Decision-making on the use of antimicrobial prophylaxis for dental procedures: a survey of infectious disease consultants and review.
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There is debate concerning use of antibiotic prophylaxis before invasive dental procedures for patients at risk of acquiring distant site infection (DSI). We determined the opinions and practices of infectious disease consultants (IDCs) regarding antimicrobial prophylaxis to prevent DSIs that result from invasive dental procedures by conducting a survey of the 797 members of the Infectious Diseases Society of America Emerging Infections Network (477 members [60%] responded). Ninety percent of respondents closely follow the American Heart Association guidelines for antibiotic prophylaxis for patients with valvular heart disease who undergo invasive dental procedures. In contrast, few IDCs recommend prophylaxis for patients with lupus erythematosus, poorly controlled diabetes mellitus, dialysis catheters or shunts, cardiac pacemakers, or ventriculoperitoneal shunts. Twenty-five percent to forty percent of respondents recommended prophylaxis for prosthetic vascular grafts, orthopedic implants, or chemotherapy-induced neutropenia. We conclude that IDCs differ considerably in their assessment of the need for prophylaxis for patients who have noncardiac risk factors for DSI. These differences underscore the need for definitive studies to delineate appropriate candidates for antimicrobial prophylaxis in dental practice. (+info)
Evaluation of the efficacy of Alpron disinfectant for dental unit water lines.
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AIMS: To assess the efficacy of a disinfectant, Alpron, for controlling microbial contamination within dental unit water lines. METHODS: The microbiological quality of water emerging from the triple syringe, high speed handpiece, cup filler and surgery hand wash basin from six dental units was assessed for microbiological total viable counts at 22 degrees C and 37 degrees C before and after treatment with Alpron solutions. RESULTS: The study found that the use of Alpron disinfectant solutions could reduce microbial counts in dental unit water lines to similar levels for drinking water. This effect was maintained in all units for up to six weeks following one course of treatment. In four out of six units the low microbial counts were maintained for 13 weeks. CONCLUSIONS: Disinfectants may have a short term role to play in controlling microbial contamination of dental unit water lines to drinking water quality. However, in the longer term attention must be paid to redesigning dental units to discourage the build up of microbial biofilms. (+info)
Waterborne biofilms and dentistry: the changing face of infection control.
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Interest in and concern about the biofilms that occur in dental equipment and waterlines have been increasing in recent years. Dental unit waterlines are ideal environments for the growth of microorganisms entering dental units from the municipal water supply. This article describes the conditions in waterline tubing that favour development of biofilms and discusses the level of risk that such microbial growth poses for both dental professionals and their patients. It is stressed that very few cases of infection have been linked directly to contamination in dental unit waterlines. Finally, potential solutions for minimizing risks are presented and discussed. (+info)
Microbiological evaluation of a range of disinfectant products to control mixed-species biofilm contamination in a laboratory model of a dental unit water system.
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Dental unit water system (DUWS) tubing harbors complex multispecies biofilms that are responsible for high microbial levels at the distal outlet. The aim of this study was to use an established biofilm laboratory model to simulate biofouling of DUWS to evaluate practical, cost-effective, and evidence-based methods of microbial decontamination. Reproducible biofilms were developed in the model over 14 days; decontamination was assessed using total viable counts (TVC) and microscopic-image analysis techniques to view the inner surface of tubing. Flushing did not reduce the biofilm coverage or TVC. Combizyme and ozone did not completely eliminate the viable bacteria (70 and 65% reduction in biofilm TVC, respectively), nor did they remove the biofilm (45 and 57% reduction in biofilm coverage, respectively). Chlorhexidine and Bio2000 (active agent: ethanol and chlorhexidine), Tegodor and Gigasept Rapid (aldehyde based), and Grotanol (hydroxide based) completely eliminated the TVC but did not completely remove biofilm (31, 53 33, 34, and 64.9% reduction of biofilm coverage, respectively). Other products including Grotanol Flussig (phenol based), Betadine (povidone-iodine based), Alpron (chlorite based), and the hydroxide-containing products Sporklenz, Sterilex Ultra, Dialox, Sterilox, Sanosil, Oxigenal, and Grotanat Bohrerbad resulted in a 100% reduction in the biofilm TVC and a >95% reduction in biofilm coverage. The study demonstrated that while many disinfectants achieve a sufficient reduction in TVC they may not necessarily remove unwanted biofilm from the tubing surfaces as tested in this laboratory-controlled biofilm model. (+info)
Biofilm and dental unit waterlines.
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Aquatic biofilms, which are well-organized communities of microorganisms, are widespread in nature. They constitute a major problem in many environmental, industrial and medical settings. The use of advanced techniques has revealed biofilm structure, formation and ecology. Special attention was given to the build-up of biofilm in dental unit waterlines (DUWLs), which are small-bore flexible plastic tubing to bring water to different handpieces. They are coated with well-established biofilms. Active biofilm is a source of microbial contamination of DUWLs water. The safety of dental treatment requires a good quality of the water used. The knowledge of nature, formation and the ways to eliminate the biofilm is the first step towards reducing health risk, both for patients and dental personnel. The article reviews these issues. (+info)
Effect of disposable infection control barriers on light output from dental curing lights.
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PURPOSE: To prevent contamination of the light guide on a dental curing light, barriers such as disposable plastic wrap or covers may be used. This study compared the effect of 3 disposable barriers on the spectral output and power density from a curing light. The hypothesis was that none of the barriers would have a significant clinical effect on the spectral output or the power density from the curing light. METHODS: Three disposable barriers were tested against a control (no barrier). The spectra and power from the curing light were measured with a spectrometer attached to an integrating sphere. The measurements were repeated on 10 separate occasions in a random sequence for each barrier. RESULTS: Analysis of variance (ANOVA) followed by Fisher's protected least significant difference test showed that the power density was significantly less than control (by 2.4% to 6.1%) when 2 commercially available disposable barriers were used (p < 0.05). There was no significant difference in the power density when general-purpose plastic wrap was used (p > 0.05). The effect of each of the barriers on the power output was small and probably clinically insignificant. ANOVA comparisons of mean peak wavelength values indicated that none of the barriers produced a significant shift in the spectral output relative to the control ( p > 0.05). CONCLUSIONS: Two of the 3 disposable barriers produced a significant reduction in power density from the curing light. This drop in power was small and would probably not adversely affect the curing of composite resin. None of the barriers acted as light filters. (+info)
Risk of exposure to Legionella in dental practice.
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Aerosols generated in dental operations are a source of exposure to microorganisms proliferated within dental unit waterlines (DUWL) biofilm. It has been suggested that presence of Legionella species in these aerosols may contribute to potential health hazards for dental staff and patients. The article attempts to provide a brief overview of the current knowledge about Legionella, its prevalence in DUWL, immunological reactions of the dentists and concepts for prophylaxis of Legionella in dentists' work place. (+info)
Resterilization of instruments used in a hospital-based oral and maxillofacial surgery clinic.
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OBJECTIVE: The transmission of pathogens from one patient to another via contaminated devices has been a high profile issue in infection control. Although single-use devices have been promoted as a preventative strategy, resterilization of instruments has been a common practice in dentistry. The purpose of this study was to investigate the rate of bacterial contamination of instruments resterilized for use in oral and maxillofacial procedures in a hospital-based clinic. METHODS: The experiment was a prospective randomized controlled study. The test group consisted of burs that had been used in surgical procedures. These burs were grossly debrided before being cleaned and gas sterilized in the central sterilizing department of the hospital. The burs were transferred in a sterile fashion into a culture medium selected to grow oral bacteria. The control group comprised new unused instruments treated in an identical fashion before culturing. All burs were incubated and monitored daily for 72 h. RESULTS: The rate of bacterial contamination in the test groups was significantly higher than in the control group (p < 0.05). CONCLUSIONS: Reuse of instruments can be cost-effective if the safety of patients can be assured; however, there is increasing evidence that the sterilization process may not be completely effective. Consideration should be given to the classification of certain types of dental burs as single-use devices if sterilization cannot be guaranteed. (+info)