A descriptive study of percutaneous injuries in National Healthcare Group POLYCLINICS dental clinics in Singapore from 2014 to 2020.

INTRODUCTION: All dental staff face risk of percutaneous injuries (PCI)s. Blood-borne diseases may be transmitted to staff via contaminated sharp instruments. Hence there are significant impacts on staff when PCIs occur. Though a PCI is an occupational hazard, it is preventable. AIM: This study aims to identify factors associated with PCIs among dental staff by evaluating the circumstances and staff designations involved. METHODS: PCIs were reported through an electronic incident reporting system from 2014 to 2020. Reports involved their nature and extent. Statistical analysis was carried out to find associations between factors such as injury site, type of instrument and staff designation. RESULTS: A total of 63 PCIs were included in this study. The type of instrument was found to be significantly associated with staff designation (p = 0.04, p < 0.05) with significantly more dental burs causing injury in dentists and more injuries caused by 'other instruments' in health attendants (p = 0.0083). Majority of PCIs occurred in dentists, then dental assistants and health attendants. Staff designation was significantly associated with the instance where PCIs occurred (p < 0.001). Dentists and dental assistants were more likely to sustain injuries during a dental procedure than before procedure and after procedure (p = 0.0167). The mean incidence of PCIs among our dentists was 15.6/100. CONCLUSIONS: All dental staff are at risk of PCIs however dentists sustain the highest number of PCIs. Needles, dental burs and metal matrices are the top three instruments. Targeted interventions might help prevent/reduce PCIs.

A retrospective cross-sectional study of early patient-reported failures of direct restorations placed in a primary dental care setting.

Introduction A retrospective cross-sectional study of early patient-reported failures of restorations was initiated to understand the reasons and factors associated with early failure. Early patient-reported failures are defined as restorations requiring replacement within three months of placement.Aim To investigate if restorative material placed or any other tooth/restoration/patient factors may be associated with early patient-reported failures.Methods In total, 360 restorations were replaced from January 2016 to December 2017. Multivariable analyses (logistic regression model) were used to identify any patient/tooth/restoration factors that were associated with early patient-reported failures.Results Dislodgement, fracture and pain/sensitivity were the three main failure modes. There was significant association between restorative material type and dislodgement and restoration fracture. The odds of dislodgement for composite resin (CR) were 4.3 times higher compared to amalgam. The odds of dislodgement for glass-ionomer cement (GIC) and resin-modified GIC were 3.7 times higher compared to amalgam. The odds of fracture for CR were ten times lower compared to amalgam. The odds of pain for teeth with a history of restoration failure for a particular tooth were five times lower compared to no history of restoration failure for a particular tooth.Conclusions Restorative material type affected patient-reported failures.

An Update on the Dental Management of Children with Haemophilia.

Children with haemophilia present a bleeding risk and a challenge for dentists. Guidelines on the dental management of haemophilia patients are largely based on expert consensus. Many existing guidelines also provide generic guidance mainly for adult patients, which have been adapted for children. However, children have unique needs that require additional considerations. With limited evidence available, it is important that dentists have an understanding of the principles of both medical and dental management and have a close collaboration with the haematologist at all times. Therefore, this paper provides some key principles related to various aspects of dental management of children with haemophilia. Furthermore, there has been a recent update to the World Federation of Haemophilia (WFH) Guidelines for the Management of Haemophilia,1 with references to novel medical therapies for haemophilia. Hence, this paper also aims to inform dentists with the standard and newer medical therapies for haemophilia, including a specific focus on the novel agent Emicizumab and the associated dental considerations.

Nitrous oxide inhalation sedation in dentistry: An overview of its applications and safety profile.

Nitrous oxide in oxygen (N2O/O2) inhalation sedation is used less commonly by Singapore dentists than their counterparts in the United Kingdom and the United States. Using this technique, trained dentists often perform the dual roles of a sedationist and an operating dentist. This paper describes the mechanism of action of N2O and highlights the modern gas delivery system commonly used in dentistry. The built-in safety features of this unique system helps to ensure that patient-specific therapeutic dosages are effectively and safely administered by dentists. Existing evidence for adverse events and the safety profile of the N2O/O2 inhalation sedation is discussed. Finally, recommendations of equipment, training and techniques for safe N2O/O2 inhalation sedation are provided.