Impact of a virtual educational intervention on knowledge and awareness of biomedical waste management among Peruvian dental professionals.

Waste from healthcare is a significant global issue, with around 85% of it being common waste and the remaining 15% being hazardous waste that is infectious and toxic. Dentistry uses various materials that create a substantial amount of biomedical waste capable of impacting the environment. Therefore, the purpose of this study was to assess the effects of a virtual educational program on the knowledge and awareness of dental material recycling and reuse, as well as biomedical waste management, among dental professionals in Peru. The current study was a longitudinal and quasi-experimental evaluation of 165 dentists from Peru. A validated questionnaire consisting of 30 items was administered at three different intervals (pre-test, immediate post-test, and 14-day post-test). Statistical analysis was conducted using the Mann Whitney U and Kruskal Wallis H tests to compare scores between categories of each sociodemographic variable, and the Cochrane's Q and Friedman test was used for related measures comparison. A significance level of p < 0.05 was considered. When comparing the percentage of correct responses regarding recycling and reuse of dental materials and biomedical waste management between the pre-test and the immediate post-test, a significant improvement in knowledge was observed for most of the questionnaire items (p < 0.05). At 14 days after the test, those who studied at a private university, unmarried, bachelors, non-specialists, non-teachers and have less than 10 years of professional experience did not did not retain knowledge on biomedical waste management (p < 0.05) or recycling and reusing dental materials (p < 0.05) to a significant extent. There was a significant enhancement in dentists' knowledge and awareness of managing biomedical waste, recycling, and reusing dental materials following the educational intervention. This improvement was observed across all sociodemographic variables considered in the study. However, this knowledge was not retained beyond two weeks for those who studied at a private university, unmarried, bachelor, with no specialty, non-teachers and with less than 10 years of professional experience. Government authorities should encourage oral health professionals to conduct research with educational interventions focused on improving and evaluating the sustainability and environmental impact of dental practices. This will enable professionals to better understand, control and evaluate the consequences of their practical work.

Safe practices of biomedical and dental waste management amongst practicing dental professionals amid the COVID-19 pandemic.

BACKGROUND: Biomedical waste can potentially compromise the environment and public safety if not safely disposed. OBJECTIVE: The aim was to assess the understanding and safe practices of biomedical and dental waste amongst the dental practitioners and practical year students amid the COVID-19 pandemic. METHODS: A structured and validated questionnaire consisting of 21 closed ended questions was used to collect data from dental practitioners and students working in hospitals and clinics. The questionnaire was distributed in paper and digital form amongst the participants. Descriptive analysis was performed for categorical and numerical variables. Spearman correlation test was used to assess the relationship between awareness and waste disposal practices of dentists. A p-value of≤0.05 was considered as statistically significant. RESULTS: More than three fourth of the participants were aware of proper dental waste disposal steps. One half was aware of the color-coded segregation of biomedical waste management. Two third of the participants were deploying safe biomedical waste practices. Nearly 68% subjects allocated separate labeled containers for disposal of COVID-19 suspected patient's waste. Furthermore, 71.63% participants were practicing PCR test before aerosol procedures. While 88.65% participants believed that the COVID-19 pandemic has increased the financial burden in terms of safe practices and dental waste management. CONCLUSION: The awareness and practices of the participants towards dental waste management was found to be moderate. Satisfactory COVID-19 prevention and transmission measures were observed amongst the participants. BMW management lessons should be included in the academic curriculum and training program needs to be adopted for mass awareness.

Characteristics of wastewater originating from dental practices using predominantly mercury-free dental materials.

Dental materials are currently undergoing a revolution. Mercury use, including traditional amalgam (mercury-containing) material used in dental fillings, is now being widely regulated under the Minamata convention, and dental amalgam is currently being replaced by resin formulations in dentistry. These resin-based materials can be tuned to offer varying material properties by incorporation of a range of nano- and micro-particle based 'fillers' for different dental properties and applications. However, these innovations may have a concomitant effect on the waste streams associated with common dental applications, in particular the potential for higher concentrations of novel micro- and nanomaterials within wastewater streams, and a potential route for novel nanomaterials into the wider Environment. These new materials may also mean that wastewater filtering apparatus commonly deployed at present, such as amalgam separators, may be less efficient or insufficient to capture these new filler materials in dental facility wastewater. In this work, we analyse dental wastewater streams from three dental facilities in Ireland with differing amalgam separators in place. The potential overall toxicity, particulate load and physicochemical properties are analysed. The overall risk posed by these new materials is also discussed.

Mercury hygiene and biomedical waste management practices among dental health-care personnel in public hospitals in Lagos State, Nigeria.

BACKGROUND: Indiscriminate disposal of hospital wastes including mercury/amalgam wastes pose a serious threat to life and environment. There is a growing concern about biomedical waste (BMW) management among health care workers, however there are limited reports on BMW management by dental personnel in developing countries. OBJECTIVES: This study investigated the level of knowledge of BMW, observance of proper mercury hygiene and BMW management practice among public dental personnel in Lagos State, Nigeria. METHODS: A cross-sectional study regarding BMW management across public hospitals in Lagos State, Nigeria was conducted following institutional ethics committee approval. A self-administered questionnaire was utilized to obtain data from different facilities selected by purposive and simple random sampling techniques as applicable. The questionnaires were distributed among 437 respondents by convenience sampling. The resulting data were statistically tested using Chi-square and G-test with p-value < 0.05 indicating significant level. RESULTS: Amongst 437 respondents, majority were females (62.5%) and the highest proportion fell within the age range of 25-34 years (44.4%). Only 17.2% of the respondents had good knowledge of BMW management/legislation and 4.1% had good BMW practice. Less than half (49.4%) of respondents disposed mercury-contaminated materials inside the trash and majority (92.2%) did not observe proper mercury hygiene. Significantly better mercury hygiene practices were observed in secondary facilities (p=0.040). CONCLUSION: A minor proportion of public dental personnel had good knowledge and practice of proper mercury hygiene and BMW management. This shows there is an urgent need for training of health personnel on proper BMW handling and disposal in developing countries like Nigeria.

Management of dental waste in dental offices and clinics in Jeddah, Saudi Arabia.

Management of dental wastes became a recent challenge facing health care practitioners and is one of the highly-sensitive environmental problems. The main purpose of this study was to assess oral health care provider's knowledge and behavior about dental waste management and evaluate their behavior toward it. A cross-sectional descriptive study was conducted on 314 dental health care providers working in four dental colleges, and 20 private dental clinics in Jeddah, Saudi Arabia. A pretested questionnaire composed of close-ended questions was used. The mean age of the participants was 27 years. About 78% of the participants reported that they were working in the public sector. Only 33.4% of the study sample received professional training on waste management. The mean behavior and knowledge scores were 3.7 ± 1.3 (out of 6) and 1.4 ± 1.3 (out of 8), respectively. Statistically significant association was noted between gender and knowledge scores but not between gender and behavior scores. On the other hand, statistically significant associations were noted between both knowledge and behavior scores and rank of the participant, type of practice, and years of experience. Oral health care providers' knowledge about the effective procedure that should be followed for segregating, collecting, transporting, and treating dental waste was weak and substandard. There is an urgent need to develop policies and regulations for dental waste management in Saudi Arabia. Implications: This study shed light for the first time on the knowledge and behavior of dentists in Jeddah, Saudi Arabia in regard to the dental waste management. Participants knowledge and behavior in regard to dental waste segregation, collection, transportation, and treatment were determined to be week and substandard. Currently, different procedures related to dental waste management in health care facilities are not clearly described. The urgent need for the development of policies and regulations for the dental waste management is obvious. This study can be a starting point for future nation-wide surveys to assess knowledge, behavior and practices related to dental waste management among oral health care providers. In addition, more efforts should be directed to incorporate this subject into dental curriculum and continuous education courses.

Clinical Evaluation of a Chairside Amalgam Separator to Meet Environmental Protection Agency Dental Wastewater Regulatory Compliance.

OBJECTIVES: The aim of this study was to evaluate the performance of a commercially available chairside amalgam separator (CAS) in a clinical setting in which a relatively high number of amalgam restorations are placed. Performance parameters investigated included service life, amalgam collected, mercury concentrations in effluent, and solids retention efficiency. METHODS AND MATERIALS: CASs were tested per International Organization of Standardization (ISO) 11143:2008 prior to installation in a military dental treatment facility and after removal from service (n=4) in order to confirm compliance with the recently enacted United States Environmental Protection Agency (EPA) Effluent Limitations Guidelines and Standards for the Dental Category. During the units' time in service, biweekly effluent grab samples were collected from the high-volume evacuation system of each chair (n=6) and analyzed for total mercury concentration by inductively coupled plasma mass spectrometry (ICP-MS). The mean total accumulated solids at the end of service life (n=6) was determined for potential design optimization. The service life expectancy in a military dental treatment facility was determined in terms of calendar and workdays. Procedural data were collected to determine the daily mean number of amalgam surfaces placed during the service life of each chairside amalgam separator (n=9). RESULTS: The CAS evaluated met minimum EPA compliance requirements when used in a military dental treatment facility. The solids removal efficiency at the end of service life was 99.82% ± 0.14% (n=4). The mean service life (n=8) was 131.6 ± 45.1 calendar days (67.1±37.6 workdays). Effluent mercury concentrations ranged from 0.05 to 11.93 mg/L. Total solids accumulated in each CAS (n=6) at the end of service life was 195.4 ± 63.4 g. The mean number of amalgam surfaces placed per workday during the service life span of each CAS was 8.4 ± 1.4.

Environmental sustainability and waste within the dental practice.

This paper forms part of a series of papers, seven in total, which have been requested by colleagues to help them as clinicians understand sustainability as it relates to dentistry. This paper focuses on waste and how the dental team can influence how waste is processed and disposed of. It is the authors' hope that this series of papers stimulates interest, debate and discussion and, as well as being economically responsible, ultimately motivates and inspires the dental team to be more socially and environmentally sustainable which in turn will help promote health and illness prevention.

Variability of Greek dental solid waste production by different dentist groups.

The objective of this work was to compare the composition and production rate of Greek dental solid waste (DSW) produced by three dentist groups of Xanthi, Greece, defined according to the country of their dental education/training: (1) dentists educated in Greece and other European Union (EU) countries, (2) dentists educated in Turkey, and (3) dentists educated in former Soviet Union and repatriated to Greece. All DSW produced by a total of 2542 patients in 20 dental practices from Xanthi, Greece, was collected, manually separated, and weighed over a period of four working weeks and classified according to Greek regulations. Production data below are presented as average (standard deviation in parenthesis). The average unit production rates of total DSW were 415(303) and 51.2(19.1) g/patient/day for dentists educated in Greece and other EU countries, 365(160) and 64.0(21.7) g/patient/day for dentists educated in Turkey, and 302(349) and 54.3(46.8) g/patient/day for dentists educated in former Soviet Union. Daily DSW production was correlated with daily number of patients and regression correlations were produced. Statistical analysis using the Kruskal-Wallis non-parametric test was conducted to compare DSW production medians by the three dentist groups. Dentists educated in Turkey had statistically higher median patient-based unit production rates at α = 0.05 for total dental, total hazardous, total infectious, total toxic and domestic-type waste, compared to the other dentist groups.

Awareness of Biomedical Waste Management among Dentists associated with Institutions and Private Practitioners of North India: A Comparative Study.

AIM: The present study aimed to obtain information about knowledge, execution, and attitude toward biomedical waste (BMW) and its management. MATERIALS AND METHODS: In the present study, a self-administered closed-ended questionnaire was designed to conduct a cross-sectional survey. It was distributed among 614 dentists (institution associated or private practitioners) in the cities of North India. The questionnaire comprised 36 questions regarding knowledge, execution, and attitude toward BMW and its management. Frequency distribution and chi-square test along with paired t-test were used to compare the data obtained between the private practitioners and institution-associated dentists. RESULTS: The study showed that 80% private practitioners were aware of the categories of BMW as compared with 100% of institution-associated dentists. However, 41% dentists associated with institution were disposing the chemical waste directly into sewer and a surprising high number of private practitioners were discarding directly without any treatment. Furthermore, regarding the mandatory maintenance of BMW records, 100% institution-associated respondents were aware, whereas only 6.5% private practitioners knew about it. Regarding BMW management not frequently being followed, 78% of private practitioners believed extra burden as the reason. CONCLUSION: Most of the dentists had adequate knowledge regarding BMW policies and its management. Although it was being practiced in mostly all the institutes on a regular basis, the majority of private practitioners were not practicing it due to various reasons, such as financial burden, lack of availability of service, and poor attitude toward its management. CLINICAL SIGNIFICANCE: There is a need to make it compulsory and organize training sessions to educate the dental personnel and to establish the importance of proper management.

Composition, production rate and characterization of Greek dental solid waste.

The overall objective of this work is to determine the composition, characterization and production rate of Greek dental solid waste (DSW). This information is important to design and cost management systems for DSW, for safety and health considerations and for assessing environmental impact. A total of 141 kg of DSW produced by a total of 2542 patients in 20 dental practices from Xanthi, Greece was collected, manually separated and weighed over a period of four working weeks. The waste was separated in 19 sub fractions, which were classified in 2 major categories, according to Greek regulations: Domestic-type waste comprising 8% and hazardous waste comprising 92% by weight of total DSW. The latter was further classified in infectious waste, toxic waste and mixed type waste (infectious and toxic together), accounting for 88.5%, 3.5% and 0.03% of total DSW by weight, respectively. The overall unit production rates (mean ±â€¯standard error of the mean) were 381 ±â€¯15 g/practice/d and 53.3 ±â€¯1.4 g/patient/d for total DSW, 337 ±â€¯14 g/practice/d and 46.6 ±â€¯1.2 g/patient/d for total infectious DSW, 13.4 ±â€¯0.7 g/practice/d and 2.1 ±â€¯0.1 g/patient/d for total toxic DSW and 30.4 ±â€¯2.5 g/practice/d and 4.6 ±â€¯0.4 g/patient/d for domestic-type waste. Daily DSW production was correlated with daily number of patients and regression correlations were produced. DSW was subject to laboratory characterization in terms of bulk density, calorific value, moisture, ash and volatile solids content. Measured calorific values were compared to predictions from empirical models.

Composition, Production Rate and Management of Dental Solid Waste in 2017 in Birjand, Iran.

BACKGROUND: The presence of toxic and pathogenic agents in the dental waste products has made it to be classified as "hazardous waste." OBJECTIVE: To assess dental waste production rate and composition and approaches used to manage these waste products in 2017 in Birjand, Iran. METHODS: 48 dental clinics were evaluated in two months of 2017. Sampling was performed from each clinic 3 times a week. Samples were manually divided into 5 categories of chemical-pharmaceutical, infectious, semi-household, sharp and cutting materials, and toxic waste products, and weighed. A checklist containing 25 questions was used to evaluate the aspects of waste management in dental clinics. RESULTS: The total amount of waste products generated in dental clinics was 7848.02 kg/ year in which semi-household waste had the highest quantity (4263.411 kg/year) and toxic waste had the lowest quantity (9.275 kg/year). Components with the highest amounts in dentistry waste products were nylon gloves (16.7%), paper and cardboard (13.4%), latex gloves (10.8%), and pharmaceuticals (10.2%). Waste separation was restricted to sharp and cutting waste. More than half (57%) of dental units were equipped with amalgam filter. Fixing solutions were directly discharged to sewage in 48.6% of clinics. There was no program to reduce waste generation in 54% of the clinics. Autoclave was the main tool for sterilizing dental instruments. CONCLUSION: This study showed a remarkable share of recyclable materials in the composition of dental waste and lack of special approach to manage waste in dental clinics. It is necessary to plan for minimizing generation of, separating, and recycling waste at source.

Investigating cross-contamination by yeast strains from dental solid waste to waste-handling workers by DNA sequencing.

Trying to widen the discussion on the risks associated with dental waste, this study proposed to investigate and genetically compare yeast isolates recovered from dental solid waste and waste workers. Three samples were collected from workers' hands, nasal mucosa, and professional clothing (days 0, 30, and 180), and two from dental waste (days 0 and 180). Slide culture, microscopy, antifungal drug susceptibility, intersimple sequence repeat analysis, and amplification and sequencing of internal transcribed spacer regions were performed. Yeast strains were recovered from all waste workers' sites, including professional clothes, and from waste. Antifungal susceptibility testing demonstrated that some yeast recovered from employees and waste exhibited nonsusceptible profiles. The dendrogram demonstrated the presence of three major clusters based on similarity matrix and UPGMA grouping method. Two branches displayed 100% similarity: three strains of Candida guilliermondii isolated from different employees, working in opposite work shifts, and from diverse sites grouped in one part of branch 1 and cluster 3 that included two samples of Candida albicans recovered from waste and the hand of one waste worker. The results suggested the possibility of cross-contamination from dental waste to waste workers and reinforce the need of training programs focused on better waste management routines.

Awareness of Biomedical Waste Management in Dental Students in Different Dental Colleges in Nepal.

AIM: The aim of this study is to assess the awareness of biomedical waste management in dental students of various dental colleges of Nepal. METHODOLOGY: A structured pretested questionnaire was used among 434 (323 males and 111 females) undergraduate dental students of five different dental colleges of Nepal. First part of the questionnaire was used to describe demographic profile of the participants. Second part of the questionnaire assessed the knowledge, attitude, and practice regarding biomedical waste management. Chi-square test was applied to find out the association between different responses obtained from different colleges. RESULT: Majority (91.82%) of participants had a positive attitude towards safe management of biomedical waste. Regarding the knowledge of BMW management policies, majority of the students (83.1% to 98.9%) had positive attitude towards the safe management of biomedical waste, whereas more than 50% of the students were unaware of the guidelines laid down by Government of Nepal. Regarding biomedical waste disposal technique in the hospital, only 29.9% to 79.8% are aware; this shows that there is lack of strict protocol in the BMW management. Association between different responses and colleges for "improper waste management causes various health hazards" ranged from 93.3% to 98.9%. CONCLUSION: There exists a lacuna in the knowledge and practice of biomedical waste management among the undergraduate dental students in Nepal. Since the students had positive attitude towards addressing this concern, workshops and trainings related to proper biomedical waste management would be a step forward towards attaining a healthy environment for the future.

Phenotypic and genotypic characterization of clinically relevant bacteria isolated from dental waste and waste workers' hands, mucosas and coats.

Infectious wastes are potential sources of pathogenic micro-organisms, which may represent a risk to the professionals who manage them. In this study, we aimed to characterize the infectious bacteria present in dental waste and waste workers. The dental waste produced over 24 h was collected and waste workers were sampled by swabbing. Isolate resistance profiles were characterized by Vitek® and PCR and biofilm formation by Congo Red agar, string test and microtitre assay. To assess similarity between the waste and the workers' samples, a random amplified polymorphic DNA test was used. Twenty-eight bacteria were identified as clinically relevant. The most frequent gene was blaTEM present in five Gram-negative micro-organisms, and one blaSHV in Klebsiella pneumoniae. All Pseudomonas aeruginosa were positive to extracellular polymeric substances formation, except one isolated from a worker. Klebsiella pneumoniae had negative results for the string test. Pseudomonas aeruginosa showed better adherence at 25°C after 48 h of incubation and K. pneumonia had the best biofilm formation at the same temperature, after 24 h. The similarity between P. aeruginosa recovered from dental waste and from workers was low, however, it is important to note that a pathogen was found on a worker's hands and that improvements in biosafety are required. SIGNIFICANCE AND IMPACT OF THE STUDY: Infectious dental waste can contain clinically relevant bacteria with important resistance and biofilm profiles. These micro-organisms could be transmitted to waste workers, other professionals and patients if the principles of biosafety measures are neglected. To our knowledge, no study has ever evaluated the microbial characterization and the potential contamination risk of dental infectious waste and waste handlers. The presence of clinically relevant bacteria in the hands and nasal mucosa of waste workers highlights the need for studies in this field to clarify the risk of these pathogens in dental healthcare services, and to stress the need for an efficient waste management.

Green dentistry: the art and science of sustainable practice.

Dentistry is highly energy and resource intensive with significant environmental impact. Factors inherent in the profession such as enormous electricity demands of electronic dental equipment, voluminous water requirements, environmental effects of biomaterials (before, during and after clinical use), the use of radiation and the generation of hazardous waste involving mercury, lead etc have contributed towards this. With rising temperatures across the world due to global warming, efforts are being made worldwide to mitigate the effects of environmental damage by resorting to sustainability concepts and green solutions in a myriad of ways. In such a scenario, a professional obligation and social responsibility of dentists makes it imperative to transform the practice of dentistry from a hazardous to a sustainable one, by adopting environmental-friendly measures or 'green dentistry'. The NHS in the UK has been proactive in implementing sustainability in healthcare by setting targets, developing guidance papers, initiating steering groups to develop measures and implementing actions through its Sustainable Development Unit (SDU). Such sustainable frameworks, specific to dentistry, are not yet available and even the scientific literature is devoid of studies in this field although anecdotal narratives abound. Hence this paper attempts to present a comprehensive evaluation of the existing healthcare sustainability principles, for their parallel application in the field of dentistry and lays out a blueprint for integrating the two main underlying principles of sustainability - resource use efficiency and eliminating or minimising pollution - in the day-to-day practice. The article also highlights the importance of social values, community care, engaging stakeholders, economic benefits, developing policy and providing leadership in converting the concept of green dentistry into a practised reality.

Knowledge, behaviour and microbial load of workers handling dental solid waste in a public health service in Brazil.

Healthcare wastes are those generated inside healthcare services, including dental clinics. Workers coming into close proximity to hazardous healthcare waste are potentially at risk. In an attempt to assess the knowledge and attitudes of workers dealing with infectious waste, a questionnaire was administered. The biological risk was investigated by evaluating the microbial load and screening some clinically relevant micro-organisms in the nasal mucosa, hands and coats of these workers. The results showed that 66.6% of the study population had incomplete primary education. Only two workers have had their blood tested to confirm anti-HBs levels. Microbial load evaluation on hand surfaces of morning workers showed statistically significant lower microbial loads after the workday when compared with the beginning of the work period. It is important to highlight that some clinically relevant bacteria, such as Pseudomonas aeruginosa and Klebsiella pneumoniae were isolated from worker's hands. This study revealed the need for more training programmes regarding awareness of safe waste disposal protocols and also the necessity of discussing vaccination and its implications. Data regarding microbial loads of the worker's hands, mostly at the beginning of the workday when handwashing is recommended worldwide, emphasise that hygiene measures should receive more attention during training exercises.

Awareness-Knowledge and Practices of Dental Waste Management among Private Practitioners.

Background Dental wastes are materials that have been utilized in dental clinics, which are no longer wanted for use and therefore discarded. Improper disposal of these dental wastes can cause harm to the dentist, the people in immediate vicinity of the dentist. Objective The present study was conducted to assess the knowledge and practices regarding Dental waste management among private practitioners. Method The study population included 186 private practitioners in three districts of Karnataka (Coorg, Mysore, Hassan), south India. A pre-tested self-administered questionnaire was distributed to assess the knowledge and practices regarding dental waste management. Descriptive statistics was used to summarize the results. The data will be statistically analyzed using chi-square test, correlation. Result Out of 186 study subjects, 71(38%) were females and 115(62%) were males, Chisquare analysis showed highly significant association between qualification of the study participants and their knowledge, practice of dental waste management. A statistically significant (0.0001) correlation was found between the knowledge and practice scores. Conclusion There was a lacunae of knowledge regarding proper biomedical waste disposal among the participants. In order to fill this vacuum CDE (Continuing Dental Education) programs have to be conducted in pursuance to maintain health of the community.

Use of Mercury in Dental Silver Amalgam: An Occupational and Environmental Assessment.

The objective of this study was to assess the occupational exposure to mercury in dentistry and associated environmental emission in wastewater of Lahore, Pakistan. A total of ninety-eight blood samples were collected comprising 37 dentists, 31 dental assistants, and 30 controls. Results demonstrate that the dentistry personnel contained significantly higher mean concentration of mercury in their blood samples (dentists: 29.835 µg/L and dental assistants: 22.798 µg/L) compared to that of the controls (3.2769 µg/L). The mean concentration of mercury was found maximum in the blood samples of older age group (62.8 µg/L) in dentists and (44.3 µg/L) in dental assistants. The comparison of mercury concentration among dentists, dental assistants, and controls (pairing based on their ages) revealed that the concentration increased with the age and experience among the dentists and dental assistants. Moreover, the mercury concentration in all the studied dental wastewater samples, collected from twenty-two dental clinics, was found to be exceeding the recommended discharge limit of 0.01 mg/L. Therefore, we recommend that immediate steps must be taken to ensure appropriate preventive measures to avoid mercury vapors in order to prevent potential health hazards to dentistry personnel. Strong regulatory and administrative measures are needed to deal with mercury pollution on emergency basis.