Dental unit waterline infection control practice and knowledge gaps.

BACKGROUND: Dental unit waterline (DWL) infection control is critical to infection prevention. Identifying challenges and barriers to its implementation is a first step toward understanding how to improve engagement. METHODS: A survey was distributed to dentists, dental hygienists, and dental assistants via the Qualtrics XM platform (Qualtrics). Responses were analyzed to quantify engagement in practices contrary to Centers for Disease Control and Prevention guidance and identify avenues to improve engagement. RESULTS: Although oral health care providers recognized DWL infection control was important, there was a lack of clarity about appropriate routine engagement (eg, what lines should be tested), what should be noted in practice infection control records, and steps to be taken in response to a failed test result (ie, ≥ 500 colony-forming units/mL), such as taking a chair out of service. CONCLUSIONS: Survey results showed there were considerable gaps in knowledge and practice that could lead to patient harm. Oral health care provider training may not prepare personnel adequately to engage in, let alone supervise, DWL infection control. DWL infection control, like other aspects of infection control, requires action informed via an understanding of what needs to be done. Although good intentions are appreciated, better approaches to DWL infection control information dissemination and strategies to engage dental assistants, dental hygienists, and dentists in best practices are needed. PRACTICAL IMPLICATIONS: Evolving standards of care, including infection control, should be reflected in the provision of dental treatment. Improvements in communicating and ensuring engagement in best practices are needed when it comes to DWL infection control.

Effect of Different Isolation Methods on Bioaerosol Distribution: An In Vitro Study.

Purpose: The purposes of this in vitro study were to evaluate the effect of three isolation methods to mitigate bioaerosols during stainless steel crown (SSC) preparations and assess the distribution of Streptococcus mutans by aerosolization in closed-room operatories. Methods: Melamine teeth coated in laboratory-grown S. mutans biofilm were prepared for SSCs using three different isolation methods. Agar plates were placed in five locations throughout the operatory and opened during each preparation as well as for 10 minutes immediately following to collect aerosolized S. mutans. Bacterial colonies were counted after incubating plates for 48 hours. Data were analyzed for differences between the isolation method and plate locations. Results: Bacterial colony counts for teeth prepared using high-volume evacuation suction (HVE) with dental dam (DD) isolation were statistically significantly higher than for those prepared using HVE with a DryShield®(DS) and HVE with no isolation at the assistant (A) (P<0.001), operator face shield (FS) (P<0.001), and patient (Pt) (P=0.002) locations. No significant differences were found among isolation methods for parent (Pa) or rear delivery (RD) locations. The location that produced the most bacterial colony counts using HVE with DD isolation was FS (P<0.001), followed by A (P=0.04), Pt (P<0.001), and RD and Pa (P<0.001). Counts produced from teeth prepared with DS isolation were significantly higher at the Pt location than the A (P<0.001), FS (P=0.002), RD (P<0.001), and Pa (P=0.008) locations. Conclusion: The use of dental dam with high-volume evacuation suction during stainless steel crown preparations increased bioaerosols near the procedure, while dental evacuation systems (DryShield®) may effectively limit their spread.

Relato de caso clínico de infecção odontogênica resultando em complicação cervicofacial / Reporte de caso clínico de infección odontogênica com resultado de complicación cervicofacial / Clinical case reportof odontogenic infectionresulting cervicofacial complication

Introdução: A saúde bucal é um aspecto que não deve ser subestimado pelos pacientes, principalmente se considerar que as infecções odontogênicas podem levar a quadros graves, incluindo complicações cervicotorácicas, como Mediastinite e cervicofaciais, como Angina de Ludwig. Para tanto, é imprescindível que os profissionais da odontologia saibam reconhecer os principais sinais e sintomas dessas infecções, sua evolução, conhecer as complicações associadas e qual o manejo adequado. Objetivo: Assim, é objetivo deste trabalho, relatar, discutir um caso clínico de uma infecção odontogênica grave que acarretou em complicação cervical, com trajeto em direção ao mediastino, necessitando manejo multidisciplinar, e explorar os principais aspectos desse quadro e a conduta necessária, que exige, no mínimo, intervenção cirúrgica, antibioticoterapia e manutenção das vias aéreas. Relato de caso: O caso trata de um paciente com infecção odontogênica, iniciada como uma pericoronarite do dente 38 semieruptado, que evoluiu para a área cervical, demandando imediata drenagem nesta região pois encaminhava-se para uma mediastinite. Após a drenagem cervical e antibioticoterapia e, assim que houve redução do trismo, foi removido o dente 38, evoluindo para a cura.Conclusões:As infecções odontogênicas, principalmente as que acometem os espaços fasciais e cervicais profundos, são potencialmente graves e devem ter suas principais manifestações clínicas entre os domínios de conhecimento dos profissionais Bucomaxilofaciais, pois necessitam de diagnóstico preciso, manejo rápido e tratamento adequado e precoce, considerando a velocidade com que podem evoluir (AU).

Introduction: Oral healthis an aspect that should not be underestimated by patients, especially considering that dental infections can lead to serious symptoms, including cervicothoracic complications, such as Mediastinitis and cervicofacial complications, such as Ludwig's Angina. Therefore, it is essential that dental professionals know how to recognize the main signs and symptoms of these infections, their evolution, know the associated complications and appropriate management.Objective: Thus, this work aims to report and discuss a clinical case of a serious odontogenic infection that resulted in a cervical complication, with a path towards the mediastinum, requiring multidisciplinary management, and to explore the main aspects of this condition and the necessary conduct, which requires, at least, surgical intervention, antibiotic therapy and airway maintenance.Case report: The case concerns a patient with odontogenic infection, which began as pericoronitis of semi-erupted tooth 38, which progressed to the cervical area, requiring immediate drainage in this region as it was heading towards mediastinitis. After cervical drainage and antibiotic therapy and, as soon as the trismus was reduced, tooth 38 was removed, progressing towards healing.Conclusions: Odontogenic infections, especially those that affect the fascial and deep cervical spaces, are potentially serious and should have their main clinical manifestations among the domains of knowledge ofOral and Maxillofacial professionals, as they require accurate diagnosis, rapid management and adequate and early treatment, considering the speed at which they can evolve (AU).

Introducción: La salud bucal es un aspecto que los pacientes no deben subestimar, especialmente considerando que las infecciones odontógenas pueden derivar en afecciones graves, incluidas complicaciones cervicotorácicas, como la mediastinitis, y complicaciones cervicofaciales, como la angina de Ludwig.Para ello, es fundamental que los profesionales odontológicos sepan reconocer las principales señalesy síntomas de estas infecciones, su evolución, conocer las complicaciones asociadas y el manejo adecuado.Objetivo: Así,el objetivo de este trabajo es reportar y discutir un caso clínico de infección odontogénica grave que resultó en una complicación cervical, con trayecto hacia el mediastino, que requirió manejo multidisciplinario, y explorar los principales aspectos de esta condicióny las medidas necesarias, que requiere, como mínimo, intervención quirúrgica, terapia con antibióticos y mantenimiento de las vías respiratorias.Reporte de caso: El caso se trata de un paciente con una infección odontogénica, que comenzó como pericoronaritis del diente 38 semi-erupcionado, la cual progresó hacia la zona cervical, requiriendo drenaje inmediato en esta región ya que se encaminaba para una mediastinitis.Después del drenaje cervical y la terapia antibiótica y, una vez reducido el trismo, se extrajo el diente 38, evolucijjonando hacia la cura.Conclusiones: Las infecciones odontogénicas, especialmente aquellas que afectan los espacios fasciales y cervicales profundos, son potencialmente graves y deben tener sus principales manifestaciones clínicas entre los dominios del conocimiento de los profesionales Orales y Maxilofaciales, pues requieren de un diagnóstico certero, un manejo rápido y un tratamiento adecuado y temprano, considerando la velocidad a la que pueden evolucionar (AU).

Anti-inflamatórios no tratamento de infecções odontogênicas: revisão da literatura / Anti-inflammatories in the treatment of dental infections: review of the literature

Infecções odontogênicas são processos patológicos de grande importância na rotina odontológica. Seu tratamento pode constituir um desafio para profissionais e ser motivo de muita discussão. Anti-inflamatórios para casos de infecção severa são rotineiramente utilizados por alguns profissionais para amenizar sintomas agudos, como dor, edema, trismo, disfagia, disfonia e dispneia. Porém, alguns estudos indicam desvantagens do uso desses medicamentos no tratamento das infecções. Uma revisão da literatura foi realizada com o objetivo de responder se indivíduos acometidos por infecção odontogênica grave apresentam melhora do quadro com o emprego de anti-inflamatórios não-esteroidais ou esteroidais quando se avalia tempo de internação hospitalar, dor, edema, trismo, entre outros aspectos. Em dezembro de 2023, a base de dados eletrônicos PubMed/MEDLINE foi acessada e termos específicos indexados no Mesh e DeCS foram utilizados para a busca. Poderiam ser incluídos estudos observacionais, ensaios clínicos ou revisões que correspondessem à pergunta foco. Ao fim do processo de seleção de artigos, quatro foram incluídos. Outros dois artigos foram encontrados em lista de referências de artigos primariamente selecionados. Um estudo transversal relatou agravos em infecções odontogênicas entre paciente que fizeram uso de anti-inflamatórios. Um segundo e um terceiro estudos transversais não relataram diferenças nos desfechos quando compararam o uso e o não uso de anti-inflamatórios. Porém, o segundo detectou um maior consumo de antibióticos por aqueles pacientes que foram medicados com anti-inflamatórios. Uma auditoria reportou baixo índice de prescrição de corticoides no tratamento de infecções odontogênicas em rotinas de centros de saúde, exceto em casos de severidade, como na presença de dispneia e disfagia. Uma revisão que objetivou relatar o uso de anti-inflamatórios em infecções odontogênicas, não sugeriu qualquer influência desses medicamentos no tratamento. Por último, uma revisão sistemática incluiu pesquisas e relatos de caso que avaliaram os efeitos de corticoides em infecções profundas em espaços cervicais, epiglotite, supraglotite, celulite orbitária e periorbitária, faringite e abscesso peritonsilar. Resultados positivos foram encontrados, porém nenhum dos estudos incluídos relataram desfechos baseados em infecções odontogênicas. Portanto, sugere-se que o uso de anti-inflamatórios pode ocultar sinais inflamatórios da infecção, retardando seu correto diagnóstico e tratamento, resultando um prognóstico não favorável. Corticoides em alta dose por curto período de tempo é visto como adjuvante no tratamento de infecções cervicofaciais severas, principalmente quando vias aéreas estão comprometidas.

Odontogenic infections are pathologic processes of great importance in the dentistry routine. Its treatment may be a challenge for professionals and it may be the subject of discussion. Usually, some professionals prescribe anti-inflammatories for severe cases of infection to alleviate acute symptoms, such as pain, edema, trismus, dysphagia, dysphonia, and dyspnea. However, some studies indicate disadvantages of using these medications to treat infections. A review of the literature was conducted to answer whether individuals affected by severe odontogenic infection improve their condition with the use of non-steroidal or steroidal anti-inflammatory drugs when evaluating length of hospitalization, pain, edema, trismus, among others aspects. In December 2023, the electronic database PubMed/MEDLINE was accessed and specific terms indexed in the Mesh were used for the search. Observational studies, clinical trials or reviews that correspond to the focus question could be included. At the end of the article selection process, four studies were included. Two other articles were found in the reference list of primarily selected articles. A cross-sectional study reported worsening of odontogenic infections among patients who used anti-inflammatories. A second and third cross-sectional studies reported no differences in outcomes when comparing the use and non-use of anti-inflammatories. However, the second detected a greater consumption of antibiotics by those who were treated with anti-inflammatories. An audit reported a low rate of prescription of corticosteroids in the treatment of odontogenic infections in the routine of dental offices, except in severe cases, such as in the presence of dyspnea and dysphagia. A review that aimed to report the use of anti-inflammatories in odontogenic infections did not suggest any influence of these medications on the treatment. Finally, a systematic review included researches and case reports that evaluated the effects of corticosteroids on deep neck infections, epiglottitis, supraglottitis, orbital and periorbital cellulitis, pharyngitis and peritonsillar abscess. Positive results were found, but none of the included studies reported outcomes based on odontogenic infections. Therefore, it is suggested that the use of anti-inflammatory drugs may hide inflammatory signs of the infection, delaying its correct diagnosis and treatment, resulting in an unfavorable prognosis. High-doses corticosteroids for a short period of time are seen as an adjuvant in the treatment of severe cervicofacial infections.

Efficacy of a chairside extraoral suction system in the reduction of aerosol contamination.

The dental setting is regarded as a high-risk environment for aerosol concentrations and transmission of respiratory infectious agents, especially in relation to the COVID-19 pandemic. Although a number of approaches and practices have evolved to reduce the spread of pathogens in the dental setting, the risk of airborne infection remains a concern. Several new extraoral suction (EOS) devices have been marketed recently; further investigation is warranted to determine their clinical effectiveness. The aim of this study was to evaluate the efficacy of a chairside EOS device (PAX 2000 Extraoral Dental Suction System) in reducing aerosol contamination from patients receiving ultrasonic scaling by a registered hygienist as a part of initial or supportive periodontal therapy. The number of colony-forming units (CFUs) was measured with agar plates before, during, and after ultrasonic scaling at 3 different locations in the dental operatory (instrument table, patient chest area, and patient foot area). Forty subjects were randomly allocated into 2 test groups (n = 20) in which ultrasonic scaling was performed with or without the use of the EOS device. The CFUs retrieved after incubation were quantified and identified by their bacterial or fungal taxon. The use of the EOS device reduced the number of CFUs during scaling at all 3 locations, but the difference was only statistically significant (P = 0.018; Mann-Whitney U test) at the patient's chest area, where the highest number of CFUs was present. The aerosols consisted of 74 different taxa of human origin. The results suggest that the tested EOS system may reduce aerosol contamination in the clinical dental setting, especially in proximity to the patient's head, where most aerosols are generated.

Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli [Pré-print]

The dissemination of carbapenem-resistant Gram-negative bacilli (CRGNB) is a global public health issue. CRGNB isolates are usually extensively drug-resistant or pandrug-resistant, resulting in limited antimicrobial treatment options and high mortality. A multidisciplinary guideline development group covering clinical infectious diseases, clinical microbiology, clinical pharmacology, infection control, and guideline methodology experts jointly developed the present clinical practice guidelines based on best available scientific evidence to address the clinical issues regarding laboratory testing, antimicrobial therapy, and prevention of CRGNB infections. This guideline focuses on carbapenem-resistant Enterobacteriales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA). Sixteen clinical questions were proposed from the perspective of current clinical practice and translated into research questions using PICO (population, intervention, comparator, and outcomes) format to collect and synthesize relevant evidence to inform corresponding recommendations. The grading of recommendations, assessment, development and evaluation (GRADE) approach was used to evaluate the quality of evidence, benefit and risk profile of corresponding interventions and formulate recommendations or suggestions. Evidence extracted from systematic reviews and randomized controlled trials (RCTs) was considered preferentially for treatment-related clinical questions. Observational studies, non-controlled studies, and expert opinions were considered as supplementary evidence in the absence of RCTs. The strength of recommendations was classified as strong or conditional (weak). The evidence informing recommendations derives from studies worldwide, while the implementation suggestions combined the Chinese experience. The target audience of this guideline is clinician and related professionals involved in management of infectious diseases.

Ultrasound protocol in odontogenic infections: a new proposal

Background: Point-of-care-ultrasound can be applied to preview a difficult airway, detect the presence of fluid collection, and soft-tissue edema, and guide the drainage location, although is rarely used. The purpose of this study is to validate a protocol for the assessment of these clinical features on patients with severe odontogenic infections.Material and methods: This was a single-group prospective cohort study (n=20) including patients with the diagnosis of deep-neck propagation of odontogenic infection. A transcervical linear high-frequency probe transducer (13-6 MHz) was used to scan the structures of the upper airway and the infectious collections. The drainage was guided by ultrasound and the patients were daily evaluated, according to the protocol. The data were extracted and the airway volume, midline deviation, and other important data such as length of hospital stay, dysphagia, voice alteration, raised floor of the mouth, dyspnea, and neck swelling were registered.Results: The ultrasound examination was correlated with multiple clinical findings, such as dyslalia (p=0,069), dysphagia (p=0,028), dyspnea (p=0,001), among others. This protocol has an advantage as it can be used at bedside evaluation, allowing the assessment of severe and unstable patients, and predicting the increase of the hospitalization time (p=0,019).Conclusions: This protocol is reliable for the assessment of the upper airway, even in an emergency, predicting not only the severity of the clinical features but aids in the determination of the length of the hospitalization time. (AU)

Ultrasound protocol in odontogenic infections: a new proposal.

BACKGROUND: Point-of-care-ultrasound can be applied to preview a difficult airway, detect the presence of fluid collection, and soft-tissue edema, and guide the drainage location, although is rarely used. The purpose of this study is to validate a protocol for the assessment of these clinical features on patients with severe odontogenic infections. MATERIAL AND METHODS: This was a single-group prospective cohort study (n=20) including patients with the diagnosis of deep-neck propagation of odontogenic infection. A transcervical linear high-frequency probe transducer (13-6 MHz) was used to scan the structures of the upper airway and the infectious collections. The drainage was guided by ultrasound and the patients were daily evaluated, according to the protocol. The data were extracted and the airway volume, midline deviation, and other important data such as length of hospital stay, dysphagia, voice alteration, raised floor of the mouth, dyspnea, and neck swelling were registered. RESULTS: The ultrasound examination was correlated with multiple clinical findings, such as dyslalia (p=0,069), dysphagia (p=0,028), dyspnea (p=0,001), among others. This protocol has an advantage as it can be used at bedside evaluation, allowing the assessment of severe and unstable patients, and predicting the increase of the hospitalization time (p=0,019). CONCLUSIONS: This protocol is reliable for the assessment of the upper airway, even in an emergency, predicting not only the severity of the clinical features but aids in the determination of the length of the hospitalization time.

Learning outcomes of a mobile application for dental infection control education.

PURPOSE/OBJECTIVES: This study aimed to apply and verify the effectiveness of a mobile-based dental infection control education application to enable students majoring in dental hygiene to learning dental infection control education without time and space constraints. METHODS: This study used a nonequivalent control group pretest-posttest design to examine differences in learning outcomes between an experimental group that learned through the mobile application and a control group that learned with handouts. The Infection Prevention and Control Mobile Application (IPC App) and handouts were developed by referring to the Center for Disease Control's (CDC) guidelines for Infection Prevention and Control in Dental Settings. Both the experimental and control groups were guided to perform self-regulated learning, where they independently led and managed their learning for two weeks. The study was conducted at the D university college with 42 students from the second grade in the Department of Dental Hygiene from August to October 2021. Differences in knowledge, self-efficacy, and summative evaluation were analyzed using an independent sample t-test and repeated measures analysis of variance (p < 0.05). RESULTS: The findings confirmed that the experimental group who learned through the IPC mobile application had improved their knowledge and indicated a higher summative evaluation than the control group that learned via learning documents (p < 0.05). CONCLUSIONS: Owing to the high accessibility and repeatability of the learning content, the mobile application recommended in this study may serve as an effective self-directed learning tool for students to gain knowledge on the standard precautions for dental infection control.

Conocimientos, actitudes y prácticas sobre prevención y control de infecciones (PCI) en alumnos de Estomatología de la UAM-Xochimilco / Knowledge, attitudes and practices on infection prevention and control in Stomatology students UAM-Xochimilco

Introducción: la prevención y control de infecciones (PCI) pretenden prevenir, detener y propagar enfermedades infecciosas en pacientes y trabajadores de la salud. Este enfoque debe comenzar con la formación y capacitación del profesional de la salud, inmunizaciones recomendadas y ejecución de medidas universales de protección. Objetivos: evaluar conocimientos, actitudes y prácticas en la prevención y control de infec- ciones de los estudiantes y pasantes de servicio social de la licenciatura en Estomatología de la UAM-X. Material y métodos: se realizó un estudio descriptivo, transversal y observacional mediante una encuesta anónima como instrumento para recolección de datos a una muestra de 108 alumnos y pasantes. Resultados: se encontró que al contestar el interrogatorio sobre «prevención y control de infecciones¼, 59.3% tuvo un nivel de conocimientos aceptable y 40.7% tuvo un nivel muy bueno. De los encuestados, 87% desinfecta y cambia las barreras de protección entre cada paciente, 9.3% al comenzar y finalizar el día; el restante 3.7%, cuando está visiblemente sucio o cuando hay derrame de sustancias de líquidos corporales. Conclusión: los encuestados tienen adecuados conocimientos y prácticas, lo que infiere que tienen el sustento teórico y habilidades para enfrentarse a la etapa postpandemia para la atención de pacientes (AU)

ntroduction: infection prevention and control (IPC) efforts to prevent, stopping and spreading infectious diseases in patients and healthcare workers. This approach should begin with education and training of the health professional, recommended immunizations and implementation of universal protective measures. Objectives: to evaluate knowledge, attitudes and practices in infection prevention and control stomatology career's students and social service interns UAM-X. Material and methods: a descriptive, cross-sectional and observational study was carried out using an anonymous survey as an instrument for data collection from a sample of 108 students and interns. Results: it was found that when answering the questionnaire on «infection prevention and control¼, 59.3% had an acceptable level of knowledge and 40.7% had a very good level. 87% of the respondents disinfect and change the protective barriers between each patient, 9.3% at the beginning and end of the day; the remaining 3.7% when visibly dirty or when there is spillage of body fluids. Conclusion: respondents have adequate knowledge and practices, inferring that they have the theoretical support and skills to face the post-pandemic stage of patient care (AU)

La COVID-19 y sus repercusiones en la práctica odontológica / COVID-19 and their repercussions on dental practice

La llegada del COVID-19 generó diversos cambios significativos en el área de la salud y particularmente en el área odontológica, donde se priorizaron los tratamientos de urgencia relegando los procedimientos menores y atención de citas a la vía virtual. Otras modificaciones se concentraron en el uso de equipos de protección personal y logística de atención tanto para el paciente como para el profesional, siguiendo las indicaciones de las normas diseñadas para esta función; adicionalmente se hicieron adecuaciones en las áreas de recepción y práctica odontológica, y se capacitó a los profesionales en temas relativos a la enfermedad. El objetivo del presente artículo es analizar las implicaciones generadas en la práctica odontológica durante la pandemia por COVID-19 en los ámbitos de triaje, infraestructura, normativa y capacitación (AU)

The arrival of COVID-19 produced a series of significant changes in the health area and particularly in the dental area where emergency treatments were prioritized, relegating minor procedures and appointment care to the virtual route, other modifications focused on the use of personal protective equipment and care logistics for both the patient and the professional following the indications of the standards designed for this function, additionally adjustments were made in the reception and dental practice areas, and professionals were trained on issues related to the disease. The objective of this article is to analyze the implications generated in dental practice during the COVID-19 pandemic in the areas of triage, infrastructure, regulations and training (AU)

Las negligencias más comunes en la práctica odontológica / The most common negligence in dental practice

Para el adecuado ejercicio de la odontología, los procedimientos realizados deben ejecutarse apegándose en todo momento a las normas y principios éticos propios de la profesión. Cuando un odontólogo decide, por voluntad propia, ejercer la profesión sin apegarse a dichos principios, se considera que actúa con negligencia. La negligencia se caracteriza por ser un acto indebido, en el cual el profesional ejecuta por voluntad propia acciones injustificables capaces de producir daños en la salud de los pacientes o en el pronóstico de un tratamiento. Los actos negligentes, además de atentar contra la integridad del paciente, ponen en riesgo a los profesionales de la salud que los cometen de sufrir consecuencias legales derivadas de dichos actos. El objetivo del presente artículo consiste en definir el concepto de negligencia, describir las formas más comunes en las que ésta se comete durante la consulta odontológica así como sus posibles consecuencias legales, ilustrándolas a su vez con la breve presentación de algunos casos (AU)

For the proper practice of dentistry, the procedures performed must be carried out adhering at all times to the standards and ethical principles of the profession. When a dentist voluntarily decides to practice the profession without adhering to these principles, he is considered to be acting negligently. Negligence is characterized as an improper act, in which the professional voluntarily executes unjustifiable actions capable of causing damage to the health of patients or the prognosis of a treatment. Negligent acts, in addition to threatening the integrity of the patient, put health professionals at risk who commit legal consequences derived from these acts. The aim of this article is to define the concept of negligence, to describe the most common ways in which it is committed during the dental practice as well as its legal consequences, illustrating them in turn with a brief presentation of some cases (AU)

Infection Control in Dental Clinics: Prosthodontics Perspectives.

AIM: The aim of this article is to discuss the infection control measures with focus on those related to prosthodontic work. BACKGROUND: The risk of transmission of several infectious microorganisms during dental procedures and the increased awareness and knowledge of infectious diseases have led to an increased attention to the importance of infection control. Prosthodontists and dental personnel are exposed directly or indirectly to a significant risk of acquiring healthcare-associated infections. REVIEW RESULTS: High standards of occupational safety and dental infection control must be applied by dental personnel for the safety of patients and dental healthcare workers. All reusable items (critical and semicritical instruments) that come in contact with the patient's saliva, blood, or mucous membranes must be heat-sterilized. Proper disinfectants should be used to disinfect nonsterilizable instruments (e.g., wax knifes, dental shade plastic mixing spatula, guides, fox bite plane, articulators, and facebows). CONCLUSION: In prosthodontics, items potentially contaminated with patient's blood and saliva are transported between dental clinics and dental laboratories. Such fluids may contain microorganisms with high potential for transmission of several diseases. Therefore, sterilization and disinfection of all items used during prosthodontic work should be part of infection control protocol in dental care setting. CLINICAL SIGNIFICANCE: In prosthodontic practice, a strict infection prevention plan should be implemented to minimalize the risk of infectious diseases transmission among prosthodontists, dental office, dental laboratory personnel, and patients.

Extrações dentárias em pacientes com diabetes mellitus: estudo retrospectivo / Dental extractions in patients with diabetes mellitus: Retrospective study

Introdução: A literatura científica médica traz evidências que suportam a hipótese de que a hiperglicemia e o diabetes mellitus (DM) aumentam o risco de infecção e atraso na cicatrização da ferida após procedimentos cirúrgicos de grande porte. Muitos autores extrapolaram esse conceito para cirurgia menores, como as extrações dentárias. Estudos prospectivos têm sugerido que a taxa de complicações após exodontias é semelhante em pessoas com e sem DM. Objetivo: Comparar a frequência e o tipo de complicações após exodontias em pacientes com DM1 e DM2. Além disso, observar se há relação entre complicações pós-operatórias infecciosas e inflamatórias e a prescrição de antibióticos. Material e Métodos: Do total de 718 prontuários de pacientes com DM atendidos entre um período de 27 anos, 311 foram incluídos na pesquisa, uma vez que esses pacientes foram submetidos a pelo menos uma exodontia. Foram coletados dados demográficos, história médica pregressa e atual, dados relativos à(s) exodontia(s) realizada(s), complicações transoperatórias e pós-operatórias e antibioticoterapia. Resultados: A maioria dos pacientes eram do sexo masculino (164/311; 52,7%), cor de pele branca (230/311; 73,9%) e com média de idade de 51 anos. Sessenta e oito (21,9%) pacientes tinham DM1 e 243 (78,1%) DM2. Duzentos e vinte e sete (73,0%) tinham comorbidades associadas ao DM, sendo as doenças cardiovasculares as mais prevalentes (208/311; 66,9%). Nos 311 prontuários, havia registro de 895 intervenções de exodontias, das quais 192 (21,5%) foram realizadas em pacientes com DM1 e 703 (78,5%) em pacientes com DM2, elas foram adiadas em 29 prontuários (29/895; 3,2%). Complicações transoperatórias estavam registradas em 08 prontuários (08/895; 0,9%), sendo a hemorragia transoperatória a complicação mais frequente, em 3 dos 8 registros. Das 895 intervenções, encontramos 25 registros de complicações após as exodontias. Pacientes com DM1 exibiram 11 (11/192; 5,7%) registros de complicações após as exodontias, sendo eles: registro de edema (1), trismo (1), abscesso (1), atrasos na epitelização (2), sequestro de espícula óssea (3), alergia a medicamento (1) e alveolite (2). Nos pacientes com DM2, computamos 14 (14/703; 2%) registros de complicações, sendo eles: registros de dor (7), parestesia (1), abcesso (1), sequestro de espícula óssea (3) e alveolite (2). Os pacientes com DM1 exibiram mais complicações após exodontias que os pacientes com DM2 (5,7% versus 2%; p=0,011). Houve prescrição antibiótica para 26% dos pacientes com DM1 (50/192) e para 15% dos pacientes com DM2 (105/703). Não foi observada associação entre complicações pós-operatórias inflamatórias e infecciosas e a prescrição de antibiótico profilático. Conclusão: A prevalência de complicações após exodontias foi baixa e semelhante entre os pacientes com DM1 e DM2. É possível afirmar que o DM não aumenta o risco de complicações infecciosas e inflamatórias após exodontias.

Bioseguridad en el laboratorio dental / Biosafety in the dental laboratory

Una enfermedad infecciosa es aquella producida por un agente infeccioso (bacterias, hongos, virus, etc.) que ingresa y se desarrolla en el organismo de un hospedero. Posteriormente, puede trasmitirse de un individuo a otro directamente por contacto entre ambos, o bien, indirectamente, por medio de un vec-tor biológico (de naturaleza animal o vegetal), o de un fómite (objeto inanimado). Las vías por las que un agente infeccioso puede ingresar a un hospedero son: inhalación (respiración de aerosoles), ingestión (salpicaduras de gotas), penetración de mucosas (na-sal, ocular y bucal) o lesiones en la piel o mucosas. Las fuentes de infección pueden ser los pacientes, el personal del consultorio o laboratorio, las superficies e instrumental contaminados y las prótesis o com-ponentes de éstas. Para evitar la propagación de los agentes microbianos se debe interrumpir el proceso de transmisión de los mismos. Todo profesional debe fortalecer y readecuar normas y protocolos de biose-guridad en la tarea diaria, para minimizar el riesgo de transmisión directa y cruzada entre el profesional, su equipo auxiliar, el laboratorista y los pacientes (AU)

An infectious disease is one caused by an infectious agent (bacteria, fungi, virus, etc.) that enters and develops in a host. Then it can be transmitted from one individual to another directly by contact between the two or, indirectly through a biological vector (an animal or plant nature), or a fomite (an inanimate object). The routes by which an infectious agent can enter a host are: inhalation (breathing of aerosols), ingestion (splash of droplets), penetration of mucous membranes (nasal, ocular and oral) and skin or mucous lesions. Sources of infection can be patients, office or laboratory personnel, contaminated surfaces and instruments and the prosthesis or component thereof. To prevent the spread of microbial agents, the process of their transmission must be interrupted. Every professional must strengthen and readjust biosafety standards and protocols in daily work to minimize the risk of direct and cross-transmission between the professional, his auxiliary team, the laboratory technician and the patients (AU)

Mucormicosis Maxilar posterior, secundaria a una exodoncia: Reporte de un caso y revisión de la literatura / Posterior maxillary mucormycosis, secondary to an exodontics: A case report and literature review

RESUMEN: La Mucormicosis se describe como una infección fúngica de tipo oportunista y potencialmente mortal, reportándose en la literatura como la tercera en frecuencia, muy por detrás de la Candidiasis y Aspergilosis. Esta infección es causada por hongos de la familia de los Mucorales. Se presenta el caso de un hombre con Diabetes Mellitus II con un control metabólico deficiente, el cual posterior a una exodoncia, presenta una Mucormicosis Maxilar, presentando una etiología atípica y logrando ser confirmada posterior a biopsias y pruebas de cultivo, demostrando elementos del tipo Mucor. Se realizó una Maxilectomía parcial del lado afectado como tratamiento con una evolución favorable. Esta revisión destaca la importancia de la búsqueda activa basada en la semiología y la importancia de los exámenes complementarios, implicando lograr un correcto diagnóstico y pronóstico de la enfermedad.

ABSTRACT: Mucormycosis is described as an opportunistic and life-threatening fungal infection, being reported in the literature as the third in frequency, far behind candidiasis and aspergillosis. This infection is caused by fungi of the Mucorales family. We present the case of a man with Diabetes Mellitus II with poor metabolic control who, after an extraction, presents a Maxillary Mucormycosis, with an atypical etiology and confirmed after biopsies and culture tests, demonstrating elements of the Mucor type. A partial maxillectomy was performed on the affected side as a treatment with a favorable outcome. This review highlights the importance of active search based on semiology and of complementary examinations, implying a correct diagnosis and prognosis of the disease.

Efectividad en reducción de unidades formadoras de colonias con soluciones desinfectantes en tina ultrasónica / Effectiveness in reducing colony forming units with disinfecting solutions in an ultrasonic vat

En la práctica clínica, los odontólogos se encuentran expuestos al riesgo de infecciones, que se transmiten a través de instrumentos contaminados con exudados. Instrumentos en contacto con el personal deben estar esterilizados o sometidos a un proceso de desinfección. Se realizó un estudio transversal-prospectivo a 30 pacientes, de los que se tomaron tres muestras con espejos estériles, pasando por fondo de saco, carrillos y lengua, después las muestras se desinfectaron, se realizó el hisopado de cada espejo y se incubó en agar tripticaseína-soya (TSA) 24 horas a 37 oC. Pasadas 24 horas se realizaron diluciones en tubos Eppendorf, y se sembraron en cajas de Petri con agar sangre, se incubaron por 48 horas a 37 oC; se contabilizaron las unidades formadoras de colonias (UFC) y registraron para su análisis. Al obtener los resultados se encontró que ID 213 tuvo mayor reducción con una media = 62.5 en comparación con Zeta 1 Ultra, media = 89.23, y control, media = 164.50, de igual manera se observó una diferencia en reducción de UFC/mL entre ID 213 con respecto a Zeta 1 Ultra con significancia de 0.012. Ambos desinfectantes resultaron efectivos, pero se estableció que ID 213 utilizando la tina ultrasónica resulta más efectivo en la reducción de UFC, que Zeta 1 Ultra (AU)

In clinical practice, dentists are exposed to the risk of infections, which are transmitted through instruments contaminated with exudates. Instruments in contact with personnel must be sterilized or subjected to a disinfection process. A cross-sectional-prospective study was carried out in 30 patients. From which three samples were taken with sterile mirrors, passing through cul-de-sac, cheeks and tongue, later the samples were disinfected with disinfectants, each mirror was swabbed and incubated in TSA 24 hours at 37 oC. After 24 hours, dilutions were made in Eppendorf tubes, and they were seeded in Petri dishes with blood agar, they were incubated 48 hours at 37 oC; CFUs were accounted for and recorded for analysis. When obtaining the results, it was found that ID 213 had a greater reduction with mean = 62.5 compared to Zeta 1 Ultra mean = 89.23 and control mean = 164.50, in the same way a difference in reduction of CFU/mL was observed between ID 213 with respect to Zeta 1 Ultra with significance of 0.012. Both disinfectants were effective but it was established that ID 213 using the ultrasonic tub is more effective in reducing CFU, than Zeta 1 Ultra (AU)

COVID-19: ¿cuál es el rol ético del odontólogo ante esta pandemia? / COVID-19: what is the ethical role of the dentist in face of this pandemic?

Introducción: Para un buen profesional de la odontología es necesaria la ética en todas las actividades que realice. La ética establece lo que es y debe ser, buscando siempre el bien y no hacer el mal o causar daño, y el odontólogo debe tener una serie de cualidades y aptitudes con el fin de llevar a cabo todo el tratamiento que amerite el paciente de manera correcta, honesta y responsable sin escatimar esfuerzos para devolverle su salud oral. La COVID-19 es una enfermedad que se ha convertido en pandemia y está afectando al mundo de manera importante. Entre los más afectados se encuentran los profesionales de la salud que arriesgan sus vidas por sanar al enfermo. Dada la situación actual, a los odontólogos se les presenta la duda si atender a sus pacientes en este periodo cumple o no con los principios éticos de la profesión. Objetivo: El objetivo del presente artículo fue realizar una revisión sistemática de la literatura con el fin de identificar el rol bioético del odontólogo ante la pandemia de COVID-19. Material y métodos: Para realizar la recolección de la literatura se compilaron artículos de diferentes bases de datos: PubMed, Cochrane, Nature y Lilacs producidos entre los años 2012 y 2020 con las palabras clave: ética, odontología, pandemia, COVID-19 y bioética en los idiomas español, inglés y portugués. Resultados: Se localizaron 70 artículos, de los cuales se escogieron finalmente 10 correspondientes a los criterios de búsqueda. Los artículos presentaron homogeneidad sobre el rol del odontólogo en la situación actual y coinciden en la búsqueda de alternativas y métodos de atención lo más seguras posibles, dando prioridad a quienes requieren atención de urgencias (AU)

Introduction: For a good dental professional, ethics is necessary in all the activities performed. Ethics stablish what is and what should be, always looking for the good and not the bad, the dentist should have a series of qualities and skills in order to perform every treatment that the patient needs in a correct, honest and responsible way without sparing efforts to give them back their oral health. COVID-19 is a disease that has converted into a pandemic affecting the world in an important manner. And, between the most affected are the health providers and professionals that risk their lives to heal the people suffering this disease. Given the current situation, dentists have been found in doubt regarding if treating their patients in this period meets or not the ethical principles of their profession. Objective: The objective of this article is to perform a systematic review of literature in order to identify the bioethics role of the dentist in face of the COVID-19 pandemic. Material and methods: To carry out the collection of literature the procedure included compiling different articles from the databases: PubMed, Cochrane, Nature, and Lilacs produced between the years of 2012 and 2020 with the key words: ethics, dentistry, pandemic, COVID-19, bioethics in the languages of Spanish, English and Portuguese. Results: 70 papers were located from which only 10 were chosen meeting the searching criteria. The papers presented homogenous results about the role of dentists in the current situation and the all agree in the search of alternatives and methods of care that are as secure as possible, giving priority to those who are in need of urgent care (AU)

O ensino odontológico e os desafios relacionados ao cumprimento dos novos protocolos de biossegu-rança no contexto da pandemia da COVID-19 / Dental education and the challenges related to complying with the new biosafety protocols in the COVID-19 pandemic context

O objetivo deste estudo foi apresentar os desafios relacionados ao cumprimento dos novos protocolos de biossegurança, na perspectiva do retorno das atividades presenciais nas instituições de ensino superior em Odontologia,no cenário da pandemia da COVID-19.Tratou-se de um estudo qualitativo, de caráter exploratório, ancorado na técnica de pesquisa documental. Foram analisados os documentos publicados pelo Ministério da Educação (MEC), Conselho Federal de Odontologia (CFO) e Associação Brasileira de EnsinoOdontológico (ABENO).Os documentos foram coletados nos websitesdas entidades selecionadas. O tratamento dos dados qualitativos foi realizado por meio da análise de conteúdo temática, sendo comparadas qualitativamente as diferentes publicações, identificando-se pontos convergentes, divergentes ou ausentes entre os documentos.Combase na problematização do objeto em questão, foram emitidas sugestões a partir das fragilidades e potencialidades relacionadas à execução das recomendações. Os dados foram distribuídos nas unidades de análise "sala de espera", "clínica" e "laboratório". As principais potencialidades foram relacionadas à diminuição do risco biológico de transmissão de patógenos e à adequação de espaços físicos em ambientes mais ergonômicos de aprendizagem. Quanto às fragilidades, aponta-se o aumento de custos para discentes e instituições e a redução no número de atendimentos. Existem desafios a serem considerados em relação ao cumprimento dos novos protocolos de biossegurança no retorno das atividades práticas nos cursos deOdontologia durante a pandemia da COVID-19 (AU).

This study presents challenges related to the fulfillment of the new biosafety protocols aiming to return the face-to-face activities in higher education institutions in Dentistry considering the pandemic scenario of COVID-19. It was a qualitative, exploratory study, anchored in the technique of documentary research. We analyzed documents published by the Ministry of Education(MEC), the Federal Council of Dentistry (FCD) and the Brazilian Association for Dental Education (BADE). The documents were collected on websites of the selected entities. The treatment of qualitative data obtained was carried out by thematic content analysisto compare qualitatively the different documents by identifying convergent, divergent or absent points between them. From the problematization of the object under study, suggestions were made based on the weaknesses and potentialities related to the execution of the recommendations. Data were distributed in the analysis units "waiting room", "clinic" and "laboratory". The main potentialities were related to the reduction of the biological risk of transmission of pathogens and the adaptation of physicalspaces in more ergonomic learning environments. As for the weaknesses, there are increased costs for students and institutions and reduced number of visits. There are challenges to be considered to comply with the new biosafety protocols in the return of practical activities in Dentistry Courses during the COVID-19 pandemic (AU).