Assessment of the effectiveness of glove use as a barrier technique in the dental operatory

To assess the effectiveness of routine glove use as a barrier technique in the dental operatory, the relationship between frequency of glove use and hepatitis B infection was examined. Hepatitis B screening results and information on infection control practices of 1,109 dentists who attended the 1985 annual session were compiled and statistically analyzed. The results showed that 18% of the dentists wore gloves routinely, 65% wore gloves intermittently, and 17% never wore gloves. Frequency of glove use was related to hepatitis B infection (P less than .01), with dentists who never wore gloves being infected more than twice as often as dentists who wore gloves routinely. Dentists with less frequent glove use and more years in practice had a higher incidence of hepatitis B infection (P less than .0001).     

Glove use in clinical practice: a survey of 2000 dentists in England and Wales

Attitudes to glove wearing by dentists practising within the NHS Regulations were tested by means of a questionnaire distributed to 2000 dentists in England and Wales. The response was 76.5%. The results indicate that 68% of the respondents wore gloves routinely for all patients and procedures, 3% never wore gloves, while the remainder (29%) wore gloves for only selected patients or selected procedures. Reasons given for not wearing gloves routinely included problems of comfort, loss of tactile sensation and the risk of cross-infection, which was perceived to be small. Of the routine glove wearers, only 12% changed gloves between patients, cost being considered to be a factor by 57% of respondents who used gloves for more than one patient. The results indicate that the respondents practising and personal details had an influence on the pattern of glove wearing, with single-handed practitioners and those who graduated before 1979 being less likely to wear gloves routinely. Comparison with the findings of earlier studies of similar type suggest that there is increased awareness in the dental profession of the necessity for glove wearing, but that there is still a need to encourage routine glove use, especially amongst certain groups of GDPs.     

Cross-infection control in dental practice in the Republic of Ireland

OBJECTIVE: The purpose of this study was to examine the infection control procedures used in general dental practices in the Republic of Ireland. DESIGN: Postal survey. SETTING: The Republic of Ireland. PARTICIPANTS: 250 general dental practices. METHODS: Postal questionnaire. MAIN OUTCOME MEASURES: Use of infection control procedures; gloves, masks, sterilisation of instruments, staff training. RESULTS: A 74% response rate (n = 177), with 162 wearing gloves for all patients, 97% of whom used latex gloves. Routine glove use by 69% of dental nurses. Approximately one third of respondents complained of hand skin irritation attributed to the wearing of latex gloves. Routine mask wearing during treatment was reported by 68% of respondents. The method of choice for sterilising instruments was the steam autoclave for 97%. Time spent on surgery cleaning between patients was less than one minute in 12 per cent of practices. CONCLUSIONS: Cross-infection control procedures practiced by a high proportion of the respondents to the survey conform to guidelines suggested by various authorities. Further education may be appropriate in a number of areas such as mask wearing and the need to change gloves between patients.     

A SURVEY OF CROSS-INFECTION CONTROL PROCEDURES: KNOWLEDGE AND ATTITUDES OF TURKISH DENTISTS

Objectives:

The objective of this study was to investigate the knowledge, attitudes and behavior of Turkish dentists in Samsun City regarding cross-infection control.

Material and methods:

A questionnaire was designed to obtain information about procedures used for the prevention of cross-infection in dental practices and determine the attitudes and perceptions of respondent dental practitioners to their procedures. The study population included all dentists in the city of Samsun, Turkey, in April 2005 (n=184). The questionnaire collected data on sociodemographic characteristics, knowledge and practice of infection control procedures, sterilization, wearing of gloves, mask, use of rubber dam, method of storing instruments and disposal methods of contaminated material, etc. Questionnaire data was entered into a computer and analyzed by SPSS statistical software.

Results:

From the 184 dentists to whom the questionnaires were submitted, 135 participated in the study (overall response rate of 73.36%). As much as 74.10% dentists expressed concern about the risk of cross-infection from patients to themselves and their dental assistants. Forty-three percent of the participants were able to define "cross-infection" correctly. The greatest majority of the respondents (95.60%) stated that all patients have to be considered as infectious and universal precautions must apply to all of them. The overall responses to the questionnaire showed that the dentists had moderate knowledge of infection control procedures.

Conclusions:

Improved compliance with recommended infection control procedures is required for all dentists evaluated in the present survey. Continuing education programs and short-time courses about cross-infection and infection control procedures are suitable to improve the knowledge of dentists.     

Disinfection procedures and infection control in the outpatient oral surgery practice

The infection control and disinfection procedures employed by 434 oral surgeons were surveyed. Gloving practices varied substantially, with 55% of respondents wearing gloves during ?10% of patient contacts and only 24% wearing gloves routinely. Gloving practices correlated strongly with having been taught in dental school or during residency training to wear gloves. While 100% of participants had received instruction in the use of intravenous fluids in dental school or residency training, usage patterns differed substantially from those currently recommended in hospitals and in outpatient, nondental surgical settings. Of the respondents who used intravenous fluids in an office setting, 68% used a single bag or bottle for more than one patient. The median number of patients receiving intravenous fluid from a single bag or bottle was 12, and the median duration of use of a single unit was three days. It was noted that infection control and disinfection procedures varied significantly by type of practice (private vs. other nonmilitary vs. military practices).     

Gloved and ungloved: performance time for two dental procedures

This study examines the time required to perform two routine dental procedures requiring fine hand manipulative skills--a pin placement procedure and an endodontic procedure. No significant time difference was noted in performing the procedures while wearing gloves or not wearing gloves. Twelve dentists who had routinely worn gloves for the past 6 months participated, each performing four procedures.     

Use of gloves among dentists in Sweden

This study among 191 public and private dentists in the Malm?hus County of southern Sweden showed that 77% of the community dentists (n = 167) and 54% of the private dentists (n = 24) used gloves regularly as infection precaution during extraction. For surgery these figures were 90% and 54% respectively. These were low figures considering the several general recommendations from both the Swedish National Board of Health and Welfare and local community authorities to dental personnel to use gloves regularly during procedures with known risk of blood contact. The survey showed that 61% (n = 167) of the public dentists and 4% (n = 24) of the private dentists used gloves regularly during all patient treatment. High cost for gloves was no major obstacle for not using them regularly but rather discomfort and old habits (79% of the answers). 21% of the dentists had experienced local infections of their hands due to patient contact, puncture wounds being the most common cause. Most of the dentists using gloves had been influenced by the general HIV/AIDS discussion in news media (65%; n = 114).     

Hygiene in dental practices.

AIM: The aim of this study was to investigate the hygienic quality of dental practices on the basis of the self-awareness expressed by dentists respondents to a self-reported questionnaire about the health/hygiene characteristics of practice, the knowledge of biologic/toxicological risks and the preventive procedures and devices improvements in professional practice. MATERIALS AND METHODS: Of the 127 practitioners contacted, 108 (85%) agreed to participate. The knowledge of infective risks was self- evaluated as good only in 24%: even if vaccinated, most of the dentists (57%) considered HBV the main infective agent to fear, not giving the same importance to the air-borne transmission of diseases. The presence of a single dental unit per surgery (90%) was considered an index of good health/hygiene education but, in spite of the use of disposable gloves, caps and masks, the dentists do not always change their coats or wash their hands between patients yet. The management of dental instruments can be considered efficient as long as they are sterilised in an autoclave (97%) and undergo periodic sterilization efficacy tests (76%). RESULTS AND CONCLUSION The results indicate a good structural and organisational status, but there is the need for continuous education concerning the prevention of cross-infections.     

An assessment of the incidence of punctures in latex and non-latex dental examination gloves in routine clinical practice

OBJECTIVE: To investigate the puncture resistance of a recently introduced non-latex, nitrile dental glove in comparison with a latex glove worn during routine clinical dental procedures. SETTING: Dentists in general dental practice working within the UK during 1999. SUBJECTS AND METHODS: 2,020 gloves worn by five general dental practitioners were examined for punctures following standard clinical use by a water inflation method. Procedures undertaken during glove usage and length of time worn were recorded. RESULTS: Following clinical use, 1.9% of the latex gloves and 5.3% of the nitrile gloves had punctures, a statistically significant difference (P < 0.0001). The puncture resistance of the nitrile gloves was superior to the puncture resistance of previously tested worn non-latex (vinyl) gloves. There was no evidence of a statistically significant difference between operators for the percentage or incidence of punctured gloves (P = 0.787) after correcting for glove type. No statistically significant difference was noted between incidence of puncture in the control, unused gloves (n = 200 for each type) and the gloves examined following clinical use (P = 0.907 for nitrile, P = 0.613 for latex). CONCLUSION: No increase in the number of punctures was noted following clinical use for either glove type. This could be considered to indicate good puncture resistance of the gloves tested in clinical use.     

Hepatitis B prevalence and infection control among dental health care workers in a community in South Korea

OBJECTIVES: The objectives of this study were to investigate the prevalence of hepatitis B vaccine and use of infection control procedures by dental health care workers in Taegu, South Korea. METHODS: Information was obtained with a mailed questionnaire sent to 300 private dental practices. Surveys were received from 177 dentists, 104 dental hygienists, and 46 dental assistants. All dental health care workers were asked to donate a blood sample for analysis of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs). RESULTS: Vaccination against hepatitis B virus was reported by 63 percent of the respondents. About 40 percent of all participants answered that they were anti-HBs positive, while another 43 percent did not know their status. About 89 percent of dentists reported that they wore a mask with all patients, while hygienists (13.6%) and assistants (13.0%) were less likely to do so. Reported use of gloves (4.5%) and protective eyewear (14%) with all patients was extremely low in every group. Among the 56 dentists who were tested for HBV markers, 23 did not receive the vaccine against hepatitis B, and 13 percent (3 of 23) were positive for HBsAg as carriers. CONCLUSIONS: About 37 percent (120 of 327) of dental health care workers surveyed in this study in Korea did not receive the vaccine against HBV infection. Basic barrier techniques to prevent cross-contamination were not being used consistently. Nationwide guidelines for barrier techniques and hepatitis vaccinations should be developed and disseminated to dental personnel.     

Use of gloves and prevalence of glove-related reactions in a sample of general dental practitioners in Italy.

OBJECTIVE: The purpose of this study was to evaluate the frequency of the use of gloves and to assess the prevalence of glove-related symptoms in a sample of Italian dentists with a high occupational exposure to latex gloves. METHOD AND MATERIALS: A 31-question instrument was mailed to all dentists (n = 550) practicing in the town of Bologna during 1994 to determine the type of procedures for which gloves were worn by dentists and the prevalence of self-reported glove-related symptoms. RESULTS: Of the dentists who replied to the items (n = 160), 94% reported that they usually wear nonsterile latex examination gloves; and 46% reported that they wear surgical gloves, even if not exclusively. About 98% reported changing gloves after contact with each patient, and 14% reported using disinfectants to treat examination gloves. Of the 106 respondents claiming to use examination gloves for surgical activities, 79 (74%) reported wearing them for extractions. Sterile surgical gloves were reported to be mostly worn for implant placement (47%) and periodontal surgery (42%). There were 46 (29%) responses indicating glove-related problems; of those subjects, 14 (30%) reported having other allergies. CONCLUSION: The use of gloves is common in the sample of Italian dentists, and the choice between nonsterile examination gloves and sterile surgical gloves seems to be made appropriately.     

Are general dentists' practice patterns and attitudes about treating Medicaid-enrolled preschool age children related to dental school training?

PURPOSE: The purpose of this study were to investigate the willingness of general practitioners to provide dental care for preschool-aged children, and to explore the relationship between dental school experiences and practitioners' attitudes about treating Medicaid-enrolled children 3 years of age and younger. METHODS: A survey was mailed to 3,559 randomly selected general dentists in Texas. Respondents were asked to answer questions about their willingness to provide specified dental procedures for children of different ages, their dental school experiences with pediatric dentistry and whether these experiences were hands-on, lecture or no training, and their attitudes concerning treating Medicaid-enrolled children 3 years of age or younger. Associations between attitudes about treating Medicaid-enrolled children and dental school experiences were determined. RESULTS: The response rate was 26%. Almost all respondents were willing to provide routine procedures such as an examination (95%) and prophylaxis (94%) for children 5 years or younger. However, as children became younger and procedures more difficult, the number of general dentists willing to provide treatment decreased. The level of dental school training was significantly associated with the attitudes of general dentists about providing dental care for Medicaid-enrolled preschool-aged children (P < or = 0.05). CONCLUSION: Identification of factors associated with general dentists' willingness to see young children may improve access by increasing the number who will provide care for preschool-aged children.     

Precautions reported to be used against cross-infection and attitudes to the dental treatment of HIV-positive patients in routine clinical dental practice in Scotland

The purpose of this study was to ascertain the precautions against cross-infection currently employed in routine practice by Scottish dentists, to relate these to current recommendations and to determine Scottish dentists' views on how dental treatment should be provided for patients known to be HIV positive. The subjects were 926 general dental practitioners and 201 clinical community dental officers among respondents to a questionnaire sent to a list of 1726 dental practitioners in Scotland. The results suggest that while some dentists are prepared to take an element of personal risk (in spite of recent improvements 18 per cent are still unvaccinated against hepatitis B, 66 per cent do not wear surgical gloves during routine treatment and 21 per cent claim not to wear gloves during procedures involving ‘bloodletting’), the vast majority (95 per cent) are nevertheless taking steps to protect their patients from cross-infection by using autoclave and dry heat sterilization. One-quarter of general dental practitioners and one-half of clinical community dental officers felt that HIV-positive patients should generally be treated in the branch of the dental service in which they worked, although greater proportions (52 per cent and 69 per cent respectively) said they were prepared to treat a regular patient who became HIV positive.     

Adverse reactions to protective gloves used in the dental profession: experience of the UK Adverse Reaction Reporting Project

The Adverse Reaction Reporting Project (ARRP) was set up to measure the extent and severity of adverse reactions to dental materials in the UK. Further analysis into the use of protective gloves has been carried out to establish the degree to which gloves are having a deleterious effect on the dental profession. In addition the survey aimed to establish the techniques used to manage adverse reactions and their effectiveness. In a 23-month period, 369 reports were received concerning adverse reactions to protective gloves used in dental practices. Reporters were contacted for further information, and a 92% response rate was achieved. The 330 reports analysed showed dentists to be the largest group to report adverse reactions, whilst dental technicians reported the fewest. The referral rate for staff and patients was similar with a third of adverse reactions being referred (n=110) to a specialist for diagnosis. A confirmed diagnosis was received in 65% of referred cases (n=72), but the symptoms reported suggested a larger degree of Type I reactions occurring than diagnosed. The use of non-powdered gloves appeared to be favoured over powdered gloves in 42% of glove changes, and nitrile gloves were used as an alternative to latex in 39% of changes. In conclusion, the results from this survey showed that wearing gloves in dental practices in the UK caused a range of adverse reactions. In 79% (n=330) of cases reported and analysed, these reactions were readily resolved or improved by self-medication, prescribed medication and/or changing to a different type of protective glove.     

Basic infection control procedures in dental practice in Khartoum-Sudan

OBJECTIVES: To survey the infection control procedures used by dental practitioners in Khartoum, Sudan. METHODS: Questionnaires were distributed to150 randomly sampled dentists practising in Khartoum state. Each questionnaire comprised 17 questions about basic infection control procedures. RESULTS: A 100% response rate to the questionnaire showed that 92% of dentists routinely wore gloves when treating patients, 50% face masks, 61% a gown and 14.7% protective eye wear. Furthermore 52% of the practitioners had been immunised against Hepatitis B. The majority of practitioners (72%) used dry heat as their method of instrument sterilisation, 22% used an autoclave, 2% used boiling water and the remainder used chemical sterilisation. Safe disposal of clinical waste was undertaken by only 23% of dentists although 47% of practitioners stored sharp items in closed containers. All respondents used disposable dental needles, but only a few used other disposable items. There was a significant difference in the implementation of cross infection control procedures between salaried and private dental practitioners, especially with regard to handpiece sterilisation, use of disposables, the wearing of face masks and the availability of additional sets of instruments. CONCLUSION: There is a clear need to improve the existing situation particularly with regard to immunisation of dentists against Hepatitis B, the safe disposal of clinical waste and instrument sterilisation in Khartoum.     

Occupational exposures and infection control among students in Nigerian dental schools.

OBJECTIVE: To assess the incidence of occupational exposures to body fluids and infection control practices among students in Nigerian dental schools. MATERIALS AND METHODS: A self-administered questionnaire survey of 112 students from three Nigerian dental schools. RESULTS: 57 (50.9%) of the students had experienced one or more occupational exposures in the previous six months. There was no statistically significant association between year group and reported number of exposures (p > 0,05). There was also no statistically significant association between sex and reported number of exposures (p > 0.05). 50.7% of the exposures were percutaneous injuries, 26.1% splatter of saliva and 23.2% splatter of aerosol. Percutaneous injuries were most frequently caused by scalers (42.9%) and needlesticks (37.1%) Most incidents occurred during scaling (37.7%),use of dental handpiece (21.7%) and cleaning of instruments (18.8%). 96.4% of the exposures were not reported. Only 36.6% of the students were immunized against Hepatitis B. None of those immunized had been post-screened for seroconversion. The routine use of gloves, masks and protective eyewear was reported by 87.5%, 65.5% and 17% of students respectively. CONCLUSIONS: This study indicates a high rate of exposure to body fluids and low compliance with infection control guidelines. There is a need for interventions to improve safe work practices, hepatitis B vaccination, HBV post-immunization serology and use of protective barriers. Also appropriate policies and procedures are needed for reporting and managing exposures.     

LOCAL ANESTHETICS AND PREGNANCY. A REVIEW OF THE EVIDENCE AND WHY DENTISTS SHOULD FEEL SAFE TO TREAT PREGNANT PEOPLE

Oral health and dental treatment are essential during pregnancy. Despite dental treatment being safe during pregnancy for mother and baby, many dentists are reluctant to treat pregnant people. Previously published FDA and ADA recommendations for the treatment of pregnant people exist. Consensus statements and injectable local anesthetic manufacturers' information exist as well. Yet many dentists continue to demonstrate reluctance and hesitancy to treat pregnant people during all stages of pregnancy and for all routine comprehensive care such as exams, diagnostic radiographs, scaling and root planning, restorative, endodontic, and oral surgical procedures. Local anesthetics are most widely used in dental treatment, and many dental procedures necessitate their use when treating pregnant people. To facilitate dentists... comfort and clinical decision-making in the use of local anesthetics in improving the pregnant population's receipt of dental treatment and care outcomes and to calibrate practices to the current standard of practice aligning with contemporary evidence, this paper will review essential published evidence-based studies, guidelines, resources, and information from national organizations responsible for protecting the public's health.     

Infection control practices and compliance to national recommendations among dentists in Romania

The aim of this study was to measure dental office compliance with current Romanian infection control regulations. A questionnaire was completed and returned from 61 randomly selected offices (32 private and 29 public with 94 dentists), where the sterilizers were also biologically monitored. Results indicated that with few exceptions, infection control practices in public and private offices were the same, with compliance on sterilising reusable instruments. Private offices monitored their sterilizers more frequently and had much newer equipment. Gowns were universally worn, but use of gloves, masks and protective eye-wear showed non-compliance with less than 10 per cent of the offices using personal protective equipment for all patients. Cost was the deciding factor. Predominant environmental disinfectants were alcohol and bleach. Offices were in compliance as to the use of disposable anaesthetic needles and carpules. Dentists reported reluctance to be vaccinated against hepatitis B even when offered free immunizations (6.4 per cent) and only 18.1 per cent of dentists had received any infection control training in the last three years. Results indicate that offices were in compliance for most national regulations. However, there are no recently published standards for dentistry in Romania concerning disinfectants or continuing education. Comparison with the literature indicates comparable compliance with recommended national infection control procedures for Romanian dentists as for dentists in other countries.     

Glove use by orthodontists: results of a survey in England and Wales.

Attitudes to glove wearing during treatment of patients were tested by distribution of a questionnaire to 2000 dentists known to be practising under the National Health Service regulations in England and Wales. Of the dentists who replied, 41 specialist orthodontists, representing approximately one-sixth of all orthodontists working in the general dental services in England and Wales, were identified. Results indicate that 39 per cent of these orthodontic respondents wore gloves routinely for all patients and procedures, while 49 per cent wore gloves for some patients or procedures, with 12 per cent never wearing gloves. Reasons given by the occasional glove wearers for not wearing gloves routinely included loss of tactile sensation, perceived small risk, lack of comfort, and restriction of movement. Six per cent of those who replied had experienced skin irritation considered to be associated with glove wearing, while latex gloves were preferred by 78 per cent of respondents who wore gloves.