New Report on the Balancing Act From Kaiser
The responsibilities of managing family health and well-being principally fall on women, often at the expense of their ability to advance in their careers. A new issue brief, Women, Work, and Family Health: A Balancing Act (http://www.kff.org/content/2003/3336/), prepared by researchers at the Kaiser Family Foundation and the UCLA Center for Health Policy Research, provides new data from mothers about the multiple responsibilities that they balance, often alone, to meet their family's health-care needs. Mothers manage most family health concerns, with about 80 percent assuming the major role in selecting their children's doctor and taking children to doctor's appointments. Working mothers must make tradeoffs between caretaking and job earnings. Almost half of working mothers reported missing work when a child is sick. See Sept/Oct 2003 WDJ.
Guidelines for Environmental Infection Control and Slide Set for Hand Hygiene
The final CDC/HICPAC Guideline for Environmental Infection Control in Healthcare Facilities, 2003 is now available at http://www.cdc.gov/ncidod/hip/enviro/guide.htm. In addition, the final CDC slide set to promote hand hygiene is available at http://www.cdc.gov/handhygiene/materials.htm.
¡No Entendiendo!
The DOH of CDC recently released draft guidance for infection control in dentistry (Draft Recommended Infection Control Practices for Dentistry, 2003). It cited policies from other federal agencies, including regulatory agencies such as the FDA and OSHA. Final guidelines are expected later this year.
The draft guidance recommended that water quality was not to exceed 500 colony-forming units per milliliter (CFU/ml). The proposed standard for dental unit water is more than twice the drinking water standards, recommended at 200 CFU/ml by the Environmental Protection Agency (EPA). At the proposed standard, many dental units would require regular cleaning or disinfection of water lines to control biofilm proliferation.
With more people living longer due to medical advances, more CFU/ml could be a problem for the 58 million with disabilities, or one in five Americans. With few prospective epidemiologic evaluations of dental treatment on patients, including those with disabilities, the impact of the proposed standard cannot be assessed. We encourage DOH to be consistent with existing EPA standard policy for the final release.
NIOSH-Approved Disposable Particulate Respirators (Filtering Facepieces)
CDC infection-control guidance recommends that health-care workers protect themselves from diseases potentially spread through the air (such as SARS or Tuberculosis) by wearing a fit-tested respirator at least as protective as a NIOSH-approved N-95 respirator. An N-95 respirator is one of nine types of disposable particulate respirators, also known as "air-purifying respirators" because they protect by filtering particles out of the air you breathe. Workers can wear any one of the respirators for protection if they are NIOSH-approved and have been properly fit-tested and maintained. NIOSH-approved disposable respirators are marked with manufacturer's name, part number, protection provided by the filter (e.g. N-95), and NIOSH. For a list of respirators strongly resistant to particulate matter, go to http://www.cdc.gov/niosh/npptl/respirators/disp_part/p95list1.html.
Amalgam Wars Continue at FDA
On May 9, the Food and Drug Administration (FDA) announced the formation of a panel to determine whether peer-reviewed, scientific literature provides any new evidence about the health effects of dental amalgam in humans. The National Institute of Dental and Craniofacial Research of the National Institutes of Health and the Division of Oral Health (DOH) of the Centers for Disease Control and Prevention (CDC) will co-sponsor the review, scheduled to begin in late 2003. Analysis of women's oral health data was not specified in the announcement.
A Study on Surface Roughness and Microleakage Test in Cavities Prepared by Er:YAG Laser Irradiation
M. Hossain, Y. Yamada, et. al. Showa University, Tokyo, Japan For complete abstract, consult: Laser Med Sci 2003; 18:25-31. (DOI 10.1007/s10103-002-0235-5)
Note: See "Erbium Laser Technology" by Janet Hatcher Rice, DDS, in this issue of Woman Dentist Journal.
The purposes of this study were to investigate the surface morphology, surface roughness of cavities prepared by Er:YAG laser irradiation, and compare the microleakage degree after composite resin restoration with etched bur cavities, in vitro. In 30 human extracted teeth, two shallow cavities were prepared; one with the Er:YAG laser system on the buccal surface, and one on the lingual (palatal) surface with a high-speed turbine. Scanning electron microscopy (SEM) was used to analyze five cavities from each group, and five were analyzed for surface roughness by color laser three-dimensional microscope. The remaining cavities were filled with a composite resin and subjected to a microleakage test under thermocycling. Only bur cavities were acid-etched before filling. Prepared cavities showed an irregular surface with the absence of a debris-like smear layer. Surface roughness was significantly increased with the laser system. Microleakage test revealed no significant differences between the laser and bur cavities. Laser cavity may facilitate good adaptation of composite resin with enamel and dentine because of increased surface roughness. The primer and an adhesive appear to penetrate the surface better when the smear layer is removed. Shallow cavity prepared by Er:YAG laser is capable of decreasing microleakage of composite resin restorations, and its efficiency is similar to etched bur cavities.
Caries Risk Training
A caries risk training curriculum has been developed by a workgroup of Indian Health Service personnel, chaired by CAPT Jeanine Tucker, DMD, MPH, with CAPT Suzanne Eberling, DMD, PhD; Mary Beth Kinney, MPH, EdD; CAPT Raymond Lala, DDS; and LCDR Bridget Swanberg-Austin, DDS. This program provides a framework to manage dental caries as an infectious disease transmitted from adults to infants. The six modules provide guidance to determine patient risk of decay, including evidence-based prevention and treatment. Completion of training provides 24 hours of AGD credit and costs about $400 plus shipping. Contact Dr. Tucker at (907) 729-3641 or [email protected].
Causes, Treatment, and Prevention of Early Childhood Caries: A Microbiologic Perspective
Robert J. Berkowitz, DDS, Chief, Division of Pediatric Dentistry, School of Medicine and Dentistry, University of Rochester, N.Y. Journal of the Canadian Dental Association 2003; 69:5 Partial abstract. For complete abstract, go to http://www.cda-adc.ca/jcda for free access.
Early childhood caries (ECC) is a virulent form of dental caries that can destroy the primary dentition of toddlers and preschool children. The prevalence of ECC among children of low socioeconomic status ranges from 11 to 72 percent, where levels of Streptococcus mutans can exceed 30 percent of plaque organisms. Diet and early acquisition of S. mutans by vertical or horizontal transmission are significant in the natural history of the disease, with rapid demineralization of tooth structure. Treatment usually consists of restoration or surgical removal of carious teeth. Relapse rates of approximately 40 percent have been reported within the first year after dental surgery. Strategies for prevention have focused on feeding behaviors with minimal success. Newer strategies using topical antimicrobial therapy appear promising.
Clinical Features, Short-Term Outcomes of 144 Patients With SARS in Greater Toronto Area
Christopher M. Booth, MD; Larissa M. Matukas, MD; George A. Tomlinson, PhD; et al. Partial Abstract — Journal of the American Medical Association 2003; 289:21:2801-2809. (DOI 10.1001/jama.289.21.JOC30885)
Severe acute respiratory syndrome (SARS) is an emerging infectious disease that first manifested in humans in China in November 2002, and has subsequently spread worldwide. Objectives — To describe the clinical characteristics and short-term outcomes of SARS in the first large group of patients in North America; to describe how these patients were treated and the variables associated with poor outcome. Methods — Retrospective study of 144 adult patients admitted to 10 hospitals in Toronto, Ontario, between March 7 and April 10, 2003, with a diagnosis of suspected or probable SARS. Patients were included if they had fever, a known exposure to SARS, and respiratory symptoms or infiltrates observed on a chest radiograph. The 21-day outcomes included death or intensive care unit (ICU) admission. Results — Of the 144 patients, 111 (77 percent) were exposed to SARS in the hospital setting. Patients self-reported at admission: fever (99 percent), elevated temperature (85 percent), nonproductive cough (69 percent), myalgia (49 percent), and dyspnea (42 percent). Laboratory features included elevated lactate dehydrogenase (87 percent), hypocalcemia (60 percent), and lymphopenia (54 percent). A total of 126 patients (88 percent) were treated with ribavirin, although its use was associated with significant toxicity, including hemolysis (in 76 percent) and decrease in hemoglobin of 2 g/dL (in 49 percent). Twenty-nine patients (20 percent) were admitted to the ICU, and eight patients died (21-day mortality, 6.5 percent; 95 percent CI, 1.9 to 11.8 percent). Multivariable analysis showed that the presence of diabetes (relative risk [RR], 3.1; 95 percent CI, 1.4-7.2; P = .01) or other comorbid conditions (RR, 2.5; 95 percent CI, 1.1-5.8; P = .03) were independently associated with poor outcome (death, ICU admission, or mechanical ventilation). Conclusions — The majority of cases in the greater Toronto area SARS outbreak were related to hospital exposure. Although SARS is associated with significant deathand disability, especially in patients with diabetes, the vast majority (93.5 percent) of patients in our cohort survived.
SARS Update in the United States
As of June 21, 2003, 41 states and Puerto Rico had reported a total of 398 SARS cases to CDC, with 327 suspected and 71 probable cases. Health-care workers with fever or respiratory symptoms 10 days following an unprotected exposure to a SARS patient should refrain from patient contact. These workers should stay home and report symptoms immediately to a health-care provider. Exclusion from duty should be continued for 10 days after resolution of symptoms. During this period, infected workers should avoid contact with people at work and in the community.
Environmental decontamination is important for contaminated surfaces. Any EPA-registered* hospital detergent-disinfectant currently used by health-care facilities for environmental sanitation may be used for SARS. Follow the manufacturer's recommendations for use-dilution (i.e., concentration), contact time, and care in handling. Clean and disinfect patient-care equipment in accordance with current CDC recommendations, manufacturer's instructions, and facility procedures for critical, semicritical, and noncritical surfaces. See www.cdc.gov/ncidod/hip/isolat/isolat.htm and www.cdc.gov/ncidod/hip/sterile/sterile.htm for more information.
Monkeypox Arrives in the United States
A viral disease related to smallpox, monkeypox, has arrived in the United States. The majority of cases have been reported from persons with contact with prairie dogs imported from Africa. However, two health-care workers have been reported with monkeypox after exposure to infected individuals. Symptoms — fever, headaches, sweating, dry cough, swollen lymph nodes, and chills — usually occur four to 12 days following exposure. Rashes develop with small vesicles or blisters, which produce scarring similar to smallpox or chickenpox. Smallpox vaccination is recommended for prevention for exposed individuals. While prior recommendations for biodefense excluded them, pregnant women and children with exposure to monkeypox are advised to receive smallpox vaccination. For more information, visit www.cdc.gov.
KUDOS!
... to The Ministry of Health and the British Dental Association for supporting women dentists. By 2004, more women than men will be dentists in the United Kingdom. The government announced plans to assist women dentists through career changes, offering incentives for continuing education during career breaks. Research has shown that about two-thirds of the female dentists who have a career break, often to have families, intend to return to practice. Health minister Hazel Blears said, "Women are an increasing force in dentistry, and this government is committed to enabling women to realize their potential in their chosen careers."
... to The Sacramento County Board of Supervisors for recognizing volunteerism among dental insurance company employees. The Board proclaimed Delta Dental Plan of California's consulting dentists among the county's "outstanding volunteers of the year," providing free dental screenings to more than 1,400 area school kids and placing more than 6,000 dental sealants with the county's dental sealant program, "Smile Keepers." Volunteer dentists and county-funded hygienists work from a mobile van in local schools. The program was started based on an employee's suggestion. Delta Dental Plan of California covers nearly 17 million enrollees in dental programs.
Call for papers!
See the January/February 2003 issue of Woman Dentist Journal for instructions on submitting editorial material for publication. You can also visit www.wdjournal.com or www.aawd.org/about/about.cfm to view an online version of WDJ's Call for Papers.
