COVID-19 Outbreak and Dentistry: Guidelines and Recommendations for the Provision of Dental Healthcare Services.

After lockdown beginning from the third week of March 2020, face-to-face dentistry is gradually resuming with dental healthcare personnel feeling encouraged to safely provide treatment to the patients amid stringent infection control strategies. Having alerted to the associated infection threat, dentists will be better responding to the challenges of infection control in their clinics. Infection control strategies will follow the rapidly evolving guidelines of the local and international regulatory bodies that are relevant to this pandemic. Despite this, a concern exists as both the dental team members and the patients do not want to be the vectors for this deadly infection; and hence, the need for guidance. This article aims to inform dental healthcare professionals of the guidelines and recommendations to follow when receiving and treating patients in reopened practices. It appears that the novel coronavirus disease 2019 (COVID-19) outbreak has significantly and adversely impacted dentistry. The impacts seem to have long-term effect on the pattern of dental care; and a need for significant changes in the way dentists will provide dental care from now onwards. A wider use of tele-dentistry consultation platforms will obviously reduce the need for patients 2019; visits to dentists and dental hospitals. Key Words: COVID-19, Dentistry, Guidelines, Standards, Healthcare services.

Knowledge, attitude and compliance of infection control guidelines among dental faculty members and students in KSU.

BACKGROUND: Infection is one of the most crucial problems in health care services worldwide. It is considered one of the most important causes of morbidity and mortality associated with clinical, diagnostic and therapeutic procedures. Therefore, the purpose of this study was to investigate knowledge, attitude, and compliance with recommended infection control guidelines among dental faculty members and students at King Saud University, Riyadh, Kingdom of Saudi Arabia. METHODS: A cross-sectional study was conducted to obtain information regarding knowledge, attitude, and compliance with recommended infection control guidelines. The sample (n = 317) comprised of dental faculty members and students (3rd, 4th and 5th year) in both male and female campuses of College of Dentistry (KSU). This questionnaire contained three parts (knowledge, attitude, and compliance) and was distributed to the participants. After validation of the survey, data were collected, entered and analyzed by SPSS software. RESULTS: A total of 317 dental faculty members and students participated in this study. Out of the total study subjects, 141 (44.5%) were female and 176 (55.5%) were male. A comparison between dental faculty members and students was made based on their knowledge, attitude, and compliance, which resulted in almost equal percentages of knowledge (49.6, 49.0% respectively). In addition, it revealed that faculty members' attitude toward infection control in the dental clinic was more positive compared to their compliance with the infection control guidelines (70.6, 65.2% respectively) while with the students it was vice versa (67.2, 69.6% respectively). There is no statistically significant difference in the knowledge and attitude of dental faculty members and students regarding infection control guidelines (P > 0.05). CONCLUSION: Our study showed that dental undergraduate student and faculty members at KSU demonstrated a good adherence to infection control guidelines. On the other hand, there was a lack in the knowledge of the basics of infection control standards.

California Infection Control Regulations for Dental Professionals.

Infection control regulations that affect dental professionals come from several regulatory agencies and are increasingly complex. Staying up to date on changes and the overlapping requirements can challenge a busy dental practice. This article reviews the current regulations in California and suggests methods for ensuring every dental office is in compliance.

Development and validation of a questionnaire to evaluate infection control in oral radiology.

OBJECTIVES: To create and validate a questionnaire to evaluate infection control in oral radiology. METHODS: The questionnaire was developed after review of the literature, which included published articles and the biosafety protocols available from healthcare agencies. The initial version of the questionnaire was composed of 14 multiple choice questions and was divided into 3 domains on handwashing, disinfection/protection of surfaces and disinfectant used. Content validity was assessed by two expert committees, which reviewed the content and scope of the questionnaire and the relevance of each item, respectively. Reliability was evaluated using test-retest and internal consistency methods with 115 undergraduate dentistry students. Construct validity was assessed using the known-groups technique and factor analysis. The known-groups technique involved 641 undergraduate dentistry students, 20 PhD students and 15 oral radiology professors. In the factor analysis, 3 radiology technicians also participated in addition to the 641 undergraduates, 20 PhD students and 15 oral radiology professors. RESULTS: The content validity results were found to be satisfactory to excellent for the ordinal variables (intraclass correlation coefficient = 0.722-1.000) and good to great for the yes/no questions (kappa = 0.662-0.913) in terms of reliability and good internal consistency (Cronbach's alpha = 0.88). After a factor analysis, some questions were excluded, and the questions were grouped into new domains. Significant differences were observed between answers from different groups. The final version of the questionnaire was composed of nine domains. CONCLUSIONS: The questionnaire created was found to exhibit good psychometric properties for assessing infection control in oral radiology.

Evaluation of bacterial contamination of dental unit waterlines and use of a newly designed measurement device to assess retraction of a dental chair unit.

INTRODUCTION: Dental unit waterline (DUWL) output water is delivered through instruments of a dental chair unit (DCU) to irrigate and cool teeth. However, these waterlines can be heavily contaminated with bacteria. AIM: The purpose of the present study was to assess retraction and investigate the contamination level and prevalence of bacteria in DUWL output water. METHODS: Fifty-eight DCUs were randomly selected from 30 hospitals in 10 districts of Tianjin, one of the four special municipalities of China. A unique sampling connector was used in place of the dental handpiece to collect water samples. Evaluation of retraction was accomplished using a retraction measurement device designed in accordance with the International Standard ISO 7494-2:2015(E). RESULTS: A total of 263 water samples were collected, and the highest concentration of bacteria [1.8 × 10(6) colony-forming units (CFU)/mL] was found in the handpiece group. Thirty (51.72%) water samples in the handpiece group and 21 (36.21%) in the air/water syringe groups were cultured, yielding colony counts of > 500 CFU/mL. Potential infectious agents, such as Bacillus cereus, Kocuria kristinae and Pseudomonas fluorescens, were isolated from the water samples. Thirty (51.72%) DCUs failed the retraction evaluation. There was a significant, positive correlation (P < 0.05) between the concentration of bacteria in the water sample and the retracted volume. CONCLUSION: It is of paramount importance to increase compliance with the standards for controlling DUWL contamination. Routine microbial monitoring and evaluation of retraction are necessary to provide high-quality water for use in dental treatment.

Keeping Patients and Staff Healthy and Safe.

New CDC document makes it easier to implement and follow infection control practices.

Manejo de la salud oral en el paciente pediátrico infectado por VIH / Oral health management in the HIV-infected pediatric patient

El síndrome de inmunodeficiencia adquirida (SIDA) se caracteriza por una infección adquirida ocasionada por el virus de la inmunodeficiencia humana (VIH), que afecta a la población linfocitaria CD4+ y que predispone al paciente a un estado de inmunodefi ciencia que lo hace susceptible a infecciones oportunistas severas y/o neoplasias inusuales. La infección por el VIH es un problema grave de salud pública, ya que hay alrededor de 34 millones de personas infectadas según el Centro Nacional de Prevención de Enfermedades de Atlanta; de esta población seropositiva para VIH 68 por ciento vive en África Subsahariana. El VIH se transmite a través de la contaminación con sangre, semen, fluidos vaginales y leche materna. Muchos de los portadores de este virus son asintomáticos lo que complica la situación en virtud de que si no se toman las precauciones de bioseguridad adecuadas, esta situación representa un riesgo para el profesional de la salud oral. Los odontólogos deben brindar un tratamiento adecuado a este tipo de pacientes e identifi car oportunamente cualquier riesgo de infección y complicaciones asociadas

cquired immunodeficiency syndrome (AIDS) is characterized by a seemingly irreversible impairment acquired in CD4 + lymphocyte population that predisposes the host to severe opportunistic infections and/or neoplastic unusual. Infection produced by human immunode-fi ciency virus (HIV) is a serious public health problem, as there are about 34 million people infected reported by the National Center for Disease Prevention Atlanta, this 68% HIV-positive population lives in Sub-Saharan Africa. HIV is transmitted through blood contamination, semen, vaginal fl uids and breast milk. Many patients infected with this virus are asymptomatic complicating the situation under if appropriate biosecurity measures are not taken; this situation represents a risk for oral health professional. Dentists should provide adequate treatment to these patients and promptly identify any risk of infection and as-sociated complications.

De la bioseguridad al control de infecciones en Estomatología / From biosafety to infection control in dentistry

Durante las prácticas estomatológicas, tanto los pacientes como el personal de servicio se encuentran en continua exposición al contacto con agentes biológicos a través de la saliva, sangre o secreciones del tracto respiratorio. Es por eso que el cumplimiento de las normas de bioseguridad en los laboratorios o durante el tratamiento de los desechos es fundamental para disminuir el riesgo al que están sometidos. Sin embargo, se necesitan además de otras recomendaciones que se encuentran contenidas específicamente en los programas de prevención y control de infecciones y que no forman parte de los manuales de bioseguridad. Objetivos: relacionar las normas y principios de la bioseguridad con los principios de los programas de prevención y control de infecciones en Estomatología, e identificar los aspectos a tener en cuenta en la elaboración de dichos programas. Métodos: se realizó una revisión bibliográfica en las principales bases de datos médicas (Scielo, Pubmed, EBSCO, Hinari) de artículos científicos y programas de diversos países relacionados con la prevención y control de infecciones para Estomatología. Además se consultó el Manual de bioseguridad contenido en el anexo 28 del Programa Nacional de Atención Estomatológica Integral a la Población. Resultados: se recopilaron datos sobre los aspectos comunes y no comunes entre los principios de bioseguridad y los principios de los programas de prevención y control de infecciones para Estomatología. Por otra parte, se obtuvo información relacionada con los aspectos a tener en cuenta en la elaboración de estos. Conclusiones: es necesario considerar las normas de bioseguridad en la elaboración e implementación de un programa de prevención y control de infecciones para los servicios estomatológicos...

During the performance of dental procedures, both patients and staff are under permanent risk of contact with biological agents from saliva, blood and respiratory secretions. Hence the importance of complying with biosafety standards in laboratories and during the performance of waste disposal tasks. Moreover, alongside the recommendations contained in biosafety manuals, attention should also be paid to those included in infection prevention and control programs. Objectives: relate biosafety standards and principles to the principles contained in infection prevention and control programs for dentistry, and identify the aspects to be borne in mind when developing such programs. Methods: A bibliographic review was conducted in the main medical databases (Scielo, Pubmed, EBSCO, Hinari) of scientific papers and programs from various countries related to infection prevention and control in dentistry. The Biosafety Manual contained in Annex 28 of the National Comprehensive Dental Care Program was also consulted. Results: data were collected about similarities and differences between biosafety principles and the principles contained in infection prevention and control programs for dentistry. Additionally, information was obtained about the aspects to bear in mind when designing such programs. Conclusions: biosafety standards should be considered when developing and implementing an infection prevention and control program for dental services...

De la bioseguridad al control de infecciones en Estomatología / From biosafety to infection control in dentistry

Introducción: durante las prácticas estomatológicas, tanto los pacientes como el personal de servicio se encuentran en continua exposición al contacto con agentes biológicos a través de la saliva, sangre o secreciones del tracto respiratorio. Es por eso que el cumplimiento de las normas de bioseguridad en los laboratorios o durante el tratamiento de los desechos es fundamental para disminuir el riesgo al que están sometidos. Sin embargo, se necesitan además de otras recomendaciones que se encuentran contenidas específicamente en los programas de prevención y control de infecciones y que no forman parte de los manuales de bioseguridad. Objetivos: relacionar las normas y principios de la bioseguridad con los principios de los programas de prevención y control de infecciones en Estomatología, e identificar los aspectos a tener en cuenta en la elaboración de dichos programas. Métodos: se realizó una revisión bibliográfica en las principales bases de datos médicas (Scielo, Pubmed, EBSCO, Hinari) de artículos científicos y programas de diversos países relacionados con la prevención y control de infecciones para Estomatología. Además se consultó el Manual de bioseguridad contenido en el anexo 28 del Programa Nacional de Atención Estomatológica Integral a la Población. Resultados: se recopilaron datos sobre los aspectos comunes y no comunes entre los principios de bioseguridad y los principios de los programas de prevención y control de infecciones para Estomatología. Por otra parte, se obtuvo información relacionada con los aspectos a tener en cuenta en la elaboración de estos. Conclusiones: es necesario considerar las normas de bioseguridad en la elaboración e implementación de un programa de prevención y control de infecciones para los servicios estomatológicos(AU)

Introduction: during the performance of dental procedures, both patients and staff are under permanent risk of contact with biological agents from saliva, blood and respiratory secretions. Hence the importance of complying with biosafety standards in laboratories and during the performance of waste disposal tasks. Moreover, alongside the recommendations contained in biosafety manuals, attention should also be paid to those included in infection prevention and control programs. Objectives: relate biosafety standards and principles to the principles contained in infection prevention and control programs for dentistry, and identify the aspects to be borne in mind when developing such programs. Methods: A bibliographic review was conducted in the main medical databases (Scielo, Pubmed, EBSCO, Hinari) of scientific papers and programs from various countries related to infection prevention and control in dentistry. The Biosafety Manual contained in Annex 28 of the National Comprehensive Dental Care Program was also consulted. Results: data were collected about similarities and differences between biosafety principles and the principles contained in infection prevention and control programs for dentistry. Additionally, information was obtained about the aspects to bear in mind when designing such programs. Conclusions: biosafety standards should be considered when developing and implementing an infection prevention and control program for dental services(AU)

An evaluation of washer-disinfectors (WD) and dishwashers (DW) effectiveness in terms of processing dental instruments.

PURPOSE: The aim of this study is to consider the effectiveness of a small sample of dishwashers (DW) compared to washer-disinfectors (WD) for cleaning dental instruments prior to sterilisation. Processing instruments in the context of this article means cleaning and disinfecting the instruments. MATERIALS AND METHODS: A number of tests were carried out on three domestic dishwashers and two instrument washer-disinfectors. These tests included: visual test; soil test; residual protein test; and, the TVC of the final rinse water. RESULTS: The washer-disinfectors (one bench-top and one under-bench) passed all the tests. The results indicate that the instruments cleaned in the dishwashers were visibly clean and dishwashers passed the TOSI soil test. There was residual protein on some of the instruments cleaned in the all of the dishwashers and the final rinse water did not comply with standard ISO 15883. CONCLUSION: Dishwashers are not effective for cleaning instruments and they do not disinfect the instruments either. They cannot be validated and there is no record available outlining the parameters of the process. Dishwashers are not designed by manufactures for processing dental instruments prior to sterilisation. The authors do not recommend the use of dishwashers in dental clinical practice.

Effectiveness of a quality management program in dental care practices.

BACKGROUND: Structured quality management is an important aspect for improving patient dental care outcomes, but reliable evidence to validate effects is lacking. We aimed to examine the effectiveness of a quality management program in primary dental care settings in Germany. METHODS: This was an exploratory study with a before-after-design. 45 dental care practices that had completed the European Practice Assessment (EPA) accreditation scheme twice (intervention group) were selected for the study. The mean interval between the before and after assessment was 36 months. The comparison group comprised of 56 dental practices that had undergone their first assessment simultaneously with follow-up assessment in the intervention group. Aggregated scores for five EPA domains: 'infrastructure', 'information', 'finance', 'quality and safety' and 'people' were calculated. RESULTS: In the intervention group, small non-significant improvements were found in the EPA domains. At follow-up, the intervention group had higher scores on EPA domains as compared with the comparison group (range of differences was 4.2 to 10.8 across domains). These differences were all significant in regression analyses, which controlled for relevant dental practice characteristics. CONCLUSIONS: Dental care practices that implemented a quality management program had better organizational quality in contrast to a comparison group. This may reflect both improvements in the intervention group and a selection effect of dental practices volunteering for the first round of EPA practice assessment.