Dental Healthcare Settings Research Articles

Occupational COVID-19 risk to dental staff working in a public dental unit in the outbreak epicenter.

The management of the COVID-19 outbreak occurred in Lombardy (Italy) implied that non-COVID-19 health care was remodeled, limiting adequate resources in non-hospital public dental healthcare settings. This situation offered the opportunity to investigate the occupational COVID-19 risk to dental staff in public non-hospital dental units. An infection control protocol was designed for dental health care in the Territorial Health and Social Services Authority (ASST) "Melegnano and Martesana" (Milan). Since specific guidance from central authorities was lacking, information was gathered from international public health organizations. The probability to visit asymptomatic COVID-19-infected patients was estimated, and the occupational risk to dental staff was calculated. The probability to visit asymptomatic patients passed from 1.2% (95% confidence interval -95 CI, 0.6%-2.5%) in the first period (20 February-15 March 2020) to 11.1% (95 CI, 5.8%-23.6%) in the second period (16 March-30 April). Dentists and dental assistants did not develop COVID-19, while one nurse did, the nature of her occupational risk was unclear, as nurses provided prevalently non-dental health care. The probabilities of developing COVID-19 per worked hour per person excluding and including this uncertain situation were 0.0% (95 CI, 0.0%-3.2%) and 0.9% (95 CI, 0.1%-4.7%). Relatively simple infection control procedures were enough to control occupational COVID-19 risk during the outbreak.

COVID-19 Pandemic and Dental Practice.

SARS-CoV-2, a virus causing severe acute respiratory syndrome, has inundated the whole world, generating global health concerns. There is a wildfire-like effect, despite the extensive range of efforts exercised by the affected countries to restrain the expanse of this pandemic, owing to its community spread pattern. Dental specialists in the upcoming days will likely come across patients with presumed or confirmed COVID-19 and will have to ensure stringent infection prevention and control to prevent its nosocomial spread. This paper strives to provide a brief overview of the etiology, incubation, symptoms, and transmission paradigms of this novel infection and how to minimize the spread in a dental healthcare setting. This review presents evidence-based patient management practice and protocols from the available literature to help formulate a contingency plan with recommendations, for the dental practices prior to patients' visit, during in-office dental treatment, and post-treatment, during the pandemic and after.

Rational perspectives on risk and certainty for dentistry during the COVID-19 pandemic

Rational perspectives on risk and certainty for dentistry during the COVID-19 pandemic

Emerging Challenges and Threats for Dental Health Care Sector Attributable to COVID-19: Tale of a Developing Country.

Prevention and control of infection in dentistry is an essential matter that has gained immense attention in recent years. There exist a lack of scientific data about the cross-transmission and its associated risk, especially in the dental health care setting of Pakistan. This article will evaluate the emerging challenges and threats for the dental community in Pakistan attributable to the COVID-19 outbreak. There is a significant knowledge gap regarding the state- and institutional-level of infection prevention and control (IPC) policies and practices. In addition, not much is known about the development, implementation, and monitoring of IPC policies and its challenges.

Prevention and Control of Legionella and Pseudomonas spp. Colonization in Dental Units.

Introduction: Dental Unit Waterlines (DUWLs) have shown to be a source of Legionella infection. We report the experience of different dental healthcare settings where a risk management plan was implemented. Materials and methods: In a Hospital Odontostomatology Clinic (HOC) and three Private Dental Clinics (PDCs) housing 13 and six dental units (DUs), respectively, an assessment checklist was applied to evaluate staff compliance with guideline recommendations. DUWLs microbial parameters were investigated before and after the application of corrective actions. Results: In the HOC a poor adherence to good practices was demonstrated, whereas protocols were carefully applied in PDCs. L. pneumophila sg 2–15 was isolated in 31% (4/13) and 33% (2/6) of DUs in HOC and PDCs, respectively, mainly from handpieces (32%, 6/19) with counts >102 colony-forming units per milliliter (CFU/L), often associated with P. aeruginosa (68%, 13/19). The shock disinfection with 3% v/v hydrogen peroxide (HP) showed a limited effect, with a recolonization period of about 4 weeks. Legionella was eradicated only after 6% v/v HP shock disinfection and filters-installation, whilst P. aeruginosa after the third shock disinfection with a solution of 4% v/v HP and biodegradable surfactants. Conclusions: Our data demonstrate the presence and persistence of microbial contamination within the DUWLs, which required strict adherence to control measures and the choice of effective disinfectants.

Graphic Simulation of SARS-CoV-2 Droplets: Why Respirators should be used in Dental Healthcare Settings?

Introduction: Knowledge about the morphological characteristics of facial masks/respirators and their relationship with the possibility of interaction with respiratory droplets in the COVID-19 pandemic is fundamental in dental healthcare settings. Aim: This study evaluated interfibrillar gaps of cloth mask, surgical mask and Filtering Face Piece 2 (FFP 2) respirator through Scanning Electron Microscopy (SEM) in order to perform a graphic simulation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) respiratory droplets in the gaps among mask fibres. Materials and Methods: A fragment (1 cm2) of the cloth mask were used to perform a SEM analysis. The distance among fibres was determined by Energy Dispersive Spectrometry (EDS). Graphic simulation of droplets with different sizes (0.5 μm; 5.7 μm; 12 μm) was performed by an image editing program (Adobe Illustrator). Results: The image analysis showed that average distance among the fibres was 67.91 μm (cloth mask), 11.72 μm (surgical mask), 11.97 μm (respirator FFP2). Superimposition of masks layers resulted in no gaps between FFP2 fibres. Surgical mask exhibited openings between fibres in 1.43% of the studied total area. The cloth mask showed large gaps, in which it would be possible to transpose more than 680 million droplets (5.75 μm). Conclusion: FFP2 respirator showed no spaces among fibres after superimposition of structural layers, which would promote the blockage of the graphic simulation of SARS-CoV-2 droplets.

Infection control practices in dental healthcare settings for the corona virus disease 2019 (COVID-19) pandemic

The constant presence of bioaerosols in dental procedures represents a challenge for dental healthcare services during the Coronavirus Disease 2019 pandemic (COVID-19). The main transmission pathway of its etiological agent-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-occurs through droplets. Thus, when considering that saliva is a reservoir for this virus, dentistry is one of the activities with greater exposure to risk, with the need to establish strict safety protocols. This study is based on relevant guidelines and research andreviewed the scientific literature in order to present infection control practices to prevent SARS-CoV-2 contamination in dental healthcare settings.

Shedding light on a potential hazard: Dental light-curing units

BackgroundDental light-curing units (LCUs) are powerful sources of blue light that can cause soft-tissue burns and ocular damage. Although most ophthalmic research on the hazards of blue light pertains to low levels from personal electronic devices, computer monitors, and light-emitting diode light sources, the amount of blue light emitted from dental LCUs is much greater and may pose a “blue light hazard.” MethodsThe authors explain the potential risks of using dental LCUs, identify the agencies that provide guidelines designed to protect all workers from excessive exposure to blue light, discuss the selection of appropriate eye protection, and provide clinical tips to ensure eye safety when using LCUs. ResultsWhile current literature and regulatory standards regarding the safety of blue light is primarily based on animal studies, sufficient evidence exists to suggest that appropriate precautions should be taken when using dental curing lights. The authors found it difficult to find on the U.S. Food and Drug Administration database which curing lights had been cleared for use in the United States or Europe and could find no database that listed which brands of eyewear designed to protect against the blue light has been cleared for use. The authors conclude that more research is needed on the cumulative exposure to blue light in humans. Manufacturers of curing lights, government and regulatory agencies, employers, and dental personnel should collaborate to determine ocular risks from blue light exist in the dental setting, and recommend appropriate eye protection. Guidance on selection and proper use of eye protection should be readily accessible. Conclusions and Practical ImplicationsThe Centers for Disease Control and Prevention Guidelines for Infection Control in the Dental Health-Care Setting–2003 and the Occupational Safety and Health Administration Bloodborne Pathogen Standard do not include safety recommendations or regulations that are directly related to blue light exposure. However, there are additional Occupational Safety and Health Administration regulations that require employers to protect their employees from potentially injurious light radiation. Unfortunately, it is not readily evident that these regulations apply to the excessive exposure to blue light. Consequently employers and dental personnel may be unaware that these Occupational Safety and Health Administration regulations exist.

Workshop: Digital quality assurance of equitable public health interventions: why, how and examples

Abstract Objectives are to highlight knowledge and experiences of follow-up and evaluation of public health interventions with a focus on health equity. A digital instrument for planning, documentation and quality assurance, used in several Swedish settings, will be presented. Health inequity emerges from structural issues. Public health interventions generally widen the health gap which is maintained and enforced by mechanisms on many levels in the societies. Interventions that aim to counteract health inequity need to take this into account and broaden the perspective to include not only life style habits but also discrimination, stigmatization, control, influence and power. Critical reflection is necessary to prevent interventions from consolidating current positions of power and to assure that communities and individuals - can influence goal-setting and measures taken. The Swedish Commission for Equity in Health highlighted the importance of methodological development and knowledge-based efforts including better follow-up, evaluation, research and dialogue. Mediators between measures taken and effects need to be clarified. Health promotion needs to be evaluated systematically with a focus on how interventions function in relation to the task of closing the gap. However, interventions are often merged into other activities and the impact of a continuously changing society cannot be controlled for. Use of evidence-based methods including influence from participants are fundamental, as is critical reflection. Documented by a digital instrument, measures taken and reflected upon can form a database for continuous summative and formative evaluation, aiming at developing methods for effective public health work. Added value Presenting and discussing a digital instrument for planning, documentation and quality assurance will increase the potential for public health efforts to close the health gap. We use it for formative and summative evaluation. For 2018, 222 activity reports were launched and discussed by team members, leading to professional development. Issues for future development included the importance of giving time for shared values to consolidate and trust to emerge. Quantitive goals were reached. Coherence Presentation 1 will clarify why control, power and influence must be taken into consideration in interventions that aim at counteracting health inequity. Presentation 2 will describe the instrument and how it draws on theories of health and critical reflection. Presentation 3 will tell the story of an example from a Swedish dental public health care setting where the instrument has been used and point at strengths and areas for development. Format Presentation 15 minutes each. Followed by short discussions (5 minutes) in the audience who will then be asked to present short inputs on post-it notes that will be collected by the organizers. During the last 30 minutes there will be a general discussion using the post-it notes as starting point. Key messages A digital instrument for planning, documentation and quality assurance, with focus on health equity, will increase the positive impact of public health efforts. Public health interventions that use the instrument will be better equipped to increase health equity.

Tobacco Cessation: Are Oral Cancer Patients Ready for It

Abstract Aims: The objective was to examine the predictors of readiness to quit tobacco among oral potentially malignant disorder (OPMD) and oral cancer (OC) patients in dental health care setting. Settings and Design: Two hundred and seven patients diagnosed with OC or OPMDs comprising 153 males and 54 females, with mean age being 52.2 years, with varying levels of addiction formed the study group. Subjects and Methods: Readiness to quit tobacco as measured by the ladder of change and the single-item readiness question was significantly correlated with measures of perceived risk. Statistical Analysis Used and Results: Pearson’s correlations showed that readiness to quit tobacco was significantly correlated with the participant’s perception of his or her health compared with other tobacco users of the same age (P < 0.005). Readiness to quit was positively correlated with the degree to which participants felt that their oral condition is related to their tobacco use (P < 0.001), how much their general health is affected by tobacco use (P < 0.01), and how much quitting tobacco could influence their health positively (P < 0.001). Post hoc analyses showed that readiness to quit was also significantly and negatively correlated with nicotine addiction (P < 0.001) and decisional balance scores (P < 0.01). Conclusions: There is an urgent need for tobacco risk assessment, intervention, and education with this population of patients, and hence, health professionals can play a significant role in motivating and assisting to quit.

Clinical protocols in dental practice: Post-COVID-19.

The COVID-19 pandemic, still on the growth curve, has had a devastating effect on the dental health sector for the past 3 months. This has become an area of enormous concern for the dentists professionally and the patients in terms of dental health. Dentistry at this point needs a complete structural change to prevent cross-infection among the patients and dentists owing to the unique characteristic of a dental health-care setting as well as to offer a sense of safety and security to the patients. This article highlights the salient points to be considered for the post-COVID phase in dentistry.

Clowning in Dental Health Care Settings: The Point of View of Dental Student

Clowning in Dental Health Care Settings: The Point of View of Dental Student

Occupational risk for Legionella infection among dental healthcare workers: meta-analysis in occupational epidemiology

ObjectiveThe occupational risk for Legionella infection among dental healthcare workers (DHCWs) is conjectured because of the risk of routine inhalation of potentially contaminated aerosols produced by the dental instruments. Nevertheless,...

Interventions for increasing health promotion practices in dental healthcare settings

Reason for withdrawal from publication This protocol of a Cochrane Review was withdrawn from the Cochrane Library as the authors did not have the resources to complete the full review.

Environmental Factors Influencing Adoption of Canadian Guidelines on Smoking Cessation in Dental Healthcare Settings in Quebec: A Qualitative Study of Dentists' Perspectives.

Background: This study aimed to understand dentists’ perspective of the environmental determinants which positively or negatively influence the implementation of Canadian smoking cessation clinical practice guidelines (5As: Ask-Advise-Assess-Assist-Arrange) in private dental clinics in Quebec. Methods: This study used a qualitative design and an integrative conceptual framework composed of three theoretical perspectives. Data collection was conducted in individual semi-directed interviews with 20 private dentists lasting between 35 and 45 min. The audio-recorded data were transcribed verbatim, followed by a directed content analysis. Results: Some of the barriers identified to counselling in smoking cessation were lack of time, patient attitude, lack of prescription of nicotine replacement therapies, lack of reimbursement, and the lack of training of the dental team. Enablers cited by participants were the style of dentist’s leadership, the availability of community, human and material resources, the perception of counselling as a professional duty, and the culture of dental medicine. In addition to these variables, dentists’ attitude and behaviour were affected by different organisations giving initial or continual training to dentists, governmental policies, and the compatibility of Canadian smoking cessation guidelines with the practice of dentistry. Conclusion: Our findings will inform the development of smoking cessation interventions in dental healthcare settings.

Transmission of blood-borne pathogens in US dental health care settings: 2016 update

BackgroundDuring the past decade, investigators have reported transmissions of blood-borne pathogens (BBPs) in dental settings. In this article, the authors describe these transmissions and examine the lapses in infection prevention on the basis of available information. MethodsThe authors reviewed the literature from 2003 through 2015 to identify reports of the transmission of BBPs in dental settings and related lapses in infection prevention efforts, as well as to identify reports of known or suspected health care–associated BBP infections submitted by state health departments to the Centers for Disease Control and Prevention. ResultsThe authors identified 3 published reports whose investigators described the transmission of hepatitis B virus and hepatitis C virus. In 2 of these reports, the investigators described single-transmission events (from 1 patient to another) in outpatient oral surgery practices. The authors of the third report described the possible transmission of hepatitis B virus to 3 patients and 2 dental health care personnel in a large temporary dental clinic. The authors identified lapses in infection prevention practices that occurred during 2 of the investigations; however, the investigators were not always able to link a specific lapse to a transmission event. Examples of lapses included the failure to heat-sterilize handpieces between patients, a lack of training for volunteers on BBPs, and the use of a combination of unsafe injection practices. ConclusionsThe authors found that reports describing the transmission of BBPs in dental settings since 2003 were rare. Failure to adhere to Centers for Disease Control and Prevention recommendations for infection control in dental settings likely led to disease transmission in these cases. Practical ImplicationsThe existence of these reports emphasizes the need to improve dental health care personnel's understanding of the basic principles and implementation of standard precautions through the use of checklists, policies, and practices.

Systemic and oral manifestations of Ebola virus disease

Ebola virus disease is a lethal viral hemorrhagic fever that has been boiling in sub-Saharan Africa since 1970s. Last year, The Ebola virus epidemic that has spread not only mainly in West Africa, but also in locals such as USA, Europe and the Antipodes via infected travelers, was brought up. Human-to-human transmission of Ebola virus disease is known only through direct contact with the blood, secretions, tissues or other bodily fluids, including saliva. Although there has not been reported infection cases in the dental healthcare settings, the fact that the infection of the Ebola virus may be made from human secretions such as saliva suggests that there is a high risk of infection for the Ebola virus of dental healthcare workers. Therefore, it is important dental healthcare workers to identify infection-suspected patients through the oral findings for infection prevention. This article will review the oral signs and symptoms of Ebola virus disease and discuss the pathogenesis, treatment and prevention. Furthermore, Infection control guidelines for oral healthcare workers are also proposed.

An Instrument to Measure Dental Students’ Communication Skills With Patients in Six Specific Circumstances: An Exploratory Factor Analysis

The aim of this study was to explore the internal structure of an instrument assessing dental students' confidence in their ability to communicate with patients in six specific circumstances (anxious, in pain, etc.) using exploratory factor analysis. In a Communication in the Dental Health Care Setting course at a U.S. dental school, second-year dental students in two years (2013 and 2014) responded to the six items on a survey instrument. Of the total 123 students, 122 fully completed the instrument, for a response rate of 99%. Analysis of the results identified a unidimensional scale with regards to patient-specific communication self-efficacy and explained 74% of the total variance. The scale had good internal consistency reflected by high Cronbach's alpha (α=0.929, 95% CI [0.907, 0.947]). These findings suggest the instrument may be a useful tool in assessing the development of patient communication skills in second-year dental students following a course in communication. Further exploration utilizing confirmatory analysis, determining predictive validity, and assessing convergent and discriminant evidence is warranted.

Undiagnosed human immunodeficiency virus-positive patients in a dental health-care setting in Benin City, Nigeria

Background: Barrier to client-initiated voluntary counselling and test. (VCT) which exists in many places in Nigeria creates additional opportunity for provider.initiated VCT. Aim: To determine the prevalence of undiagnosed human immunodeficiency virus (HIV) infection among dental patients in a missionary hospital in Benin City, Edo State, Nigeria. Materials and Methods: This retrospective study was conducted in a Pentecostal missionary hospital in Benin City. The data of interest which included age, gender, occupation, primary reason for dental attendance, primary diagnosis, and HIV status were collected from the case notes with self-designed pro forma. The obtained data were analyzed using IBM SPSS Statistics version 21.0 (IBM Corp., Armonk, NY). Results: Out of the 613 cases assessed, 7 of them were HIV-positive giving a prevalence of 1.14%. The HIV-positive patients were aged between 11 and 50 years. More females (1.5%) than males (0.7%) were HIV-positive. HIV-positive patients were involved in diverse occupations ranging from schooling, business, and clergy to professionals. The patients whose primary reason for dental attendance was toothache had the highest prevalence of HIV and those with primary diagnosis as periodontitis had the highest prevalence of HIV. Conclusion: Data from this study revealed the one out of approximately every 88 patients attending the Dental healthcare setting Clinics in Benin City, Edo State, had undiagnosed HIV.positive status. The affected patients who were more females than male and aged between 11 and 50. years had their major presenting complaints and diagnosis as toothache and periodontitis, respectively. Dental health.care setting may serve as a provider.initiated VCT center for ambulatory patients.

Computerized Tool to Manage Dental Anxiety

Anxiety regarding dental and physical health is a common and potentially distressing problem, for both patients and health care providers. Anxiety has been identified as a barrier to regular dental visits and as an important target for enhancement of oral health–related quality of life. The study aimed to develop and evaluate a computerized cognitive-behavioral therapy dental anxiety intervention that could be easily implemented in dental health care settings. A cognitive-behavioral protocol based on psychoeducation, exposure to feared dental procedures, and cognitive restructuring was developed. A randomized controlled trial was conducted (N = 151) to test its efficacy. Consenting adult dental patients who met inclusion criteria (e.g., high dental anxiety) were randomized to 1 of 2 groups: immediate treatment (n = 74) or a wait-list control (n = 77). Analyses of covariance based on intention-to-treat analyses were used to compare the 2 groups on dental anxiety, fear, avoidance, and overall severity of dental phobia. Baseline scores on these outcomes were entered into the analyses as covariates. Groups were equivalent at baseline but differed at 1-mo follow-up. Both groups showed improvement in outcomes, but analyses of covariance demonstrated significant differences in dental anxiety, fear, avoidance, and overall severity of dental phobia in favor of immediate treatment at the follow-up assessment. Of the patients who met diagnostic criteria for phobia at baseline, fewer patients in the immediate treatment group continued to meet criteria for dental phobia at follow-up as compared with the wait-list group. A new computer-based tool seems to be efficacious in reducing dental anxiety and fear/avoidance of dental procedures. Examination of its effectiveness when administered in dental offices under less controlled conditions is warranted (ClinicalTrials.gov NCT02081365).