Infection control and disease update

It is a pleasure to have been asked to contribute a column for Dental Economics®.

It is a pleasure to have been asked to contribute a column for Dental Economics®. This column will be devoted to providing dental practitioners with clinical updates in selected topics of interest in microbiology, infectious diseases, and infection control. I am honored that Dr. Joe Blaes asked me to submit a periodic contribution aimed at considering current and emerging knowledge as well as clinical challenges. As an introduction to future columns, I begin with a statement I use with my students during their first infection control class: We must know where we have been in order to see where we are, and to figure where we want to go.

Historical progress leading toward the control of infectious diseases has been marked by steady accomplishments, and has been punctuated by extraordinary achievements. In an earlier milestone, the sciences of microbiology and immunology were forever interwoven in the late 1790s when Dr. Edward Jenner introduced and successfully proved the efficacy of his smallpox vaccine. Numerous developments have occurred since then that have allowed us to successfully combat health problems such as smallpox, diphtheria, tetanus, poliomyelitis, hepatitis B, rubella, measles, mumps, and chicken pox. Concurrent with historical scientific advances, volumes of accumulated evidence have demonstrated the effectiveness of infection control precautions in limiting the potential for microbial disease transmission in health-care settings. Technological advances also have facilitated evolution of preventive precautions in recent decades. Without a doubt, however, the most significant reason for the successful application of appropriate infection control principles has been the willingness of health-care providers to respond to documented science about occupational risks and recommendations for minimizing the potential of microbial cross-infection.

In many respects, dental medicine has led the way in addressing clinical challenges of infection control. A few of the more noteworthy examples of the profession’s attention at asepsis include the frequent use of antiseptic handwash agents before and after patient treatment, adaptation to and use of personal protective barriers, receipt of hepatitis B vaccination, and routine sterilization of reusable instruments and high-speed handpieces. Most dentists and their staffs incorporated these and other principles into their professional routine long before the OSHA Bloodborne Pathogens Standard became mandated in 1991.

When evaluating the current state of infection control precautions, younger dental professionals sometimes find it difficult to believe that many of their teachers and personal dentists were educated, and provided patient care using “wet-fingered dentistry.” When I ask clinicians about this in seminars, the typical response is one of sheepishness and amusement. The reason I ask the question is not to embarrass, but to point out to those who entered the profession later that clinicians who were trained without using gloves are - in fact - pioneers of dental infection control. Initially, they learned during the latest and best available procedures, and became competent. Many excelled beyond competence. When they decided to adopt more stringent infection control guidelines, they had to relearn procedures. This time, though, they wore latex gloves. This phase of education did not occur in school but in their individual practices with patients who had come to expect expert, quality dental care. To those who fit the above description, you did it. Thank you.

Emerging and reemerging infection control challenges will continue to confront us and our patients in the 21st century. We already have faced the first epidemic of the century - the SARS (Severe Acute Respiratory Syndrome) outbreak in late 2002 and 2003. In addition, we continue to follow avian influenza outbreaks among domesticated birds in Asia while looking for evidence of viral mutation that could facilitate human-to-human transmission. These and other issues, with potential implications for infection control, will be highlighted in future columns. I hope you will find my discussion of these topics beneficial. I also ask that you feel free to let me know what topics you would like to see included. I look forward to working with Dental Economics and you as we explore occupational infectious disease challenges and issues.

Dr. John A. Molinari received a PhD in microbiology from the University of Pittsburgh School of Dental Medicine. Currently, he is professor and chairman of the Department of Biomedical Sciences at the University of Detroit Mercy School of Dentistry. He has published and lectured in the areas of infectious diseases, clinical immunology, and infection control. He also addresses these areas as a consultant to the CDC, ADA Council on Dental Practice, and Council on Scientific Affairs. Dr. Molinari can be contacted via telephone at (313) 494-6632, or via e-mail at molinaja@udmercy.edu.

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