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17.11.2015

Pathogens in a dental practice

Managing an invisible risk. The most feared organism in the world has neither claws nor teeth. It may look primitive, but it is efficient and highly developed. Invisible to the human eye, it lives under the skin, in our hair roots and in the corners of our mouths and eyes. Our bodies have ten times the number of bacteria as cells. Although many are harmless, the more dangerous of these microbes excrete toxins, multiplying until they cause infections such as pneumonia, blood poisoning or tuberculosis.

A false sense of security

The historical battle between man and microbes seemed to have been decided by the advent of antibiotics. Many believe the antibiotic to be an invention of modern medicine. In fact, microorganisms developed these enzymes three million years ago as a defence against competitors. Mankind only adopted this strategy. The use of antibiotics ushered in a period of relative calm for the Western industrialised nations - during which time fears of infection receded. The new weapon against pathogen microorganisms was applied liberally. Today, every person in the world consumes an average of ten grams of antibiotics per year. Some 30,000 tonnes of antibiotics are produced per year and circulate freely in the ecosystem. As a consequence, a number of bacteria became resistant against penicillin in the 1980s and then all other antibiotics. Those clinics which use a large number of antibiotics have seen the rise of highly resistant microbes. The topic of pathogen microbes is also relevant to dental surgeries. Patients, dentists and their assistants come into close contact with each other. Pathogen microorganisms can be spread by a hand contact, via surfaces and instruments, or droplet infection, causing serious illnesses. Viruses and fungi is also represent a serious health risk. Statistics show that in Germany alone, some 20,000 people die from the consequences of the influenza virus every year. Highly infectious hepatitis viruses represent an especial threat to medical personnel. They are so resistant, that they can survive in dried blood particles for up to a week.

Decontamination de lege artis

The University clinic Düsseldorf is one centre providing significant figures for infection risks following dental treatment. When extracting a diseased tooth, there is a 75-88 per cent chance of an infection. Without prior inflammation, this is reduced to 20-66 per cent. Even the use of a dental damm brings a 30 per cent change of transferring pathogen microbes. The dentist must be able to rely on his staff to follow the correct hygiene measures. In practical terms, this means that they must bring potentially-infectious material into a state in which it no longer pose a threat to human health. This means the reduction of hundreds of thousands of pathogen microbes to just a single germ. Sterilization procedures are subject to strict specifications. From one million augmentable pathogens, only one may survive. With spurting blood , saliva and other secretions on the arm rests of the treatment unit or in the spittoon, this requirement presents the dental team with a serious challenge. A situation requiring especial care is the danger presented by the pathogen-loaded aerosol cloud emitted from the patient's mouth. This has an average radius of up to two metres. Surfaces must be subjected to a comprehensive disinfectant wipe-down after every patient.

Fully-virucidal products

The recommendations of the » Robert Koch Institute (RKI) represent the most important basis for the implementation of a hygiene plan. The newly-issued version from the autumn of 2012 includes a range of detailed changes and new appendixes.

The new guidelines continue to evaluate and differentiate between medical products in accordance with the risk classes A-B-C, but have refined important new formulations. A manual chemical disinfection procedure is still permissible with critical and semi-critical A (+B)- medical products. The guidelines include, however, the newly-explicit requirement that the » disinfectant be bactericidal, fungicidal, and fully virucidal. This places greater emphasis on a virucidal effect for an effective infection prevention strategy. Nevertheless, the RKI has not ruled as to the exact scope of application of disinfectants with a virucidal and partially-virucidal action. The guidelines dictate the use of virucidal agents or procedures in the preparation of medical devices only if is impossible to sterilize the medical devices after disinfection.

In case of doubt, (fully-) virucidal products provide better protection against infection. As a result, they should also be used in contexts in which they have not been specified, such as in the disinfection of instruments and surfaces. Dürr Dental is the only manufacturer to provide (fully) virucidal products for these central areas, the effectiveness of which has been attested by independent institutions such as the » German Association for Combatting Virial Disease (Deutscher Verein zur Bekämpfung von Viruskrankheiten e. V. - DVV), or the » Association for Applied Hygience (Verbund für angewandte Hygiene e. V. VAH, previously the DGHM). Corresponding labels often cause confusion. For instance, disinfectants stating "Tested by the VAH" or "VAH-listing pending" do not number amongst the listed products. Statements such as "disables viruses" or "effective against viruses" are misleading. The only relevant terms are "partially-virucidal" and "virucidal". Partially virucidal preparations are effective against enveloped viruses, whereas fully virucidal agents are also effective against non-enveloped viruses such as Polio and Polyoma SV40. Practices thus have access to effective substances which can reduce the danger of » pathogen infection of staff and patients.

Published by: rf/tk 04/16
Microbes under an electron microscope

Microbes under an electron microscope

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