William Kohn

The Effectiveness of Sealants in Managing Caries Lesions

A barrier to providing sealants is concern about inadvertently sealing over caries. This meta-analysis examined the effectiveness of sealants in preventing caries progression. We searched electronic databases for comparative studies examining caries progression in sealed permanent teeth. We used a random-effects model to estimate percentage reduction in the probability of caries progression in sealed vs. unsealed carious teeth. Six studies, including 4 randomized-controlled trials (RCT) judged to be of fair quality, were included in the analysis (384 persons, 840 teeth, and 1090 surfaces). The median annual percentage of non-cavitated lesions progressing was 2.6% for sealed and 12.6% for unsealed carious teeth. The summary prevented fraction for RCT was 71.3% (95%CI: 52.8%–82.5, no heterogeneity) up to 5 years after placement. Despite variation among studies in design and conduct, sensitivity analysis found the effect to be consistent in size and direction. Sealing non-cavitated caries in permanent teeth is effective in reducing caries progression.

Guidelines for infection control in dental health-care settings - 2003

This report consolidates previous recommendations and adds new ones for infection control in dental settings. Recommendations are provided regarding 1) educating and protecting dental health-care personnel; 2) preventing transmission of bloodborne pathogens; 3) hand hygiene; 4) personal protective equipment; 5) contact dermatitis and latex hypersensitivity; 6) sterilization and disinfection of patient-care items; 7) environmental infection control; 8) dental unit waterlines, biofilm, and water quality; and 9) special considerations (e.g., dental handpieces and other devices, radiology, parenteral medications, oral surgical procedures, and dental laboratories). These recommendations were developed in collaboration with and after review by authorities on infection control from CDC and other public agencies, academia, and private and professional organizations.

Patient-to-Patient Transmission of Hepatitis B Virus Associated with Oral Surgery

We used molecular epidemiologic techniques to document patient-to-patient transmission of hepatitis B virus (HBV) between 2 outpatient oral surgery patients operated on 161 min apart. Serological testing of 25 (93%) of 27 patients operated on after the source patient revealed that 19 (76%) of 25 were previously immune to HBV; no additional cases were identified. We found no deficiencies in infection control practices. Transmission may have been limited by the high prevalence (64%) of patients vaccinated against HBV. To our knowledge, this is the first documented case of patient-to-patient transmission of a bloodborne pathogen in a dental setting in the United States.

A comparison of selected evidence reviews and recommendations on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries

Medical Subject Headings (MeSH): cariostatic agents, community dentistry, community health planning, community health services, decision making, dental caries, evidencebased medicine, facial injuries, fluoridation, intervention studies, meta-analysis, mouth protectors, oral health, pharyngeal neoplasms, pit and fissure sealants, practice guidelines, preventive dentistry, preventive health services, public health dentistry, public health practice, review literature, tooth injuries

CDC weighs in on TADs

Double-package or double-wrap surgical instruments so that the outer package (which might have been contaminated during storage or transport) is removed when setting up for the surgical procedure. 3. Chemical indicators should be on the outside and inside of the package. Some self-seal sterilization pouches have internal chemical indicators printed inside the package. If the pouch does not have an internal chemical indicator, indicator strips can be added to the the instrument package or cassette before sealing. The internal chemical indicator ensures that the sterilizing agent (steam) touched the surface of the instruments. An internal chemical indicator provides a higher level of sterility assurance but is not required at this time. 4. Sterilize. 5. Allow the sterile instruments packages to dry in the autoclave; do not remove wet packages. 6. Store sterile instrument packages in closed or covered cabinets or drawers.