Risk of hepatitis B virus transmission via dental handpieces and evaluation of an anti-suction device for prevention of transmission

Efficiency of a high-speed handpiece with anti-retraction adapter to minimize cross-contamination during the routine dental procedure: A clinical study

Background

This study aimed to detect the efficiency of anti-retraction adapter (ARA) attached to a handpiece (HP).

Materials and Methods

Two types of dental HP with and without the ARA were used in this study. A total of 30 sets of samples were obtained from two groups and were subjected to a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) and microbial culture for quantitative analysis of total bacterial and Legionella count.

Statistical Analysis Used

The data obtained were tabulated using the Statistical Package for the Social Sciences (SPSS, IBM version 26.0) for statistical analysis.

Results

The water samples were analyzed using PCR, Legionella-specific PCR, and culture-based analysis. In Groups 1 and 2, there was no significant difference between bacterial load in the water samples taken from both HP and coupling of the Dental Unit Waterline (DUWL).

Conclusions

The reduction in bacterial load in DUWLs analyzed using quantitative RT-PCR was similar in both experimental groups. Overall, the bacterial load was lower in the group with ARA when compared to the group without ARA but not statistically significant. ARA was not effective in reducing the Legionella species load in DUWLs.

Coronavirus disease (COVID-19) transmission through aerosols in restorative and endodontic practice: Strategies for prevention

Rapid spread of coronavirus disease 2019 (COVID-19) in several countries of the world has created a state of public health emergency. COVID-19 is principally a respiratory disease, and the virus is present in respiratory secretions. Oral health-care professionals are susceptible to being infected with the disease since they work in close proximity to patient's face and oral cavity for long period of time. Restorative dentists and endodontists play a significant role in delivering "urgent" or "emergency" dental care to patients. Occupational Safety and Health Administration has categorized dentists performing aerosol-generating treatment procedures at "very high exposure risk" whereas the dentists not performing aerosol-generating procedures at "high exposure risk." Most of the restorative and endodontic treatment procedures involve generation of aerosols. Owing to the possibility of transmission of virus through aerosols, these procedures may transmit the disease to clinician or other patients. A comprehensive search of literature was conducted with the help of PubMed/MEDLINE and Scopus databases using a combination of terms, "COVID-19," "severe acute respiratory syndrome coronavirus 2," "aerosols," "restorative dentistry," and "endodontics." Along with universal precautions, some additional precautions need to be taken to prevent such transmission and cross-infection. This article reviews the research evidence about the role of aerosols in the transmission of COVID-19 and various measures which should be implemented during restorative and endodontic practice for the prevention of such transmission.

Knowledge and Apprehension of Dental Health Professionals Pertaining to COVID in Southern India: A Questionnaire Study

Aim:

This study was intended to evaluate the knowledge and apprehension of dental health professionals pertaining to COVID-19.

Materials and Methods:

In this cross-sectional survey, a self-administered questionnaire survey was used to validate the dental health professional's knowledge and apprehension pertaining to COVID-19. In this regard, a preliminary study with a convenience sample of 124 dentists working in various clinics in southern India was conducted so as to evaluate the knowledge and apprehension of dentists related to COVID-19 in India. This study, while limited in sample size, benefits the general practitioners as target readers to assess the awareness pertaining to COVID-19.

Results:

The results of this study reveal that there exists a good knowledge among dental health professionals pertaining to the COVID-19 virus and its oral manifestations in addition to the precautions to be taken for the prevention of COVID-19 in a clinical setup. However, there exists an apprehension as well as lack of awareness pertaining to the laboratory test to be carried out in a patient suspected with COVID-19 infections as well as the role of a mouthwash and the management of contaminated air in the dental clinic.

Conclusion:

The results elicited that there is a dearth of knowledge and relatively a fair apprehension among dental health professionals pertaining to COVID-19.

Dentistry and the COVID-19 Outbreak

INTRODUCTION

Infection prevention in dental practice is a principle of utmost importance aiming to protect patients, the dental team, and ultimately, public health. The recent pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has instigated worldwide public concern. This highly contagious disease has called for profound changes in patient care around the world. The goal of this article is to review the current literature and introduce essential knowledge about COVID-19, recommend management protocols and adequate protection for dental professionals during the outbreak.

MATERIAL AND METHODS

The literature search was conducted from April to June 2020. After full-text screening a total of 85 studies were included.

RESULTS

Given the novelty of SARS-CoV-2, some characteristics of the virus remain yet unknown. The virus is aerosol-transmissible and, because of the nature of dental procedures, this puts dental professionals and patients at a high risk of contamination by this pathogen. Adequate management protocols and specific protective approaches are essential to minimise the spread of COVID-19 in dental settings during the outbreak.

DISCUSSION

The overall impact of COVID-19 in health care worldwide is yet to be determined. This constitutes a significant limitation to this review because the information obtained risks being outdated as the pandemic progresses. The prudent practitioner will use this review as a starting point and continue to proactively update themselves as the outbreak continues. Further studies are required to investigate the potential impact of infections with SARS-CoV-2 within dental settings.

Challenges, limitations, and solutions for orthodontists during the coronavirus pandemic: A review

INTRODUCTION

Orthodontic patients worldwide missed appointments during the early months of the coronavirus disease 2019 (COVID-19) pandemic. A significant problem with this virus is its high transmission power. Asymptomatic patients can transmit the virus. The aim of this review is to examine orthodontic emergencies and the necessary strategies and measures for emergency and nonemergency treatment during the coronavirus pandemic.

METHODS

The following databases were comprehensively searched: PubMed, MEDLINE, Scopus, and Google Scholar. Up-to-date data released by major health organizations such as the World Health Organization and major orthodontic associations involved in the pandemic were also evaluated.

RESULTS

Few studies were conducted on managing orthodontic offices or clinics during the pandemic, and most are not of high quality. Appropriate communication is the most important issue in managing orthodontic patients, particularly virtual counseling. Many orthodontic emergencies can be managed in this way by patients themselves. Most studies recommend using the filtering facepiece 2 masks, equivalent to N95 masks for non-COVID-19 patients undergoing aerosol-generating procedures and all suspected or confirmed COVID-19 patients in orthodontic visits.

CONCLUSIONS

At this time, there are no definitive clinical protocols supported by robust evidence for orthodontic practice during the COVID-19 pandemic. Orthodontists should not rush to return to routine orthodontic work and should follow state guidelines. Nonemergency orthodontic visits should be suspended during the severe acute respiratory syndrome coronavirus 2 pandemic in high-risk areas. Resuming orthodontic procedures during the pandemic requires paying special attention to screening, performing maximum efforts to reduce aerosol generation, using appropriate personal protective equipment, having proper ventilation, and fully adhering to sterilization and disinfection principles.

Being a front-line dentist during the Covid-19 pandemic: a literature review

Coronavirus is an enveloped virus with positive-sense single-stranded RNA. Coronavirus infection in humans mainly affects the upper respiratory tract and to a lesser extent the gastrointestinal tract. Clinical symptoms of coronavirus infections can range from relatively mild (similar to the common cold) to severe (bronchitis, pneumonia, and renal involvement). The disease caused by the 2019 novel coronavirus (2019-nCoV) was called Covid-19 by the World Health Organization in February 2020. Face-to-face communication and consistent exposure to body fluids such as blood and saliva predispose dental care workers at serious risk for 2019-nCoV infection. As demonstrated by the recent coronavirus outbreak, information is not enough. During dental practice, blood and saliva can be scattered. Accordingly, dental practice can be a potential risk for dental staff, and there is a high risk of cross-infection. This article addresses all information collected to date on the virus, in accordance with the guidelines of international health care institutions, and provides a comprehensive protocol for managing possible exposure to patients or those suspected of having coronavirus.

Pivoting Dental Practice Management during the COVID-19 Pandemic-A Systematic Review

Background and Objectives: The aims of this systematic review were to identify additional infection control measures implemented in dental practice globally to prevent cross-infection and evaluate the psychological impacts of the pandemic among dental professionals. Materials and Methods: A sequential systematic literature search was conducted from December 2019 to 30 April 2020 through PubMed, CINAHL, Scopus, Google Scholar, Embase, and Web of Science databases. The search yielded the following results: "COVID-19" (n = 12,137), "Novel corona virus" (n = 63), "COVID-19 and dentistry" (n = 46), "COVID-19 and oral health" (n = 41), "Novel Corona virus and Dentistry" (n = 0), "dental health and Novel Coronavirus" (n = 26), and "dental practice and Novel Coronavirus" (n = 6). Results: After a careful review and eliminating articles based on inclusion and exclusion criteria, the final review included 13 articles. Management of infection control is discussed extensively in the literature and remains the main theme of many Coronavirus Disease 2019 (COVID-19) articles on dentistry. Telephone triage using a questionnaire, hand hygiene, personal protective equipment (PPE) for clinical and nonclinical staff, a preprocedural mouth rinse, and aerosol management have been discussed and implemented in few countries. Three studies recommended that elective treatments for patients with a temperature of >100.4 F or 38 °C should be postponed or performed in an airborne infection isolation room (AIIR) or negative-pressure room. Limiting the number of patients in the waiting area, the removal of shared objects, proper ventilation, and physical distancing were highly recommended. Psychological distress among dental professionals in relation to existing medical conditions and self-efficacy has been discussed. Conclusions: Although the COVID-19 pandemic has had a substantial impact on the dental profession worldwide, our review highlights many practice management approaches to adopt the new norm. More research highlighting evidence-based safety practices and multisectoral collaboration is required to help dental professionals make informed decisions and make the profession safe, both for the patient and dental professionals.

Proposal for a provisional protocol for the care and identification of dental transmission routes of COVID-19 in Latin America: A Literature review

BACKGROUND

The new coronavirus called COVID-19 originated in the city of Wuhan, China and has currently spread to different continents, leading the World Health Organization (WHO) to declare a "pandemic". Therefore, the aim of this review was to present a new proposal for a care protocol in Peruvian Dentistry: Provisional review of the diagnosis, treatment, epidemiological characteristics, routes of transmission and recommendations of COVID-19.

MATERIAL AND METHODS

A search of digital scientific literature was made in the databases: Science Direct, Pubmed and Google Scholar. The Boolean operators AND, OR and NOT: "Covid-19" "Dental" "Routes of transmission. They were included Scientific articles published in English between December 2019 - March 2020.

RESULTS

Different studies were found mainly of epidemiological, observational and experimental design. On March 6, 2020, the President of the Republic of Peru confirmed and declared in Peru the beginning of the first case of coronavirus. According to reports from the Ministry of Health (MINSA) as of July 30, there are: PCR (+) 108, 299; Rapid test (+) 292, 384 positive cases and 18, 816 deceased with a lethality of 4.7%.

CONCLUSIONS

Within the limitations of this literature review, the presence of the virus is inevitable in dental practice. The dentist must understand the evolution of this microorganism like all vulnerable professionals in the health sciences. Key words:COVID-19, dentistry, Peru, protocol, routes of transmission.

A five-step risk management process for geriatric dental practice during SARS-CoV-2 pandemic

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an RNA virus that causes coronavirus infection (COVID-19). COVID-19 is a highly contagious disease transmitted through respiratory droplets, saliva and other contact routes. Within 10 months of its outbreak, SARS-CoV-2 has infected more than 23 million people around the world. Evidence suggests that older adults are the most vulnerable to infection and have an increased risk of mortality. Reduced immunity and underlying medical conditions make them risk-prone and vulnerable to critical care. Older adults affected with the SARS-CoV-2 virus present with distinct clinical manifestations necessitating specific treatment needs and management protocols. While it is crucial to prevent the spread of novel coronavirus (2019-nCoV), the role of oral healthcare workers in addressing the specific needs of ageing adult patients by adopting specific guidelines and appropriate infection control protocols is timely. This paper aims to develop specific guidelines and protocols for the dental management of geriatric patients during the COVID-19 pandemic.

Dental care management during the COVID-19 outbreak

Aim

The level of preparedness of the healthcare system plays an important role in management of coronavirus disease 2019 (COVID‐19). This study attempted to devise a comprehensive protocol regarding dental care during the COVID‐19 outbreak.

Methods and result

Embase, PubMed, and Google Scholar were searched until March 2020 for relevant papers. Sixteen English papers were enrolled to answer questions about procedures that are allowed to perform during the COVID‐19 outbreak, patients who are in priority to receive dental care services, the conditions and necessities for patient admission, waiting room and operatory room, and personal protective equipment (PPE) that is necessary for dental clinicians and the office staff.

Conclusion

Dental treatment should be limited to patients with urgent or emergency situation. By screening questionnaires for COVID‐19, patients are divided into three groups of (a) apparently healthy, (b) suspected for COVID‐19, and (c) confirmed for COVID‐19. Separate waiting and operating rooms should be assigned to each group of patients to minimize the risk of disease transmission. All groups should be treated with the same protective measures with regard to PPE for the dental clinicians and staff.

Control of SARS-CoV-2 transmission in orthodontic practice

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has attracted worldwide concerns because of its high person-to-person infectivity and lethality, and it was labeled as a pandemic as the rapid increase in the number of confirmed patients in most areas around the world became evident. The SARS-CoV-2 is mainly transmitted through respiratory droplets and close contact. There is also evidence of transmission through aerosols and digestive tracts. Because orthodontic treatment involves a large population who need routine return-visits, it was significantly affected and suspended because of the COVID-19 pandemic and the shutdown of the dental clinics and hospitals. Although the spread of COVID-19 has been effectively controlled in China, and many areas have gradually resumed work and classes, orthodontic participants are still under high risks of SARS-CoV-2 infection. This is due to the fact that the asymptomatic carriers of SARS-CoV-2 or patients in the incubation period may cause the cross-infection between orthodontic practitioners and patients. The close proximity between the practitioners and the patients, and the generation of droplets and aerosols that contain saliva and blood during treatment further increase the risks of transmission. In this article, we summarized the preventive strategies for control of SARS-CoV-2 transmission to protect both staff and patients during the orthodontic practice.

Infection Control in Dental Practice During the COVID-19 Pandemic

COVID-19 is the disease supported by SARS-CoV-2 infection, which causes a severe form of pneumonia. Due to the pathophysiological characteristics of the COVID-19 syndrome, the particular transmissibility of SARS-CoV-2, and the high globalization of our era, the epidemic emergency from China has spread rapidly all over the world. Human-to-human transmission seems to occur mainly through close contact with symptomatic people affected by COVID-19, and the main way of contagion is via the inhalation of respiratory droplets, for example when patients talk, sneeze or cough. The ability of the virus to survive outside living organisms, in aerosol or on fomites has also been recognized. The dental practitioners are particularly exposed to a high risk of SARS-CoV-2 infection because they cannot always respect the interpersonal distance of more than a meter and are exposed to saliva, blood, and other body fluids during surgical procedures. Moreover, many dental surgeries can generate aerosol, and the risk of airborne infection is to be considered higher. The aim of this paper is to provide practical advice for dentists based on the recent literature, which may be useful in reducing the risk of spreading COVID-19 during clinical practice.

Saliva is a non-negligible factor in the spread of COVID-19

SARS‐CoV‐2, a novel emerging coronavirus, has caused severe disease (COVID‐19), and rapidly spread worldwide since the beginning of 2020. SARS‐CoV‐2 mainly spreads by coughing, sneezing, droplet inhalation, and contact. SARS‐CoV‐2 has been detected in saliva samples, making saliva a potential transmission route for COVID‐19. The participants in dental practice confront a particular risk of SARS‐CoV‐2 infection due to close contact with the patients and potential exposure to saliva‐contaminated droplets and aerosols generated during dental procedures. In addition, saliva‐contaminated surfaces could lead to potential cross‐infection. Hence, the control of saliva‐related transmission in the dental clinic is critical, particularly in the epidemic period of COVID‐19. Based on our experience of the COVID‐19 epidemic, some protective measures that can help reduce the risk of saliva‐related transmission are suggested, in order to avoid the potential spread of SARS‐CoV‐2 among patients, visitors, and dental practitioners.

Novel Coronavirus (COVID-19) and Dentistry-A Comprehensive Review of Literature

The novel coronavirus (COVID-19) pandemic has become a real challenge for healthcare providers around the world and has significantly affected the dental professionals in practices, universities and research institutions. The aim of this article was to review the available literature on the relevant aspects of dentistry in relation to COVID-19 and to discuss potential impacts of COVID-19 outbreak on clinical dentistry, dental education and research. Although the coronavirus pandemic has caused many difficulties for provision of clinical dentistry, there would be an opportunity for the dental educators to modernize their teaching approaches using novel digital concepts in teaching of clinical skills and by enhancement of online communication and learning platforms. This pandemic has also highlighted some of the major gaps in dental research and the need for new relevant knowledge to manage the current crisis and minimize the impact of such outbreaks on dentistry in the future. In conclusion, COVID-19 has had many immediate complications for dentistry of which some may have further long-term impacts on clinical practice, dental education and dental research.

Awareness and Practices of Dental Students and Dentists Regarding Infection Control in Prosthodontic Clinics

Background:

Patient safety is a priority for achieving higher quality health care standards and human error> reduction.

Objective:

The aim of this study was to evaluate the level of appropriate infection control practices in a prosthodontic clinic in Jeddah, Saudi Arabia.

Methods:

This cross-sectional study included 460 dental students and dentists recruited from five centers. Data were collected by self-administered questionnaires> composed of 25 questions. The questionnaires> assessed infection control practices in prosthodontic clinics, including wearable barriers, disinfection measures among patients, disinfection of laboratory submissions, and proper infection control. Other questions assessed sources of knowledge, self-evaluation of knowledge, implementation, and satisfaction with knowledge application.

Results:

Total correct answers for proper practice (16 questions) had a mean of 12.5 with a standard deviation of 2.8. The most commonly practiced procedure was wearing a mask (99.8%) and the least was sterilizing the facebow before its use by the patient (53.7%). Participants from governmental colleges (m = 13.67, SD = 2.17) had significantly higher scores than participants from private colleges (m = 12.35, SD = 2.9),p<0.001. Only 2.8% had never attended a lecture, and only 13.8% had never had hands-on training for infection control. Despite 49.1% evaluating themselves as having very poor to poor knowledge, 90.7% had fair to very good valuation of their infection control implementations, and 87.6% were satisfied with their knowledge and performance levels.

Conclusion:

Dental students and dentists have high levels of adequate infection control practices in the prosthodontic clinic despite the moderate level of their satisfaction with their knowledge.

Transmission routes of 2019-nCoV and controls in dental practice

A novel β-coronavirus (2019-nCoV) caused severe and even fetal pneumonia explored in a seafood market of Wuhan city, Hubei province, China, and rapidly spread to other provinces of China and other countries. The 2019-nCoV was different from SARS-CoV, but shared the same host receptor the human angiotensin-converting enzyme 2 (ACE2). The natural host of 2019-nCoV may be the bat Rhinolophus affinis as 2019-nCoV showed 96.2% of whole-genome identity to BatCoV RaTG13. The person-to-person transmission routes of 2019-nCoV included direct transmission, such as cough, sneeze, droplet inhalation transmission, and contact transmission, such as the contact with oral, nasal, and eye mucous membranes. 2019-nCoV can also be transmitted through the saliva, and the fetal-oral routes may also be a potential person-to-person transmission route. The participants in dental practice expose to tremendous risk of 2019-nCoV infection due to the face-to-face communication and the exposure to saliva, blood, and other body fluids, and the handling of sharp instruments. Dental professionals play great roles in preventing the transmission of 2019-nCoV. Here we recommend the infection control measures during dental practice to block the person-to-person transmission routes in dental clinics and hospitals.

Biofouling of surgical power tools during routine use

Surgical power tools (SPTs) are frequently used in many surgical specialties such as dentistry, orthopaedics, ophthalmology, neurology, and podiatry. They have complex designs that may restrict access to cleaning and sterilization agents and frequently become contaminated with microbial and tissue residues following use. Due to these challenges, surgical power tools can be considered the weak link in the decontamination cycle and present a potential for iatrogenic transmission of infection. We aimed to review the existing literature on the decontamination of surgical power tools and associated iatrogenic transmission of infection. A search of the medical literature was performed using Ovid online using the following databases: Ovid Medline 1950-2014, Embase 1980-2014, and EBM Reviews Full Text--Cochrane DSR, ACP Journal Club, and Dare. Despite challenges to decontamination processes, reported episodes of iatrogenic infection directly linked to SPTs appear rare. This may reflect a true picture but more likely represents incomplete reporting, failure to investigate power tools, or lack of surveillance linking surgical site infections (SSIs) to power tools. Healthcare professionals should be aware of the complexities associated with the decontamination of different SPTs, and should review manufacturers' reprocessing instructions prior to purchase. More clarity is required in the manufacturers' validation of these reprocessing instructions. This particularly applies to the emerging surgical robot systems that present extreme challenges to decontamination between uses. Investigation of cross-infection incidents or SSI surveillance should include an element of assessment of SPT decontamination to further elucidate the contribution of SPTs to skin and soft tissue infections.

Impact of vaginal-rectal ultrasound examinations with covered and low-level disinfected transducers on infectious transmissions in france

BACKGROUND

The risk of cross-infection from shared ultrasound probes in endorectal and vaginal ultrasonography due to low-level disinfection (LLD) is difficult to estimate because potential infections are also sexually transmitted diseases, and route of contamination is often difficult to establish. In France, the widely used standard for prevention of infections is through the use of probe covers and LLD of the ultrasound transducer by disinfectant wipes. We performed an in silico simulation based on a systematic review to estimate the number of patients infected after endorectal or vaginal ultrasonography examination using LLD for probes.

STUDY DESIGN

We performed a stochastic Monte Carlo computer simulation to produce hypothetical cohorts for a population of 4 million annual ultrasound examinations performed in France, and we estimated the number of infected patients for human immunodeficiency virus (HIV), herpes simplex virus, hepatitis B virus, hepatitis C virus, human papilloma virus, cytomegalovirus, and Chlamydia trachomatis. Modeling parameters were estimated by meta-analysis when possible.

RESULTS

The probability of infection from a contaminated probe ranged from 1% to 6%, depending on the pathogen. For cases of HIV infection, this would result in approximately 60 infected patients per year. For other common viral infections, the number of new cases ranged from 1,600 to 15,000 per year that could be attributable directly to ultrasound and LLD procedures.

CONCLUSIONS

Our simulation results showed that, despite cumulative use of probe cover and LLD, there were still some cases of de novo infection that may be attributable to ultrasound procedures. These cases are preventable by reviewing the currently used LLD and/or upgrading LLD to high-level disinfection, as recommended by the US Centers for Disease Control and Prevention.

Microbial contamination of used dental handpieces

Microbial contamination of used, unprocessed internal components of dental handpieces (HPs) was assessed. HPs were dismantled aseptically, immersed in phosphate-buffered saline, ultrasonicated, and cultured. A median of 200 CFU per turbine (n = 40), 400 CFU per spray channel (n = 40), and 1000 CFU per item of surgical gear (n = 20) was detected. Isolates included oral streptococci, Pseudomonas spp, and Staphylococcus aureus. Recovery of S aureus confirms the need for appropriate HP cleaning and sterilization after each patient to prevent cross-infection.

Dental handpiece contamination: a proteomics and surface analysis approach

Dental handpieces (DHPs) become biofouled internally with patient derived material that is difficult to access for removal and inactivation. This study undertook a quantitative and qualitative investigation of protein contamination of internal components from three different types of DHP: the turbine, slow speed contra-angle and surgical. Eluates from the high speed turbine, low speed spray channels and surgical gear were assayed for protein using an orthophthaldehyde assay. Eluates concentrated by Amicon ultrafiltration were also analysed by SDS-PAGE, mass spectroscopy, Western blotting and ELISA. The surfaces of handpiece components were also investigated by SEM, EFSCAN and EDAX microscopy. Surgical gears contained highest levels of protein (403 μg), followed by low speed spray channels (17.7 μg) and the high speed turbine (<5 μg). Mass spectroscopy of surgical gears demonstrated mostly serum derived proteins. Decontamination of the DHPs using an automated washer disinfector and handpiece irrigator showed a significant reduction in residual protein levels.

Development of a validated process for manual preparation of dental transmission instruments

The goal of the study was to develop a validated manual preparation process that conforms to the requirements of validation guidelines. Twelve dental transmission devices from various manufacturers (turbines, handpieces, and contra-angle handpieces) were artificially contaminated with bovine hemoglobin for the test. Ten microliters (corresponding to 800 μg) of bovine hemoglobin solution (concentration 80 mg/ml) was pipetted into the spray water and spray air channels. The manual preparation was conducted by blowing air through the spray channels of the transmission instruments through an attachment to a treatment unit (model 1060T, KaVo, Biberach, Germany) for 5 s. The spray channels were cleaned with WL-Clean (Alpro, Georgen, Germany) as directed by the manufacturer. The spray channels were disinfected with WL-Cid (Alpro) and the spray channels were blow-dried with WL-Dry (Alpro) at the end of the exposure time as directed by the manufacturer. To determine the protein content (protein residue analysis) in the channels of the transmission instruments, 2 ml of an alkaline SDS solution (1%; pH 11) was flushed through the channels. For the quantitative protein residue analysis, the Biuret method was used as described in DIN EN 15883-1:2006. After the application of this method, all results of the protein residue analysis were within the acceptance criteria of the validation guideline. The newly developed manual preparation process is therefore confirmed as suitable from a hygienic viewpoint for preparation of transmission instruments in the dental practice.

Italian multicenter study on infection hazards during dental practice: control of environmental microbial contamination in public dental surgeries

Background

The present study assessed microbial contamination in Italian dental surgeries.

Methods

An evaluation of water, air and surface microbial contamination in 102 dental units was carried out in eight Italian cities.

Results

The findings showed water microbial contamination in all the dental surgeries; the proportion of water samples with microbial levels above those recommended decreased during working. With regard to Legionella spp., the proportion of positive samples was 33.3%. During work activity, the index of microbial air contamination (IMA) increased. The level of microbial accumulation on examined surfaces did not change over time.

Conclusion

These findings confirm that some Italian dental surgeries show high biocontamination, as in other European Countries, which highlights the risk of occupational exposure and the need to apply effective measures to reduce microbial loads.