California Infection Control Regulations for Dental Professionals

Infection control regulations that affect dental professionals come from several regulatory agencies and are increasingly complex. Staying up to date on changes and the overlapping requirements can challenge a busy dental practice. This article reviews the current regulations in California and suggests methods for ensuring every dental office is in compliance.

Knowledge and attitudes about HIV/AIDS of students in H.P. Government Dental College and Hospital, Shimla, India

The purpose of this cross-sectional survey was to assess the knowledge and attitudes towards patients with HIV/AIDS among dental students in H.P. Government Dental College, Shimla, India. In November 2011, a survey was conducted of all the dental students of the college using a forty-five-item, self-administered questionnaire. The total mean knowledge score was 68.3 percent (good knowledge). The mean knowledge score was statistically higher in the clinical group than in the preclinical group. A majority of the students were aware of the association between HIV and oral candidiasis (89.1 percent), major aphthous (83.2 percent), and Kaposi's sarcoma (68.9 percent). Only 4.9 percent had professional attitudes about treating patients with HIV/AIDS. Male students had significantly fewer negative attitudes and higher positive attitudes than female students. The overall attitude score was significantly higher in the clinical group than in the preclinical group. Although a majority of the students had good knowledge, there were some inadequacies in their knowledge; those were more frequently seen in the preclinical students. It is important that dental students, as future dentists, develop not only the necessary practical skills but also knowledge and attitudes that will prepare them to treat patients with HIV/AIDS.

Health considerations for oral piercing and the policies that influence them

With the increase in popularity of piercings, the health care professional needs to be aware of the complications that can occur due to lack of regulations of the piercing establishments. Due to lack of training of piercing professionals and lack of enforcement of sterilization procedures, infection and life threatening complications can arise. Complications include, but are not limited to, hemorrhage, nerve damage, gingival recession, HIV, tongue swelling, tooth fracture, Bactermia, Ludwigs angina, increase salivary flow, jewelry aspiration, and localized infection. Texas requires an individual to be 18 years of age to receive a piercing. However, Texas does not regulate the piercing establishment or the artist providing the services. Oral health care providers should be aware of the lacking regulations of piercing studios so they can be more vigilant of oral complications that may occur.

Is your office prepared for an accidental needlestick or other unexpected exposure incident?

Recommendations and mandatory guidelines for preventing and managing needlestick incidents and other accidental exposures to bloodborne pathogens in healthcare facilities have been published by the Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC) for more than 2 decades. Over the years, the incidence of official enforcement actions has declined and a complacency about the standards may have evolved in some dental offices. Some practitioners may not have written an occupational exposure incident protocol or made appropriate arrangements for medical laboratory testing and postexposure medical evaluation following an unexpected needlestick or other exposure incident in the office. When an unexpected event occurs, practitioners may become confused regarding the steps to be taken, and may turn to their local dental society or fellow practitioners for guidance. The provided information may or may not be complete, accurate and/or current. Implementation of periodic personnel training to prevent exposure incidents is extremely important and could ultimately save a dental practice thousands of dollars in expenses related to the occurrence of even one exposure incident, as well as save the life and/or career of a dental healthcare provider. This article does not comprehensively detail all infection control and bloodborne pathogen transmission prevention requirements for dental offices. Rather, the article provides suggestions for dental practitioners regarding the step by step management of exposure incidents, and provides resource information for additional steps that can be taken towards prevention, improved office compliance, and improved litigation protection.

The business of dentistry

There are many reasons why someone chooses to become a dentist: a family member was in the profession, they have a proclivity for the sciences of health care, or they like the autonomy of having their own practice. Mark Gonthier, assistant dean for admissions of Tufts University School of Dental Medicine, offered this description of the ideal dental school applicant, "We are looking for mature, well-rounded students capable of handling the rigor of the basic sciences curriculum and are equally adept and committed to providing quality comprehensive patient oral health care" Few dentists will report that they chose their profession because they wanted to run a small retail business.

Dentistry and the ethics of infection

Currently, any dentist in the UK who is HIV-seropositive must stop treating patients. This is despite the fact that hepatitis B-infected dentists with a low viral load can continue to practise, and the fact that HIV is 100 times less infectious than hepatitis B. Dentists are obliged to treat HIV-positive patients, but are obliged not to treat any patients if they themselves are HIV-positive. Furthermore, prospective dental students are now screened for hepatitis B and C and HIV, and are not allowed to enrol on Bachelor of Dental Surgery degrees if they are infectious carriers of these diseases. This paper will argue that: (i) the current restriction on HIV-positive dentists is unethical, and unfair; (ii) dentists are more likely to contract HIV from patients than vice versa, and this is not reflected by the current system; (iii) the screening of dental students for HIV is also unethical; (iv) the fact that dentists can continue to practise despite hepatitis B infection, but infected prospective students are denied matriculation, is unethical; and (v) that the current Department of Health protocols, as well as being intrinsically unfair, have further unethical effects, such as the waste of valuable resources on 'lookback' exercises and the even more damaging loss of present and future dentists. Regulation in this area seems to have been driven by institutional fear of public fear of infection, rather than any scientific evidence or ethical reasoning.

Patient notification exercise following a dentist's admission of the periodic use of unsterilized equipment

During 2001, Greater Glasgow National Health Service (NHS) Board undertook a patient notification exercise in a Glasgow dental practice following the admission, by the dentist, of the use of unsterilized dental equipment on patients. Four thousand and eighty-nine exposed patients were identified; of these, 1696 contacted the NHS helpline and 1005 were counselled and screened for hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus. One patient showed evidence of previous HBV infection and 13 had antibodies to HCV. Molecular investigation of the HCV isolates indicated no significant associations. The investigation found no evidence of patient-to-patient transmission of HCV among patients attending the practice of a dentist who admitted periodically using unsterilized equipment.

OSHA--what is its role in dentistry and how do we provide training?

The mission of the Occupational Safety and Health Administration (OSHA) is to ensure the safety and health of America's workers. Although OSHA's focus is on safety, there is a natural overlap into the infection control arena. The work practice control, engineering control, and personal protective equipment regulations are examples of OSHA safety topics that have a direct impact on dental infection control. In a similar fashion, the regulations designed to protect the dental health care worker often translate into increased safety for the dental patient. To ensure their safety, OSHA requires workers to be appropriately trained. This article reviews the regulatory significance of OSHA, compares OSHA with other regulatory and advisory agencies, and discusses OSHA's training requirements. Principles for conducting training in the dental health care setting along with suggestions for assessing training also are presented.

Legal issues for healthcare workers with bloodborne infectious disease

The risk of bloodborne disease transmission in dental settings is very low. Available data support the low risk of transmission. The rate of occupational injuries among dental health care workers has decreased over the last decade and, other than the 1990 case of HIV transmission in a dental office, there have been no additional reports of bloodborne disease transmission by dental health care workers. However, public policy and judicial decisions focus less on science and more on emotion. Although many infection control organizations have updated their policies to remain current with science, the USPHS's policy remains as released in 1991. It would be prudent for these guidelines to be updated to reflect current scientific evidence and be inclusive for all bloodborne pathogens.

OSHA bloodborne pathogens rule--revisions and clarifications

Recent revisions to the Occupational Safety and Health Administration's Bloodborne Pathogens Rule have clarified requirements for record keeping and engineered sharps injury protection devices. It is important for dental workers, and especially dentists who are employers, to be aware of the changes in the regulatory language and be prepared to modify existing programs to meet these new demands. This article provides an overview of the 2001 Bloodborne Pathogens Rule with an emphasis on the impact on dental offices.

[Considerations on vaccinations for the dental staff]

In this article the available vaccinations in the Netherlands that might be of value to dentistry are discussed. This in view of protection of both the patient and the medical worker. Furthermore vaccines that are necessary but do not exist or have not been developed yet, are mentioned. Of the available vaccinations, the one against hepatitis B is of the utmost importance. This has been stressed in the Netherlands from all sides for a long time already; nonetheless not all dental workers have been vaccinated up until now. The vaccines against human immunodeficiency virus (HIV) and viral hepatitis C rank high on the list of medical achievements most wanted.

OSHA 2000: a review of compliance issues

The California Occupational Safety and Health Administration is responsible for enforcing worker safety regulations in the state of California. The infection control regulation, while the best known to dentists, is only one of many that affect every dental practice. The past two years have brought significant changes to Cal/OSHA rules. This paper reviews some of the current regulations that apply to dental offices.

Infection control practices and compliance to national recommendations among dentists in Romania

The aim of this study was to measure dental office compliance with current Romanian infection control regulations. A questionnaire was completed and returned from 61 randomly selected offices (32 private and 29 public with 94 dentists), where the sterilizers were also biologically monitored. Results indicated that with few exceptions, infection control practices in public and private offices were the same, with compliance on sterilising reusable instruments. Private offices monitored their sterilizers more frequently and had much newer equipment. Gowns were universally worn, but use of gloves, masks and protective eye-wear showed non-compliance with less than 10 per cent of the offices using personal protective equipment for all patients. Cost was the deciding factor. Predominant environmental disinfectants were alcohol and bleach. Offices were in compliance as to the use of disposable anaesthetic needles and carpules. Dentists reported reluctance to be vaccinated against hepatitis B even when offered free immunizations (6.4 per cent) and only 18.1 per cent of dentists had received any infection control training in the last three years. Results indicate that offices were in compliance for most national regulations. However, there are no recently published standards for dentistry in Romania concerning disinfectants or continuing education. Comparison with the literature indicates comparable compliance with recommended national infection control procedures for Romanian dentists as for dentists in other countries.

Hepatitis viruses A, B, C, D, E and G: implications for dental personnel

BACKGROUND

This article provides dental personnel with a brief overview of the different types of viral hepatitis, including their epidemiology, clinical features, prevention and treatment. It also explores the ramifications of these diseases for the practice of dentistry. DESCRIPTION OF THE CONDITION: Viral hepatitis is an inflammation of the liver caused by one of at least six distinct viruses. The hepatitis A and E viruses, or HAV and HEV, are enterically transmitted viruses that produce acute disease only. The hepatitis B, C and D viruses, or HBV, HCV and HDV, are most efficiently transmitted by infected blood, but also can be transmitted by exposure to other infectious bodily fluids. These three viruses can cause acute or chronic hepatitis. People with chronic viral hepatitis can develop chronic liver disease, cirrhosis and hepatocellular carcinoma. The hepatitis G virus was recently identified, and its ability to cause clinically significant acute or chronic hepatitis is unknown.

CONCLUSIONS

Dental health care workers, or DHCWs, should be concerned primarily with HBV, HCV and HDV, as occupational exposure to these pathogens places them at risk of developing acute or chronic infections. Vaccines and immune globulins are available and effective in protecting against infections with HAV, HBV and HDV, but not HCV.

CLINICAL IMPLICATIONS

DHCWs should become knowledgeable about viral hepatitis. They should be vaccinated against hepatitis B. Adherence to infection control measures will help prevent occupational transmission of all bloodborne pathogens, including hepatitis viruses.