A solution to cross-contamination in the dental practice

By Donna M. Smith, CDA

“60 Oklahoma dental patients test positive for Hepatitis, HIV.” (04/18/13 ABC News)

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Cross-contamination continues to be a major problem for every dental practice. The major culprit is the dental mixing pad. These pads are compressed paper on a cardboard base. The pads are used to mix any dental materials such as cements or bases. At this point, you have already been working in the patient’s mouth with gloves containing saliva, blood, or plaque when you touch the sides and bottom of the mixing pad. The pad has about 65 sheets, so you have used the mixing pad with 65 patients. The pad is on cardboard, which becomes porous like a dirty sponge. This mixing pad cannot be disinfected nor can the pad be covered with a barrier. You mix, deliver, and tear off the top sheet, then place the used pad in the drawer with the clean 2 X 2 or cotton rolls or leave it out on the counter to be aerosoled. To prove conclusively that contamination is taking place, an independent lab was hired to culture several used mixing pads. Colonies of bacillus and gram-positive cocci were found. Colony count was between one and 296 colonies. The risk of patient-to-patient contamination is high.

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This cross-contamination problem has been discussed with the Health Department, SPICE, Occupational Safety & Health Administration (OSHA), U.S. Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and Healthcare Infection Control Practices Advisory Committee (HICPAC). It has been suggested to double-glove or change gloves before using the mixing pad. How will dental auxiliaries know to change gloves when they are not aware of the problem? How would the dentist change gloves to base a tooth, going back and forth from the mixing pad to the patient’s mouth? Would you just double-glove for all procedures? This scenario would be quite expensive and time-consuming.

Why are we using the mixing pad as one unit? We have been taught in dental school to mix on the pad as one unit. The picture diagrams showing how to mix cements and bases show the gloved hand and mixing pad used as one unit. Mixing pads can be purchased with a nonslip base, which suggests that they are to be used as one unit.

The CDC recommends Guidelines for Infection Control in Dental Health-Care Settings — 2003. It states that dental patients and dental health-care professionals can be exposed to pathogenic microorganisms including cytomegalovirus (CMV), HBV, HCV, herpes simplex viruses types 1 and 2, HIV, mycobacterium tuberculosis, Staphylococci, Streptococci and other viruses, and bacteria that colonize or infect the oral cavity and respiratory tract. These organisms can be transmitted in dental settings through 1) direct contact with blood, oral fluids, or other patient materials; 2) indirect contact with contaminated objects (e.g., instruments, equipment, or environmental surfaces; 3) contact of conjunctival, nasal, or oral mucosa with droplets (e.g., splatter) containing microorganisms generated from an infected person and propelled a short distance (e.g., by coughing, sneezing, or talking); and 4) inhalation of airborne microorganisms that can remain suspended in the air for long periods.

The CDC states: “Exposing patients or dental health-care personnel to water of uncertain microbiological quality, despite the lack of documented adverse health effects, is inconsistent with generally accepted infection control principles.” This statement also applies to the use of the dental mixing pads.

There is a solution to the problem of cross-contamination. It is the use of the dental mixing sheet dispenser, U.S. Patent application #12/915443. This is an injection-molded device, which houses the dental tape and is completely enclosed. The dispenser opens with a tap. It slides open and is held open by a magnet. The paper is then pulled to the desired length and torn off by pulling against the cutting edge. This now is a single-use mixing sheet. The only paper touched is the portion of paper that will be used on that individual patient. There is no opportunity for cross-contamination. To close the dispenser, tap at the back and it glides forward to a closed position.

The paper roll is waterproof. It has light adhesive on the back side. The paper is easy to use, stays flat down on the countertop, and is repositionable so as to mix in another direction. It will stick to the glove delivered to the dentist. The size of the paper is at your discretion. This is the only product of its kind in the industry. The design stops the opportunity to cross-contaminate the mixing sheet.

In conclusion, current mixing pads are an anomaly. The design allows cross-contamination. They are not within the guidelines of infection control as are other products that are single use or that can be disinfected or a barrier placed.

The dental sheet dispenser meets is a real need in the dental industry. The design does not allow cross-contamination and is convenient. The dispenser is not only necessary but economical. The dental tape dispenser is a true advancement in dentistry. We are only as strong as our weakest link.

Donna M. Smith, CDA Donna Smith is a wife, mother, and grandmother. She has been a Certified Dental Assistant for 35 years. She worked 10 years in civil service at Fort Bragg. Donna has worked in orthodontics, periodontics, oral surgery, and general dentistry offices. She currently works in a general dentistry office in High Point, N.C. Donna wants to make a positive influence in people’s lives. You may contact Donna by email at smithmdonna@yahoo.com.

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Communicating shade to dental labs

Chris Salierno, DDS 12/04/2014

Dr. Salierno offers four practical tips that will help all dentists communicate more clearly with their dental labs for succes, and it invovles more effort than just writing a letter and a number on a lab script. I used to just wrtie “A2″ in a box on a lab sheet and hope that the lab would figure it out.  That was pretty dumb.

Unfortunately (or fortunately) our teeth are not identical to the VITA shade guide tabs.  There is far more complexity that exists in our dentin and enamel, so if we are to hope to acheive a higer level of replication we must put in some more effort than just writing a letter and a number on a lab script.

The good news is that you don’t need a masters degree in the fine arts to be able to take a good shade.  Here are some simple steps I use:

(1) Buy a damn digital SLR camera with flash and macro lens

I promise you that getting a professional camera will bring you to another level of dentistry.  There are a number of reasons, which our friend, Dr. Albert Yoo, is writing about in this month’s issue of Dental Economics.  But for now let’s be concerned with the fact that shade communication is far better with a proper camera set up than with your smart phone.  Two popular palces to get the whole package are Lester Dine and PhotoMed.

(2) Pick a few shades that look good

Don’t just pick one shade for your photo; pick a few.  Chances are that there’s more than one shade tab that will offer insight into the teeth of interest.  Giving more than one tab will also give the lab technician some variety and the ability to compare elements of color between photographs.  Don’t forget to give the lab a stump shade (shade of the prepared tooth) if you are using all-ceramic restorations.

(3) Take a proper photograph with the shade tab

Make sure the tab identifier is visable (e.g. A2, C4, etc).  Make sure the tab is held at a similar orientation as the teeth of interest so that the light plays off of it similarly.  Take a few photographs under different lights and not just your treatment room.

The orientation of the shade tab is a bit off, thus giving us a reflection that is not present on the teeth of interest.  This photo isn't terrible, but we lose an opportunity communicate some information to the lab.
The orientation of the shade tab is a bit off, thus giving us a reflection that is not present on the teeth of interest. This photo isn’t terrible, but we lose an opportunity communicate some information to the lab.

These photos are more accurate.  We have good orientation of the tabs, we can see the tab identifiers, and the lab has two photos for comparison.
These photos are more accurate. We have good orientation of the tabs, we can see the tab identifiers, and the lab has two photos for comparison.

(4) There’s more than just shade to communicate

But of course we’re not ONLY interested in communicating shade, are we?  There is also characterization and texture; what are the nuances of how the shade is distributed on the surfaces and what tiny lumps and bumps are to be found?  For these bits I like to take an extreme close-up photo, which can really only be done with a camera with a proper macro lens.  This can be separate from your shade tab photos so you’ll have a free hand to use a cool toy like a contrastor.

- See more at: http://thecuriousdentist.com/communicating-shade-to-labs/#sthash.iInTcl6F.dpuf 

Championship communication with your dental lab: Part III

David Rice, DDS 12/04/2014

Dentists and lab technicians both want to experience success, and communication is a key part of that success.

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