Dentists' Perceptions of Their SARS-CoV-2 Risk and Infection Control Needs.

OBJECTIVE: Rapid worldwide dissemination of SARS-CoV-2 has prompted dental professionals to optimise their infection control procedures. To help identify areas of opportunity for protecting dentists and their patients, the aim of this investigation was to analyse Mexican dentists' early perceptions of their risk of exposure to SARS-CoV-2 and their need for comprehensive infection control education. METHODS: This cross-sectional survey was conducted from May 9 to June 3, 2020, during the social distancing phase in Mexico. The survey adhered to relevant guidelines for ethical research design. The questionnaire was designed with Google Surveys and applied online in Spanish. The questionnaire included items on demographics and clinical specialisation. To obtain time-sensitive perceptions, statements were preceded by "While SARS-CoV-2 circulates in the community and new COVID-19 cases are reported"; responses were collected in a 5-point Likert-type scale. RESULTS: The survey's link received 1524 "clicks." Over 25 days, 996 dentists participated (39% men; 89% working in Mexico and 11% in other Spanish-speaking Latin American countries). Most participants (73%) fully agreed that "Looking after patients will pose a risk for the dentist." Total agreement was more common (P = .0001) amongst dentists in Mexico (76%) than amongst those in other countries (53%). Knowing someone with COVID-19 was more common amongst Mexican dentists (P = .0008). The perceived need for enhanced infection control procedures increased with age (P = .0001). Forty-nine percent totally agreed that they sterilise dental handpieces between patients. One-third expressed total agreement that everyone in their clinic was trained in infection control. CONCLUSIONS: Amongst this nonprobabilistic self-selected sample of dentists, age and country of work influenced their perceptions about occupational exposure to SARS-CoV-2 and infection control needs. This survey revealed areas of opportunity to improve infection control education and training for dental professionals.

Eleven Basic Procedures/Practices for Dental Patient Safety.

OBJECTIVES: This study aimed to help alleviate the shortage of reliable information on clinical care issues; the Spanish Observatory of Dental Patient Safety (OESPO) has resorted to the study of legal claims by patients and searched those which produced clinical problems. METHODS: Based on OESPO data, this article proposes 11 basic procedures/practices for dental patient safety to help mitigate most preventable adverse events. RESULTS: The sample of the OESPO is large (415 adverse events studied), but it has the bias of a judicial source. However, the results provide an interesting approach to clinical safety in dentistry. When studying in detail the causes that led to preventable adverse events, it can be seen that most of these (and most severe) events have been caused by a small number of erroneous behaviors. CONCLUSIONS: Most preventable adverse events during the dental health care are produced by a relatively small number of causes. Therefore, a few basic safety procedures can reduce significantly these preventable adverse events.

Dentists Survey on Adverse Events During Their Clinical Training.

BACKGROUND: Adverse events (AEs) begin challenging the safe practice of dentistry early when students start treating patients at dental school. We assessed the frequency with which dentists caused common AEs during their undergraduate clinical training. METHODS: A convenience sample of dentists, graduated from more than 34 dental schools in Mexico and other Spanish speaking countries, answered a confidential, self-administered questionnaire with closed-format questions on common AEs they caused and their active errors that could have led to AEs in the teaching clinics. RESULTS: Of 207 participants, 80% had graduated recently. As undergraduates, 79% caused AEs; 38% admitted to causing one adverse event, 41% to causing two or more, and 36% committed active errors that could have hurt patients. No significant associations between AEs and sex or type of school were observed. CONCLUSIONS: The results indicate that dental students caused AEs or committed errors that placed patients at risk, during their clinical training. PRACTICAL IMPLICATIONS: Dental schools must identify challenges to patient safety at their teaching clinics and introduce risk reduction strategies to protect their patients and foster a safety culture in dental education.

Instrument processing with lauryl dimethyl benzyl ammonium bromide: a challenge for patient safety.

The quaternary ammonium compound (QUAT) lauryl dimethyl benzyl ammonium bromide (LDBAB) is commercialized in the Caribbean, Central, and South America under label claims to sterilize medical and dental instruments in 30 minutes or less. But QUAT formulations are classified as low-level disinfectants with no sporicidal activity or tuberculocidal efficacy. This study evaluated the presumptive sporicidal and tuberculocidal activities of 2 LDBAB formulations with label claims of high-level disinfectant action used widely in the Americas. In this study, sporicidal activity was evaluated against a challenge inoculum of 10(6)Bacillus atrophaeus spores. Tuberculocidal activity was evaluated against Mycobacterium tuberculosis H37Rv using the quantitative suspension test described in European Standard EN14348:2005. Tested at the recommended product concentrations indicated on their respective labels, both LDBAB solutions failed to demonstrate sporicidal activity and tuberculocidal efficacy. These findings underscore the need for public health authorities, as well as medical and dental professionals, to correctly identify LDBAB as a low-level disinfectant and avoid its use in instrument processing, a practice that may endanger lives.

Sporicidal activity in liquid chemical products to sterilize or high-level disinfect medical and dental instruments.

BACKGROUND: Various liquid chemical products are commercially available in Mexico under sporicidal label claims. Frequently, information provided on their labels conflicts with published data on active ingredients, use concentrations, or exposure times. OBJECTIVE: To evaluate sporicidal activity in 8 chemical products sold for the sterilization or high-level disinfection of medical and dental instruments. METHODS: Bacillus atrophaeus ATCC 9372 spores were suspended (10 6 spores in 50 mL) in each of 4 glutaraldehyde solutions: a super oxidized solution, a hydrogen peroxide formulation, a quaternary ammonium compound, and an ortho -phthalaldehyde solution. After up to a 10-hour exposure, the solutions were passed through 0.22-mum filters, which were then rinsed with 1% sodium bisulfite, washed, and incubated on tryptic soy agar for 5 days at 37 degrees C. RESULTS: At the use concentrations stipulated on their labels, only 2 of 6 products registered as sterilants showed sporicidal activity when challenged with 6 log 10 : a 2% glutaraldehyde in 10 hours and the hydrogen peroxide solution in 6 hours. Of 2 products registered as high-level disinfectants, only the ortho -phthalaldehyde showed noticeable sporicidal activity after 10-hour exposure. CONCLUSION: The results show that some chemical products, commercially available in Mexico as "Liquid Chemical Sterilants/High-Level Disinfectants" cannot be used reliably to process instruments between patients.

A cluster analysis model for caries risk assessment.

Cluster analysis was applied to determine, the natural grouping of individuals, among sixty 8-10-year-old children, and to identify the most significant set of markers for risk assessment. The risk clusters were obtained with initial clinical and bacteriological measurements including dmf + DMFS, active caries, mutans streptococci and lactobacilli counts in plaque or saliva on two media, and Snyder's test results. The morbidity clusters were constructed with the final clinical indexes and incidence after 18 months (dependent variables). A risk cluster was identified that included the following significant initial variables; dmf + DMFS, active caries, counts of mutans streptococci from plaque on TSY20B and lactobacilli in saliva, and Snyder's test results. This set of markers identified 86% of the children at high risk who developed high morbidity, as well as 94% of children in the low-risk cluster who developed low or no caries. The results of this investigation provide the basis to develop a system for caries risk assessment.

Biologic monitoring of dental office sterilizers in Mexico.

BACKGROUND: Biologic indicators (BIs) are the quality control applicable to sterilization cycles, but their use was not previously taught in Mexican dental schools or recommended by professional associations. A Mexican official standard, the Mexican Official Norm, published by health authorities in 1999 makes it compulsory for dentists to biologically verify sterilization cycles. However, only a few dentists comply because the use of BIs is largely unknown and the standard is not being enforced. OBJECTIVE: To evaluate the incidence of sterilization failures in a convenience sample of dental offices in Mexico. METHODS: Spore strips were distributed to dentists interested in using this service. The dentists mailed the processed BIs to the laboratory for culture. RESULTS: In 6 years, 3277 tests were submitted from 82 dental offices. Thirty-four offices (41%) submitted 1 to 12 tests, 22 (27%) sent 14 to 48 tests, 18 (22%) mailed 49 to 96 tests, and 8 (10%) sent >97 tests. The sterilization methods were steam (74.4%), dry heat (20%), and chemical vapor (5.6%). A total of 242 sterilization failures (7.4% of all cycles) were detected. Convection dry heat failed with a greater frequency with chi(2) analysis (chi(2) = 13.71, P =.0175). CONCLUSIONS: Sterilization failures occurred in instrument loads used in patient treatment. Steam and chemical vapor under pressure failed less often than convection dry heat. When corrective action is taken, routine use of BIs increases patient safety.

Nuevas estrategias para la inmunización contra la caries / New strategies for immunization against caries

La evidencia científica acumulada en los últimos treinta años indica que las bacterias Streptococcus mutans y Streptococcus sobrinus son los principales causantes de la caries en el ser humano. La vacunación contra la caries tiene por objetivo la producción de anticuerpos que evitan la acumulación de bacterias cariogénicas sobre los dientes. La inmunización activa, mediante la inoculación o por la ingestión de la vacuna, es la estrategia tradicional que recientemente incluyó el uso de bacterias no cariogénicas modificadas genéticamente para expresar proteínas de Streptococcus mutans y de Streptococcus sobrinus. La inmunización pasiva, mediante la aplicación local de anticuerpos de origen animal (producidos ya sea "in vivo" o "in vitro"), es una alternativa de evaluación. Existen diversas vacunas anticaries que resultan efectivas e inocuas en animales de experimentación. Algunas de éstas formas de inmunización están sujetas a pruebas clínicas en voluntarios y en pocos años serán utilizadas ampliamente

Pénfigo vulgar: autoanticuerpos y actividad clínica / Pemphigus: antibodies and clinic activity

Aún existe controversia sobre la utilidad de las titulaciones seriales de autoanticuerpos, mediante inmunofluorescencia, en la evaluación de la actividad del pénfigo. Por ello, el desarrollo de una prueba de alta sensibilidad y con potencial pronóstico sería de gran valor en la regulación del tratamiento con esteroides. Se desarrollo un ensayo radioinmune en fase sólida para detectar anticuerpos antiepiteliales en el suero de pacientes con pénfigo. De todas las líneas celulares estudiadas, sólo se detectó actividad antigénica en la línea celular SCaBER. Un antígeno con un peso molecular aparente de 105,000 fue aislado a partir de extractos de la membrana de células SCaBER