses of the oral tissues to immunosuppression. This, in turn, may result in a better appreciation of common dental diseases especially periodontitis. The information on infection control has emphasized how a knowledge of the basic microbiologic concepts regarding disease transmission should be used as the foundation for effective prevention of disease transmission.     

Occupational hazards in dentistry

Professional risk factors in dentistry may harm the dentist and the dental team. It is essential for the dentist to recognize these risk factors and protect against them. Among the various organs that are vulnerable in the dental situation are (in a nut-shell): The eyes, the ears, the respiratory system, the palm of the hand, and the back and the vertebrae. In addition, the dentist and the dental team must recognizes the potential for Hepatitis (A, B, C, D, E), and for the acquired immune deficiency syndrome due to the HIV virus. The primary means for protecting against these potential hazardous factors is meticulously keeping proper working conditions such as good ventilation of the operating room, using face masks which are capable of blocking even small particles, using eye protection and gloves, and proper seating at the chair. It is reasonable to adopt a routine of taking a vaccine against Influenza and Hepatitis B, and to routinely check the level of antibodies for Hepatitis B. Personal accidents- and severe-diseases-insurances, as well as insurance against losing the ability to work are advised for every dentist.     

Hepatitis, HIV infection and AIDS: some issues for the practitioner

Hepatitis B virus and hepatitis delta virus among the viral causes of hepatitis are of principal concern to the dentist. A dentist previously infected with HBV is at risk from HDV for there are reservoirs of this infection in the population. Dentists will be most at risk from HBV because of per cutaneous inoculation but in the general population there is emphasis on the non-percutaneous transmission of the virus perinatally. Numerous carriers of HBV are being added to the population annually but their identification is often difficult. Immunization with a hepatitis B vaccine is a protection which all dentists should seek. A booster dose at 5 years is recommended. There is no evidence that hepatitis B vaccine transmits HIV. Transmission of this virus intraoperatively is much less likely than the transmission of HBV but a slight risk is there. To avoid the risk of HBV and HIV infections, full infection control precautions should be observed at all times.     

The first step in infection control is hand hygiene

A dental health care worker (DHCW) has an obligation to prevent the spread of health care associated infections. Adhering to proper hand hygiene procedures, selecting appropriate hand hygiene products and the use of gloves are all important elements of infection control. The CDC Guidelines for Hand Hygiene state that improved hand hygiene practices can reduce transmission of pathogenic microorganisms to patients and personnel in health care settings. DHCWs must also protect themselves by recognizing pitfalls such as irritants or allergies that may pose obstacles to proper hand hygiene. Occupational irritants and allergies can be caused by frequent hand washing, exposure to hand hygiene products, exposure to chemicals and shear forces associated with wearing or removing gloves. Since the primary defense against infection and transmission of pathogens is healthy, unbroken skin, DHCWs must take steps to ensure that their skin remains healthy and intact. These steps include evaluating different types of hand hygiene products, lotions and gloves for the best compatibility. If the DHCW sees a breakdown of his or her skin barrier, steps should be taken to determine the cause and remedy. Remedies can include the use of alcohol-based hand sanitizers containing emollients and moisturizers and regular use of a medical grade hand lotion. The bottom line: healthy skin protects you at work and at home. Selection and use of appropriate hand hygiene products, including moisturizers, are an essential part ofa dental office infection control program. My coworker lost the use of her thumb for several months due to complications of a staph infection. She was unable to work and found even simple tasks such as closing a button hard to do. Think of how difficult your work would be if something happened to your hands. Injury, irritation or allergies could alter your ability to work or even perform routine tasks. Our hands provide us with the ability to work in clinical dentistry. It makes good sense to protect your hands, your most valuable tools.     

Indications for and anticipated difficulty of third molar surgery: a comparison between a dental hospital and a specialist high street practice

OBJECTIVE: To investigate the indications for and anticipated difficulty of third molar surgery between two different referral settings. DESIGN: A prospective study involving completion of a proforma pre- and post-operatively. SETTING: A dental teaching hospital and a specialist surgical dentistry practice in 2003. SUBJECTS AND METHODS: Patients referred for the assessment of their third molars were recruited. Details of the clinical and radiographical assessment for each patient were recorded pre-operatively and the extent of surgery required post-operatively. RESULTS: The main indication for referral for third molar extraction was pericoronitis in both centres. A larger number of patients were assessed and treated in a shorter period of time at the surgical dentist compared with the dental hospital. The surgical dentist was accurate in his assessment of the difficulty of surgery 96% of the time compared with 66% for the dental hospital staff. CONCLUSIONS: This study highlights the benefits for patients in being treated by a surgical dentist. As dental students require exposure to surgical dentistry in order to attain a level of competence, a reduction in the number of patients being referred to dental hospitals may impact upon students' ability to both assess and perform surgical procedures. This may mean that undergraduates will be less able to fulfil the recommendations of the General Dental Council. An outreach programme for final year dental students to surgical dentistry practices would benefit all concerned.     

The management of occupational exposures to blood and saliva in dental practice

Accidental injuries when handling sharp or rotating instruments can allow inoculation of a dental team member by the patient's blood or saliva. The risk of transmission of HIV from occupational exposure among dental workers is low and to date no occupational exposure has resulted in HIV transmission. However, hepatitis B and C have a high morbidity and mortality and are more infectious than HIV. This paper demonstrates how occupational exposures to blood and saliva could be managed in general dental practice and outlines the legal responsibilities of a dentist in the management of these exposures.     

What the dentist should know about a patient with HIV/AIDS

Chances are good that oral health care providers will treat someone with diagnosed or undiagnosed HIV during their careers. The Centers for Disease Control and Prevention estimate that 650,000 to 900,000 U.S. residents are living with HIV infection, more than 200,000 of whom are unaware of their infection. As with any medical condition, it is possible for a dentist to do great harm by ignoring systemic manifestations of HIV. On the other hand, dentists who are ignorant of modern HIV disease management often request unnecessary medical consultations resulting in dental treatment delays. Since 1996, the growing use of highly active anti-retroviral therapy and ultrasensitive viral load testing has changed the picture of the dental patient with HIV. The goal of this article is to update and summarize information the oral health care provider needs to safely treat a person with HIV/AIDS. It is not intended to replace previous comprehensive publications on HIV and dentistry, as they are still excellent resources for information. Here, simple instructions for physical evaluation of a patient with HIV/AIDS will be presented and steps for determining safe procedures explained.