How to manage the biological risk in a dental clinic: current and future perspectives

Portable ozone sterilization device with mechanical and ultrasonic cleaning units for dentistry

A portable device for cleaning and ozone sterilization of small-sized delicate dental instruments that cannot withstand the high heat and humidity of standard autoclaving has been developed. The device contains a remote unit for magnetic mechanical washing, an ultrasonic bath for pre-cleaning treatment, and a container for ozone sterilization with a reactor based on dielectric barrier discharge. The maximum ozone concentration in water reached 8.5 mg/l for 10 min of operation at a water temperature of 19 °C. The results of inactivation of Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus are presented. Distilled water with such seeded micro-organisms was bubbled with an ozone-air mixture at an ozone concentration of 5.8 mg/l at 17 °C for 5 min, 10 min, 20 min, and 30 min. The maximum bactericidal effect was manifested for Pseudomonas aeruginosa cells with their total elimination within 10 min. Inactivation of Escherichia coli bacteria was monitored after 20 min of treatment, and Staphylococcus aureus-after 30 min of treatment.

Sterilisation in Dentistry: A Review of the Literature

In a small and medium-sized dental facility, the correct management of the sterilisation and presterilisation phases plays a fundamental role in good management of instruments and personnel, in order to ensure conditions that are more efficient with less down time. Nowadays, instrument sterilizers are increasingly efficient in achieving results, both in terms of time and size, and ensure that materials are sterile and ready to be stocked in a reasonable time. A literature search for articles related to revision work was performed using electronic databases such as PubMed, Scopus, and Google Scholar. The following keywords have been entered in the previously mentioned databases: sterilisation instruments; dental autoclave; precleaning; instruments disinfectants. The records obtained were screened by three reviewers, and only relevant articles were read full text. In addition, the timings of dental and sterilisation procedures were measured, and from these, suggestions are made in order to improve the efficiency of instrumentation management (facility used as study subject: University Dental Clinic, University of Foggia) as a function of the health-care interventions. We arrived at the conclusion that without doubt, sterilisation of instruments and products plays a fundamental role, but the efficiency of the sterilisation and presterilisation procedures cannot be separated from managing the personnel in charge by giving them specific and precise tasks.

Observance of Sterilization Protocol Guideline Procedures of Critical Instruments for Preventing Iatrogenic Transmission of Creutzfeldt-Jakob Disease in Dental Practice in France, 2017

Effective sterilization of reusable instruments contaminated by Creutzfeldt–Jakob disease in dental care is a crucial issue for public health. The present cross-sectional study investigated how the recommended procedures for sterilization were implemented by French dental practices in real-world settings. A sample of dental practices was selected in the French Rhône-Alpes region. Data were collected by a self-questionnaire in 2016. Sterilization procedures (n = 33) were classified into 4 groups: (1) Pre-sterilization cleaning of reusable instruments; (2) Biological verification of sterilization cycles—Monitoring steam sterilization procedures; (3) Autoclave performance and practitioner knowledge of autoclave use; (4) Monitoring and documentation of sterilization procedures—Tracking and tracing the instrumentation. Answers were provided per procedure, along with the global implementation of procedures within a group (over 80% correctly performed). Then it was verified how adherence to procedure groups varied with the size of the dental practice and the proportion of dental assistants within the team. Among the 179 questionnaires available for the analyses, adherence to the recommended procedures of sterilization noticeably varied between practices, from 20.7% to 82.6%. The median percentages of procedures correctly implemented per practice were 58.1%, 50.9%, 69.2% and 58.2%, in Groups 1, 2, 3 and 4, respectively (corresponding percentages for performing over 80% of the procedures in the group: 23.4%, 6.6%, 46.6% and 38.6%). Dental practices ≥ 3 dental units performed significantly better (>80%) procedures of Groups 2 and 4 (p = 0.01 and p = 0.002, respectively), while no other significant associations emerged. As a rule, practices complied poorly with the recommended procedures, despite partially improved results in bigger practices. Specific training regarding sterilization procedures and a better understanding of the reasons leading to their non-compliance are needed.

Bisphosphonates therapy in children with Osteogenesis imperfecta: clinical experience in oral surgery

Objectives

To define the possible complications of oral surgery in childhood in patients affected by type 1 Osteogenesis imperfecta (OI) and treated with bisphosphonates (BP).

Methods

The study was conducted among 20 patients in childhood with an age range 8-14 (12 ♂ e 8 ♀) affected by OI. Patients were initially evaluated at the Policlinico Umberto I, University Hospital of Rome, Rare Disease Center Skeletal Dysplasia-Bone Metabolic Pathologies and after at the Policlinico Umberto I, University Hospital of Rome, Head and Neck Department, UOC Pediatric Dentistry.

Results

From this experience, we showed that a proper patient management from the medical and dental point of view can protect these patients from the risk of post-operative problems, such as onj, soft tissue flogos, intraoral and extraoral fistulas, failure to heal the post-extractive alveolus, infections, post-operative pain and pathological fractures. The follow-up, ranging from a minimum of 2 years to a maximum of 5 years, have not demonstrated the presence of particular complications or healing defects.

Conclusions

The clinical experiences observed in these patients are encouraging because no postoperative complications have been observed compared to patients non-affected by OI.