Occupation-related allergies in dentistry.

BACKGROUND: Allergies to natural rubber latex (NRL) were unknown in dentistry until 1987. That changed with the publication of a report documenting NRL-based anaphylaxis in a dental worker. This case and others prompted regulatory and manufacturing changes in rubber products and increased awareness throughout the profession. However, other common dental chemicals cause allergic reactions and irritation and often are handled with insufficient precautions. Although recognition of NRL allergy has improved, awareness of other potential allergens and irritants in dentistry still is limited. OVERVIEW: Recent research indicates that the prevalence of NRL protein allergy may be decreasing. In contrast, occupation-related dermatoses associated with other dental products may be more common. Encounters with bonding agents, disinfectants, rubber, metals and detergents can cause occupation-based irritant contact dermatitis and allergic contact dermatitis. These conditions may be found in more than one-quarter of dental and medical personnel. Therefore, dental-specific information about the recognition and management of allergic and irritant reactions is needed. CONCLUSIONS AND CLINICAL IMPLICATIONS: The prevalence of occupation-related dermatitis may be increasing in dentistry. Reducing exposure to potential irritants and allergens and educating personnel about proper skin care are essential to reversing this trend.

Efficacy of Listerine Antiseptic in reducing viral contamination of saliva.

AIM: The anti-viral efficacy of oral antimicrobial rinses has not been adequately studied in terms of potential clinical significance. As a follow-up to an in vitro study on the effect of oral antiseptics on Herpes simplex virus, Type 1, this study was undertaken to evaluate the in vivo effect of an essential oil containing oral antiseptic on the reduction of viral titer in saliva during active viral infection. METHOD: Patients were recruited and evaluated in a single visit protocol at the onset of a perioral outbreak, consistent historically and clinically with recurrent Herpes labialis. Direct immunofluorescence of cytological smears of the lesions/oral fluids was used to confirm Herpes simplex virus types I or II. Patients were randomly assigned to one of two treatment groups: (1) active ingredient and (2) sterile water control. The viral lesion was evaluated as to clinical stage according to standard protocol. Salivary fluid samples were taken: (1) at baseline; (2) immediately following a 30 s rinse; (3) 30 min. after the 30 s rinse; and (4) on the repeat trial, also at 60 min. after the 30 s rinse. All samples were evaluated for viral titer and results compared. RESULTS: In Trial 1, the sample population consisted of 19 males and 21 females with an average age of 29.2 and in Trial 2, 21 males, 19 females with an average age of 28. In both Trials 1 and 2, recoverable infectious virions were reduced to zero after a 30 s experimental rinse; whereas, the control rinse resulted in a non-significant (p>0.05) reduction. The experimental group also demonstrated a continued significant (p<0.05) reduction 30 min. post rinse when compared with baseline while the control group returned to baseline levels. In Trial 2, the 60 min. post rinse follow-up demonstrated a 1-2 log residual reduction from baseline in the experimental group; however, this was not significant. CONCLUSIONS: There is clinical efficacy in utilizing an oral rinse with the antimicrobial agent Listerine Antiseptic in reducing the presence of viral contamination in oral fluids for at least 30 min. after oral rinse. The risk of viral cross contamination generated from these oral fluids in person to person contact or during dental treatment may be reduced.

Efficacy of A-dec's ICX dental unit waterline treatment solution in the prevention and treatment of microbial contamination in dental units.

OBJECTIVE: Even though some chemical agents can disinfect biofilms in dental unit waterlines, there remains concern that all remnants of the biofilm matrix are not eliminated. Even with periodic treatments, the bacterial populations in dental unit waterlines recur rapidly. In addition, with some previously tested products, patient safety, as well as toxic, caustic and corrosive residual chemicals are also a concern. This study evaluated ICX, A-dec's new water treatment solution, in a series of experiments for prevention, microbial spectrum of activity, minimum inhibitory time determination, and treatment of established biofilms. METHODOLOGY: New dental unit waterline tubing was treated continuously during simulated patient care over 28 days with municipal water. It was then treated with ICX. Effluents from lines with established biofilms (averaging > 10(4) CFU/ml at day 0) were treated to assess levels of CFU counts within 21 days of exposure to ICX. RESULTS: Tubing treated with ICX did not develop a detectable biofilm using ruthenium red staining, and microbes in effluents remained undetectable. CONCLUSION: ICX is effective in maintaining the effluent within the American Dental Association's and the Centers for Disease Control's recommendation for < 500 CFU/ml. In addition, considering the preliminary finding that ICX reduces microbial contamination of effluents from established biofilm lines, it may be useful in long-term treatment alone or when coupled with a shock treatment to assist in biofilm destruction.

Effect of a dental unit waterline treatment solution on composite-dentin shear bond strengths.

OBJECTIVE: The control of biofilm and effluent contamination of dental unit water lines (DUWL) includes additions of antimicrobial solutions, as well as automatic dosing units. There are, however, varying reports on the effects of such agents on the bond strength of restorative dental materials and, particularly, between these agents and dental hard tissues. METHODOLOGY: The possible effects of an antimicrobial DUWL treatment solution on the adhesion of composite resin to dentin was evaluated by shear bond strength (SBS) testing. A total of 20 caries-free human molar and premolar teeth were used as the test substrates. The teeth were divided into two sets of 10 teeth which, after appropriate cleaning with water and pumice, were embedded horizontally in dental die stone. The buccal surface of each tooth was ground flat to a 17 microns finish using water-lubricated SiC paper. The teeth were then etched for 15 seconds with 37% H3PO4 and rinsed with either water (control) or a proprietary DUWL treatment (ICX) solution. Thereafter, the teeth were lightly blown dry with clean dry air, and the dentin conditioned with Prime & Bond NT for 20 seconds. The excess solvent was then removed by gentle air drying for 5 seconds, and the conditioner cured with visible light for 10 seconds. A cylinder of composite was placed on the conditioned surface and cured. A second group of 20 caries-free human molar and premolar teeth were used as test substrates to evaluate the effect of the ICX DUWL treatment solution on a different dentin priming system (OptiBond Solo Plus). The teeth in the second group were divided into two sets and after a 15 second etch with 37% H3PO4, were rinsed with water (control) or the proprietary ICX DUWL treatment solution. Thereafter, the teeth were lightly blown dry with clean, dry air and the dentin conditioned with OptiBond Solo for 20 seconds. The excess solvent was then removed by gentle air drying for 5 seconds, and the conditioner cured with visible light for 10 seconds. A cylinder of composite was placed on the conditioned surface and cured. Shear bond strength testing was performed with a universal test machine at the default cross-head speed of 0.1 mm/min. A set of teeth, sectioned, mounted and etched as above but rinsed with a 0.01% mineral oil/water mix prior to conditioning and bonding, was used as the negative control. A separate corrosion testing was performed by immersing brass coupons in water and ICX for 31 days and measuring the weight loss. The brass coupons were bright-dipped, electroless nickel-plated and bright nickel electroplated. RESULTS: The bonding studies indicated that the DUWL treatment solution applied to a cut and etched dentin surface prior to conditioning and bonding with an adhesive system has no effect (p > 0.05) on bond strength for either group of specimens, compared to water. Negative control specimens were found to have minimal bond strengths. The corrosion study indicated no difference in the behavior of the test specimens in ICX compared to those in water, although differences were noted between the different surface finishes applied to the brass substrate. CONCLUSION: The findings of this study demonstrate that exposure of an etched dentin surface to a water-based DUWL treatment mixture has no adverse effects on subsequent adhesion strength. Minimal corrosive attack was noted in the ICX solution and water for brass coupons provided with three different surface finishes.

Effect of a dental unit waterline additive on resin bond strengths.

The literature indicates that the addition of an antimicrobial mouthrinse to self-contained water systems in dental units will control biofilm and effluent contamination; however, reports have varied concerning the possible effects of such agents on adhesive dentistry bond strengths. This study evaluated shear bond strengths and the potential effects of a mouthrinse containing essential oils on cut tooth surfaces by grinding flat the buccal surface of extracted human teeth. Seven groups consisting of five teeth each were etched with 37% H3PO4 solution and rinsed with water or different dilutions of the mouthrinse. Each tooth was blotted dry before a film of adhesive resin was applied to the surface and photocured. A cylinder of composite was placed on the surface and photocured. Shear bond strength testing was performed using a universal test machine. The cut tooth surfaces were ground (using water or the test mouthrinse mixtures as coolant) and evaluated by scanning electron microscopy.

Infection control and dental practice: frequently asked questions.

The principles of infection control are constantly evolving to meet the challenges presented by newly emerging diseases. The Centers for Disease Control and Prevention (CDC) Guideline for Infection Control in Dental Health-Care Settings, 2003, is an important update of current infection control practices that will help the dental profession be better prepared to reduce the transmission of infectious disease(s) in the foreseeable future. However, basic questions still abound. This article reviews frequently asked questions and formats their answers according to recommendations from the 2003 CDC document.

Managing the care of patients infected with bloodborne diseases.

BACKGROUND: The emergence of the bloodborne pathogens HIV, the cause of AIDS; hepatitis B virus, or HBV; and hepatitis C virus, or HCV, has been a milestone in the history of the dental profession. In the early 1980s, new cases of AIDS increased dramatically, and fear of acquiring this disease compelled clinicians to modify the delivery of medical and dental care to allay fears of transmission on the part of both patients and health care workers. Arguably, the AIDS pandemic has been the most significant factor in the evolution and delivery of modern medical and dental care in the last century. OVERVIEW: To help ally fears and remove barriers to caring for the HIV population, the Centers for Disease Control and Prevention, or CDC, introduced the concept of universal precautions in 1983. This was followed by the Occupational Safety and Health Administration's Bloodborne Pathogens Standard in 1991. Specific to the dental profession was the development of the principles of infection control in dentistry recommended by the CDC (1993); the American Dental Association (1995) and the Organization for Safety & Asepsis Procedures (1997). While initially difficult for some clinicians to acknowledge, these recommendations now are universally accepted throughout the profession, and provision of oral health care to patients infected with bloodborne disease is becoming commonplace. Compliance with recommended infection control practices remains an important component of dental practice. But it must be accompanied by an understanding of infectious and bloodborne diseases and the medical/dental management of the care of infected dental patients. CONCLUSIONS AND PRACTICE IMPLICATIONS: The emergence of the bloodborne pathogens and the increasing number of infected patients who seek oral health care compel clinicians to have a thorough knowledge about bloodborne diseases and the medical/dental management of the care of patients presenting with HIV, HBV or HCV infection.

A review of the science regarding dental unit waterlines.

BACKGROUND: The National Institute of Dental and Craniofacial Research, or NIDCR; the American Dental Association, or ADA; and the Organization for Safety & Asepsis Procedures, or OSAP, sponsored a workshop on the topic of dental unit waterlines, or DUWLs, on Sept. 29, 2000, at the National Institutes of Health in Bethesda, Md. These organizations invited a group of experts from the ADA, NIDCR, OSAP, the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, the U.S. Department of Defense, academia and private industry to participate. TYPES OF STUDIES REVIEWED: The sponsors asked the participants to critically review the scientific literature on the subject in an attempt to determine the evidence basis for management of DUWL contamination and potential health risks, if any, in dental procedures. The ultimate goal of the workshop was to determine if a research agenda in the area of DUWLs should be pursued and what questions such an agenda should involve. RESULTS: The workshop yielded four questions that need to be addressed in future research: What is the safest and most effective agent(s)/device(s) for achieving microbial levels of no more than 200 colony-forming units per milliliter, or CFU/mL, in the effluent dental water? How should these products be evaluated and by whom? What are the adverse health effects, if any, of chronic exposure to dental bioaerosol or to the agents introduced into the dental unit to treat the waterlines for both dental staff members and patients? How could these health issues be evaluated? CLINICAL IMPLICATIONS: Developing evidence-based parameters for the management of biofilm contamination that are efficacious and cost-effective will allow clinicians to meet in proposed ADA standard of no more than 200 CFU/mL of effluent water.

Bloodborne pathogens: current concepts.

In the early 1980s, the AIDS hysteria began to gain momentum. As a direct result of this phenomenon, the delivery of dental care changed dramatically. By 1989, most dentists had begun to accept the concept of universal precautions and compliance with infection control recommendations from the Centers for Disease Control and Prevention and the Organization for Safety & Asepsis Procedures. The emergence of bloodborne pathogens from the 1970s has been a significant milestone in the history of the dental profession. Patients infected with human immunodeficiency virus, hepatitis B virus, and hepatitis C virus are commonly encountered in the modern dental practice, and dental providers need to have a thorough knowledge about bloodborne diseases and the dental management of patients presenting with these diseases.