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DEN 110 Dental Fundamentals

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Salayne Formica Escalante

on 14 April 2015

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Transcript of DEN 110 Dental Fundamentals

Infection Control Practices
Waste Management
DEN 110 Dental Fundamentals
Study of microorganisms, esp pathogens
Pioneers: Aristotle (remember this guy?!)
theory of spontaneous generation
van Leeuwenhoek: microscope guy--not generous! 'animalcules'
Tyndall: heat it up!
Cohn: named 'em endospores
Lister: one of my faves! Carbolic Acid
Koch: we still use his techniques/postulates
Petri: at least got his name on something!
Pasteur: saviour of French wine, pasteurization, rabies guy
Major Groups of Microorganisms
Large gp of 1-celled mircroorganisms; live indep
Love warm, dark, moist environments! Like where?
We usu. have normal flora, but some opportunistic
Shape: Cocci, Bacilli, Spirochete
Gram's stain: you know he named it after himself!

Disease Transmission and Infection Prevention
The Chain of Infection
Disease Transmission in the Dental Office
Patient to Dental Team
direct contact most common
droplet infection
indirect contact EXAMPLES?
Dental Team to Patient
most unlikely if using correct methods
Patient to Patient
more likely medical field, only 1 documented case in dentistry
Dental Office to Community
Community to Office to Patient
Dental water lines
Methods of Sterilization
Steam: 4 cycles, 250/15/15 (30); Proper packaging/placement must be completed
Flash: unpackaged, instruments must be used immediately. Example: STATIM
Unsaturated Chemical vapor
Dry Heat: Static and Forced Air
Ethylene Oxide
Liquid Sterilants: gluteraldehyde, toxic, must be in contact for 10+ hours

Physical, Chemical, Biologic: which indicates sterility?

Handpiece Sterilization
Flushing Techniques
Sterilizing Techniques
Chemical and Waste Managment
Hazardous Chemicals: ignite, react/explode, corrosive, toxic
Exposure to Chemicals: inhalation, absorption, ingestion
Acute and Chronic Chemical Toxicity
Hand Protection, Eye Protection, Protective Clothing, Inhalation Protection
Control of Chemical Spills, especially amalgam mercury
Eyewash Units
Storage and Disposal of Empty Containers; Hazardous Waste Disposal
Hazard Communication Program/'Globally Harmonized System of Classification and Labeling of Chemicals (GHS)
Written Program
SDS (used to be called MSDS--you will probably still hear the term)
Proper Labeling: National Fire Protection Association Labels and HCS labels
health hazard (blue), flammability (red), reactivity (yellow), special hazard symbols (white)
Classification of Waste
Regulated, contaminated, and toxic waste
Major Groups of Microorganisms:
Bacteria, Algae, Protozoa, Fungi, Viruses
viruses: "perfect parasites", prions: no RNA/DNA but resp for some chronic diseases (more on this later!)
Other considerations:
Oxygen: some bacteria can live in an oxygenated state, some can't, and others are not affected as greatly.
Capsule: protective coating: to what?
Spores: form-changers! Why so hard to kill?
And the other ones...
Rickettsiae: live inside other pests, require host
Algae: You know as green slimy stuff on water
Protozoa: Not all cause disease, but watch out!
Fungi: the 'not green' crowd:
Candida--what is it in the mouth?
Yeasts and molds
Prions: 'small proteinaceous infectious particles'
associated with Creutzfeldt-Jakob disease and mad cow disease (spongiform encephalopathies)
no RNA or DNA: causes shape-shifting!
much smaller than bacteria
can only survive/replicate inside a host cell
specificity to cells, and latent period
tx: symptoms only, no cure! can kill on surface items
transmit by direct contact, insects, blood transfusions, contaminated food, inhalation
Viral Hepatitis: Who knew it was this much fun?!
Hep A: fecal/oral route --WASH YOUR HANDS!
Hep B: affects liver, bloodborne disease--VACCINATE
Hep C: Percutaneous exposure--NO TATOOS
Hep D: coinfection with Hep B
Hep E: fecal/oral epidemics
bloodborne, AIDS caused by HIV; affects T cells #s
transmitted: sexually, infected needles
Very few documented tx in dental world
Herpes simplex virus (HSV)
Herpes zoster (HZV)
Cytomegalovirus (CMV)
Epstein-Barr Virus (EBV)
HSV Type 1/2:
recurrent labialis
Can we tell the difference? What do we do with a pt with a breakout?
Other viruses:
West Nile Virus
H1N1 Virus (Swine Flu)
Bacterial Diseases:
Mycobacterium tuberculosis
seen in HIV/AIDS patients
Legionnaires' Disease
Legionella pneumophilia
aerosols/aspirate of contaminated water
'lockjaw'" why?
Treponema pallidum
3 stages--highly contagious!!
Methicillin-Resistant Staphylococcus aureus (MRSA)
developed by excessive antiobiotic use
Good hygiene practice necessary!
4 Links
Virulence: degree of pathogenicity
# of microorganisms: must have enough to overwhelm defenses
susceptible host: less resistance to infection by host
portal of entry: bloodborne and airborne
Types of Infection
Acute Infection
Chronic Infection
Latent Infection
Opportunistic Infection
Chapter 19
Modes of Disease Transmission
Direct Transmission
person-to-person: big concern in the dental office
Indirect Transmission
microorganisms transmitted to surface, then to next person.
Airborne Transmission
droplet infection
Aerosol, Spray, Spatter
Super yuck, and definitely a concern
Parenteral Transmission
through the skin--needle stick injuries
Blood-Borne Transmission
indirect or direct, BBP standard
Food & Water Transmission
Fecal-Oral Transmission
The Immune System
allows the body to resist disease/infection
Inherited Immunity
present at birth

Acquired Immunity
Naturally acquired: indiv. previously contracted disease and is now resistant.
active: body of host involved with immune process
passive: during pregnancy, baby receives antibodies from mother
Artificially Acquired:
Immunization/Vaccination (attenuated)
Roles/Responsibilities of CDC/OSHA
CDC is not regulatory agency!! Can only make recommendations
Dec 2003: Guidelines for Infection Control in Dental Healthcare Settings; expanded on 1993 doc
Guidelines apply to ALL paid/unpaid dental health professionals, now is the standard of care.
OSHA is reg agency, issues standards by which we must comply, otherwise HEAVY FINES!! Most important standard: BBP
required employers to protect employees from exposure to blood and OPIM, and proper procedure if exposure occurs.
BBP standard must be present in every dental office/clinic
Exposure Control Plan
Must be written; reviewed/updated annually; copy avail to all employees
Standard/Universal Precautions
Universal: all pts potentially infectious
Standard: the standard of care for all pts.
Occupational Exposure: percutaneuos and permucosal
Post exposure management: exact steps to be taken
Employee training must occur, with documentation
Hep B vaccination: Cat I/II job, offered within 10 days of employment, with documentation.
Employee Medical Records: length of work + 30 yrs.
Sharps: of what comprised?
container must be red, puncture resistant, labeled
Handwashing: must be done before/after gloving!
Alcohol-Based Hand Rubs: NOT A SUB FOR WASHING!
PPE: gown, mask, gloves, eye protection
What about shoes?
BBP prohibits employee taking protective clothing home to launder.
Provide patient eyewear
Gloves: Exam, Overgloves, Sterile surgical, Utility, Non-Latex (Allergies, anyone?)
How do we not cross-contaminate when gloved?
Classification: General, Contaminated, Hazardous, Infectious/Regulated (Biohazard)
Handling of each type
Saliva Ejector notes
Dental Lab: potential cross-contamination issues.
Preprocedural mouth rinse: Love it!!
Other Concerns: TB, Creutzfeldt-Jakob and other prions, laser/electrosurgery plumes
Principles and Techniques of Disinfection
Cross-contaminated surfaces are reservoirs for bacteria.
Housekeeping and Clinical Contact Surfaces
touch, transfer, splash/spatter/droplet
Surface Barriers used: disposables
Preclean/Disinfect between patients
Categories of Disinfectants: NEED TO KNOW!

Principles and Techniques of Instrument Processing and Sterilization
Use: Critical, Semicritical and Noncritical
Most needlestick injuries here
Central sterilization area
Designated dirty side/clean side single loop
Ultrasonic Cleaning remove bioburden
Packaging Instruments
Usu. bags approved by FDA (medical device)
Regulatory and Advisory Agencies
Associations and Organizations
American Dental Association (ADA)
American Dental Assistants Association (ADAA)
American Dental Hygienists' Association (ADHA)
Organization for Safety, Asepsis and Prevention (OSAP)
Government Agencies
Centers for Disease Control and Prevention (CDC)
Food and Drug Administration (FDA)
Environmental Protection Agency (EPA)
Occupational Safety and Health Administration (OSHA)
National Institutes of Health (NIH)
National Institute of Dental and Craniofacial Research (NIDCR)
National Institute for Occupational Safety and Health (NIOSH)
Dental Unit Waterlines
Measures CFUs, want below 500
Occupational exposure, esp to immunocompromised pts; Legionella
Sources: public water supply & pt's mouth
Biofilm: slime layer inside tubing (is also dental plaque); really hard to kill
Planktonic: free floating in system
Stagnation of water is problematic
Methods to counteract:
Self-contained water reseviors
Microfiltration cartridges
Chemical Agents
Sterile water for surgery
Flushing Waterlines
Minimizing Aerosols
Use Protective Barriers
Monitor Water Quality
Saliva Ejectors?
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