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Ding J, Li J, Qi J, Fu L. Characterization of dental dust particles and their pathogenicity to respiratory system: a narrative review. Clin Oral Investig 2023; 27:1815-1829. [PMID: 36773127 PMCID: PMC9918839 DOI: 10.1007/s00784-023-04910-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES Dental professionals are exposed to large amounts of dust particles during routine treatment and denture processing. This article provides a narrative review to investigate the most prevalent dust-related respiratory diseases among dental professionals and to discuss the effects of dental dust on human respiratory health. MATERIALS AND METHODS A literature search was performed in PubMed/Medline, Web of Science, and Embase for articles published between 1990 and 2022. Any articles on the occupational respiratory health effects of dental dust were included. RESULTS The characterization and toxicity evaluation of dental dust show a correlation between dust exposure and respiratory system injury, and the possible pathogenic mechanism of dust is to cause lung injury and abnormal repair processes. The combination use of personal protective equipment and particle removal devices can effectively reduce the adverse health effects of dust exposure. CONCLUSIONS Dental dust should be considered an additional occupational hazard in dental practice. However, clinical data and scientific evidence on this topic are still scarce. Further research is required to quantify dust in the dental work environment and clarify its pathogenicity and potential toxicological pathways. Nonetheless, the prevention of dust exposure should become a consensus among dental practitioners. CLINICAL RELEVANCE This review provides dental practitioners with a comprehensive understanding and preventive advice on respiratory health problems associated with dust exposure.
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Affiliation(s)
- Jiaxin Ding
- grid.64924.3d0000 0004 1760 5735Hospital of Stomatology, Jilin University, Changchun, China
| | - Junxuan Li
- grid.64924.3d0000 0004 1760 5735Hospital of Stomatology, Jilin University, Changchun, China
| | - Junnan Qi
- grid.64924.3d0000 0004 1760 5735Hospital of Stomatology, Jilin University, Changchun, China
| | - Li Fu
- Department of Oral Implantology, Hospital of Stomatology, Jilin University, 1500 Qinghua Road, Chaoyang District, Changchun, 130021, China.
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Steenen SA, Zeegers MA, van Wijk AJ, Al-Zubaidi S, Jethu-Ramkrishan M, Loddin A, de Lange J, de Jongh A. Dentist Empathic Accuracy Is Associated With Patient-Reported Reassurance. Int Dent J 2022; 73:101-107. [PMID: 35896426 PMCID: PMC9875228 DOI: 10.1016/j.identj.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/02/2022] [Accepted: 06/15/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The aim of this work was to determine dentists' ability to accurately estimate patients' anxiety level during dental treatment (ie, "empathic accuracy") and to determine the strength of the association between empathic accuracy and patient-reported reassurance. METHODS A cross-sectional study was conducted amongst 177 adult patients who underwent different invasive dental procedures (ie, extractions or procedures requiring injections and drilling) performed by 10 different dentists from 3 dental offices in the Netherlands. Patients reported their anxiety level during treatment and the extent to which they felt reassured by the dentist using a visual analogue scale (VAS). Simultaneously, the dentists estimated patients' anxiety level. Empathic accuracy was calculated as an absolute difference between patient-reported anxiety (100-point VAS) and dentist estimation of anxiety (100-point VAS). RESULTS Agreement between dentists' assessment of patients' anxiety and patient-reported anxiety proved good, intraclass correlation coefficient (177) = 0.63; 95% confidence interval [CI], 0.53-0.71. A small to medium-sized positive correlation, r (177) = 0.15; 95% CI, 0.00-0.29, was found between dentists' empathic accuracy and patient-reported reassurance. A negative correlation was found between empathic accuracy and patients' anxiety scores, r (177) = -0.23; 95% CI, -0.38 to -0.09. CONCLUSIONS Given that greater empathic accuracy was associated with higher patient-reported reassurance during treatment, training young dental professionals in empathic accuracy might help patients feel reassured. Importantly, our results also suggest that with elevated levels of patient anxiety it is increasingly challenging for dentists to recognise this emotion, and thus support the patient in anoptimal manner.
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Affiliation(s)
- Serge A. Steenen
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands,Corresponding author. Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, 1105 AZ, Room D2-240, Amsterdam, The Netherlands.
| | - Moniek A.J. Zeegers
- Department of Psychology, Mondium GGz, Clinical Health Center, Beesd, The Netherlands
| | - Arjen J. van Wijk
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Saif Al-Zubaidi
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Minakshi Jethu-Ramkrishan
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Aida Loddin
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ad de Jongh
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Institute of Health and Society, University of Worcester, Worcester, UK,School of Psychology, Queen's University, Belfast, Northern Ireland
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Choi ES, Noh HJ, Chung WG, Mun SJ. Development of a competency for professional oral hygiene care of endotracheally-intubated patients in the intensive care unit: development and validity evidence. BMC Health Serv Res 2021; 21:748. [PMID: 34315462 PMCID: PMC8316100 DOI: 10.1186/s12913-021-06755-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 07/14/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Professional oral care in the intensive care unit may reduce the incidence of Ventilator Associated Pneumonia, which increases the patient's mortality rate. This study aimed to develop a competency for professional oral hygiene care of endotracheally-intubated intensive-care patients. METHODS First, we developed a competency draft by reviewing the literature on oral hygiene care of patients in the intensive care unit. Next, we developed expert validity test questionnaires using this draft and conducted expert validity tests twice on 18 experts. We determined competency as a content validity index of 0.8 or more and received expert additive opinions about competency through an open-questionnaire expert validity test paper in this methodology study. RESULTS The content validity index ranged from 0.8 ~ 1.0 for all items. The competency of 'professionalism' comprised 2 sub-competencies with 7 behavioral indicators. 'POHC preparation' comprised 3 sub-competencies with 10 behavioral indicators. 'POHC implementation' comprised 3 sub-competencies with 6 behavioral indicators. 'POHC evaluation' comprised 2 sub-competencies with 8 behavioral indicators. Lastly 'Cooperation among experts' comprised 3 sub-competencies with 7 behavioral indicatiors. CONCLUSIONS To provide patients with high quality oral hygiene care, these competencies should be implemented, and oral hygiene care professionals and related medical personnel should form a cooperative system.
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Affiliation(s)
- Eun-Sil Choi
- Department of Dental Hygiene, The Graduate School, Yonsei University, Wonju, South Korea
| | - Hie-Jin Noh
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwondo, 26493, Republic of Korea
| | - Won-Gyun Chung
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwondo, 26493, Republic of Korea
| | - So-Jung Mun
- Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, 1 Yonseidae-gil, Wonju, Gangwondo, 26493, Republic of Korea.
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Kottek AM, Hoeft KS, White JM, Simmons K, Mertz EA. Implementing care coordination in a large dental care organization in the United States by upskilling front office personnel. Hum Resour Health 2021; 19:48. [PMID: 33827583 PMCID: PMC8028788 DOI: 10.1186/s12960-021-00593-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Care coordination is a key strategy used to improve health outcomes and efficiency, yet there are limited examples in dentistry. A large dental accountable care organization piloted care coordination by retraining existing administrative staff to coordinate the care of high-risk patients. Following the pilot's success, a formal "dental care advocate" (DCA) role was integrated system-wide. The goal of this new role is to improve care, patient engagement, and health outcomes while integrating staff into the clinical care team. We aim to describe the process of DCA role implementation and assess staff and clinician perceptions about the role pre- and post-implementation. METHODS Guided by the Consolidated Framework for Implementation Research, semi-structured interviews with clinical and operational administrative staff and observation at the company-wide training session were combined with pre- and post-implementation electronic surveys. Descriptive statistics and mean scores were tested for significance between each survey sample (t-tests), and qualitative data were thematically analyzed. RESULTS With preliminary evidence from the pilot and strong executive support, a dedicated leadership team executed a stepwise rollout of the DCA role over 6 months. Success was facilitated by an organizational culture of frequent interventions deployed rapidly through a centralized system, along with supportive buy-in from managerial teams and high staff acceptance and enthusiasm for the DCA role before implementation. Following implementation, significant changes in attitudes and beliefs about the role were measured, though managers held stronger positive impressions than DCAs. DCAs reported high confidence in new skills and dental knowledge post-implementation, including motivational interviewing and the ability to confidently answer patients' questions about their oral health. Overall, the fast-paced implementation of this new role was well received, although consistent and significant differences in mean attitudes between managers and DCAs indicate more work to fine-tune the role is needed. CONCLUSIONS Successful implementation of the new DCA role was facilitated by a strong organizational commitment to team-based dentistry and positive impressions of care coordination among staff and managers. Upskilling existing administrative staff with the necessary training to manage some high-risk patient needs is one method that can be used to implement care coordination efforts in dentistry.
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Affiliation(s)
- Aubri M. Kottek
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
- Healthforce Center at UCSF, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
| | - Kristin S. Hoeft
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
| | - Joel M. White
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
| | - Kristen Simmons
- Willamette Dental Group, P.C., 6950 NE Campus Way, Hillsboro, OR 97124 United States of America
- Skourtes Institute, 6950 NE Campus Way, Hillsboro, OR 97124 United States of America
| | - Elizabeth A. Mertz
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
- Healthforce Center at UCSF, School of Dentistry, University of California, San Francisco, 490 Illinois Street, Floor 11, Box 1242, San Francisco, CA 94143 United States of America
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El-Badry A, Rezk M, El-Sayed H. Mercury-induced Oxidative Stress May Adversely Affect Pregnancy Outcome among Dental Staff: A Cohort Study. Int J Occup Environ Med 2018; 9:113-119. [PMID: 29995016 PMCID: PMC6466979 DOI: 10.15171/ijoem.2018.1181] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/21/2018] [Indexed: 12/04/2022]
Abstract
Background:
Dental staff may be at increased risk of adverse pregnancy outcome secondary to their chronic exposure to mercury.
Objective:
To investigate obstetric outcome among dental staff and explore the oxidative stress induced by mercury exposure.
Methods:
A cohort of 64 pregnant dental staff (exposed group) and 60 pregnant employees (non-exposed group) were studied. Urinary mercury level and blood antioxidant activity were measured. Participants were followed to assess their obstetric outcome.
Results:
The exposed group had a higher mean urinary mercury level and a lower blood antioxidant activity during the three trimesters compared to non-exposed group (p<0.001). Women in the exposed group were experienced more frequently spontaneous abortion and pre-eclampsia (p<0.05). Babies born to the women in the exposed group tended to be smaller for gestational age compared to those of non-exposed group (p<0.001).
Conclusion:
Pregnant dental staff suffered higher odds of developing spontaneous abortion and pre-eclampsia and giving birth to babies smaller for gestational age. This may be linked to oxidative stress induced by exposure to mercury.
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Affiliation(s)
- Aziza El-Badry
- Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
| | - Mohamed Rezk
- Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Hanan El-Sayed
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Barzangi J, Unell L, Skovdahl K, Arnrup K. Knowledge, experiences and attitudes of dental and health care personnel in Sweden towards infant dental enucleation. Eur Arch Paediatr Dent 2018; 19:229-237. [PMID: 29987668 PMCID: PMC6132442 DOI: 10.1007/s40368-018-0351-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 05/14/2018] [Indexed: 11/25/2022]
Abstract
Purpose To examine self-rated knowledge of clinical experiences and attitudes towards the practice of infant dental enucleation among dental and health care personnel in Sweden. Methods A questionnaire survey was performed among 776 licensed dental and health care personnel working in emergency departments, midwifery, child health centres, school health services and public dental health services in 10 Swedish cities. The response rate was 56.2% (n = 436). Results Fewer than a fifth of the respondents reported self-rated knowledge of the practice. Approximately 13% of personnel encountering children professionally believed they had seen subjected patients in their clinical practice. Personnel with self-rated knowledge and clinical experience worked mostly in dental care. Additionally, the personnel had diverging attitudes regarding agreement and disagreement concerning professional responsibility for patients subjected to or at risk of infant dental enucleation. Conclusions The study indicated there is need for increased knowledge about the practice and for clarification of obligatory responsibilities among dental and health care personnel regarding management and prevention of cases of infant dental enucleation.
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Affiliation(s)
- J Barzangi
- Dental Research Department, Public Dental Health Service, Örebro, Region Örebro County, Sweden.
- Specialisttandvårdskliniken, Västmanland Hospital Västerås, Västerås, Region Västmanland County, Sweden.
| | - L Unell
- Dental Research Department, Public Dental Health Service, Örebro, Region Örebro County, Sweden
- School of Health Sciences, Örebro University, Örebro, Sweden
| | - K Skovdahl
- Faculty for Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - K Arnrup
- Dental Research Department, Public Dental Health Service, Örebro, Region Örebro County, Sweden
- School of Health Sciences, Örebro University, Örebro, Sweden
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Gustafsson CH, Östberg AL. Experiences from the Merger of Clinics in the Swedish Public Dental Service - the Employee Perspective. Open Dent J 2017; 11:503-511. [PMID: 29151991 PMCID: PMC5676013 DOI: 10.2174/1874210601711010503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/16/2017] [Accepted: 08/12/2017] [Indexed: 12/05/2022] Open
Abstract
Objectives: The purpose of this study was to investigate the experiences of employees regarding the merger of clinics within the Public Dental Service (PDS), Västra Götaland Region, Sweden. Methods: Employees (dentists, dental hygienists, dental nurses) affected by both administrative and geographical mergers of dental clinics answered a web-based survey about experiences and effects of the merger process (n = 99, 47%). The Swedish short-form version of “The Nordic Questionnaire for Psychological and Social Factors at Work” (QPSNordic), the QPSNordic-34+ was used. Chi-squared tests and logistic regression analyses were used. Results: Two thirds of the participants were aged ≥ 50 years. The respondents stated that the reasons for the merger were often made clear (78%). Satisfaction with and involvement in the merger process received lower scores (45%). Work was often perceived as stressful, irrespective of the merger. Job demands and engagement scored positively, but control at work was given a low score (one fifth stated fairly high or high control). Dentists (OR 5.9; 95%, CI 1.1-32.3), but not dental hygienists (OR 2.8; 95%, CI 0.9-9.0), indicated stress significantly more often than dental nurses (reference) (adjusted for age and gender). Conclusion: Employees in the Public Dental Service (PDS) in a Swedish region had mainly positive experiences after the merger of clinics; however, their involvement in the process was low. Work demands were perceived as high. These findings should be considered when planning mergers in dental organizations.
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Affiliation(s)
| | - Anna-Lena Östberg
- Public Dental Service, Västra Götaland, Sweden.,Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,R&D Centre Skaraborg, Skövde, Sweden
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Deinzer R, Schmidt R, Harnacke D, Meyle J, Ziebolz D, Hoffmann T, Wöstmann B. Finding an upper limit of what might be achievable by patients: oral cleanliness in dental professionals after self-performed manual oral hygiene. Clin Oral Investig 2017; 22:839-846. [PMID: 28676902 DOI: 10.1007/s00784-017-2160-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/20/2017] [Indexed: 01/22/2023]
Abstract
AIMS Though patients have been shown to have difficulties in achieving oral cleanliness after self-performed oral hygiene, scientifically and empirically justified standards for the degree of oral cleanliness they should achieve are lacking. Oral cleanliness of dental staff was therefore assessed as an indicator of what might be an upper limit of what can be expected by patients. MATERIALS AND METHODS In a multicentre study, N = 64 university dentists, N = 33 dental students and N = 30 dental assistants were asked to perform manual oral hygiene to the best of their abilities. The presence or absence of dental plaque adjacent to gingival margins was assessed by the marginal plaque index (MPI). As full-crown index, the Turesky modification of the Quigley and Hein Index (QHIm) was applied. RESULTS Only three participants showed papillary bleeding and only one a clinical pocket depth of more than 3.5 mm. After self-performed oral hygiene, no differences between groups were observed with respect to plaque nor did results differ between those who habitually used a powered toothbrush only and those who did not. Most participants (96%) achieved oral cleanliness at more than 70% of their gingival margins and QHIm levels below .63. Half of the participants showed QHIm levels below .17 and oral cleanliness at 96% of gingival margins. CONCLUSIONS AND CLINICAL RELEVANCE Considering that half of the dental professionals achieved oral cleanliness at 96% of gingival margins and QHIm levels below .17 after thorough oral hygiene, this might reflect an upper limit of what can be expected by patients.
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Affiliation(s)
- Renate Deinzer
- Institute of Medical Psychology, Justus-Liebig-University, Giessen, Germany.
| | - René Schmidt
- Institute of Medical Psychology, Justus-Liebig-University, Giessen, Germany
| | - Daniela Harnacke
- Institute of Medical Psychology, Justus-Liebig-University, Giessen, Germany
| | - Jörg Meyle
- Department of Periodontology, Justus-Liebig-University, Giessen, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Thomas Hoffmann
- Department of Periodontology, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Bernd Wöstmann
- Policlinic of Prosthetics, Justus-Liebig-University, Giessen, Germany
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Bhayat A, Jarab F, Mansuri S, Ahmad MS, Mahrous MS. Assessment of knowledge of dental staff at a saudi arabian university regarding the prophylaxis for infective endocarditis. Open Dent J 2013; 7:82-7. [PMID: 23986793 PMCID: PMC3750974 DOI: 10.2174/1874210601307010082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 04/27/2013] [Accepted: 04/30/2013] [Indexed: 01/24/2023] Open
Abstract
The use of prophylactic antibiotics for the prevention of infective endocarditis following dental procedures has long been debated and there is still confusion regarding its efficacy. As a result, the prophylactic treatment varies considerably amongst different countries across the world and amongst different dental practitioners.
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Affiliation(s)
- Ahmed Bhayat
- College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia
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Abstract
Dental professionals are predisposed to a number of occupational hazards. These include exposure to infections (including Human Immunodeficiency Virus and viral hepatitis); percutaneous exposure incidents, dental materials, radiation, and noise; musculoskeletal disorders; psychological problems and dermatitis; respiratory disorders; and eye insults. Percutaneous exposure incidents remain a main concern, as exposure to serious infectious agents is a virtual risk. Minimizing percutaneous exposure incidents and their consequences should continue to be considered, including sound infection control practices, continuing education, and hepatitis B vaccination. Basically, for any infection control strategies, dentists should be aware of individual protective measures and appropriate sterilization or other high-level disinfection utilities. Strained posture at work disturbs the musculoskeletal alignment and leads to stooped spine. The stooped posture also involved certain groups of muscles and joints. This may lead to diseases of the musculoskeletal system. Continuous educating and appropriate intervention studies are needed to reduce the complication of these hazards. So, it is important for dentists to remain constantly up-to-date about measures on how to deal with newer strategies and dental materials, and implicates the need for special medical care for this professional group.
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