Cross-infection in dentistry: an appraisal of the control guidelines with regard to contamination of dental unit water systems

The incidence of emotional disorders and mental illness among Native American adolescents is strikingly high. Yet despite promises of support from the federal government, the mental health resources available among Indian communities are negligible and must be expanded. Two federal laws--the Indian Health Care Amendments of 1990, and the Indian Health Care Amendments of 1992--help address this problem, including the integration of community health services into schools, the development of innovative mental and physical health programs for Native American youth, and the recruitment of more health professionals into Native American communities.     

Infection control in the dental practice with emphasis on the orthodontic practice

Infections present a significant hazard in the orthodontic office because they can be transmitted by blood or saliva through direct or indirect contact, droplets, aerosols, or contaminated instruments and equipment. Because the incidence of certain microbial cross-infections in the dental environment has not been well documented, orthodontic personnel may not take the problem of cross-infection as seriously as they should, and they may transmit or contract more infections than they realize. The use of effective infection-control procedures in the orthodontic office and laboratory will prevent cross-contamination that may extend to the orthodontist, office staff, assistants, and patients. The goal of this article is to present infection control in a simple, yet comprehensive, manner, and to encourage all orthodontic practitioners to implement essential infection-control procedures in their practices.     

Using lasers in clinical dental practice

Lasers are an impressive potential treatment modality for a variety of clinical conditions. This article profiles several clinical applications in dentistry.     

Infection control in dental radiology

Although exposure to blood is rare in oral and maxillofacial radiology, contact with saliva occurs. Thus the spread of infectious diseases is possible through cross-contamination, and specific infection control protocols and unit dosing of items are needed. This article outlines rationale for implementing state-of-the-art infection control procedures; and explains federal standards and guidelines with an impact on infection control and occupational safety in dental radiology procedures.     

Anxious children: coping in dental practice

Treating anxious children is a challenge that many dentists face. Not only do anxious children find it difficult to cope with dental treatment but dentists also find it difficult to cope with anxious children. This article is intended to simplify the management of anxious children in general dental practice. Behavioural management, the coordination of the whole dental team, treatment planning and the use of inhalation sedation will be discussed.     

Patient-centered care and today''s dental practice

Certain constitutional chromosomal abnormalities increase the risk of malignancy and/or decrease treatment tolerance. We identified two patients with the XYY syndrome among a total of 444 male children with acute lymphoblastic leukemia who had complete cytogenetics studies. In both cases, the leukemic cell karyotype suggested a constitutional XYY abnormality that was confirmed in studies of lymphocytes obtained during remission. The incidence rate in our series is higher than that of the XYY syndrome in the general population (0.0045 vs. 0.001), but not significantly so. This finding and a literature review failed to confirm an increased frequency of the XYY syndrome among children with acute lymphoblastic leukemia. Both of our patients remain in remission 24 and 28 months, respectively, postdiagnosis. Their tolerance of intensive treatment, including high-dose methotrexate, suggests that the untoward treatment toxicity seen in patients with chromosomal abnormalities such as trisomy 21 does not extend to the XYY syndrome.     

Hepatitis B virus infection in dental surgical practice

Sixty-one dental surgeons at King's College Hospital were interviewed to establish the incidence of attacks of viral hepatitis and to relate this to environmental risk factors. Six (10%) had a history of hepatitis, in one case due to infection with the hepatitis B virus. Screening blood for HBsAg by radioimmunoassay showed no carriers of the antigen, but transient antigenaemia was observed in one dentist. Antibody to HBsAg, tested by radioimmunoassay, was detected in four dentists (7%), only one of whom had had clinical hepatitis. Dental surgeons may be more at risk from infection with the hepatitis B virus than the general population, although this should be minimised in hospital practice, where the most infected patients will already have been identified and appropriate precautions can be taken. The risk of transmission from an antigen-positive dentist to his patients is probably much smaller, and there is no evidence to restrict his clinical activities.     

Response to intravenous midazolam sedation in general dental practice

The object of this study was to grade the response of patients undergoing a variety of dental procedures with the aid of intravenous midazolam sedation in general dental practice and to explore any relationships between the patients preoperative anxiety assessment and the clinician's assessment of co-operation whilst under sedation. One hundred consecutive patients aged between 18 and 58 years (mean 32 years; sd 10 years) and in ASA Class I or II were prospectively studied. Results showed that despite attempts to grade patient's behaviour it was not possible to reliably predict patient's responses under intravenous sedation. In addition to these findings, the great individual variation in sensitivity to midazolam was confirmed.     

Rationalizing infection control in the dental office

We performed a prospective study in 17 consecutive patients following Autologous bone marrow (BM) or rhG-CSF primed peripheral blood item cell (PBSC) transplantation, with the objective of comparing immune recovery between both procedures and to evaluate results in rhG-CSF mobilized peripheral blood stem cell transplantation (PBSCT). Kinetics of immune reconstitution showed differences, with a faster recovery of CD3+ and CD8+ T cells, and a more rapid and sustained recovery of CD8+/-/CD56+ natural killer (NK) cells in the PBCSCT group. Autologous bone marrow transplantation (ABMT) was associated with a improved reconstitution of the CD19+/CD5+/-subpopulation. Moreover, rhG-CSF mobilized PBSCT generated a greater recovery of CD8+/-/CD56+ cells than previous data concerning transplantation with peripheral blood (PB) progenitors collected after myelosuppressive chemotherapy or myelosuppressive therapy plus rhG-CSF. Our results show differences in the rate and pattern of B and T lymphocytes reconstitution after ABMT and PBSCT. Additionally, we state an enhancement of CD56+ cells in patients undergoing PBSCT mobilized solely using rhG-CSF.     

West Midlands regional training scheme for orthodontics in dental practice

The need for continuing education in orthodontics is recognised by many practitioners and the demand for post-graduate courses is high. The limitations of such courses, particularly the short technique type, are recognised and within the West Midlands the value of a longer term clinical attachment has been emphasised. The West Midlands has a well established orthodontic consultant service with fifteen NHS and one honorary consultant; the specialist practitioner service is small by national standards. All of the orthodontic consultants have long supported the clinical assistant post as a valuable vehicle for practitioners' continuing education. Building on the example given by the consultants in the four Thames Regions, a structured, centralised academic programme has been developed to enhance the clinical training given during these two year posts.     

A review of orthodontic appliance problems in general dental practice

Data from the literature, as well as our previous work, indicate a protective effect of superoxide dismutase (SOD) in topical application against UV-induced cutaneous damage. In the present article we show that pre-treatment of the skin with SOD protects against PUVA-induced inflammatory reactions not only in murine, but also in human skin. Using fluorescently labelled Cu,Zn SOD, epifluorescence microscopy and digital image processing, we demonstrate that the FITC fluorescence localizes in the stratum corneum and upper granulosa, as well as in the epidermal cell layer surrounding the lumina of the hair follicles. These findings were similar for murine and human skin. Since autofluorescence was eliminated by a special filter, it can be ascertained that the fluorescence observed in the tissues was due to FITC-labelled SOD.     

Spit tobacco intervention in dental practice: recommendations for clinicians

To address ST use effectively, awareness needs to be raised regarding its harmful affects and addictive nature. Clinicians can and should take a leadership role in the control of ST by addressing ST use with patients. The recommendations provide clinicians with practical tools and strategies for intervention with ST users and potential users. Although many of these strategies require training and time, it should be emphasized that even minimal intervention can be effective in combating ST use.