Current status of biomedical waste management practices and barriers among private Jordanian dental clinics: A cross-sectional investigation of the capital Amman.

Biomedical waste management (BMWM) is vital in facilitating safe providing of healthcare. Developing countries suffer from the impact of mishandled biomedical waste (BMW) on the general public in addition to healthcare practitioners. Thus, this study aims to investigate the awareness and compliance of dental facilities to BMW regulations. Through a questionnaire designed as per the WHO guidelines on BMWM, we randomly recruited a total of 421 dental facilities representative of Jordan's capital. Mean BMWM practice scores were relatively high for the studied sample (0.748 ± 0.12). Nonetheless, while collection, transportation and storage standards were acceptable, those pertaining to segregation and disposal demonstrated lack of compliance to BMWM safety measures. An alarming number of participants dispose of infectious waste (40%), extracted teeth (48.5%), expired pharmaceuticals (44.4%), liquid chemicals (53.2%), X-ray films (35.0%) and solutions (48.7%) in the general trash or draining system. Such is attributed to either lack of resources, lack of proper equipment or poor awareness with BMWM guidelines. Moreover, it appears that location of the clinic (p < 0.001), occupation (p = 0.026) and presence of regulatory instructions (p = 0.048) were associated with higher BMWM scores. Overall, dental practitioners require proper training in terms of handling hazardous dental, chemical and radioactive wastes. Moreover, regulatory bodies should actively enforce regulations and monitoring, update current compliance legislations and subsidize eco-friendly practices.

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.

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.

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.

Evaluation of mercury contamination in patients and water during amalgam removal.

AIM: The aim of this study was to evaluate mercury levels in wastewater and in patients during the removal of dental amalgam restorations. MATERIALS AND METHODS: To test for mercury levels, patients were tested before and after amalgam restoration removal. To test for mercury emissions, samples of constant volume of wastewater from high-speed drills were collected before and during amalgam restoration removal. RESULTS: Although the systemic mercury levels were lower than the limit of biological tolerance, all patients had increased levels after dental restorations. All samples of wastewater had increased mercury levels too. CONCLUSION: The urinary levels of mercury increased with dental amalgam removal using a high-speed drill. During the process of amalgam removal, water used for cooling the dental drill was contaminated with mercury. CLINICAL SIGNIFICANCE: The mercury released by the physical action of the drill, the replacement material and especially the final destination of the amalgam waste can increase contamination levels that can be a risk for human and environment health.

Dental solid waste characterization and management in Iran: a case study of Sistan and Baluchestan Province.

The management of dental solid waste continues to be a major challenge, particularly in most healthcare facilities of the developing world. In Iran, few studies on management of dental solid waste and its composition are available. An effort has been made through this study to evaluate the hazardous and infectious status of dental solid waste, keeping in mind its possible role in cross-infection chain. For this study, 123 private dental centres and 36 public dental centres were selected and the composition and generation rate of dental solid waste produced were measured. Dental solid waste was classified to four main categories: (i) domestic-type; (ii) potentially infectious; (iii) chemical and pharmaceutical; and (iv) toxic, which constituted 11.7, 80.3, 6.3, and 1.7%, respectively, of the total. Also, the results indicated that the dental solid waste per patient per day generation rate for total, domestic-type, potentially infectious, chemical and pharmaceutical, and toxic wastes were 169.9, 8.6, 153.3, 11.2, and 3.3 g/patient/d, respectively. Furthermore, the per day generation rates for total, domestic-type, potentially infectious, chemical and pharmaceutical, and toxic wastes were 194.5, 22.6, 156.1, 12.3, and 3.4 kg/d, respectively. According to findings of this study, for best management of dental waste it is suggested that source reduction, separation, reuse, and recycling programmes be implemented and each section of dental waste be collected and disposed of separately and in accordance with related criteria.

[Study of remains and dental wastes of a First World War German rest camp]. / Etude des restes et déchets dentaires d'un camp de repos allemand de la première guerre mondiale.

INTRODUCTION: This article presents the analysis of dental remains and waste from the dental office of a German rest camp of the First World War in order to study the living conditions of the soldiers, the care policy and the prosthetic rehabilitation techniques used in this context. MATERIALS AND METHODS: The study included both dental and prosthetic remains, revealed during the excavation. The criteria to determine dental and periodontal health were the presence or absence of caries, wear, tartar and periodontal lesion. Location, severity and frequency of each of these parameters were examined. Regarding the prosthetic remains, the type of prosthesis and the materials used were determined. RESULTS: Three hundred and twenty seven (327) dental remains were analyzed. A high prevalence of large caries, especially in the molar areas, was highlighted. The incisal areas had however more wear and tartar. 183 casts of plaster dental arcade allowed to highlight a significant proportion of posterior edentulous. Prosthetic remains and laboratory waste revealed the use of vulcanite and porcelain for making dentures.

Tips for maintaining sterilization in your orthodontic work station.

Sterilization and disinfection have been a matter of concern amongst dental health care workers since long. Delicate materials, electrical parts, orthodontic pliers, orthodontic wire cutters, are to be treated according to the manufacturer's instructions to safe guard the life of the instrument as well as to claim warranty for any damage incurred. Sterilization procedures used in Orthodontics should be simple but effective and of relatively short duration so that there is a readily available supply of sterile instruments and materials. The procedure should not cause any appreciable damage to dental instruments and other materials. An attempt has been made through this article, to provide information concerning methods and means of disinfection and sterilization of orthodontic clinics, instruments, materials and also waste disposal which can be adopted in private clinics as well as in hospital set ups.

Simulation clinic waste audit assessment and recommendations at the University of Washington School of Dentistry.

OBJECTIVE: Dentistry produces waste contributing to climate change and adverse health outcomes, thus reducing waste is essential; however, there has been minimal emphasis on sustainability or climate action in dentistry. Waste audits quantify the type and amount of waste produced and may inform waste reduction strategies. We conducted a waste audit to identify areas of potential waste reduction and recommend interventions to reduce waste. METHODS: In this cross-sectional study, we conducted a waste audit of garbage produced during a typical 4-hour pre-clinical restorative dentistry simulation exercise. The sample was composed of 72 second-year dental students. This exercise is part of a standard curriculum with a uniform format regarding supplies used and participants. Potentially infectious materials were not used during this exercise. RESULTS: In total, 26.6 kg of waste was discarded. Plastic was the largest contributor by mass (57.5%), followed by paper barriers (19.6%), then impression materials (6.5%). We found 894 gloves and 70 masks discarded. CONCLUSIONS: Based on these findings, we categorized waste reduction opportunities into policy changes, purchasing sustainable materials, and increasing awareness through education. Specific suggested actions include: relaxing glove and gown requirements during laboratory simulations; replacing single use items with more sustainable options; increasing use of intraoral scanners; and posting informational signage with examples of what can be recycled.

Waste management from dental clinics: A case study in Belo Horizonte, Brazil.

Healthcare waste management is a critical aspect of public health and environmental protection, particularly in establishments such as dental clinics. This study examined the dental clinic waste (DCW) management processes in clinics within the city of Belo Horizonte, Brazil. Utilizing data from Healthcare Waste Management Plans (HCWMP) provided by the Urban Cleaning Superintendence, the study investigated waste generation, segregation, storage, collection, treatment, and final disposal practices. The results revealed that hazardous DCW represented a significant portion (26.5 %) of waste generated in dental clinics, exceeding the World Health Organization's recommended threshold. Biological waste (22.9 %), mainly consisting of cotton, gauze, and gloves contaminated with blood or body fluids, was the most generated hazardous waste group, followed by chemical (2.2 %) and sharps waste (1.3 %). Incineration was the predominant treatment method for hazardous DCW, raising concerns about environmental impacts and greenhouse gas emissions. Non-hazardous waste, primarily destined for landfills, had limited recycling rates (2.4 %), emphasizing the need for improved waste management strategies to minimize environmental impacts and increase circular economy. Challenges in DCW management included inadequate segregation practices, limited recycling initiatives, and incomplete HCWMPs lacking descriptions of waste management beyond establishment boundaries. Addressing these challenges requires comprehensive training programs, strengthened regulations, and increased environmental awareness among healthcare professionals. In conclusion, improving DCW management in dental clinics is crucial for mitigating occupational and environmental risks. Collective efforts are needed to enhance waste segregation, promote recycling, and ensure compliance with regulations, ultimately safeguarding public health and the environment.

Percutaneous injuries amongst Greek endodontists: a national questionnaire survey.

AIM: To investigate amongst Greek endodontists the incidence of percutaneous injuries, the circumstances associated with them, the therapeutic measures taken after the injuries and their compliance with infection control measures. METHODOLOGY: One hundred and forty-seven endodontists met the inclusion criteria and were invited to participate in the survey. Personal and professional data, information on percutaneous injuries in the past 5 years and on infection control practices were gathered through interviews based on a questionnaire. Data were analysed using chi-square test, independent samples t-test, one-way anova and Pearson's correlation coefficient. The level of significance was set at P = 0.05. RESULTS: The response rate was 84%. The injury rate was estimated at 1.35 per endodontist per year. Endodontic files were associated with 37% of the injuries and fingers were injured in 75% of the most recent cases. Medical assistance was sought in 36% of the most recent injuries. Endodontists who always or usually practiced 4-handed endodontics (P = 0.007) as well as those not performing surgical endodontics (P = 0.007) reported significantly fewer injuries. In 91% of the participants, a complete hepatitis B virus vaccination was reported. Gloves, masks, rubber dam isolation and puncture-resistant containers for disposal of sharp instruments were always used by 98%, 94%, 100% and 81% of the respondents, respectively. CONCLUSIONS: The injury rate was low. The practice of four-handed endodontics was associated with a reduced number of percutaneous injuries; the performance of surgical endodontics increased their incidence. Greek endodontists showed a high level of compliance with infection control measures.

Jordanian dentists' knowledge and implementation of eco-friendly dental office strategies.

OBJECTIVE: To investigate the implementation of eco-friendly dental office strategies by Jordanian dentists. METHODS: Self-designed questionnaires were provided to 150 dentists working in private dental practices in the city of Amman, the capital of Jordan. Dentists' names and addresses were obtained from the Jordanian Dental Association. RESULTS: Overall, the level of knowledge about eco-friendly dental offices strategies was high for amalgam, radiology, paper waste, infection control and energy and water conservation. In terms of implementation, the majority of Jordanian dentists apply few eco-friendly dental offices strategies. The most frequently identified barriers to implementation of eco-friendly dental offices strategies were cost and lack of incentives from the government. CONCLUSION: Most Jordanian dental practices are not eco-friendly. A continued focus on the impact of dental practices on the environment is needed through formal and continuing dental education. Results of this study can guide policy development to encourage implementation of eco-friendly strategies.

Compliance of Saudi dental students with infection control guidelines.

The aim of this study was to investigate compliance of dental students in a Saudi dental school with recommended infection control protocols. A pilot-tested questionnaire concerning various aspects of infection control practices was distributed to 330 dental students. The response rate was 93.9% (n = 311). About 99% of students recorded the medical history of their patients and 80% were vaccinated against hepatitis B. The highest compliance (100%) with recommended guidelines was reported for wearing gloves and use of a new saliva ejector for each patient. Over 90% of the respondents changed gloves between patients, wore face masks, changed hand instruments, burs and handpieces between patients, used a rubber dam in restorative procedures and discarded sharp objects in special containers. A lower usage rate was reported for changing face masks between patients (81%), disinfecting impression materials (87%) and dental prosthesis (74%) and wearing gowns (57%). Eye glasses and face shield were used by less than one-third of the sample. The majority of students were found to be in compliance with most of the investigated infection control measures. Nevertheless, further education is needed to improve some infection control measures including vaccination for Hepatitis B virus (HBV), wearing eye glasses, gowns and face shields and disinfecting impression materials and dental prostheses.

Blood contamination of used dental anesthetic cartridges.

This study sought to determine the levels of blood contamination found in and/or on used dental anesthetic cartridges and to measure antibacterial effects after exposure to a local anesthetic solution. The study analyzed a total of 1000 used cartridges from an oral surgery clinic, containing 1 of 3 anesthetic types. Blood testing included visual observations (using a dissecting microscope) and chemical analyses. From each cartridge, either 0.5 ml of residual anesthetic solution or a combination of anesthetic solution plus added saline was removed. Using reagent strip dipsticks, the solutions were analyzed for minute amounts of blood. Visual examinations were scored on a positive or negative scale. In addition, 4 types of bacteria were mixed with lidocaine or phosphate buffered saline (PBS) for up to 30 days, and viable cell counts decreases were measured for the 2 solutions. A majority of the cartridges evaluated contained lidocaine, and while only 7 of the 1000 cartridges examined contained visible blood, the reagent strips detected blood in more than 76% of all cartridges. Lidocaine and PBS produced similar bacterial death rates. The authors concluded that blood contamination levels in the absence of pronounced antibacterial activity indicate that dental anesthetic cartridges could be considered a potential type of regulated medical waste.

Going green with eco-friendly dentistry.

Eco-friendly dentistry is currently transforming the medical and dental field to decrease its affect on our natural environment and reduce the amount of waste being produced. Eco-friendly dentistry uses a sustainable approach to encourage dentists to implement new strategies to try and reduce the energy being consumed and the large amount of waste being produced by the industry. Many reasonable, practical and easy alternatives do exist which would reduce the environmental footprint of a dental office were it to follow the 'green' recommendations. Dentist should take a leading role in the society by implementing 'green' initiatives to lessen their impact on the environment. This article provides a series of 'green' recommendations that dentists around the world can implement to become a leading Stewards of the environment.

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.

Current biomedical waste management practices and cross-infection control procedures of dentists in India.

OBJECTIVES: To investigate the knowledge, attitudes and behaviour of dentists working in dental clinics and dental hospitals regarding biomedical waste management and cross-infection control. METHODS: A national survey was conducted. Self-administered questionnaires were sent to 800 dentists across India. RESULTS: A total of 494 dentists responded, giving a response rate of 61.8%. Of these, 228 of 323 (70.6%) general dentists reported using boiling water as a sterilising medium and 339 (68.6%) dentists reported disposing of hazardous waste such as syringes, blades and ampoules in dustbins and emptying these into municipal corporation bins. CONCLUSIONS: Dentists should undergo continuing education programmes on biomedical waste management and infection control guidelines. Greater cooperation between dental clinics and hospitals and pollution control boards is needed to ensure the proper handling and disposal of biomedical waste.

Improper waste disposal of silver-mercury amalgam.

The objective of this work was to estimate the quantity of mercury residue present in dental amalgam that is generated and discarded in the city of Manaus (Amazon-Brazil). For this purpose, the locations of amalgam usage (10 public and 31 private dental clinics), the method by which the residue is discarded (14 clinics improper disposal), and the analysis of total mercury in the sediment of the controlled landfill (2.68-3 µgHg/g), were described. It was concluded that: there are dental clinics in the city that discard mercury residue into the common waste disposal system, which contravenes health safety standards.