Biomedical subjects
Publications and source records attributed to J A Molinari.
Without adequate protection, dental practitioners risk infection from microorganisms from patients' mouths. The authors discuss the role of pre-procedural mouthrinses in the infection control process.
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Unsterile polyvinyl, regular latex, and powder-free, modified latex examination gloves were evaluated following usage in routine dental procedures to assess their loss of integrity. Glove fingers were filled with a suspension of red-pigmented Serratia marcescens and drawn across the surface of tryptic soy agar plates. The appearance of red-pigmented Serratia colonies on the plates was used as an indication of glove defects. Unused, unwashed gloves taken at random from boxes served as controls. Of the gloves used in clinical procedures, 83.3% of the polyvinyl gloves, 35.0% of the regular latex gloves, and 7.5% of the powder-free, modified latex gloves allowed penetration of Serratia. Data thus suggest that advances in technology continue to develop a glove with more resistance than regular latex and vinyl gloves to routine clinical usage.
This paper defines infection control in dentistry as it exists in 1991 and makes some predictions about the future of this area. A total of 21 items form the basis of a comprehensive infection control program.
To evaluate instrument sterilization procedures in Minnesota, biological indicators were used to monitor 406 sterilizers in 381 dental offices. Findings suggest a general improvement in instrument performance over that of a decade ago, but sterilization failure rates are still too high. Sterilizer operator errors are a major cause of sterilization failures. BIs are useful in monitoring sterilization performance only when sterilization procedures are performed consistently and competently by well-trained staff using adequately maintained equipment.
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The purpose of the present study was to investigate the capacity of various disinfectant chemicals to cause epithelial toxicity with repeated exposure. The abdominal area of 3-month old, experimental ICR/CD-1 mice was initially shaved, denuded with a depilatory agent and allowed to rest for 24 hours. Commercial preparations of iodophors, bleach, synthetic phenols, phenolic/alcohols, and glutaraldehydes were then sprayed onto the exposed abdominal tissue 8 times/day (0.8 ml spray) for 2 consecutive days. The applied disinfectant was allowed to dry between procedures. In comparison to controls sprayed with distilled water, each disinfectant stimulated some degree of epidermal changes. Resultant multiple brownish lesions showed local thickening and hardening. Histologically, epidermal changes ranged from mild hypertrophy to extensive epithelial erosion. A few inflammatory cells were occasionally detected in the epithelium. When present, dermal reactions ranged from a mild inflammation to focal areas of collagen degeneration. The results indicated that iodophors stimulated the mildest reactions, followed by the synthetic phenol preparations, bleach, phenolic/alcohols, and glutaraldehyde sprays. Similar assays using glutaraldehyde immersion sterilants/disinfectants produced marked tissue destruction.
The ADA Council on Dental Therapeutics recognizes many commercial products as effective for use in dentistry as disinfectants or sterilants. Some of the products act only as disinfectants and do not sterilize; some have an odor that is unpleasant; others stain or bleach surfaces; and some of the formulations are corrosive to metallic surfaces. Therefore, it is essential that, before purchasing a chemical sterilant/disinfectant or a surface disinfectant for routine use, the practitioner, dental hygienist, and assistant obtain as much detailed information as possible. With sufficient information, subsequent decisions may be used on appropriate efficacy criteria, and the potential for product misuse may be reduced.
Information is scant regarding epidemiologic risk factors for human immunodeficiency virus (HIV) infection among parenteral drug abusers (PDAs) residing in areas of low seroprevalence. A detailed interview and HIV serologic testing were conducted among PDAs hospitalized at Detroit Receiving Hospital for reasons unrelated to HIV infection. The study involved 22 seropositive (17 men, 5 women) and 52 seronegative (34 men, 18 women) drug abusers in Detroit, Michigan, an area of relatively low HIV prevalence. The interviews included inquiries regarding risk factors such as duration of drug abuse, visits to "shooting galleries," use of "hit men," needle sharing, sterile injection techniques, use of "street" antibiotics, promiscuity, visits to prostitutes, homosexuality, history of sexually transmitted diseases, and history of travel to areas of high HIV prevalence. A strong association was noted between the number of risk factors present and HIV seropositivity. The presence of any three or more risk factors was significantly associated (P less than .05) with seropositivity. Awareness of epidemiologic risk factors for HIV infection among PDAs in a low-prevalence area is useful in identification of seropositive drug abusers and is crucial in designing educational interventional strategies to interrupt viral transmission.
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A survey was mailed to the deans of all U.S. dental schools in November 1988 requesting information regarding infection control instruction and protocols within the school. Fifty-five of 59 surveys were returned. Compared to results of previous surveys, schools are paying increased attention to infection control and the application of recommended protocols. The paper contrasts the 1988 data with those of surveys conducted in 1982, 1986, and 1987, and highlights remaining obstacles to implementation of infection control programs within the dental school environment.
Dentistry has made great strides in infection control over the past 10 years. An effective asepsis program is part of "the standard of care" in dental practice as we approach the twenty-first century. Several areas of dental infection control are undergoing change as new information is obtained, thereby providing points for discussion and some controversy. An effective vaccine to protect against hepatitis B viral infection is available but has met with indifference on the part of many. This readily available protection should be obtained by all health care providers. Surface disinfection is another area of controversy. A variety of chemical agents with differing properties are available for use in dentistry. Many of these are effective as disinfectants but have limited cleansing action, and this must be considered in their application. The practice of prosthodontics also presents numerous opportunities for cross-contamination. The sterilization and disinfection of dental impressions, prostheses, appliances, and a variety of plastic and wooden items provide a challenge for future research as newer products and techniques are developed. Infection control has literally been placed in the hands of health professionals. We, our patients, and families will continue to benefit from our positive efforts in this area.
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