Infection prevention and control is an important part of safe patient care. In the
dental office, concerns about the possible spread of blood-borne diseases, and the
impact of emerging, highly contagious respiratory and other illnesses, require
practitioners to establish, evaluate,continually update and monitor their infection
prevention and control strategies and protocols.

These Guidelines are significantly broader than previous documents, and they reflect
current knowledge of the transmission of infections, and how to prevent and control
them.

Before I get into the latest and most current infection control guidelines for dental
offices, I would like to tell you how we did it in the 50’s and 60’s. We merely washed
our hands with soap and proceeded to place our hands into a patient’s mouth to begin
most dental procedures.

Although it was appropriate at the time, it certainly would not come close to
measuring up to the much higher standards of infection control recommended and
enforced today!

Most conscientious dentists in the old days always washed their hands before
embarking on a dental procedure. I know I did and I only wore latex gloves when
I was performing a surgical procedure of some kind. I did not want or like to get
any blood on my hands or under my finger nails.

Dentists in general have always been concerned about disease transmission in the
dental office, and traditionally this has been accomplished by the sterilization of
all operative and surgical instruments that are used when providing dental procedures
in the office.

In the early days, these sterilization techniques involved the use of an
autoclave which was an apparatus effecting sterilization using high pressure
and steam to kill the oral bacteria.

In the old days like in the 40’s,50’s and early 60’s many dentists had their
instruments scrubbed,washed and placed in a bacteriocidal and/or bacteriostatic
solutions.The bacteriocidal solutions killed the bacteria while the bacteriostatic
solutions merely prevented them from growing and multiplying in great numbers.

The appreciation that dentists are at risk of acquiring a number of serious diseases
such as Hepatitis B (a liver disease ) for example, has resulted in the realization
that disease may be transmitted not only from patient to patient but also from patient
to dentist and dentist to patient.

This has created the realization that all blood, saliva and other body fluids must
be considered potentially infectious.That being said, such an understanding has
necessitated a revision of previous infection control procedures.

The Canadian Dental Association for example, developed guidelines for dentists to
follow in protecting their patients from diseases. Since medical history and
examination cannot reliably identify all patients infected with HIV,HBV or any other
blood-borne pathogens, precautions should be consistently used for all patients.

The following infection control procedures that were developed are:

1. All dental team members must use facial masks, protective eye-wear and latex or
vinyl gloves while working in a patient’s mouth.

2. Dental team members must keep the treatment rooms clean,using germicidal
solutions that will kill all bacteria on all potentially contaminated surfaces.

3. Dental team members must use extremely efficient suction methods for removal of
saliva, blood,and other debri from the oral cavity.

4. The hands should be washed with a germicidal solution prior too and immediately
after the use of each set of gloves used.

5. Rubber dams should be used during any restorative procedure where ever
possible.

6. Up-to-date immunization status must be maintained for all dentists and staff
members who have patient related duties.These include: Hepatitis B, Rubella,
Mumps, Measles and influenza vaccine shots.

7. The appropriate sterilization methods must be used on all dental instruments.

8. All Hand-pieces and similar intra-oral devices must be cleaned and sterilized.
Where this is not possible, these instruments must receive a very high level of
disinfection.

9. Counter-tops,working surfaces and all operatory furniture should be protected
by disposable covers or disinfected if aerosols and/or blood splatter will
be generated during a dental procedure.

10. All materials used should be discarded in plastic bags and all sharps like
needles and scalpel blades should be placed in a puncture resistant container
before disposing them.

11. A high temperature wash cycle with normal bleach concentration,followed by machine
drying,is highly recommended for any clothing worn during dental procedures.
Dry cleaning and/or steam pressing is also appropriate.

Now all the above being said, the dental office is not likely a place where serious
infections are transmitted. Dentists have always used and continue to use effective
methods of preventing infections including the more serious infections like the Aids
virus and Hepatitis B virus.

The Aids virus can only be trasnmitted from one person to another through the body
fluids and almost always by way of sexual intercourse or the sharing of needles by
drug addicts.

All of the steps taken by the dental team to prevent other types of infections, works
extremely well against the Aids and Hepatitis B viruses. There is no evidence to
suggest that the aids virus can be transmitted during a dental procedure if the
recommended preventive measures are used.

The clinical evidence has proven that the aids virus is quite unstable and dies very
quickly once out of its normal environment. Normal sterilization techniques such as heat
sterilization of various kinds is effective in destroying the aids virus. Some cold
sterilization solutions are also quite effective in killing the aids virus.

The transmission of the aids virus from one patient to another in a dental office is
highly unlikely. Therefore casual contact,touching chairs and/or furniture will not
spread this virus.

The greater concern would be for the more sturdy and stubborn hepatitis B virus.

The term ‘hepatitis’ simply means inflammation of the liver. Hepatitis may be caused
by a virus or a toxin such as alcohol. Other viruses that can cause injury to liver
cells include the hepatitis A and hepatitis C viruses. These viruses are not related
to each other or to hepatitis B virus and differ in their structure,the ways they are
spread among individuals, the severity of symptoms they can cause,
the way they are treated, and the outcome of the infection.

Direct contract with blood may occur through the use of dirty needles during illicit
drug use, inadvertent needle sticks experienced by healthcare workers, or contact with
blood through other means. Semen, which contain small amounts of blood, and saliva that
is contaminated with blood also carry the virus.

• The virus may be transmitted when these fluids come in contact with a broken
skin lesion or a mucous membrane (in the mouth, genital organs, or rectum) of an
uninfected person.

People who are at an increased risk of being infected with the hepatitis B virus
include the following:

* Men or women who have multiple sex partners, especially if they don’t
use a condom

* Men who have sex with men

* Men or women who have sex with a person infected with hepatitis B virus

* People with other sexually transmitted diseases

* People who inject drugs with shared needles

* People who receive transfusions of blood or blood products

* People who undergo dialysis for kidney disease

* Institutionalized mentally handicapped people and their attendants,
caregivers, and family members.

* Health care workers who are stuck with needles or other sharp
instruments contaminated with infected blood.

* Infants born to infected mothers

In some cases, the source of transmission is never known.

You cannot get hepatitis B from the following activities:

* Having someone sneeze or cough on you

* Hugging someone

* Handshaking a persons hand

* Breastfeeding your child

* Eating food or drinking water

* Casual contact (such as an office or social setting)

What are the symptoms of acute hepatitis B?

Acute hepatitis B is the period of illness that occurs during the
first one to four months after acquiring the virus. Only 30% to 50% of
adults develop significant symptoms during acute infection. Early symptoms may

be non-specific, including fever, a flu-like
illness, and joint pains. Symptoms of acute hepatitis may include:

* fatigue,

* loss of appetite,

* nausea,

* jaundice (yellowing of the skin and eyes), and pain in the upper right abdomen
(due to the inflamed liver).

The dentist, hygienist and dental assistants are at a greater risk of getting
infections in the dental office environment by coming into contact with lesions
that may be present on their hands or mucous membranes with infected blood and
possibly saliva from the infected patient.

Although the potential for transmission of blood-borne viruses between patients
and the dentist health provider will continue because of the nature of the dental
procedures that are required to provide dental treatment.

There are no scientific studies that confirm the transfer of infection through the
dental hand-piece(drills) or any other dental equipment.The dental profession’s
foremost responsibility remains the health, safety and welfare of its patients!

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