Whole stimulated salivary flow in patients with chronic hepatitis C virus infection

BACKGROUND: Salivary gland disorders have been included among the extra-hepatic manifestations related to HCV infection. METHODS: The whole stimulated salivary flow rate (spitting technique) was studied in 74 HCV infected patients to evaluate salivary gland dysfunction. RESULTS: The salivary flow of the patients with chronic HCV infection was similar to that of the healthy controls. The association between subjective xerostomia salivary flow was seen to be very weak. No significant associations were found between salivary flow and age, sex, risk factor of acquired infection, ALT, AST, GGT, ALP values, time lapsed since the diagnosis or HCV-RNA detection in saliva. CONCLUSIONS: Although the functional repercussion of hepatitis C related lymphocytic sialoadenitis remains unclear, we did not find a significant reduction in the whole stimulated salivary flow in HCV infected patients.     

The increasing problem of hepatitis C virus infection

The widespread incidence of hepatitis C (HCV) infection throughout the community is of concern. Although many of those infected will not suffer significantly from their infection, up to one-third will have liver disease, fatigue and oral health problems. General dental practitioners need to be aware of the precautions necessary in treating people with severe liver disease. This paper discusses the issues associated with treating patients who have HCV infection including the importance of preventive programs to reduce dental pathology and maximise oral health.     

Concepts for the Prophylaxis of Infective Endocarditis in Dentistry

Oral commensal microorganisms are commonly associated with the pathogenesis of infective endocarditis. Despite modern antimicrobial and surgical treatment, infective endocarditis continues to cause substantial morbidity and mortality. Although dentistry is no longer considered a major risk factor for infective endocarditis, it is current standard for practice that dental procedures likely to produce significant bacteraemia in patients who are susceptible to this disease be prophylactically covered with an antimicrobial agent. The concepts of antimicrobial prophylaxis prior to invasive dental procedures are outlined in this review, with particular reference to the latest recommendations of the Australian Dental Association.     

Dental students' knowledge and compliance in cross infection control procedures at a UK dental hospital

OBJECTIVES: To assess the knowledge and clinical practice of dental students in infection control procedures at a UK dental hospital.
DESIGN: A questionnaire concerning various aspects of infection control was completed by all clinical dental students under examination conditions. Their actual clinical practice was later observed and certain aspects recorded.
SETTING: A UK dental hospital.
SUBJECTS: One hundred and eleven dental students from three clinical years completed the questionnaire. Clinical practice for all 3 years was observed in a total of 280 treatment events.
METHODS: The questionnaire was marked by two of the authors and observations recorded by another author. MAIN OUTCOME MEASURES: Degree of compliance with recognised policy for infection control.
RESULTS: Knowledge of infection control procedures was variable particularly concerning duties usually undertaken by the dental nurse. The suggested high compliance with masks and eye protection was not always apparent in clinical practice, although virtually all students washed their hands prior to donning gloves, which were worn by all students.
CONCLUSION: There can be marked differences between what students say they would do and what they actually do in clinical practice. The topic of infection control requires a pro-active approach throughout the course, since results for the final year were not significantly different from the other clinical yearS. Ways of improving compliance are discussed.     

Continuing dental education: evaluation of the effectiveness of a disinfection and decontamination course

Aim: To evaluate a disinfection and decontamination dental postgraduate course run by the Wales Dental Postgraduate Deanery between 2008 and 2010. Methods: Pre‐ and post‐course multiple choice questionnaires were completed by 1177 course attendees. Mean scores before and after participation on the training course were compared and analysed. Results: Mean pre‐course score was 45.3%, rising to 87.0% in the post‐course assessment, reflecting an improvement of 41.8%. Prior to training, 30.7% achieved a satisfactory score of 13/20 (65%) compared to 98.3% on completion of training. Dental technicians were found to score significantly lower than other occupation groups both before and after course attendance. Decade of graduation had no effect on results. Theoretical microbiology was the question area which showed least improvement. Conclusion: Attending the disinfection and decontamination course significantly improved participants’ knowledge. Theoretical microbiology, as a topic area, may be targeted for improvements in future courses to improve results further.     

一种牙科综合治疗台无菌化供给系统的微生物实验研究

目的检验一种牙科综合治疗台无菌化供给系统的有效性。方法使用无菌化供给系统的牙科综合治疗台,在人工口腔中,对污染乙肝病毒、血链球菌的牙齿使用高速涡轮机进行分牙操作,对治疗椅无菌化供给系统的水气道进行细菌学及免疫学检验。结果操作前手机连接管、三用枪连接管及吸引管均未检出微生物,治疗操作后手机连接管及吸引管检出微生物。结论牙科治疗回吸存在,但牙科综合治疗台无菌化供给系统能保障供给系统的无菌化。     

A Symposium on the Future of Dentistry Report: Implications for the Public Sector: Does Dentistry as We Know It Have a Future?

The American Dental Association's Strategic Plan for the Future of Dentistry is primarily a self-serving document in that it attempts to protect the dentist regardless of the changing oral health needs of the population. Marketing, even if initially successful, will not increase the absolute demand for dental services, because persons on maintenance care require less care per year than sporadic users. Higher use will be balanced by less need. Excess supply creates incentive to overtreat. Today's dentist, as the dominant provider, does not have major motivation toward prevention, either by training or economic self-interest. The paper proposes that a modified hygienist, with more diagnostic training, should become the primary dental provider, with a better trained dentist as a secondary provider, combining problem solving and "surgical" skills. These changes would function best under a system combining group practice with a national health service.     

Oral health of patients with hepatitis C virus infection: a pilot study

OBJECTIVES: This study examined the oral health of a cohort of hepatitis C virus (HCV) patients. In particular, the prevalence of lichen planus and xerostomia were determined. Experiences of discrimination against HCV-infected patients by their dentists were also recorded. METHODS: Forty patients infected with HCV, who were not undergoing anti-viral treatment, were examined. Patient information collected included demographic details together with patients' perception of their oral health and access to dental care since being diagnosed with hepatitis C. Both extra-oral and intra-oral examinations were conducted. Teeth present and visible caries were recorded, periodontal condition was measured using a Community Periodontal Index of Treatment Need (CPITN) probe and denture fit and hygiene were assessed where appropriate. The soft tissues were examined and lichen planus diagnosed clinically. Salivary flow rates were estimated by the Salivette system. RESULTS: The oral health of this cohort was poor. Eight patients had clinical evidence of oral lichen planus (OLP), although this was not confirmed histologically. The salivary flow rates were significantly lower (P < 0.001) than in previously reported healthy controls. Of the 15 (37.5%) regular dental attenders, two had encountered problems accessing dental care. CONCLUSIONS: Chronic hepatitis C patients have significant oral health needs. More effective oral health education is required for both HCV-infected patients and their carers, including dental practitioners.     

丙型肝炎病毒在口腔扁平苔藓发病中的意义

目的：探索丙型肝炎病毒在口腔扁平苔藓发病中的意义。方法：应用ＰＣＲ技术对６０例口腔扁平苔藓患者进行了丙型肝炎病毒ＲＮＡ的检测。结果：在６０例口腔扁平苔藓患者中，其中７例丙型肝炎病毒ＲＮＡ阳性，与对照组相比具有显著性差异（Ｐ＜０．０５）；且丙型肝炎病毒ＲＮＡ阳性患者的损害均表现为白纹伴糜烂。结论：在口腔扁平苔藓中，尤其是在糜烂伴白纹的口腔扁平苔鲜患者中，应用敏感的ＰＣＲ技术检测血液中的丙型肝炎病毒ＲＮＡ，不仅对于防治慢性肝炎，而且对于探索口腔扁平苔藓的病因与治疗均具有重要意义。     

唾液中丙型肝炎病毒抗体的检测及应用

目的　探讨唾液中丙型肝炎病毒 (hepatitisCvirus,HCV)抗体检测的可行性及其临床应用的意义。方法　应用改进后的酶免疫技术 ,分别对 86例患者外周血和唾液样品中的HCV抗体 (抗 HCV)进行平行检测、对比分析。结果　 86例患者中 ,外周血抗 HCV阳性 2 9例 ,其中 2 7例唾液检测抗 HCV也是阳性 ,另外 2例为阴性 ;外周血抗 HCV阴性 57例 ,其唾液检测也均为阴性。与外周血的检测结果相比 ,唾液样品中抗 HCV检测的灵敏度 (93 1 % ,2 7/2 9)、特异性 (1 0 0 % ,57/57)均较好。结论　唾液中抗 HCV的检测可用于HCV感染的临床诊断和流行病学研究     

Oral conditions in hepatitis C virus-infected Iranian patients: a case-control study

Abstract Aim: Hepatitis C virus is now found worldwide, giving rise to concern that general populations might become infected. Extrahepatic manifestations might indicate latent disease. The aim of this study was to evaluate the association between oral lichen planus and xerostomia with hepatitis C virus infection in an Iranian population. Methods: The study (case) group consisted of 73 individuals with hepatitis C virus infection. The control group consisted of 139 age- and sex-matched individuals. All patients were examined for oral conditions, and their hepatitis C virus infection was confirmed by an antihepatitis C virus antibody and hepatitis C virus-RNA polymerase chain reaction. Results: The prevalence of oral lichen planus was 1.4% and 4.1% of individuals complained of a dry mouth. There were no statistically-significant differences between the case and control groups. Conclusion: Our findings reinforce other regional studies that there is no association between hepatitis C virus infection and oral conditions in the north of Iran, an area with a low prevalence of this infection.     

新型冠状病毒肺炎流行期降低口腔诊疗中气溶胶传播风险的策略

新型冠状病毒肺炎(COVID-19)自2019年12月爆发以来,迅速在全国蔓延。《新型冠状病毒肺炎诊疗方案(试行第六版)》明确了在相对封闭环境长时间暴露于高浓度气溶胶的情况下存在气溶胶传播COVID-19的可能。口腔诊疗操作中可产生大量气溶胶,是交叉感染的重要风险因素之一。本文根据现有国内外公开发表的相关资料,分析并总结口腔诊疗中应注意的防控措施,为口腔诊疗工作的安全开展提供参考。     

HIV and hepatitis B infection in an international cohort of dental hygienists

Abstract – The risk for dental hygienists to contract HIV and hepatitis B infection at work was studied in an international cohort of 167 dental hygienists from 13 countries. A significant proportion of the hygienists had taken care of HIV-positive patients or patients known to be at risk for contracting HIV infection. None of the hygienists had antibodies to HIV. Five hygienists who came from or worked in high-endemic areas for hepatitis B infection had antibodies to hepatitis B core antigen, consistent with previous infection with hepatitis B virus. The study is in agreement with previous reports on blood-borne infections among health care workers, concluding that the risk for dental hygienists of contracting HIV and hepatitis B infection is minimal.     

Occupational exposures occurring in students in a UK dental school.

BACKGROUND: Students whilst training may encounter a number of incidents where infection from patient body fluids may occur, especially as their manual skills are underdeveloped and their clinical experience is limited. PURPOSE OF STUDY: (a) To assess the nature of the occupational exposures occurring to students in a UK dental school, (b) to assess the rate of reporting of incidents, and (c) to evaluate the association of various factors with these exposures. Students in the third, fourth and final years of the 5-year undergraduate dental course at the University of Birmingham were asked to complete a questionnaire that inquired into personal details, number and nature of incidents, their reporting and follow-up. A 100% response rate was achieved. RESULTS: Across the years, there was no significant correlation (p > 0.01) between sex, dominant hand, use of protective glasses or time of day. Slightly more exposures occurred in males, right-handed students, and in the afternoon. A significant decrease in exposures (p < 0.01) occurred within final year, and when an assistant was employed. Significantly more incidents occurred while a patient was being treated than during operational clean-up procedures. A substantial number of dental students had experienced one or more occupational exposures during training. Of these, percutaneous injuries predominated. Junior students appear to be more likely to experience exposures, and in these students, needlestick injuries are the most common source. CONCLUSIONS: To reduce the incidence of these exposures, more instruction and training may be required in the earlier clinical years and more chairside assistance. Improvements are required in the monitoring of post-screening for seroconversion after HBV immunization, and in the reporting of test results in the event of an exposure incident. Under-reporting of incidents is common and ways to encourage and facilitate reporting should be sought.     

黑龙江地区口腔扁平苔藓患者丙型肝炎病毒感染的检测

目的 检测黑龙江地区口腔扁平苔藓(OLP)患者丙型肝炎病毒(HCV)的感染率,并讨论两者之间的关系。方法 采用双抗夹心酶联免疫吸附试验(ELISA)对本地区62例OLP患者和61例非OLP黏膜病患者及22例健康志愿者进行血清丙型肝炎病毒抗体(HCV-Ab)的检测。结果 口腔扁平苔藓组HCV感染率(9.7%)明显高于非OLP黏膜病组(1.6%)和健康组(0%)HCV感染率(P<0.05)。结论 黑龙江地区OLP的发病与HCV感染存在一定的关系。     

High prevalence of hepatitis C virus antibody and RNA in patients with oral cancer

We have investigated the correlation between the prevalence of hepatitis C virus (HCV), which is detectable in saliva, and oral cancer and other digestive tract cancers in the Northern Kyushu region of Japan. Anti-HCV antibodies were detected in sera from 24 of the 100 patients with oral cancer (24%, p<0.05 vs the control group, p<0.01 vs the stomach cancer group), in 11 of 104 patients with non-malignant diseases receiving dental treatment (the control group, 10.6%), and in 12 of 113 patients with stomach cancer (10.6%). HCV-RNA was detected in sera from 17 of 100 oral cancer patients (17%, p<0.05 vs the control group) and 4 of 104 patients of the control group (3.9%). These results indicate a high prevalence of HCV infection in oral cancer patients, which warrants a systematic study of etiological associations between oral cancer and HCV.     

Vasculitis of dental pulp associated with cryoglobulinemia in hepatitis C virus patients: case report

Introduction

This report presents a case of impacted lower third molar extracted for surgical reasons in patient with uncontrolled hepatitis C. After decalcification, dental pulp vasculature and its tissue quality were investigated.

Methods

Serial sections of 4-μm thickness along the midline buccolingually for the demineralized specimen were obtained, mounted on a glass slide, stained with hematoxylin-eosin, covered, and viewed under the light microscope.

Results

The histologic investigation of the pulp tissue revealed thickening, stenosis, and occlusion of the vessel wall, ectopic calcification of the pulp tissue in close association with pulpal blood vessels, interrupted and vacuolated odontoblastic layer in the coronal pulp chamber, with an inflammatory cell infiltrate throughout the pulpal tissue.

Conclusions

Cryoglobulinemia associated with uncontrolled hepatitis C virus infection in patients endangers the dental pulp vasculature and alters its normal tissue architecture.     

口腔医院住院患者丙型肝炎病毒感染现状分析

目的：研究口腔医院感染丙型肝炎病毒（hepatitis C virus,HCV）的住院患者在性别、年龄、年份、病种上的分布及感染者的肝功能状况。方法：收集2008-2012年在南京医科大学附属口腔医院进行过丙肝抗体检测的住院病人的数据,按性别、年龄及检测年份的不同分组比较丙肝抗体的阳性率,并观察丙肝抗体阳性病人的病种情况。分析丙肝抗体阳性病人的丙氨酸氨基转移酶（alanine aminotransferase,ALT）和天门冬氨酸氨基转移酶（aspartate aminotransferase,AST）数据,以期了解感染者的肝功能状况。结果：口腔医院住院患者抗-HCV阳性率为0．25％,低于文献中所述的一般人群3．2％的抗．HCV阳性率流行率;住院患者抗-HCV阳性病人的肝功能异常率为53．33％,较乙型肝炎表面抗原（hepatitis B surface antigen,HBsAg）阳性患者17．77％肝功能异常率有显著性提高（X^2=9．11,P〈0．01）。结论：对口腔患者术前和创伤性治疗前的抗。HCV的检测能及早发现HCV感染者;同时口腔医院的医护员工需加强对病人和自身的保护,严格消毒操作器械,防止HCV的医院内传播;HCV感染者需定期进行肝功能检查,防止肝脏的损伤。