In Vivo Study of Aerosol, Droplets and Splatter Reduction in Dentistry.

Oral health care workers (OHCW) are exposed to pathogenic microorganisms during dental aerosol-generating procedures. Technologies aimed at the reduction of aerosol, droplets and splatter are essential. This in vivo study assessed aerosol, droplet and splatter contamination in a simulated clinical scenario. The coolant of the high-speed air turbine was colored with red concentrate. The red aerosol, droplets and splatter contamination on the wrists of the OHCW and chests of the OHCW/volunteer protective gowns, were assessed and quantified in cm2. The efficacy of various evacuation strategies was assessed: low-volume saliva ejector (LV) alone, high-volume evacuator (HV) plus LV and an extra-oral dental aerosol suction device (DASD) plus LV. The Kruskal-Wallis rank-sum test for multiple independent samples with a post-hoc test was used. No significant difference between the LV alone compared to the HV plus LV was demonstrated (p = 0.372059). The DASD combined with LV resulted in a 62% reduction of contamination of the OHCW. The HV plus LV reduced contamination by 53% compared to LV alone (p = 0.019945). The DASD demonstrated a 50% reduction in the contamination of the OHCWs wrists and a 30% reduction in chest contamination compared to HV plus LV. The DASD in conjunction with LV was more effective in reducing aerosol, droplets and splatter than HV plus LV.

Assessment of the ergonomic risk from saddle and conventional seats in dentistry: A systematic review and meta-analysis.

OBJECTIVE: This study aimed to verify whether the saddle seat provides lower ergonomic risk than conventional seats in dentistry. METHODS: This review followed the PRISMA statement and a protocol was created and registered in PROSPERO (CRD42017074918). Six electronic databases were searched as primary study sources. The "grey literature" was included to prevent selection and publication biases. The risk of bias among the studies included was assessed with the Joanna Briggs Institute Critical Appraisal Tool for Systematic Reviews. Meta-analysis was performed to estimate the effect of seat type on the ergonomic risk score in dentistry. The heterogeneity among studies was assessed using I2 statistics. RESULTS: The search resulted in 3147 records, from which two were considered eligible for this review. Both studies were conducted with a total of 150 second-year dental students who were starting their laboratory activities using phantom heads. Saddle seats were associated with a significantly lower ergonomic risk than conventional seats [right side (mean difference = -3.18; 95% CI = -4.96, -1.40; p < 0.001) and left side (mean difference = -3.12; 95% CI = -4.56, -1.68; p < 0.001)], indicating posture improvement. CONCLUSION: The two eligible studies for this review provide moderate evidence that saddle seats provided lower ergonomic risk than conventional seats in the examined population of dental students.

The effect of abrading and cutting instruments on machinability of dental ceramics.

The aim was to investigate the effect of machining instruments on machinability of dental ceramics. Four dental ceramics, including two zirconia ceramics were machined by three types (SiC, diamond vitrified, and diamond sintered) of wheels with a hand-piece engine and two types (diamond and carbide) of burs with a high-speed air turbine. The machining conditions used were abrading speeds of 10,000 and 15,000 r.p.m. with abrading force of 100 gf for the hand-piece engine, and a pressure of 200 kPa and a cutting force of 80 gf for the air-turbine hand-piece. The machinability efficiency was evaluated by volume losses after machining the ceramics. A high-abrading speed had high-abrading efficiency (high-volume loss) compared to low-abrading speed in all abrading instruments used. The diamond vitrified wheels demonstrated higher volume loss for two zirconia ceramics than those of SiC and diamond sintered wheels. When the high-speed air-turbine instruments were used, the diamond points showed higher volume losses compared to the carbide burs for one ceramic and two zirconia ceramics with high-mechanical properties. The results of this study indicated that the machinability of dental ceramics depends on the mechanical and physical properties of dental ceramics and machining instruments. The abrading wheels show autogenous action of abrasive grains, in which ground abrasive grains drop out from the binder during abrasion, then the binder follow to wear out, subsequently new abrasive grains come out onto the instrument surface (autogenous action) and increase the grinding amount (volume loss) of grinding materials.

Electromagnetic interference of dental equipment with implantable cardioverter defibrillators.

OBJECTIVE: Implantable cardioverter defibrillators (ICDs) are subject to electromagnetic interference (EMI). The aim of this study was to assess both the EMI of dental equipments with ICDs and related factors. MATERIALS AND METHODS: High- and low-speed handpieces, an electric toothbrush, an implant motor and two types of ultrasonic devices were tested next to an ICD with different sensitivity settings. The ICD was immersed in a saline solution with electrical resistance of 400-800 ohms to simulate the resistance of the human body. The dental equipments were tested in both horizontal (0°) and vertical (90°) positions in relation to the components of the ICD. The tests were performed with a container containing saline solution, which was placed on a dental chair in order to assess the cumulative effect of electromagnetic fields. RESULTS: The dental chair, high- and low-speed handpieces, electric toothbrush, implant motor and ultrasonic devices caused no EMI with the ICD, irrespective of the program set-up or positioning. No cumulative effect of electromagnetic fields was verified. CONCLUSIONS: The results of this study suggest that the devices tested are safe for use in patients with an ICD.

Influence of electronic apex locators and a gutta-percha heating device on implanted cardiac devices: an in vivo study.

AIM: To evaluate the potential for electromagnetic interference (EMI) of electronic apex locators (EALs) and a gutta-percha heating device (HD) in patients with implantable cardiac pacemakers (ICPs) or cardioverter-defibrillators (ICDs). METHODOLOGY: Two types of EALs (Romiapex A-15 and Novapex) and a HD (Touch'n Heat) were tested in patients followed in an outpatient clinic for cardiac arrhythmias. The heart rhythm was monitored on a computer screen during all experimental phases. After baseline data collection, the patient held each appliance (turned on) for 30 s, simulating their clinical use. If background noise was detected on the cardiac monitor, the sensitivity of the ICP/ICD was lowered by the cardiologist to evaluate the intensity of the detected EMI. RESULTS: Twelve patients were evaluated (5 female and 7 male), and in nine instances, background noise in their cardiac devices related to the use of the endodontic devices was detected (6 patients). After lowering the sensitivity of the cardiac implants, three patients had more severe EMI in six instances, including pauses in ICP function. The presence of a symptomatic or asymptomatic pause was related to the patient's underlying heart rhythm. The HD device produced background noise more often compared to EALs. These were associated with more severe types of EMI. CONCLUSION: The EALs and gutta-percha HD were capable of causing background noise detection or pauses in cardiac implants in vivo. The use of electronic dental devices nearby patients with cardiac implants should be carefully considered in clinical practice.

Cutaneous lupus erythematosus flare following exposure to surgical light during a dental procedure.

A patient in her 60s with systemic lupus erythematosus presented to an outpatient dermatology clinic on multiple occasions, with exacerbations of cutaneous lupus after exposure to surgical lighting during dental procedures. Her photosensitivity to surgical lighting suggests that artificial light sources pose potential triggers of lupus erythematosus in extra photosensitive individuals. This case report summarises those potential triggers and some options to decrease exposure from surgical lighting.

Evaluating the effects of different dental devices on implantable cardioverter defibrillators.

INTRODUCTION: The implantable cardioverter defibrillator (ICD) is an electronic device that emits electrical signals to the heart via lead wires and electrodes. It is used for cardiac rhythm monitoring and treatment. Because electronic dental devices have been shown to produce electromagnetic fields, we hypothesize that they may interfere with ICD function. METHODS: Nine dental devices (heat carrier, electronic apex locator, electric pulp tester, unipolar electrosurgery unit, electric motor, curing light, and 3 gutta-percha guns) were tested in this study for their ability to interfere with the function of 4 ICDs (2 single-chambered and 2 dual-chambered ICDs). ICD activity was monitored for 30 seconds using an ICD programmer (Medtronic 2090; Minneapolis, MN) and evaluated through an electrogram test strip printout. RESULTS: Electromagnetic interference was detected with the electric motor, curing light, electric pulp tester, and electrosurgery unit although no electromagnetic disturbances were detected with these devices. No electromagnetic interferences were observed for the gutta-percha guns, heat carrier, and apex locator. However, the electrosurgery unit affected the dual-chambered ICD (Consulta CRT-D, Medtronic) and delivered therapies for fibrillation when no ventricular fibrillation was present. CONCLUSIONS: Our results suggest that the electrosurgery unit produces electromagnetic disturbances with unwanted therapy delivery shock and potentially clinically significant outcomes.

The dangers of dental devices as reported in the Food and Drug Administration Manufacturer and User Facility Device Experience Database.

BACKGROUND: The authors conducted a study to determine the frequency and type of adverse events (AEs) associated with dental devices reported to the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database. METHODS: The authors downloaded and reviewed the dental device-related AEs reported to MAUDE from January 1, 1996, through December 31,2011. RESULTS: MAUDE received a total of 1,978,056 reports between January 1, 1996, and December 31, 2011. Among these reports, 28,046 (1.4%) AE reports were associated with dental devices. Within the dental AE reports that had event type information, 17,261 reported injuries, 7,777 reported device malfunctions, and 66 reported deaths. Among the 66 entries classified as death reports, 52 reported a death in the description; the remaining were either misclassified or lacked sufficient information in the report to determine whether a death had occurred. Of the dental device-associated AEs, 53.5% pertained to endosseous implants. CONCLUSIONS: A plethora of devices are used in dental care. To achieve Element 1 of Agency for Healthcare Research and Quality's Patient Safety Initiative, clinicians and researchers must be able to monitor the safety of dental devices. Although MAUDE was identified by the authors as essentially the sole source of this valuable information on adverse events, their investigations led them to conclude that MAUDE had substantial limitations that prevent it from being the broad-based patient safety sentinel the profession requires. PRACTICAL IMPLICATIONS: As potential contributors to MAUDE, dental care teams play a key role in improving the profession's access to information about the safety of dental devices.

Interference between dental electrical devices and pacemakers or defibrillators: results from a prospective clinical study.

BACKGROUND: The authors aimed to determine whether electrical dental devices would interfere with the function of cardiac pacemakers or implantable cardioverter defibrillators (ICDs) in humans. METHODS: The authors exposed asymptomatic nonpacemaker-dependent patients to commonly used electrical dental equipment (for example, battery-operated curing lights, ultrasonic baths, ultrasonic scalers, electric pulp testers, and electric toothbrushes) in an outpatient cardiology clinic. The authors operated dental devices at various distances and programmed cardiac devices to sense and pace. The authors obtained cardiac tracings using a cardiac programming unit and a cardiac provider who noted any interference interpreted the results in real time. RESULTS: The authors enrolled 32 consecutive patients and tested 12 pacemakers and 20 ICDs. They did not observe any significant clinical interference in sensing and pacing functions in any patient; however, they noted minor interference without clinical impact in the telemetry from the cardiac programming unit during use of the ultrasonic scaler and bath. CONCLUSIONS: The findings of this prospective study suggest that electrical devices commonly used in dental practices do not interfere with the sensing and pacing of contemporary cardiac patients' pacemakers or ICDs. However, they do interfere with the telemetry from the cardiac programming unit, without any clinical impact on patient safety. These findings should help in the development of clinical guidelines regarding dental management of patients with pacemakers or ICDs. PRACTICAL IMPLICATIONS: Electrical dental devices (for example, ultrasonic baths, ultrasonic scalers) induced minor interference with programmers that interrogate cardiac devices implanted in patients; however, overall, dental devices do not appear to interfere with pacemakers' and defibrillators' pacing and sensing function.

Analysis of adverse events with use of orthodontic sequential aligners as reported in the manufacturer and user facility device experience database.

BACKGROUND: Sequential aligners (SAs) introduced about a decade ago, changed the practice of orthodontics as we knew it but the adverse events and reactions (AER) associated with SA is not known. The Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database is a reliable database that has AERs reported. The manuscript attempts to review the AER associated with SA using the MAUDE database. MATERIALS AND METHODS: The authors downloaded and reviewed the SA-related AER from MAUDE for a period of 5 years. In-depth analysis of the site and nature of intraoral and extraoral AERs were performed. We attempted to calculate the probability of pathologies being directly related to SA use, using Bayes' theorem. RESULTS: In the study period of 5 years, 175 cases of AER registered with MAUDE database owing to use of SA. Of the 175 cases, 129 (73.71%) instances were mandatory reports filed by the manufacturer. Of all AERs, 32 (18.29%) cases had been diagnosed/suspected to have an allergic reaction, 20 (11.43%) of them with anaphylactic reaction and 4 (2.29%) of them with angioedema. Lesions involving tongue, throat, and lip such as soreness, inflammation, and hives were more commonly reported. In addition, 12 cases (6.86%) reported of nausea, 11 (6.29%) of gastrointestinal issues (stomach upset, diarrhea, and vomiting), 13 (7.43%) of neuromuscular issues (muscle cramps, spasm, and pain), 13 (7.43%) of cough, 10 (5.71%) of persistent headache, 3 (1.71%) of fever, and 12 (6.86%) of cardiac-related issues were identified. CONCLUSIONS: The AERs associated with SA has been described. Though the MAUDE database is not an exact, wholesome and reliable source to identify the potential AER, currently, it is the only available source of AERs associated with SA use. The nature of AERs with the use of SA and its potential pathogenesis and implications has been discussed.

Interferência eletromagnética dos equipamentos odontológicos nos dispositivos cardíacos eletrônicos implantáveis / Electromagnetic interference of dental equipment in cardiovascular implantable electronic devices

Os dispositivos cardíacos eletrônicos implantáveis (DCEI) são rotineiramente utilizados no tratamento de doenças cardiovasculares, especialmente na população idosa. Estes dispositivos estão sujeitos à interferências eletromagnéticas (IEM) provocadas por equipamentos eletrônicos. Desta forma, este estudo objetivou avaliar a IEM causada por equipamentos odontológicos nos DCEI (marcapasso ­ MP e desfibrilador cardíaco implantável ­ DCI). Para tanto, foram delineados três artigos científicos: uma revisão sistemática da literatura e dois estudos in vitro. Para a revisão sistemática foi realizada buscas em bases de dados eletrônicas, por meio de descritores, para a identificação de estudos potencialmente relevantes. Foram incluídos artigos in vitro e in vivo. Para os estudos in vitro foi utilizado um recipiente contendo solução salina com uma resistência elétrica que simulava a do corpo humano, onde foram testados 10 tipos de equipamentos odontológicos nos DCEI, com polaridades, sensibilidades e distâncias variadas. Dentre os equipamentos odontológicos avaliados na revisão sistemática e nos dois estudos in vitro, o amalgamador, a cadeira odontológica, a escova elétrica, a peça de mão, o teste elétrico pulpar, a unidade radiográfica, o laser endodôntico, o motor de implante, o motor endodôntico, o ultrassom piezoelétrico, o microscópio e o termoinjetor não causaram IEM nos DCEI. Entretanto, a cuba ultrassônica, o bisturi elétrico, a diatermia, o fotopolimerizador, o localizador apical, o termocompactador e o ultrassom magnetostricção causaram algum tipo de IEM, que variou de acordo com a marca do equipamento odontológico, distância, polaridade e sensibilidade do DCEI. Baseado nos resultados desse estudo, verificou-se que o amalgamador, a cadeira odontológica, a escova elétrica, a peça de mão, o teste elétrico pulpar, a unidade radiográfica, o laser endodôntico, o motor de implante, o motor endodôntico, o microscópio, o termoinjetor e o ultrassom piezoelétrico não causam IEM nos DCEI. Embora, nenhum equipamento tenha causado dano permanente aos DCEI, os localizadores apicais, o termocompactador, o bisturi elétrico e o fotopolimerizador devem ser utilizados com cautela. Ademais, sugere-se que se evite o uso da cuba ultrassônica, diatermia e ultrassom magnetostricção. (AU)

The cardiovascular implantable electronic devices (CIED) are routinely used in treatment of cardiovascular diseases, especially in elderly population. These devices are subject to electromagnetic interference (EMI) caused by electronic equipment. Thus, this study aimed to evaluate the EMI caused by dental device in CIED (pacemaker - PM and implantable cardiac defibrillator - ICD). Thus, three papers were outlined: a systematic literature review and two in vitro studies. In the systematic review was carried out searches on electronic databases, using MeSH (Medical Subject Headings) terms to identify potentially relevant studies. We included articles in vitro and in vivo. For the in vitro studies we used a vessel with saline solution to simulate the electrical resistance of the human body, where were tested 10 types of dental device in CIED with different polarities, sensitivities and distances. Among the dental device evaluated in systematic review and two in vitro studies, the amalgamator, dental chair, electric toothbrush, handpiece, electric pulp test, radiographic unit, endodontic laser, dental implant motor, endodontic motor, microscope, heated injector and piezoelectric ultrasound unit did not cause EMI in CIED. However, the ultrasonic bath cleaner, electrosurgical unit, diathermy, curing, apex locator, thermocompactor and ultrasonic device caused some type of EMI, which varied according to the brand of dental device, distance, polarity and sensitivity of CIED. It is concluded that: no dental device caused permanent damage to CIED. Based on the results of this study, it was found that the amalgamator, dental chair, electric toothbrush, the handpiece, the electric pulp test, radiographic unit, endodontic laser, dental implant motor, endodontic motor, microscope, heated injector and the piezoelectric ultrasound unit does not cause EMI in CIED. Although, no equipment has caused permanent damage to DCEI, the apex locators, thermocompactor, electrosurgical unit and curing light should be used with caution. Furthermore, it is suggested to avoid the use of the magnetostriction ultrasonic unit and diathermy. (AU)

Fear and/or anxiety of children and parents associated with the dental environment.

AIM: To assess levels of anxiety in children concerning different dental instruments and equipment and to relate them with parents' anxiety levels moments before the appointment. MATERIALS AND METHODS: Fifty children from 4 to 12 years of age (average of 10±3.07) and their respective parents were evaluated. A facial scale was used to assess children's anxiety levels, while the Dental Anxiety Scale (DAS) was used to assess parents. Friedman test was applied to check any differences in children's anxiety levels relative to the equipment/instruments, and this was complemented by the use of the Wilcoxon test for two-by-two comparison. In order to assess correlation between parents' and their children's anxiety levels, the study used Spearman correlation coefficient. RESULTS: With regard to parents' anxiety levels, 4% resulted as null, 18% were low, 56% were moderate, and 22% were exacerbated; children's anxiety level results were: 52% light, 44% intermediate, and 4% intense. Anxiety levels related to instruments/equipment were, in descending order: carpule syringe > paediatric forceps > dental explorer > x-ray machine > rubber dam punch > high speed handpiece > rubber dam forceps > mouth mirror > clinical tweezers > dental chair. No correlation was found between parents' anxiety levels and those of their children (p=0.546). CONCLUSION: The instruments/equipment used in the assessment generated different anxiety levels in the children. No correlation was found between parents' anxiety levels and those of their children.

Occupational safety threats among dental personnel and related risk factors.

Occupational diseases are primarily considered to be important health problems for individuals with occupations in heavy industry fields. Although dentists work in very clean and elegant offices, they are frequently exposed to various chemicals and high-intensity, sound-producing instruments, such as compressors and aerators. In our study, we aimed to investigate the risk for occupational hearing loss of dental personnel, by performing pure-tone audiometry in 40 dentists and comparing the results with those of healthy individuals. We also sampled the nasal mucosa to investigate the effects of occupational chemicals on the nasal mucosa of the dentists. The pure-tone audiometric thresholds at 5 different frequencies (1000, 2000, 4000, 6000, and 8000 Hz) and working time were evaluated as potential risk factors. The pure-tone audiometric results (as decibels) at each frequency and the median values for each side (right and left ears) were significantly higher for dentists than for the control group (P < 0.05). The pure-tone audiometric results did not significantly differ between the women and men in the study group (P > 0.05). The findings in the nasal mucosa (goblet cell hyperplasia, neutrophil/eosinophil/basophil distribution, metaplasia, dysplasia, premalignant or malignant cells) were similar in the study and control groups (P > 0.05). In conclusion, our study indicated that high-intensity, sound-producing equipment is an important occupational threat for dentists, whereas chemical agents have minimal hazardous effects.

Comparison of anxiety levels associated with noise in the dental clinic among children of age group 6-15 years.

Fear or anxiety due to noise produced in the dental clinic is rated third among the reasons to avoid dental visits. The aim of the present study was to determine anxiety levels associated with noise in a dental clinic. The study was done using a survey questionnaire containing 10 questions and was divided into two parts. The first part included demographic information such as name, age, gender, and school; the second half included questions regarding patient's feelings toward noise in the dental clinic and its possible link to dental anxiety. Two-hundred and fifty children and adolescents of age group 6-15 years participated in the study. Results of the study showed that 50% of females, 29% males avoided a visit to the dentist because of anxiety and fear, 38% subjects of age group 6-11 years reported that sound of the drill makes them uncomfortable, followed by having to wait in the reception area. Gender gap was also observed with more females feeling annoyed than males on the 1-10 annoyance level scale. More than 60% felt "annoyed" to "extremely annoyed" by noise in the dental clinic. 45% of subjects preferred watching television to cope with such noise. This study concludes that the noise produced in dental clinic is anxiety provoking and significantly contributes to avoidance of dental treatment and the best way opted by the majority of subjects to overcome this anxiety was audiovisual distraction method.

Occupational health problems among dentists in Moldavian Region of Romania.

AIM: The aim of this study was to evaluate the occupational health problems among dentists in the Moldavian Region of Romania. MATERIAL AND METHODS: Questionnaire-based study was conducted on 152 dentists aged between 25-65 years practicing in 6 counties the Moldavian Region of Romania. The questionnaire included questions related to the dentists' occupational health pathology. Data were statistically analyzed using SPSS 14.0 and chi-square test (p<0.05). RESULTS: The majority of the dentists (91%) consider that they are exposed to an occupational risk and 41.8% of them experienced a percutaneus injury caused by sharp instruments in the last year.74.6% of the dentists are protected by vaccination against hepatitis B and 76.1% against influenza. 49.3% of the dentists reported eye injuries caused by solid particles (13.2%), blood splashes (14.7%) and/or chemicals (20,5%). Allergies associated to professional activity were reported by 76.1% of the dentists. CONCLUSIONS: The dental staff must be informed in order to recognize, control and prevent the potential occupational hazards in the workplace.

A four-part setting on examining the anxiety-provoking capacity of the sound of dental equipment.

This paper reports the results of a four-part questionnaire survey to assess the effects of the sound of dental equipment on people's perceptions and dental anxiety levels. The convenience sample for the survey comprised 230 dental students and 230 gender and age matched non-dental university students. The subjects were requested to complete the questionnaires themselves. The results show that the sound of dental equipment has a great influence on dental anxiety. Dental students, who are more familiar with the operation of this equipment, are less prone to anxiety when they hear its sound than their non-dental counterparts.