Dental Health Care Workers Research Articles

A patient notification exercise following infection control failures in a dental surgery

To investigate the association between treatment by a dental healthcare worker (HCW) and patient infection with a blood-borne virus (BBV). Nested case control study. A patient notification exercise (PNE) arising from a hepatitis C virus positive HCW that was undertaken because of deficiencies in infection control practice. Cases were individuals with a BBV infection identified as a result of the PNE. Controls were randomly selected individuals with negative tests for BBVs. Detailed information on dental treatment was obtained from patient notes. Information on risk factors for BBV infection was obtained using a structured questionnaire administered by telephone interview. Thirty patients had evidence of infection with a BBV. The mean number of visits for treatment was 20.5 in cases and 18.6 in controls; the difference 1.8 (95% CI -5.4 to 9.1) was not statistically significant (p = 0.62). Transmission of hepatitis C in the dental setting was excluded by sequencing of the viral genome or establishing alternative risk factors. There was no evidence of transmission of hepatitis C virus from the HCW to patients, or transmission of a BBV from patient to patient. To ensure consistent practice within the UK the National Institute for Health and Clinical Excellence should produce guidance on PNEs for the NHS.

Attitudes of Irish dental, dental hygiene and dental nursing students and newly qualified practitioners to tobacco use cessation: a national survey

Ireland has some of the strictest smoking regulations in the world. Little is known of the attitudes of student Irish dental healthcare workers towards tobacco control and tobacco use cessation. This study aimed at determining the knowledge and attitudes of these students towards the deleterious effects of tobacco in the mouth and towards tobacco use cessation in dental practice. A questionnaire survey was distributed to 654 students (including newly qualified) on dentistry, dental hygiene and dental nursing programmes in Irish dental schools. Information sought included college, course, year of study, sex, age, nationality, smoking status, knowledge of effects of tobacco in the mouth and attitudes towards tobacco use cessation in dental practice and towards the Irish smoking bans. There was a 90% response rate. In all, 12% of dental students, 25% of dental hygiene students and 31% of dental nursing students were current smokers. Newly qualified dental hygienists were as knowledgeable about tobacco effects in the mouth as newly qualified dentists. Overall, the majority in each student category believed that all three groups could be effective tobacco counsellors and should provide tobacco use cessation counselling to patients, although less than half of evening course dental nursing students felt that dental nurses could be effective counsellors or should provide counselling. There was overwhelming support for the Irish smoking ban. Only a minority of dental students and dental nursing students had received instruction in tobacco use cessation counselling. There are strong positive attitudes to tobacco use cessation counselling in dental practice among these young dental healthcare students. This is true even amongst those who have not received specific instruction in tobacco use cessation counselling.

HCVあるいはHBV感染者における歯科治療時の自己申告調査

We distributed a questionnaire to 209 patients who visited the Digestive Disease Center of Kurume University for liver disease treatment from October 2006 to April 2007 to determine whether patients with hepatitis C virus (HCV) or hepatitis B virus (HBV) disclosed their disease status to dental clinics personnel. We found that 59.8% (125/209) always did so, 12.0% (25/209) sometimes did so, and 28.2% (59/209) never did so. The main reason (71.2%) for nondisclosure was failure of dental healthcare workers to ask whether patients had systemic disease. Other reasons included fear of negative reactions from healthcare workers (11.9%) and not wanting dentists or staff to know their specific liver ailment (10.2%). Men were less likely than women to disclose status for these reasons. It thus cannot be over emphasized that liver disease patients be advised by medical specialists to make known their HCV or HBV status when undergoing dental care. Above all, it is important for dental workers to take standard precautions with all patients to ensure medical safety and to prevent infection in dental practice. The government should take appropriate measures to encourage and support dentists who use precautions to prevent nosocomial infection.

FDI report on adverse reactions to resin-based materials

Resin-based restorative materials are considered safe for the vast majority of dental patients. Although constituent chemicals such as monomers, accelerators and initiators can potentially leach out of cured resin-based materials after placement, adverse reactions to these chemicals are rare and reaction symptoms commonly subside after removal of the materials. Dentists should be aware of the rare possibility that patients could have adverse reactions to constituents of resin-based materials and be vigilant in observing any adverse reactions after restoration placement. Dentists should also be cognisant of patient complaints about adverse reactions that may result from components of resin-based materials. To minimise monomer leaching and any potential risk of dermatological reactions, resin-based materials should be adequately cured. Dental health care workers should avoid direct skin contact with uncured resin-based materials. Latex and vinyl gloves do not provide adequate barrier protection to the monomers in resin-based materials.

Percutaneous injuries among dental professionals in Washington State.

BackgroundPercutaneous exposure incidents facilitate transmission of bloodborne pathogens such as human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV). This study was conducted to identify the circumstances and equipment related to percutaneous injuries among dental professionals.MethodsWe used workers' compensation claims submitted to the Department of Labor and Industries State Fund during a 7-year period (1995 through 2001) in Washington State for this study. We used the statement submitted by the injured worker on the workers' compensation claim form to determine the circumstances surrounding the injury including the type of activity and device involved.ResultsOf a total of 4,695 accepted State Fund percutaneous injury claims by health care workers (HCWs), 924 (20%) were submitted by dental professionals. Out of 924 percutaneous injuries reported by dental professionals 894 (97%) were among dental health care workers in non-hospital settings, including dentists (66, 7%), dental hygienists (61, 18%) and dental assistants (667, 75%). The majority of those reporting were females (638, 71%). Most (781, 87%) of the injuries involved syringes, dental instruments (77, 9%), and suture needles (23%). A large proportion (90%) of injuries occurred in offices and clinics of dentists, while remainder occurred in offices of clinics and of doctors of medicine (9%), and a few in specialty outpatient facilities (1%). Of the 894 dental health care workers with percutaneous injuries, there was evidence of HBV in 6 persons, HCV in 30 persons, HIV in 3 persons and both HBV and HVC (n = 2) exposure.ConclusionOut of hospital percutaneous injuries are a substantial risk to dental health professionals in Washington State. Improved work practices and safer devices are needed to address this risk.

The use of dental radiographs: Update and recommendations

The National Council on Radiation Protection & Measurements updated its recommendations on radiation protection in dentistry in 2003, the Centers for Disease Control and Prevention published its Guidelines for Infection Control in Dental Health-Care Settings in 2003, and the U.S. Food and Drug Administration updated its selection criteria for dental radiographs in 2004. This report summarizes the recommendations presented in these documents and addresses additional topics such as patient selection criteria, film selection for conventional radiographs, collimation, beam filtration, patient protective equipment, film holders, operator protection, film exposure and processing, infection control, quality assurance, image viewing, direct digital radiography and continuing education of dental health care workers who expose radiographs. This report discusses implementation of proper radiographic practices. In addition to these guidelines, dentists should be aware of, and comply with, applicable federal and state regulations. Dentists should weigh the benefits of dental radiographs against the consequences of increasing a patient's exposure to radiation and implement appropriate radiation control procedures.

Book Review

Guidance for the Management of Natural Rubber Latex Allergy in Dental Patients and Dental Healthcare Workers. FGDP(UK) Good Practice Guidelines. By E.A. Field and L.P. Longman. Faculty of General Dental Practitioners, The Royal College of Surgeons of England, London, 2004 (40pp., free to members of FGDP).

Functional Training for Dentistry: An Exercise Prescription for Dental Health Care Personnel

Athlete's Performance, an organization of specialists in the development of athleticism and injury prevention, has analyzed the seated postural demands of dental health care workers for the purpose of developing an exercise protocol appropriate to the dental profession. As with their individualized exercise prescriptions for some of the world's most acclaimed athletes, the conditioning of the torso is the focus of a prescription for exercise when injury prevention is emphasized. An analysis of the seated postural demands common to dental health care workers is the basis for an exercise protocol intended to strengthen the torso and encourage "good" seated posture.

Biomonitoring of titanium, mercury, platinum, rhodium and palladium in dental health care workers

In dentistry, titanium, mercury, platinum, rhodium and palladium are used to produce dental fillings. Therefore, dental workers who apply such materials may be exposed to these metals. The study concerned 40 healthy subjects-20 controls and 20 dental health care workers-to determine serum and urinary levels of the aforementioned metals by inductively coupled plasma mass spectrometry. Mean urinary and serum titanium did not reveal statistically significant differences in the two groups. The very low urinary and serum levels of mercury, platinum, rhodium and palladium prevented us from making a statistical evaluation between the two groups. We did not find a significant increase in serum and urinary titanium levels in dental health care workers. Measurement of mercury, platinum, rhodium and palladium in urine and serum was not useful in determining occupational exposure.

Severe acute respiratory syndrome and dentistry: A retrospective view

BackgroundSevere acute respiratory syndrome, or SARS, which has created panic in Asia and in some parts of North America, is the first epidemic of the new century. Although it has been well-contained, sporadic cases continue to emerge.ObjectivesThe authors trace the emergence of the SARS outbreak from southern China and its spread worldwide, discuss the viral etiology of the infection and its clinical features, and review the infection control guidelines issued during the outbreak by the health authorities in Hong Kong, the Centers for Disease Control and Prevention, the World Health Organization and the American Dental Association. They also review the prospects for a new outbreak and preventive measures.OverviewThe disease, which is caused by a novel coronavirus termed the “SARS coronavirus,” or SARS-CoV, essentially spreads through droplet infection and affects people of any age. It has a mortality rate ranging from 10 to 15 percent. A major hallmark of this disease has been the rate at which it has affected health care workers through nosocomial transmission; in some countries, up to one-fourth to one-third of those infected were in this category. However, no dental health care worker has been affected by SARS in a nosocomial or dental setting.Conclusions and Clinical ImplicationsResearchers believe that a combination of factors, including the universal infection control measures that the dental community has implemented and/or the low degree of viral shedding in the prodromal phase of SARS, may have obviated the spread of the disease in dental settings. The dental community should reflect on this outbreak to reinforce the currently applied infection control measures.

Dentists Can Contribute Expertise in a Major Public Health Disaster

The time for dental professionals to educate themselves to respond to, and assist with, a catastrophic medical disaster is here. California dental healthcare workers must understand the various duties they may be asked to perform if a large-scale disaster were to occur. This article explores the various duties, which may need to be performed in the event of a medical disaster, and the duties a dentist, or dental auxiliary, may be able to complete, with minimal additional training. California dentists must be educated, at minimum, to recognize the symptoms of exposure to biological agents or naturally occurring diseases, such as avian flu and SARs, in their patients. Dentists must be further educated to correctly counsel their patients who exhibit such symptoms. Finally, dentists must alert the appropriate public health authorities of such exposure. California should consider amending the California Dental Practice Act to provide for the expansion of the definition of the practice of dentistry in the event of a declared healthcare emergency. The new definition should, at minimum, allow dentists to administer vaccines and dispense medications at a mass prophylactic distribution site. The definition could be further expanded to allow dentists to perform more complicated or invasive duties in the event of a disaster with large numbers of bodily injuries. In either event, California will also need to provide limited liability to dentists who do participate in emergency situations, similar to the Good Samaritan laws, which currently apply to physicians and surgeons. Dentists and their dental auxiliaries can augment the existing medical professionals, in responding to a declared medical emergency. In order to be ready to respond, dentists and their dental auxiliaries must receive additional training through continuing education courses developed specifically to train them in recognizing symptoms of exposure to biological agents.

Occupational Hazards Among Clinical Dental Staff

Although identification of risks to dental healthcare workers has been explored in several industrialized nations, very little data is available from developing countries. This paper examines the occupational hazards present in the dental environment and reports survey results concerning attitudes and activities of a group of Nigerian dental care providers. A survey on occupational hazards was conducted among the clinical dental staff at the Dental Hospital of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife in Osun State, Nigeria. Thirty eight of the forty staff responded, yielding a response rate of 95%. Subject ages ranged from 26 to 56 years with approximately 25% in the 31-46 year old bracket. All of the staff were aware of the occupational exposure to hazards, and the majority had attended seminars/workshops on the subject. Only five staff members (13.2%) owned a health insurance policy and 26 (68.4%) had been vaccinated against Hepatitis B infection. All dentists (24) had been vaccinated compared with only two non-dentists; this relationship was significant (p= 30.07, chi2=0.000). Fourteen members of the clinical staff (36.8%) could recall a sharp injury in the past six months, and the majority (71.1%) had regular contact with dental amalgam. Wearing protective eye goggles was the least employed cross infection control measure, while backache was the most frequently experienced hazard in 47% of the subjects. The need for Hepatitis B vaccinations for all members of the staff was emphasized, and the enforcement of strict cross infection control measures was recommended. The physical activities and body positions that predispose workers to backaches were identified and staff education on the prevention of backaches was provided.

Hepatitis C infection among dental personnel in the West of Scotland, UK

Hepatitis C virus (HCV) is considered a serious occupational hazard for healthcare workers, particularly those performing exposure-prone procedures. In the UK, the majority of dental procedures are classified as exposure prone. In order to gauge the prevalence and determinants of infection among dental healthcare workers, a voluntary anonymous survey of HCV infection among primary care dental workers employed in the West of Scotland was undertaken, in which occupational and personal risk data were collected in parallel with a blood specimen. The overall prevalence of HCV antibodies was 0.1% (1/880, 95% CI 0–0.6); this is no greater than the estimated prevalence of HCV infection in the local population. Personal risk data collected suggested that the single infection identified was acquired through a non-occupational route. These results suggest that HCV infection is not a major occupational risk for dental healthcare workers.

Provision of hepatitis B vaccination for primary care dental staff in Scotland.

All dental surgeons should be protected from hepatitis B virus (HBV) infection by immunisation, ideally administered and monitored via occupational health services (OHS). This study examined relevant OHS systems in place for dental primary care healthcare workers (DHCW) across all Health Board Areas (HBAs) in Scotland. It also explored the DHCWs' knowledge of, and access to, these systems in three HBAs. Data from senior staff in all Scottish Health Boards and Primary Care Trusts were collected by self-completing questionnaires. Information from DHCWs was collected via telephone interviews with General Dental Practitioners (GDPs) and Community Dental Officers (CDOs) in each of Ayrshire and Arran, Highland and Lothian Health Boards. Thirteen of the 15 HBAs had robust HBV vaccination and monitoring systems. However, only 7/15 (47%) of these covered all DHCWs. Seven HBAs provided vaccination and monitoring for CDOs only, leaving GDPs to undertake these responsibilities for themselves. Of the 105 DHCWs approached, 82 gave an interview. These interviews highlighted major differences between HBAs in relation to access of DHCWs to OHS and indicated that CDOs had greater access than GDPs to OHS. Overall, 31% of DHCWs were not satisfied with the OHS available. In order to safeguard both staff and patients, significant further work is required to ensure that all DHCWs have access to appropriate OHS support for provision and monitoring of immunisation procedures and related functions such as management of sharps injuries.

Prevalence of GBV-C infection among dental personnel.

Healthcare workers who carry out exposure-prone procedures are theoretically at increased risk of acquiring blood-borne virus infections. GB virus C (GBV-C) is a recently described blood-borne virus that is related distantly to hepatitis C virus. The occupational risk of GBV-C infection to healthcare workers is unknown. This study collected detailed occupational and personal risk data in parallel with a blood specimen, to establish the prevalence and determinants of GBV-C infection among dental healthcare workers. The presence of GBV-C antibodies was detected using commercially available ELISA; GBV-C RNA was detected by nested PCR using primers from the conserved 5' noncoding region. The overall prevalence of GBV-C antibodies among the study population was 11.1% (98/880, 95% confidence interval [CI], 9.1-13.4%) and 4.6% were positive for GBV-C RNA (46/879, 95% CI, 2.5-5.1%), resulting in a cumulative prevalence of 15.7%. These figures are similar to those described in other populations. There was no significant difference in lifetime exposure to GBV-C between dentists (17.7%) and dental nurses/hygienists (14.3%). Significantly more dental nurses/hygienists aged 16-30 years had been exposed to GBV-C compared to dentists of the same age (chi(2) = 13.75; P < 0.001). Conversely, significantly more dentists 46 years or older had evidence of exposure to GBV-C compared to dental nurses/hygienists (chi(2) = 6.79; P = 0.009). The high prevalence of GBV-C infection did not seem to be related to past parenteral exposure, and the data suggest that sexual transmission, rather than occupational transmission, was a more important route for GBV-C infection among this population.

Microbial Aerosol Contamination of Dental Healthcare Workers' Faces and Other Surfaces in Dental Practice

The purpose of this study was to focus attention on the need to adopt infection control procedures in dentistry. The quantitative and qualitative bacterial contamination of dental healthcare workers' faces and other surfaces in dental practice was determined. Oral fluids become aerosolized during dentistry and oral microbes have been used as the markers of their spread that may carry blood-borne pathogens.

Re-emergence of tuberculosis and its variants: implications for dentistry

Tuberculosis is one of the deadliest scourges of mankind and, overall, one third of the global population is infected with this mycobacterium or its variants. The advent of the human immunodeficiency virus (HIV) pandemic has accelerated its spread inexorably whilst the multi-drug resistant strains of the bacillus have hampered disease management. Given the alarming spread of the disease, there appears to be a significant potential for occupationally acquired tuberculous infection amongst health care workers, including dental care workers. This review addresses the basic microbiology and the pathogenesis of tuberculosis, its oral manifestations, mycobacteria other than tuberculosis (MOTT), multi-drug resistant tuberculosis (MDR-TB), management including aspects of the global programme on tuberculosis (DOTS programme), the potential for occupationally acquiring the disease and finally, the infection control measures that are available for dental and other health care workers.

An investigation of the effect of prolonged glove wearing on the hand skin health of dental healthcare workers

Objectives. Glove wearing during patient treatment has been central to dental surgery infection control for over 15 years. However, little is known about the cutaneous effects of glove wearing on the hands of dental healthcare workers (DHCWs). The objective of this project was to assess the hand skin health of DHCWs before and after wearing gloves of two types and to compare this with a control group of non-DHCWs. Methods. Following a mailing to all dentists in the West of Scotland, 50 DHCWs who wore gloves during dental treatment procedures for a minimum of 8 h daily for at least 4 days per week were invited to participate in the project. The control group comprised 25 subjects who did not routinely use surgical or examination gloves. Hands were assessed by clinical examination and by transepidermal water loss at baseline, 1 month and 3 months. Results. Of the 50 DHCWs, 26 wore a non-powdered latex glove (Microtouch Powder-free: Johnson and Johnson, Arligton, TX, US), and 24 wore a nitrile glove (Hartalega SDN BHD, Malaysia) from the time of the baseline examination until the 3-month examination. No differences were observed in hand skin health between the control group and the DHCWs at baseline, nor between those wearing the latex or nitrile gloves during the 3 month period of the study. Conclusion. It is concluded that the hand skin health of the DHCWs examined were no different from those of a control group of non-DHCWs, and that the wearing of the two types of gloves used in the 3 month study had no significant effect.

Ergonomics and the Dental Office: An Overview and Consideration of Regulatory Influences

Nearly 2 million workers suffer from musculoskeletal disorders each year. These problems are caused by repetitive, awkward, or stressful motions. Dental health care workers are susceptible to these types of injuries. This article will discuss state and federal programs to control job-related injuries and relate the regulations to dental practice.

Survey of dental hygienists and healthcare workers for microorganisms in the oral cavity.

Over 350 bacterial species are known to form communities on tooth surfaces in the oral cavity, and opportunistic pathogens are frequently isolated from samples taken from the oral cavities of immunocompromised hosts, as well as elderly people with poor oral hygiene. To confirm the correlation between the prevalence of opportunistic pathogens in the oral cavity and oral hygiene, dental plaque and saliva samples from 15 dental hygienists and 15 healthcare workers were investigated. No opportunistic pathogens were found in the samples from dental hygienists, however, they were isolated from 10 of the 15 healthcare workers (66.7%). The total amounts of Streptococcus sp. and Lactobacillus sp. were also significantly higher in the healthcare workers. The amount of Streptococcus mutans was also higher, although the difference was not significant. From our results, we concluded that the prevalence of opportunistic pathogens and cariogenic bacteria in the oral cavity may be reduced by proper oral hygiene measures.