Occupational allergic contact dermatitis and composition of acrylates in dentin bonding systems

Background Dentin-bonding systems contain sensitizing acrylates. They are increasingly used in dentistry, but only few cases of allergy have been encountered. Objective This study reports observations on eleven patients sensitized by acrylates in dentin-bonding compounds. Furthermore, the composition of dentin-bonding products was analysed and compared with the information given in the material safety data sheets. Methods Patch testing was performed to reveal allergic contact dermatitis, and chamber provocation tests to reveal possible respiratory sensitivity. Gas chromatography/mass spectrometry was used to analyse the chemical composition of the bonding products. Results The most common sensitizer in our material of eleven patients was 2-hydroxyethyl methacrylate (2-HEMA). Another putative sensitizer, BIS-GMA, used in dentin adhesives, did not cause sensitization. The typical allergic dermatitis localized to the fingertips (pulpitis). Seven of the eleven patients also developed paresthesia of the fingertips. One patient with positive patch test reactions to (meth)acrylates had pharyngitis hut no skin symptoms. One patient was sensitized because she had been patch tested with too high a concentration (undiluted) of dentin-bonding components. Material safety sheets gave inaccurate or wrong information about the contents. Conclusion Dentin-bonding acrylates are strong sensitizers, and even a single exposure may sensitize.     

牙科医师体表和诊室环境的污染状况分析

目的 通过牙科医师治疗过程中,身体表面及诊室空气各处的细菌检测,了解牙体治疗和牙周治疗时对医师和空气的污染情况.方法 牙科医师进行牙体、牙周治疗时,将普通血培养基固定在其口罩、防护眼镜、胸前体表及固定在牙科治疗椅照明灯、牙科治疗椅旁屏风处,暴露1 min,实验室37℃培养24 h,各取10例,计算均值.诊室连续使用3.5 h后,将普通血培养基放置于牙科治疗椅水杯平台、牙科治疗椅后方2 m远的护士操作台表面,暴露5 min,实验室37℃培养24 h,隔日1次,共取10次,统计菌落均值,计算空气细菌菌落总数.结果 牙科医师身体表面不同部位及牙科治疗椅周边均被污染,污染最严重的是口罩,与防护眼镜的污染有显著性差异(P＜0.05);诊室使用后,空气污染明显.结论 在口腔治疗过程中,牙科医师和牙科治疗椅周边的污染均十分严重;诊室空气细菌菌落总数明显高于医院消毒卫生标准.医师应注重自身防护,诊室设备、空气应及时消毒、灭菌.     

Reopening Dental Offices for Routine Care Amid the COVID-19 Pandemic: Report From Palestine

ObjectivesThis study reports on the readiness of Palestinian dentists to reopen their practices for routine care during the current coronavirus disease 2019 (COVID-19) pandemic.MethodsA cross-sectional study targeted dentists in the West Bank area of Palestine using an online survey during the first 2 weeks of May 2020. Questions mainly asked about dentists’ perception of the risks of COVID-19, readiness to reopen their clinics for routine care, and the level of confidence in dealing with patients suspected of having COVID-19.ResultsA total of 488 dentists completed the survey. Almost 60% believed that they were not ready to reopen their practices. Almost 13% had “no confidence” in dealing with patients with COVID-19, while 64% had “little to moderate” confidence. Confidence was correlated negatively with increased fear of becoming infected (ρ = -0.317, P < .0001) and positively with years of practice (ρ = 1.7, P < .0001). Dentists who received updated training on infection control or on COVID-19 reported higher levels of confidence (χ² = 53.8, P < .0001, χ² = 26.8, P < .0001, respectively). Although 88% preferred not to treat patients with COVID-19, 40% were willing to provide care to them. Almost 75% reported that they were already facing financial hardships and could not survive financially until the end of the current month.ConclusionsEthical and financial reasons were the main drivers for dentists in this sample to reopen their practices for routine care. Data from this study highlights the fragility of private dental practice in emergency situations. Ethical, health, and financial challenges that emerged during COVID-19 require dentists to adapt and be better prepared to face future crises.     

The physically disabled dentist: 10 years' experience at the Kriser Institute

This article outlines the origins, development, and current status of the David B. Kriser Institute for the Rehabilitation of Disabled Dentists. During its first decade of existence this unique facility has provided retraining for more than 30 physically disabled dentists who have subsequently been able to resume dental practice. A case study highlights the Institute's mode of operation.     

Geographic distribution of specialist orthodontists and orthodontic providers in Japan

ObjectiveThis study aimed to clarify the geographic distribution of specialist orthodontists and dentists who provide orthodontic services in Japan.MethodsWe obtained data on the populations of 1750 municipalities in Japan in 2010 by referring to the census. We obtained data on the number of dentists who mainly provide orthodontic services (specialist orthodontists) and the number of dentists, including general dentists, who provide orthodontic services (orthodontic providers), by referring to the Survey of Physicians, Dentists, and Pharmacists. Furthermore, we referred to the directory on the website of the Japanese Orthodontic Society (JOS) to obtain data on JOS-qualified orthodontists. To assess the distribution of specialist orthodontists and orthodontic providers, we used Lorenz curves and Gini coefficients.ResultsThe median value for the number of specialist orthodontists and number of JOS-certified orthodontists per 100,000 persons aged between 5 and 40 years old was 0, while that of orthodontic providers was 27.5. Gini coefficients for specialist orthodontists and JOS-certified orthodontists were 0.523 and 0.615, respectively. On the other hand, the Gini coefficient for orthodontic providers was 0.258.ConclusionsRegional inequalities in the availability of specialist orthodontists are high, and medical access to specialist orthodontic services may be limited in areas other than urban districts. In municipalities with a population of fewer than 50,000 inhabitants, the number of specialist orthodontists was very low, but orthodontic providers were relatively evenly distributed. Our research results suggested that studying the distribution of specialist orthodontists and orthodontic providers can provide valuable information for developing dental care policies.     

Systematic review of the effect of dental staff behaviour on child dental patient anxiety and behaviour

Objectives

To review the literature, of the past 30 years, on the effects of dental staff behaviour on the anxiety and behaviour of child dental patients; especially to determine staff behaviours that reduce anxiety and encourage cooperation of children.

Methods

A systematic literature review was conducted using PubMed, Web of Science, The Cochrane Library, PsycINFO, Embase and CINAHL.

Results

Initial search returned 31 publications of which 11 fulfilled the criteria for review. Among seven studies that measured anxiety, four used validated measures. Five observational studies coded behaviour using Weinstein et al.’s (1982) coding scheme [1]. An empathic working style and appropriate level of physical contact accompanied by verbal reassurance was found to reduce fear-related behaviours in children. Findings regarding positive reinforcement and dentists’ experience increasing cooperative behaviour were inconsistent.

Conclusions

Measures for anxiety and behaviour varied across studies. Relationships between certain dental staff behaviours and child anxiety/behaviour were reported. However, limited work was identified and research using improved sampling, measurement and statistical approach is required.

Practice implications

Understanding what routine clinical behaviour of dental staff affects children's dental anxiety/behaviour will inform investigators of how children comply and help staff be aware the significance of their daily behaviour on treatment success.     

Consequences of childhood sexual abuse experiences on dental care

OBJECTIVE: Around 20% of female patients seeking dental care may have experienced childhood sexual abuse (CSA). Several similarities between abuse situations and dental treatment lead to dental fear. Since dental fear hampers oral health, the long-term effects of CSA on dental care and the specific factors that lead to increased stress during dental treatment have been investigated in women exposed to CSA. METHODS: A self-administered questionnaire, which was developed to investigate the objectives of the study, was distributed to 111 women recruited from support centers for women with CSA experiences. CSA was explored with a modified version of the questionnaire developed by Wyatt. Data from 85 women with CSA experiences were used for comparison to the data of 170 matching control women recruited, who were mothers of children attending kindergarten. RESULTS: Compared to controls, women exposed to CSA exhibited several long-term effects on dental care in terms of major psychological strain during dental treatment (36.5%/18.8%; P<.005), a lower number of prophylactic controls (72.9%/89.4%; P<.005), and preference for a female dentist to a male dentist (29.4%/8.2%; P<.0001). Women with CSA experiences considered four of five defined stressors associated with dental treatment as more intense. Of these women, 28% suffered from memories of their original abuse situations during dental treatment, and 29.4% believed that the dentist should have known about their history of abuse. CONCLUSION: CSA experiences may increase psychological strain during dental treatment. To improve dental care for women exposed to CSA, dentists should adjust their treatment plans to the specific needs of these patients.     

Dentist Workforce Trends in a Primarily Rural State: Iowa: 1997–2007

BackgroundState dental boards maintain minimal demographic and practice characteristics about licensed dentists. The authors describe the creation and monitoring of an enhanced surveillance system concerning Iowa's dentists.MethodsThe Iowa Dentist Tracking System (IDTS) was used to collect demographic, educational, practice arrangement, office location and work hour data for all active Iowa dentists beginning in 1997. IDTS staff members add newly licensed dentists to the system as practice locations become available. They also contact each dental office semiannually by telephone to update this information. The IDTS Advisory Committee meets annually to review these data and monitor trends.ResultsThe Iowa dentist workforce was relatively stable from 1997 through 2007; however, a large number of dentists are expected to retire during the next decade, which could create a shortage of providers, especially in rural areas. Although the percentage of male and female dentists who practice part time (< 32 hours per week) decreased between 1997 and 2007, young female dentists are more likely than young male dentists to practice part time.ConclusionsIDTS is a workforce tracking model that can be used to understand trends at the community, regional and state levels. An aging dentist workforce in Iowa could put a strain on the public's ability to access dental care, especially in rural counties.Practice ImplicationsIn the development of workforce policy, workforce tracking systems such as IDTS provide additional information in considering the number of dentists, location, accessibility and potential productivity of a workforce.     

银汞充填对口腔科医生健康影响的调查

目的　研究使用银汞合金充填牙齿对口腔科医生健康的影响。方法　将 10 0位口腔科医生按用汞量分为两组 ,观察组 5 1名 ,为每月用汞量 80克以上的医生 ,对照组 4 9名 ,为每月用汞量 2 0克以下的医生 ,详细记载两组的工作环境、操作方法、防护和体检情况。结果　观察组医生出现牙龈炎、头晕、失眠、腰痛、记忆力减退、性格变急躁易怒 ,手指颤、唾液分泌增多、尿汞高等症状和体征与对照组间差异有显著性意义 (P <0 0 5 )。结论　长期大量使用手工调制的银汞合金 ,如不注意防护 ,口腔科医生易患慢性汞中毒。