*Alicja Porenczuk1, Bartłomiej Górski2, Wioletta Bielas1, Dariusz Gozdowski3, Agnieszka Mielczarek1
The application of restorative material packed in blisters in cross infection control in restorative dentistry
Zastosowanie materiału wypełnieniowego pakowanego w blistry w zapobieganiu zakażeniom krzyżowym w stomatologii zachowawczej
1Restorative Dentistry Department, Medical University of Warsaw
Head of Department: Agnieszka Mielczarek, MD, PhD
2Department of Periodontology and Oral Diseases, Medical University of Warsaw
Head of Department: Professor Renata Górska, MD, PhD
3Faculty of Agriculture and Biology, Department of Experimental Design and Bioinformatics, Warsaw University of Life Sciences
Head of Department: Krzysztof Polanowski, PhD
Streszczenie
Wstęp. Procedury stomatologiczne są obarczone ryzykiem transmisji patogenów prowadzącej do wystąpienia zakażenia krzyżowego. Podejmowane są metody zapobiegawcze niedopuszczające do bezpośredniego kontaktu z zakażonymi tkankami pacjenta. Mniejszą uwagę przykłada się do zagrożeń pośrednich, takich jak zakażenie drobnoustrojami materiałów wypełnieniowych. Materiały wypełnieniowe porcjowane i pakowane w jednorazowe blistry mogą skutecznie wyeliminować zagrożenie wynikające z niezmierzonej transmisji mikroorganizmów do opakowania materiału.
Cel pracy. Celem badania była ocena wiedzy i podejścia polskich studentów stomatologii dotyczących ryzyka zakażenia materiałów wypełnieniowych podczas zabiegów rekonstrukcyjnych.
Materiał i metody. Przeprowadzono badanie ankietowe wśród studentów Wydziału Lekarsko-Dentystycznego Warszawskiego Uniwersytetu Medycznego, którzy otrzymali jednorazowe opakowanie materiału odtwórczego do wypełnienia wybranego ubytku w trakcie zajęć praktycznych.
Wyniki. Wszyscy studenci nabyli wiedzę teoretyczną dotyczącą problematyki zakażeń krzyżowych w czasie studiów. Mniej niż połowa z nich deklaruje zainteresowanie dodatkowymi zajęciami z tego tematu. Prawie wszyscy (96%) potwierdzili, że transmisja patogenów może nastąpić podczas zabiegu przy użyciu tego samego nakładacza do pobierania materiału wypełnieniowego ze strzykawki i jego nakładania do ubytku, choć jedynie 68% z nich stosuje odrębne nakładacze podczas zabiegu rekonstrukcyjnego. 100% studentów uważa, że pakowanie materiału wypełnieniowego w blistry może przyczynić się do zwiększenia bezpieczeństwa zabiegu poprzez zmniejszenie ryzyka zakażenia materiału wypełnieniowego.
Wnioski. Polscy studenci stomatologii wymagają dodatkowych zajęć poświęconych tematyce kontroli zakażeń krzyżowych w stomatologii zachowawczej. Materiały wypełnieniowe porcjowane i pakowane w jednorazowe blistry mogą przyczynić się do zwiększenia bezpieczeństwa pacjenta podczas zabiegów rekonstrukcyjnych.
Summary
Introduction. Dental procedures bear risk of pathogens transmission leading to cross--infection. Means of protection aim at preventing direct contact with patient’s infected tissues. Less attention is paid to indirect threats, such as the restorative material’s infection during treatment. Restorative materials portioned and packed in disposable blisters may effectively eliminate the risk of material’s contamination.
Aim. The aim of the study was to assess the knowledge and attitude of polish dental students on infection of dental restorative materials during treatment.
Material and methods. A survey was conducted among students of the Faculty of Dentistry at the Medical University of Warsaw, who were given disposable packages of the restorative material for cavity reconstruction during practical classes.
Results. All students gained theoretical knowledge on cross-infection control. Less than half declared need for more classes in this field. Almost all of them (96%) admitted that pathogens transmission may occur during restorative treatment where one spatula is used for both picking the material from the syringe and placing it in the cavity. Only 68% of them actually use separate instruments during restorative treatment. All of them think that packing of the material in separate blisters may increase safety during treatment through minimizing risk of the material contamination.
Conclusions. Polish dental students need more classes concerning cross-infection control in restorative dentistry. Restorative materials packed in disposable blisters may increase patients safety during restorative treatment.
Introduction
Dental procedures bear high risk regarding transmission of pathogens, such as bacteria, viruses and fungi, as both the dental staff and the patients may have contact with blood, saliva and respiratory secretions (1). The human hepatitis B/C virus (HBV/HCV), human immunodeficiency virus (HIV) and herpes simplex virus (HSV) may be listed among the most dangerous microorganisms, which can be transferred in a dental office. All patients should therefore be treated as potential bearers of infectious diseases, which would help to implement safety standards. Dental procedures involve direct and/or indirect contact with blood and other tissue fluids of the human organism. As a result, a transmission of contagious biological material from one patient to another, patient to the dental staff and vice versa and between members of the dental staff may occur (2). Such incidence is called cross-infection. Most practitioners pay attention to preventing cross-infection caused by direct contact with patient’s secretions, particularly blood and saliva. In restorative dentistry, the direct exposure may take place when using non-sterile instruments, not changing of burs, handpieces, endodontic files or other instruments, and/or injuries caused by non-sterile instruments during and after dental procedure, ex. used needles, scalpel blades, tip of endodontic file. The indirect contact with the infected material takes place through water spray created during the procedure and may be even more risky for both the patients and the dental staff than the direct exposure. The aerosol containing the patient’s secretions and pathogens scatters around the dental office and its closest environment, while water droplets settle on dental instruments and all surfaces bearing risk of cross-infection. To prevent both the direct and indirect risk factors of cross-infection, means of surface disinfection, disposable materials (needles, blades, syringes and other), means of personal protection (disposable rubber gloves, eyewear and masks) and other (protective sheets for the dental unit and handpieces) are used. Moreover, disinfection and sterilization of the non-disposable instruments, dental unit and working surfaces are applied after each procedure. Implementing knowledge among the dental staff on ways of transmission of the pathogens and their elimination is indispensable (3). Such training should be a part of an undergraduate dental course, as students’ understanding of the paths of transmission of infectious diseases would establish a well-protected environment in the future. Unfortunately, the knowledge and attitude towards cross-infection control vary between dental schools and countries, which is illustrated in table 1. A study conducted in Saudi Arabia (4) showed satisfactory knowledge and positive attitude of the students of dentistry regarding cross-infection. They were able to recognize risks of percutaneous injuries with infected needles and could identify means of self-protection, such as gloves, masks and eyewear (4). In the restorative dentistry, the operating area should be well protected from the scatter by means of a rubber dam, which significantly reduces the level of the spread microorganisms (1). It also protects dental instruments from touching other parts of the oral cavity than the lesion. Although there is a high degree of acceptance of the rubber dam, it’s not used on a routine basis in restorative dentistry (5). A study proceeded by Kumar et al. (1) showed that only 29.8% of the students in India routinely used rubber dam during restorative procedures. Likewise, as much as 49.6% of students in Malaysia do not use a rubber dam during treatment (6). Although the students of dental schools are well aware of the risk caused by transmission of the pathogens, there is a risk for abandoning of the taught procedures after graduation. A study conducted in British dental offices showed that more than 50% of the British post-graduates stops using rubber dam after leaving school (7). The majority of the Irish and the Welsh dentist (63%) do not use a rubber dam for any restoration (7). Similar situation has developed in Turkey, where rubber dam isolation is used in 23.7% of cases (8). Therefore, mandatory training on cross-infection control should be implemented during undergraduate training, with an impact on post-graduate regular updates.
