![]() There are three types of reactions to gloves: irritant contact dermatitis, allergic contact dermatitis, and latex allergy. One CFU is considered as one or a small number of bacterial cells. ![]() The water samples from the dental units had a total microbial count averaging 93,333 colony-forming units (CFUs) per milliliter well above the CDC-recommended maximum of 500 CFUs/mL (the drinking water standard indicated by the US Environmental Protection Agency ). M abscessus (an opportunistic microbe commonly present in domestic water supplies) was isolated from the water exiting all seven dental units in the practice and the isolates were indistinguishable from those isolated from the children. 11 All required hospitalization with granulomatous swellings of the face or neck. 10 In 2015, 20 children ages 3 to 11 who received pulpotomies (removal of tooth pulps) in a pediatric dental practice in Georgia, developed oral infections with Mycobacterium abscessus. A report from England in 1987 describes how two cancer patients acquired oral infections with Pseudomonas aeruginosa from dental unit water. Two other routes of microbe spread involving dentistry are (1) dental office to community (eg, improper containment of contaminated medical waste during transport or sending a contaminated dental impression to a dental laboratory) and (2) community to dental office (eg, contaminated municipal water being used in patient care). The spread was likely limited to one patient due to the high incidence of hepatitis B immunity in the staff and several patients. ![]() Although the transmission was clearly documented, no clear-cut mode of viral spread was identified. Several of the patients seen after the source patient that week tested positive for hepatitis B immunity. Fourteen of 15 employees in the practice showed evidence of hepatitis B vaccination, and none had a history of the disease. Molecular epidemiology techniques determined that the same virus caused hepatitis B in both women. After, she has some teeth extracted the same oral surgeon, and staff extracted seven teeth from another patient (a 61-year-old female) who later developed hepatitis B. 9 The source patient was an asymptomatic carrier of the HBV and did not tell anyone in the office she was a carrier. 8 In another incident, the CDC confirmed that hepatitis B was spread from one patient to another on the same day in 2001 in an oral surgery practice. This pathway, involving improperly washed hands of a dental hygienist, has been documented in the spread of herpes simplex virus from a herpes labialis lesion of one patient to the mouths of several other patients, resulting in herpes gingivostomatitis. Thus, the pathways for cross-contamination in dentistry involve numerous possible combinations of modes of microbe spread and entrance into the body, all of which must be addressed in a dental infection prevention program.Ĭross-contamination from one patient to another patient may occur by indirect routes through contaminated instruments, surfaces, equipment, or the hands of dental personnel. In the dental setting, microbes can enter the body through (1) needlesticks and instrument punctures and cuts (2) invisible breaks or cuts in the skin (3) mucous membranes of the mouth, nose, eyes (4) through open lesions (5) inhalation and (6) ingestion. 1 These pathways involve one or more of the four major modes by which microorganisms may be shared between individuals: (1) direct contact (touching oral surfaces and fluids), (2) droplet infection (airborne contamination with larger droplets of aerosols or spatter of oral and respiratory fluids), (3) indirect contact (contact with contaminated instruments, needles, environmental surfaces or hands), (4) airborne (spread of smaller particles of respiratory fluids such as droplet nuclei through the air). Cross-contamination is the spread of microorganisms from one person to another, and there are three main pathways by which this may occur in dentistry: (1) patient to dental personnel, (2) dental personnel to patient, and (3) patient to patient. The main source of potential pathogenic microbes in dental facilities is the patients’ mouths. Standard procedures of sterilization, disinfection, and asepsis must be applied to all types of dental care to reduce the chances of cross-contamination that may lead to serious infectious diseases. The practice of dentistry spans a wide variety of oral treatments, ranging from the simple polishing of a restoration (filling) to complex and extensive surgery of the osseous and soft orofacial tissues.
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