Oral Hygiene May/Jun 2022

IT’S TIME FOR PLUG & PLAY

oral hygiene , therapy , infection control , management and more ...

VOL.32 NO.3

MAY/JUNE 2022

A new high-tech intraoral sensor providing versatility, Unwanted guests reliability in in image quality and ease of use your waterlines? in the daily workflow

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Unwanted guests in your waterlines?

When you SHOCK, let ICX RENEW.

FOR MORE INFORMATION, CONTACT YOUR LOCAL AUTHORISED DISTRIBUTOR NSW/ACT Chairs Delivery Systems Lights Monitor Mounts Cabinets Maintenance Imaging

Dental Installations Miranda (02) 9526 3500 Pegasus Dental Services South Hurstville (02) 9585 1100 Presidental Warners Bay 1800 773 743

When you SHOCK, let ICX RENEW. For more information Email: a-dec@a-dec.com.au

Tristan’s Dental Equipment Service Campbelltown (02) 9820 8086

QLD

Dental Depot Windsor (07) 3857 0011 Medical Dental Solutions NQ Currajong

Leading Dental Murarrie (07) 3139 1549 QDS Noosa Heads 1300 770 977

VIC

Alldent Port Melbourne (03) 9646 3939 Medi-Dent

SA/NT

Dental Concepts Edwardstown (08) 8177 0600

WA

Dental Intelligence Osborne Park (08) 9244 8888 West Coast Dental Depot Belmont

VOLUME 32 | NUMBER 3 MAY/JUNE 2022

OH | CONTENTS

On the cover...

ICX Renew is a new shock treatment that clears deposits and contamination which can build up in waterlines over time

READ ME FOR

CPD

4 6 16 20

12

PREVENTING NEEDLE STICK INJURY BRIEFS NEWS & EVENTS

Dr Greg Mahoney looks at how sharps injuries in dental practice remain a concern today even though dentistry adopted preventive practices in the 1980s

CPD CENTRE READ ME FOR

ABSTRACTS

CPD

22

INFECTION CONTROL: FACTS VERSUS FALLACIES IN THE POST-JUNE 2022 WORLD Emer. Prof. Laurie Walsh highlights that with the significant changes occurring in infection control, it is important not to be misled by those who would seek to profit from the confusion

facebook.com/auxiliarynow

Annual Subscriptions: Australia or NZ: OralHygiene $22.00 p.a.

Overseas: A$38.00 p.a.

Australasian Dental Practice (including OralHygiene) $99.00p.a.

SUBSCRIBE ONLINE at http://shop.dentalpractice.com.au

twitter.com/auxiliarynow Publisher & Editor: Joseph Allbeury

28

READ ME FOR

CPD

EFFECTIVE PATIENT COMMUNICATION STARTS WITH SOCIAL MEDIA Rita Zamora Advice advises on how to create a social media plan that engages your patients and protects your revenue

32

READ ME FOR

CPD

HOW TO TALK ABOUT PEDO CROWNS WITH YOUR PAEDIATRIC PATIENTS Both hygienists and therapists have a role to play when strainless steel paediatric crowns are in order

instagram.com/dentevents www.oralhygiene.com.au

Oral Hygiene (formerly Auxiliary) ISSN 1323-4919 is printed in Australia and published six times per year by Main Street Publishing P/L ABN 74 065 490 655 • PO Box 586, Cammeray 2062

Telephone: (02) 9929-1900 Facsimile: (02) 9929-1999 Email: info@dentist.com.au © 2022. All rights reserved. The contents of this magazine are copyright and must not be reproduced without the written permission of the publisher. Permission to reprint may be obtained upon application. Correspondence and manuscripts for publication are welcome. Although all care is taken, the editor and publisher will not accept responsibility for the opinions expressed by contributors to this magazine, or for loss or damage to material submitted for publication.

news | EVENTS New MDP2 (Mobile Dental Photography 2)

T

he Smile Lite MDP2 Mobile Dental Photography by Prof. Louis Hardan - the ultimate evolution in mobile dental photography – is here. It’s equipped with three groups of next generation “Sun-Like“ LEDs and each group can be lit up individually.

A dimmer function gives you the possibility to set four different illumination levels. The increased light power is perfect for posterior shots and the new integrated ergonomic handle provides stable support. The back of the Smile Lite MDP2 is equipped with a universal adapter that is adjustable and fits any smartphone with a width between 55-85mm.

Available from Alphabond Dental on (02) 9417-6660, email info@alphabond.com.au or www. alphabond.com.au.

In the genes - risk factors for severe COVID evere COVID-19 results from immune-mediated inflammatory lung injury. Critically-ill COVID-19 patients are more likely to have the primary disease process - hypoxaemic respiratory failure - and that this group of patients have a divergent response to immunosuppressive therapy compared to other hospitalised patients. Host genetic variation influences the development of illness requiring critical care or hospitalisation following SARS-CoV-2 infection. The GenOMICC (Genetics of Mortality in Critical Care) database was used for comparing the genomes from critically-ill COVID-19 cases with population controls in order to find underlying disease mechanisms. This study used whole genome sequencing in 7,491 critically-ill COVID-19 cases compared with 48,400 controls. There were 23 gene loci that significantly predispose to severe Covid-19, with 16 new independent associations, including variants within genes involved in interferon signalling (IL10RB, PLSCR1), leucocyte differentiation (BCL11A) and blood type antigen secretor status (FUT2). Using transcriptome-wide association and co-localisation to infer the effect of gene expression on disease severity, there was evidence implicating multiple genes, including reduced expression of a membrane flippase (ATP11A) and increased mucin expression (MUC1), in critical disease. There was evidence from Mendelian analysis for causal roles for myeloid cell adhesion molecules (SELE, ICAM5, CD209) and coagulation factor F8. These adhesion molecules have known roles in inflammatory cell recruitment to sites of inflammation, including E-selectin (SELE), intercellular adhesion molecule 5 (ICAM5) and dendritic cell-specific intercellular adhesion molecule3-Grabbing non-integrin (DC-SIGN, CD209). Mendelian randomisation results were consistent with a direct link between plasma levels of a closely-related cytokine receptor subunit, IL3ra and critical COVID-19. Mendelian randomisation revealed the genetic evidence in support of a causal role for coagulation factors (F8) and platelet activation (PDGFRL) in critical COVID-19. Overall, these findings are also broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. A key implication is that genetic factors are important in susceptibility and that adhesion molecules could be targets for drug therapy.

S

Kousathanas A et al. Whole genome sequencing reveals host factors underlying critical Covid-19.

Nature 2022 March 7, doi: 10.1038/s41586-022-04576-6.

4 oral|hygiene

in | BRIEF A robotic microswarm may one day automate the routine of rinsing, brushing and flossing teeth to create a hands-free system for the treatment and removal of tooth-decay-causing bacteria and dental plaque. The technology, developed by a multidisciplinary team at the University of Pennsylvania, is poised to offer a new and automated way to perform the mundane but critical daily tasks.

It’s a system that could be particularly valuable for those who lack the manual dexterity to clean their teeth effectively themselves. The building blocks of these microrobots are iron oxide nanoparticles that have both catalytic and magnetic activity. Using a magnetic field, researchers could direct their motion and configuration to form either bristle-like structures that sweep away dental plaque from the broad surfaces of teeth, or elongated strings that can slip between teeth like a length of floss. In both instances, a catalytic reaction drives the nanoparticles to produce antimicrobials that kill harmful oral bacteria on site.

Min Jun Oh, Alaa Babeer, Yuan Liu, Zhi Ren, Jingyu Wu, David A. Issadore, Kathleen J. Stebe, Daeyeon Lee, Edward Steager, Hyun Koo. Surface Topography-Adaptive Robotic Superstructures for Biofilm Removal and Pathogen Detection on Human Teeth. ACS Nano, 2022; DOI: 10.1021/acsnano.2c01950 Researchers from the University of Louisville School of Dentistry and their colleagues have discovered details of how proteins produced by oral epithelial cells protect humans against viruses entering the body through the mouth.

They also found that oral bacteria can suppress the activity of these cells, increasing vulnerability to infection.

Carlos J. Rodriguez-Hernandez, Kevin J. Sokoloski, Kendall S. Stocke, Himabindu Dukka, Shunying Jin, Melissa A. Metzler, Konstantin Zaitsev, Boris Shpak, Daonan Shen, Daniel P. Miller, Maxim N. Artyomov, Richard J. Lamont, Juhi Bagaitkar. Microbiome-mediated incapacitation of interferon lambda production in the oral mucosa. Proceedings of the National Academy of Sciences, 2021; 118 (51): e2105170118 DOI: 10.1073/pnas.2105170118

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news | EVENTS

Upload your videos to Dentevents.TV now and win a smartphone gimbal

D

entevents.TV has launched a brand new feature to allow anyone working in dentistry to upload and share videos that’s easier than ever. Simply login at www. dentevents.tv and click “Upload Video” to get started.

Whether you have a webinar recording, a product hack, a clinical technique, a product review or unboxing, a diatribe on difficult patients or some wisdom or humour about dentistry, you’re invited to share your video with your peers.

Plus, the author of the video that receives the most votes before August 31 will receive a DJI OM 5 Smartphone Gimbal Stabiliser (Phone not included) to help you make even better videos in the future.

6 oral|hygiene

“Dentevents.TV has continued to grow in popularity following its launch during the first COVID lockdown, but moving forward, we need to attract more content to take it to the next level,” said Dentevents.

TV publisher Joseph Allbeury.

“We have a great catalogue of dental videos available free and on demand 24/7 already, but now we’re looking for more content created by members of the dental community.

“Many people working in dentistry are already prolific content creators and we want to engage with these people and encourage them to use dentevents. tv as an additional way to share their videos with their peers. Part of this is making it far easier to load videos and part of this is incentivising videos creators to share their content.”

The latest videos added to the site appear under “Recently Added” and a new “VOTE” button has been added to enable anyone visiting the site to vote for the videos they like.

“You have to login to Dentevents.TV to watch the videos and vote,” Mr Allbeury said. “Each person can only vote once for a video, but they can vote for multiple videos.

Only videos added between 1 July and 31 August 2022 can be voted for.

So if you load a video onto the site, then it’s in your interests to encourage your friends to login as well and vote for it.

The VOTE button activates after you have watched the video.”

For more information on the contest, visit Dentevents.TV. It’s free to login and watch any of the videos 24/7 and VOTE.

May/June 2022

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news | EVENTS

Proven 3-Step water treatment protocol

W

ith increased emphasis on infection control in the current pandemic environment, there is a new focus on ensuring dental unit waterline quality is adequately maintained A-dec Product Manager, Shal Hafiz says that together with daily waterline maintenance with a proven solution like A-dec ICX tablets, it’s important to monitor water quality and periodically shock the lines. New A-dec ICX Renew – launched in Australia in May – is the perfect complement to self-contained waterline units to ensure the highest quality water is delivered to patients.

ICX Renew is a shock treatment and part of the “A-dec 360 Maintenance” approach which includes regular waterline maintenance; waterline quality monitoring; and periodic shock treatment.

ICX Renew clears deposits and contamination which can build up over time, without harming plastic tubing or corroding dental unit components, unlike some harsh treatments.

“Contaminated water lines can cause odour and foul-tasting water that can also present a potential health risk,” Mr Hafiz said.

The latest ADA Infection Control Guidelines suggest a shock treatment if

8 oral|hygiene

CFU (colony forming units) reach 200 CFU/mL. “These shock treatments are required periodically to clean dental unit waterlines and more often if dental units have been left unused for any period, such as over a holiday break,” Mr Hafiz said.

He said A-dec dealers now offer a waterline testing service using a highly accurate high tech Lumitester device.

This water testing service could easily be incorporated in clinics as part of routine equipment servicing.

“It’s good practice to test microbial levels in water lines regularly – at least every six months, as this is a good protocol to ensure dental unit waterline quality is not forgotten,” Mr Hafiz said.

“In keeping with ADA Guidelines, A-dec recommends a three-step: ‘Maintain, Monitor, and Shock’ approach to keeping water lines clean.

“Monitoring requirements will depend on your water quality and the clinic’s individual requirements,” Mr Hafiz said.

“Initially, test water once a month. If the results pass your specified action level for three successive months (i.e. 200 CFU/ mL), reduce the testing protocol to quarterly.”

Mr Hafix said the A-dec 360 Maintenance system took the uncertainty out of waterline maintenance, ensuring water quality and patient safety was maintained and that equipment was protected.

“Some testing systems are inaccurate and take up to 72 hours to produce a result, which could mean you are using contaminated water on patients while awaiting your test results.

“A-dec’s 2-minute Lumitester system produces an accurate result in just two minutes, without the need for cumbersome and potentially inaccurate manual counts.

If your test triggers an action level, treat your dental units with ICX Renew. Best results are achieved by adding the ICX Renew Tablets to the dental unit waterline and letting it sit overnight.”

ICX Renew turns the dental unit waterline water blue, indicating the shock treatment is at work in the waterline. The next day the lines are flushed until they are clear and are then ready to be refilled with clean water and a regular ICX tablet matching the size of the water bottle.

Mr Hafiz said both ICX and ICX Renew were completely safe to use in dental units and did not cause corrosion of metals or damage to soft components.

“Some other shock treatments use harsh nappy sanitiser chemicals which can harm dental tubing, diaphragms and ‘O’ rings.”

A-dec ICX, ICX Renew and the Lumitester dental unit waterline test are all available from your A-dec dealer.

Contact A-dec on 1800-225-010 or visit: australia.a-dec.com to find your nearest authorised A-dec dealer or representative.

May/June 2022

Unwanted guests in your waterlines?

When you SHOCK, let ICX RENEW. Unwanted visitors like bacteria love to colonise in your dental unit waterlines.

A daily waterline maintenance protocol with A-dec ICX® waterline treatment tablets, along with periodic ICX Renew™ shock treatments, will help reduce these nasty microorganisms.

For complete trademark information, visit a-dec.com/legal/trademarks.

To find out more, visit australia.a-dec.com

© 2021 A-dec Inc. All rights reserved.

news | EVENTS

Waterpik® Water Flosser: Significantly more effective than interdental brush for improving gingival health Water Flosser compared to interdental brush on bleeding scores and gingival abrasion Slot DE, Lyle DM, Van der Sluijs E, Hennequin-Hoenderdos N, Van der Weijden F. J Dent Res 2018; 97(Special Iss. B): Abstract #0622 (www.iadr.org).

Conducted at Academic Center for Dentistry Amsterdam (ACTA), Netherlands.

Objective o compare the effectiveness of a Waterpik Water Flosser (WF) and interdental brush (IDB) on bleeding indices and gingival abrasion.

T

Methodology eventy-eight subjects completed this 4-week, randomized controlled trial.

Subjects were assigned to one of two groups; Waterpik Water Flosser (WF) plus a manual toothbrush or interdental brush (IDB) plus a manual toothbrush.

Gingival inflammation was evaluated by measuring Bleeding on Pocket Probing (BOPP) and Bleeding on Marginal Probing (BOMP). Data was collected on contra-lateral quadrants. The Gingival Abrasion Score (GAS) was used to compare the incidence of abrasion between the groups.

S

Plaque Removal 100

80

String Floss

29%

Water Flosser

% Reducation

57.7%

MORE EFFECTIVE*

MORE EFFECTIVE*

81.6%

MORE EFFECTIVE*

74.4%

60

24%

29%

85.7%

33%

MORE EFFECTIVE*

68.2%

63.4%

69.4%

51.1%

40

39%

MORE EFFECTIVE*

62.9%

45.2%

Results oth groups demonstrated a significant reduction in BOPP and BOMP from baseline to four weeks for all sites and interdental sites separately.

The WF group was significantly more effective than the IDB group for reducing BOPP for all sites at week four (p=0.030) and BOMP for all sites and interdental sites at week four (p=0.003, p=0.019 respectively). There were no differences in gingival abrasion scores between the groups.

20

B

10 oral|hygiene

0

Whole Mouth Approximal

Marginal

* Statistically significant difference

he Waterpik Water Flosser is significantly more effective than the interdental brush for improving gingival health in this clinical study.

Lingual

Want more information?

Conclusion

T

Facial

or more information or to book a free Waterpik Lunch and Learn, email professionalAU@waterpik.com

F

May/June 2022

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Clinically Proven Results Untreated

Treated

Removes up to 99.9% of plaque from treated areas2

Up to 50% more effective for improving gum health vs floss2

Up to 2X as effective for improving gum health around implants vs string floss2

Up to 3X as effective for removing plaque around braces vs strong floss2

*Dependent upon location of practice. Sessions via face to face or Zoom.

1. Terms & Conditions apply. Please visit Waterpik.com.au/shop for more information. 2. Independent clinical studies. Go to Waterpik.com.au for details.

Visit www.waterpik.com.au for more information or email professionalau@waterpik.com

infection | CONTROL

READ ME FOR

CPD

Preventing needle stick injury

By Dr Greg Mahoney, BDSc, PhD, MSc (Dent), GradDipClinDent, FADI, FPFA

S

harps injuries in dental practice remain a concern today even though dentistry adopted preventive practices in the 1980s.

An Australian study found 27.7% of dentists had experienced at least one sharps injury in the previous 12 months and 16.1% of these involved a contaminated instrument that had been previously used on a patient. Furthermore, the most common devices to cause sharps injury in the previous 12 months were needles (14.4%).1 Hollow-bore needle injuries are of particular concern, since they are likely

12 oral|hygiene

to contain residual blood and are associated with an increased risk for blood-borne virus transmission. Of the 57 documented cases of occupational HIV transmission to healthcare personnel reported to CDC from June 1995 to December 2002, 50 (88%) involved percutaneous exposure.

Of these, 45 (90%) were caused by hollow-bore needles and half of these needles were used in a vein or an artery.2

The risk lood-borne viruses that could potentially be transmitted by a sharps injury include hepatitis B and C, as well as HIV. The risk of transmission following a skin puncture injury is dependent on:

B

• Whether the person who previously used the object had an infection; • The level of virus in their blood; • The amount of blood involved; • The type of needle or syringe in question; • The time that has elapsed since it was used; and • The nature of the injury.

So in dentistry, the most likely source of a blood-borne virus transmission is the local anaesthetic needle, being hollow and injected into a vascular rich area. It is estimated that up to 14% of inferior dental nerve blocks result in an intravascular injection and with an infiltration may too puncture a blood vessel.3

May/June 2022

ULTRA SAFETY PLUS TWIST

A LONG-PROVEN infection | CONTROL EFFICACY A study demonstrated that when introduced in a dental school, Ultra Safety Plus was a the key success factor for avoiding needle stick injuries.

fe & easy

otects you and your fromUltra needle stickPlus injuries Figure 1. staff The new Safety Twist from Septodont. mplies with latest regulations uitive device ailable with either sterile single use or sterilisable handle

FREQUENCY OF NEEDLE STICK INJURIES ULTRA SAFETY PLUS INTRODUCTION

sive or active aspiration:

ity for the patient

sparent barrel:

ation is clearly visible

ng protective sheath:

ction from needle stick injuries

YEAR 1 Two different positions:

first Holding Position (reversible) final Locking Position (irreversible)

Figure 2. The Ultra Safety Plus from Septodont.

YEAR 2

YEAR 3

YEAR 4

YEAR 5

Figure 3. Zakrzewska thatstick the number With Ultra Safety Plus,found needle injuries of avoidable needle decreased an average 11.8 to11.8 0 injuries per stick injuriesfrom reduced from anofaverage per 1,000,000 hours (1) 1,000,000 hours worked worked to zero in UK dental schools. Consequently it has been adopted by most dental school across the UK.8-10 (1) J.M Zakrzewska et al. Introducing safety syringes into a UK dental school – a controlled study. Brit Dent J 2001 ; 190; 88-92.

The risks of acquiring other bloodborne viruses from a contaminated needle are considerably higher than the 0.23% for HIV with 6-30% for hepatitis B and 1.8% for hepatitis C.4 Acquired hepatitis B and C cases have been reported in Australia.5,6 Following known exposure to blood borne virus, post-exposure prophylaxis (PEP) should be considered. PEP is known to be over 80% effective in preventing HIV from needle stick injuries and while oral health care workers are vaccinated against hepatitis B, there is no vaccination for Hepatitis C. Post exposure prophylaxis protocols are an essential part of everyday practice although are an expensive and time consuming process with a considerable emotional toll.7 It makes eminent sense for all dental operatories to adopt effective needle stick injury prevention protocols and safety equipment. The criteria for local anaesthetic delivery should be:

May/June 2022

• Compatible with the existing local anaesthetic cartridge; • Able to be used for all techniques for local anaesthesia; • Single use or autoclavable; • Proven to be effective in reducing or eliminating needle stick injury; and • Cost effective.

Prevention review of the availability of safety systems, including needleless systems, found that one system met the above criteria - the Ultra Safety Plus from Septodont. The Ultra Safety Plus™ and now the new Ultra Safety Plus Twist (also from Septodont) system – which does not require the re-sheathing or removal of a needle from its syringe – has been in my private practice for over 10 years and in that time there has been no cases of local anaesthetic needle stick injury.

A

Evaluating the system against the desirable criteria Compatibility: The system uses the existing 2.2ml cartridges.

Technique: The system comes with preloaded a 27 or 30 gauge needle in short and extra short and looks, feels and acts like the traditional dental injection.

Autoclavable: It comes in single use and if desired, an autoclavable plunger.

Effectiveness at reducing needle sticks: Zakrzewska found that the number of avoidable needle stick injuries reduced from an average 11.8 per 1 million hours worked to zero in UK dental schools (Figure 3).

Consequently it has been adopted by most dental school across the UK.8-10 Cost effectiveness. The University of Queensland found the cost of safety syringes was comparable to non-disposable syringes, however the reduction in the cost of managing sharps injuries was substantial.11

oral|hygiene

13

2

infection | CONTROL

“The system works by sliding down a captive rigid lock sheath over the needle when loading up a new cartridge, exposing the needle and cap.

After injection, the sheath is moved up to the first click so that the needle can be uncovered for a second injection if required. At the of 100 sterile needles end1 box the handle injection, the sheath 1 box of 50 sterile need +of 1 STERILISABLE is slid up till the second click which is a one way lock to permanently lock the sheath in place over the needle, preventing sharps injuries 1 box of 50 sterile SINGLE-USE handles 1 sterilisable handl during changeover between patients...”

ULTRA SAFETY PLUSA secure ULTRA SAFETY PLUS TWIST TWIST

A INTUITIVE NEW PATENDED DESIGN Only 2 easy steps are needed for a secure assembly

A secure lock

1.

Introduce the pins of the handle in the notches 1. of the barrel Introduce the pins of the handle in the notches of the barrel

2.

length

Twist the finger grip to lock it

gauge

x short - 10 mm short - 25 mm short - 25 mm long - 35 mm long - 35 mm

2.

Twist the finger grip to lock it

color code

30 g 30 g 27 g 27 g 25 g

Please visit our website for more information: www.septodont.com

P w

Find the relevant details in the instructions manual

Find the relevant details in the instructions manual

BROCHURE 3 volets SEPTODONT v16 GAMME XL OK 23/09.indd 1-3

The system works by sliding down a captive rigid sheath over the needle when up a new BROCHUREloading 3 volets SEPTODONT v16 cartridge, GAMME XL OKexposing 23/09.indd 1-3 the needle and cap. After injection, the sheath is moved up to the first click so that the needle can be uncovered for a second injection if required. At the end of the injection, the sheath is slid up till the second click which is a one way lock to permanently lock the sheath in place over the needle, preventing sharps injuries during changeover between patients.

Adopting sharp safe methods is essential in all dental practices. The Ultra Safety Plus and Ultra Safety Plus Twist provides the dental team with the necessary tool to provide safe practice. If sharp safe habits are not expected of each team member, the risk of a sharp injury increases.

14 oral|hygiene

References 1. Leggat PA, Smith DR. Prevalence of percutaneous exposure incidents amongst dentists in Queensland.

Aust Dent J. 2006;51(2):158-61.

2. CDC. Workbook for Designing, Implementing and Evaluating a Sharps Injury Prevention Program 14 Dec 2019]. Available from: https://www.cdc.gov/ sharpssafety/part1TEXTONLY.htm.

3. Taghavi Zenouz A, Ebrahimi H, Mahdipour M, Pourshahidi S, Amini P, Vatankhah M. The Incidence of Intravascular Needle Entrance during Inferior Alveolar Nerve Block Injection. J Dent Res Dent Clin Dent Prospects. 2008;2(1):38-41.

4. CDC. Exposure to Blood :s What healthcare personnel need to know. National Center for Infectious Diseases Divison of Healthcare Quality Promotion and Division of Viral Hepatiti. 2003.

5. Haber PS, Young MM, Dorrington L, Jones A, Kaldor J, De Kanzow S, et al. Transmission of hepatitis C virus by needle-stick injury in community settings. J Gastroenterol Hepatol. 2007;22(11):1882-5.

6. Res S, Bowden FJ. Acute hepatitis B infection following a community-acquired needlestick injury.

J Infect. 2011;62(6):487-9.

7. McAllister J. Literature review for the national guidelines for post-exposure prophylaxis after nonoccupational and occupational exposure to HIV (revised). National PEP Guidelines Expert Reference Group 2016;Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine.

8. Zakrzewska JM GIaJJ. Introducing safety syringes into a UK dental school – a controlled study. BrDent J 2001(190):188-92.

9. Zakrzewska JM BE. Use of dental safety syringes in British and Irishdental schools. . Br Dent J. 2003(195):207-9.

10. Oliver G, David DA, Bell C, Robb N. An Investigation into Dental Local Anaesthesia Teaching in United Kingdom Dental Schools. SAAD Dig. 2016;32:7-13.

11. Walsh L. Sharps injuries during patient changeover: Are you getting the point. Australasian Dental Practice January/February 2018:64-6.

May/June 2022

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oral|hygiene CPD CENTRE infection | CONTROL

infection | CONTROL

READ ME FOR

Infection control: Facts versus fallacies in the post-June 2022 world

Preventing needle stick injury

By Emeritus Professor Laurence J. Walsh AO

I

By Dr Greg Mahoney, BDSc, PhD, MSc (Dent), GradDipClinDent, FADI, FPFA

S

harp’s injuries in dental practice remain a concern today even though dentistry adopted preventive practices in the 1980s.

An Australian study found 27.7% of dentists had experienced at least one sharps injury in the previous 12 months and 16.1% of these involved a contaminated instrument that had been previously used on a patient. Furthermore, the most common devices to cause sharps injury in the previous 12 months were needles (14.4%).1 Hollow-bore needle injuries are of particular concern, since they are likely

to contain residual blood and are associated with an increased risk for blood-borne virus transmission. Of the 57 documented cases of occupational HIV transmission to healthcare personnel reported to CDC from June 1995 to December 2002, 50 (88%) involved percutaneous exposure.

Of these, 45 (90%) were caused by hollow-bore needles and half of these needles were used in a vein or an artery.2

The risk lood-borne viruses that could potentially be transmitted by a sharps injury include hepatitis B and C, as well as HIV. The risk of transmission following a skin puncture injury is dependent on:

B

12 oral|hygiene

READ ME FOR

CPD

CPD

t is important that all dental practices are aware of some significant changes which are occurring from June 29, 2022 and are not misled by those who would seek to profit from the confusion that these changes may create.

• Whether the person who previously used the object had an infection; • The level of virus in their blood; • The amount of blood involved; • The type of needle or syringe in question; • The time that has elapsed since it was used; and • The nature of the injury.

Hence this article is themed around “an audit of the auditors”.

So in dentistry, the most likely source of a blood-borne virus transmission is the local anaesthetic needle, being hollow and injected into a vascular rich area. It is estimated that up to 14% of inferior dental nerve blocks result in an intravascular injection and with an infiltration may too puncture a blood vessel.3

The DBA change here is a significant change in the position being taken by the Dental Board of Australia (DBA), with the move away from its 2010 policy, towards the use of a structured comprehensive self-reflection tool. This move does not in any way

T 22 oral|hygiene

May/June 2022

denigrate the importance of the existing national standards and guidelines, nor does it lower the expectations for dental practices in terms of infection control. The Board has made these two points abundantly clear in its communications to registrants about these changes.

The key point from the DBA change is that a greater emphasis is being placed on practitioners being aware of the regulatory environment for infection control and staying up-to-date with changes as they occur. The DBA self-reflection tool is designed to prompt serious consideration by individual clinicians around how well-informed they are now and how they plan to remain wellinformed going into the future. As one of the individuals involved in testing the draft of the tool, I can say from first-hand experience that when done properly, it will take some time (e.g. around 1.5 to 2 hours) to complete in a thorough manner.

This is not a quick “tick and flick“ document.

May/June 2022

Question 1. How effective is post-exposure prophylaxis in preventing HIV from needle stick injuries?

Question 6. A significant change in the position being taken by the Dental Board of Australia in relation to infection control:

a. 20% b. 40% c. 60% d. 80%

a. Denigrates the importance of the existing standards and guidelines. b. Lowers the expectations for dental practices. c. Places greater emphasis on practitioners being aware of the regulatory environment and staying up-to-date with changes. d. All of the above.

Question 2. The new version of the Ultra Safety Plus is called the... a. Ultra Safety Plus Snap b. Ultra Safety Plus Twist c. Ultra Safety Plus Pro d. Ultra Safety Plus Lock Question 3. The risk of transmission following a skin puncture injury is dependent on: a. The level of virus in their blood. b. The amount of blood involved. c. The type of needle or syringe in question. d. The time that has elapsed since the needle was used. e. All of the above.

Question 4. The risks of acquiring HIV from a contaminated needle are: a. 0.23% b. 0.56% c. 1.8% d. 6-30% Question 5. Following the implementation of Ultra Safety Plus, a study found that the number of avoidable needle stick injuries reduced to an average of: a. 14.8 per 1 million hours worked. b. 8.3 per 1 million hours worked. c. 11.8 per 1 million hours worked. d. 7.3 per 1 million hours worked. e. 0 per 1 million hours worked.

Question 7. In regard to infection control, the Dental Board of Australia has moved towards the use of a structured comprehensive self-reflection tool that can be completed: a. Quickly with a tick and flick. b. In 15-20 minutes. c. In anout an hour. d. In 90 minutes to 2 hours. e. In 4-6 hours.

Question 8. The ADA guidelines for infection prevention and control and the Risk Management Principles for COVID were prepared in consultation with: a. The Dental Board of Australia. b. DHAA and ADOTHA c. DAA d. ADPA e. All of the above.

Question 9. ADA guidelines are: a. Only guidelines so you can ignore them. b. Are a key reference document that parallels NHMRC guidelines. c. Designed for infection control auditors as a cheat sheet. d. Out of date and need to be updated.

Question 10. Australian standards automatically overrule all guidelines: a. True b. False

INSTRUCTIONS: OralHygiene™ is now offering PAID subscribers the ability to gain 2 Hours CPD credit from reading articles in this edition of the magazine and answering the questions above. To participate, contact OralHygiene for your Username and Password. Then log into the Dental Community website at www.dentalcommunity.com.au and click on the CPD Questionnaires link; select the Oral Hygiene May/Jun 2022 questionnaire and then click START. A score greater than 80% is required to PASS and receive CPD.

READ THE ARTICLES BELOW AND ANSWER THE QUESTIONS ONLINE AT WWW.DENTALCOMMUNITY.COM.AU - 2 HOURS OF CPD practice | MANAGEMENT

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Explaining the benefits of pedo crowns

Advice on how to create a social media plan that engages your patients and protects your revenue

F

ear has stopped about 20% of people in the U.S. from visiting the dentist. This statistic is pre-COVID-19, according to Mark S. Wolff, DDS, PhD, Dean, University of Pennsylvania, School of Dental Medicine. In a recent webinar, Dr Wolff shared, “Whether real or perceived, fear of the unknown, not knowing what to expect – not to mention fear of needles, pain, or uncomfortable procedures – has kept patients from dental care.

COVID-19 is expected to bring a higher level of dental practice fear and requires us to be more communicative than ever.”

You and your team know that safety starts with Personal Protective Equipment (PPE) and the other measures you’ve implemented to protect patients and staff, but are your patients aware of this? An April 2020 RDH Magazine survey of 2,200 dental hygienists in the United States found that 55% of patients were not being communicated with about changes in the dental practice.

Perhaps you’re struggling with what to say in your patient communication or wondering what the best method is to connect with patients.

If so, you’re not alone. With everything going on in the world, not to mention the new day-to-day protocols you and your team are getting used to in the world of living with COVID, it’s not surprising patient updates may have taken a back seat.

You may already know how vital patient relationships are to your practice.

If not, here’s a reminder.

28 oral|hygiene

READ ME FOR

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Excellent communication is the number one way to...

• Reduce patient anxiety; • Establish and grow trust; • Increase patient satisfaction; and • Grow strong relationships.

Trust and strong relationships allow patients to feel comfortable to...

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Accept your treatment plans; Pre-pay for treatment; Share positive reviews; Refer friends and family; and Remain loyal to your practice.

The good news is that you have unprecedented opportunities to communicate with patients through tools like social media. Yes, you can call, email or text, but social media is where patients are spending a lot of their time – and now more than ever.

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May/June 2022

A

pplied to permanent molars, sealants can reduce the risk of cavities by 80%. But, what about deciduous teeth... and the caries that can sometimes show up? When it does happen, it’s common SCAN to Add or for parents to be upset worried. And that anxiety Update Yourand Practice can easily pass along to the child.

So, how can you help both parents and their children have a positive dental experience, even when the dentist finds a cavity?

The key is to approach those conversations as an opportunity for learning.

Let parents know that they’re not alone - tooth decay is the most common chronic disease in children and more than 40% of children will have dental caries by the time they reach kindergarten. Parents may not know that decay spreads quickly between deciduous teeth because that enamel is thinner than on permanent teeth.

Follow up with the good news. They have an excellent option for treatment when significant tooth loss has occurred as a result of rampant or very advanced caries: pedo crowns.

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32 oral|hygiene

May/June 2022

Question 11. Excellent patient communication can:

Question 16. In the BOIT system, the “I” stands for:

a. Reduce patient anxiety. b. Establish and grow trust. c. Increase patient satisfaction. d. Grow strong relationships. e. All of the above.

a. Incisal b. Insidious c. Inside d. Intensive

Question 12. The main hurdle with social media communication is: a. A lack of time available to post. b. Poor skills in knowing how to post. c. A lack of interest in posting. d. All of the above.

Question 13. Protocols should be implemented to: a. Create a calendar in advance for content posting. b. Schedule content so it posts automatically. c. Pay to boost content. d. Reply to comments or messages left on social media. e. All of the above.

Question 14. Fear of the dentist stops how many people in the US from visiting a practice annually:

Question 17. Removing deciduous teeth too early is a problem because: a. It creates space for neighbouring teeth to move into. b. It can interfere with how permanent teeth come through. c. It makes it harder for the child to chew some foods. d. It is very unaesthetic. e. All of the above.

Question 18. According to the article, what percentage of children will have dental caries by the time they reach kindergarten? a. 10% b. 25% c. 40% d. 55% e. 70%

a. 10% b. 20% c. 30% d. 40% e. 50%

Question 19. In the BOIT system, the “T” stands for:

Question 15. Trust and strong relationships allow patients to feel comfortable to:

Question 20. Hu-Friedy pre-trimmed, crimped and contoured crowns are made from:

a. Accept your treatment plans. b. Share positive reviews. c. Refer friends and family. d. Remain loyal to your practice. e. All of the above.

a. Nickel b. Titanium c. Stainless Steel d. Zirconia

To retrieve your FREE Dental Community Login:

Call (02) 9929 1900 or Email info@dentist.com.au

a. Teeth b. Tonsils c. Tongue d. Tip

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This course will discuss recent developments in infection control and their practical implementation in dental practice. The course is presented face-to-face with some video materials as required content to be watched prior to the session. The video material covers recent changes in the regulatory space in terms of the Dental Board of Australia (July 2022) and the ADA (4th edition guidelines August 2021 and the ADA Risk management principles for dentistry during the COVID-19 pandemic (October 2021).

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TOPICS for the face-face session include: Topics for the face-to-face session include: n

Applying the chain of infection and risk assessment to special situations - including pandemics of coronaviruses and influenza viruses.

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Best practices for PPE, Hand hygiene and Environmental cleaning.

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Preventing the spread of contamination using high volume evacuation and pre-procedural rinses and dental dam

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Applying quality assurance measures to instrument cleaning and sterilizing, including performance tests for washer disinfectorsand ultrasonic cleaners

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Common errors in instrument reprocessing and how to prevent them

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Low temperature sterilization technologies

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Enhancements in dental clinic design, including airflow

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Managing water quality for dental practice

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A Vital Update on recent changes...

Dental Board of Australia (Jul 2022) ADA Guidelines (Aug 2021) COVID-19 (Oct 2021)

FULL UPDATE! All the changes to Infection Control Guidelines in 2022

Laurie Walsh is a specialist in special needs dentistry who is based at the University of Queensland in Brisbane, where he is an emeritus professor. Laurie has been teaching and researching in the areas of infection control and clinical microbiology for over 25 years and was chief examiner in microbiology for the RACDS for 21 years. His recent research work includes multiple elements of infection control, such as mapping splatter and aerosols, COVID vaccines and novel antiviral and antibacterial agents. Laurie has been a member of the ADA Infection Control Committee since 1998 and has served as its chair for a total of 8 years, across 2 terms. He has contributed to various protocols, guidelines and checklists for infection control used in Australia and represented dentistry on 4 committees of Standards Australia and on panels of the Communicable Diseases Network of Australia and of the Australian Commission on Safety and Quality in Health Care.

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Register Online Now at www.icupdate.au

abstracts | 2022

Oral Hygiene Abstracts 2022

By Emer. Prof. Laurence Walsh AO

Huff and puff in the gym - aerosol generation during exercise

Physical activity and recreational and competitive sports not only are an important part of our culture and leisure activities but also prevent many diseases. Exercise is also an effective treatment for at least 26 major diseases. However, indoor group exercise in small, poorly ventilated rooms promotes infection with SARS-CoV-2 via aerosol transmission. During exercise, pulmonary ventilation can increase over 10-fold and therefore, exercisers will exhale a greater volume of aerosol-containing air. However, until now it is not known how exercise affects the concentration of aerosol particles in exhaled air and the overall emission of aerosol particles. This study used a new method to measure in parallel the concentration of aerosol particles in expired air, pulmonary ventilation and aerosol particle emission at rest and during a graded exercise test to exhaustion, for 8 women and 8 men. The aerosol particle concentration in expired air increased significantly from 56 particles/litre at rest to 633 particles/litre at maximal intensity. Aerosol particle emission per subject increased by a factor of 132 from 580 particle/min at rest to 76,200 particles/min during maximal exercise. There were no gender differences in aerosol particle emission, but endurance-training subjects emitted significantly more aerosol particles during maximal exercise than untrained subjects. The concentration of aerosol particles during exercise was greater than the increase reported for loud speech (that was 320 particles/litre). Deeper inspiration and expiration during exercise increases the particle concentration in expired gas. During intensive exercise, this is exacerbated by increases of ventilation by a factor of 10 or more. These data partly explain superspreader events especially during high-intensity group exercise indoors and suggest that strong infection prevention measures are needed especially during intense exercise.

Mutsch B et al. Aerosol particle emission increases exponentially above moderate exercise intensity resulting in superemission during maximal exercise. PNAS 2022;119(22): e2202521119 doi: 10.1073/pnas.2202521119

The spread of irrigant fluid versus saliva during periodontal procedures

Dental procedures generate particles that are a mixture of saliva, blood, water coolant, plaque, gingival crevicular fluid, tooth hard tissue debris, calculus and dental restorative materials. The extent and spread pattern of common dental aerosol-generating procedures (AGPs) need to be identified before applying mitigating strategies. This study evaluated particle spread associated with various common periodontal AGPs in a simulated setting and in a periodontal clinic. The simulation study visualised the aerosols, droplets and splatter spread with and without high-volume suction (HVS, 325 L/min, Cattani Aspi-Jet 6) during common dental AGPs, namely ultrasonic scaling, air flow prophylaxis and implant drilling after fluorescein dye was added to the water irrigant as a tracer.

Each procedure was repeated 10 times. These experiments were carried out in a 25m2 room which had 7 air changes per hour. The air flow device produced the highest amount of splatter, while the ultrasonic scaler generated the most aerosol and droplet particles at 1.2 m away from the source. HVS significantly reduced the spread of splatter, droplets and aerosols for ultrasonic scaler and air polisher, with reductions up to 96% for splatter generation for all three dental AGPs and 93% for aerosols. HVS did not alter the median size of splatter particles. The clinical study measured the spread of contaminated particles within the dental operatory and quantified airborne protein dispersion following 10 mins of ultrasonic supragingival scaling of 19 participants during routine periodontal treatment. The closed operatories used were each 15 m2 and had 7 air changes per hour, with delivery air outlets and return air collection on the ceiling of the operatory. All patients used hydrogen peroxide pre-procedural rinses. Bioaerosol contamination at each location for each patient was estimated based upon the protein quantity at that location and the protein concentration of the patients’ original whole saliva sample. Higher protein levels above background levels following ultrasonic supragingival scaling were detected in fewer than 20% of patients, indicating minimal particle spread. Fluids recovered at large distances from the oral cavity are comprised of coolant water rather than material from the patient’s mouth. While three common periodontal AGPs produce aerosols and droplet particles up to at least 1.2 m from the source, the use of HVS is of significant benefit. Routine ultrasonic supragingival scaling produced few detectable traces of salivary protein at various sites throughout a 10-min treatment. The likelihood of aerosol spread to distant sites during common periodontal AGPs is greatly reduced by high-volume suction. Clinically, limited evidence of protein contaminants was found following routine ultrasonic scaling, with the majority of fluid being irrigant rather than organic matter from the oral cavity.

Pulich A et al. Simulated and clinical aerosol spread in common periodontal aerosol-generating procedures.

Clinical Oral Investigations 2022 May 17;1-12. doi: 10.1007/s00784-022-04532-8.

20 oral|hygiene

May/June 2022

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infection | CONTROL

READ ME FOR

CPD

Infection control: Facts versus fallacies in the post-June 2022 world

By Emeritus Professor Laurence J. Walsh AO

I

t is important that all dental practices are aware of some significant changes which are occurring from June 29, 2022 and are not misled by those who would seek to profit from the confusion that these changes may create.

Hence this article is themed around “an audit of the auditors”.

The DBA change here is a significant change in the position being taken by the Dental Board of Australia (DBA), with the move away from its 2010 policy, towards the use of a structured comprehensive self-reflection tool. This move does not in any way

T 22 oral|hygiene

denigrate the importance of the existing national standards and guidelines, nor does it lower the expectations for dental practices in terms of infection control. The Board has made these two points abundantly clear in its communications to registrants about these changes.

The key point from the DBA change is that a greater emphasis is being placed on practitioners being aware of the regulatory environment for infection control and staying up-to-date with changes as they occur. The DBA self-reflection tool is designed to prompt serious consideration by individual clinicians around how well-informed they are now and how they plan to remain wellinformed going into the future. As one of the individuals involved in testing the draft of the tool, I can say from first-hand experience that when done properly, it will take some time (e.g. around 1.5 to 2 hours) to complete in a thorough manner.

This is not a quick “tick and flick“ document.

May/June 2022

infection | CONTROL

Figure 1. The regulatory environment for infection prevention and control, showing major inputs that clinicians should be considering.

The upper right box groups together those linked to national health approaches, such as the National hand Hygiene Initiative and the Immunise Australia program.

Consensus and uniformity he regulatory environment for infection control has been through significant recent changes, with the publication in 2021 of the fourth edition of the ADA guidelines for infection prevention and control and the Risk Management Principles for COVID, which replaced the previous restriction levels framework.

It is important to appreciate that both of these ADA documents went through extensive consultation, involving not just consultation within ADA branches, but also with external stakeholders including professional peak bodies (ADOHTA, DHAA, ADPA, DAA) and the Dental Board of Australia, all of whom supported these two key documents. This broad base of support is important when considering what would be used by a regulator, such as a public health unit in a particular jurisdiction, or the DBA, in terms of expectations on what practitioners should be following.

Likewise, it is also important to note that the ADA guidelines are one of the key reference documents that inform the development of the NHMRC infection control guidelines and

T

May/June 2022

in a reciprocal way, changes in the NHMRC infection control guidelines are reflected in the ADA guidelines and other ADA publications and advice. While this is not difficult to understand, it is very frustrating that some individuals who are involved in auditing dental practices completely misunderstand this point and as a result, they give misleading advice, such as “they are only guidelines so you can ignore them”.

Context is important t is up to each practice to apply the guidelines to the situation of their own clinical environment and this is explained clearly in the opening sections of the ADA document. Likewise, the introduction to the NHMRC guidelines state that these have been written with an emphasis on an acute care hospital environment and that they need to be interpreted for other contexts to determine which components are relevant and appropriate. The ADA guidelines are this interpretation and they follow the same principles of evidence as the NHMRC use when compiling their guidelines.

I

oral|hygiene

23

infection | CONTROL One reason why some auditors might get such a fundamental point completely wrong is because those individuals are not actually registrants. They do not understand the regulatory environment around AHPRA, nor the existence of co-regulatory jurisdictions and how they function. Typically, they have no appreciation of the activity of public health units and their significant powers under the various jurisdictional public health acts and regulations. Through the COVID-19 pandemic, the general awareness of the powers that sit under public health acts have reached greater prominence, so there is no excuse today for not recognising that registrants need to meet the requirements of their registration body, as well as the public health regulator in their particular jurisdiction.

As a specific example of this local flavour, registrants in Queensland are required to have compiled an infection control management plan (ICMP), which details the nature of the risks, the approach to their management, how the control strategies are implemented and monitored, who was responsible for implementing them and how often the plan is updated. Such requirements are enshrined in Queensland legislation.

Figure 1 gives a summary of the regulatory environment.

It is more than one thing espite such points being abundantly clear, one will sometimes hear of auditors who say “you only need to comply with this particular Australian standard and you can ignore everything else”, which clearly is incorrect. Likewise, they will make statements such as “after our audit, you will never be able to get in trouble for infection control in the future”. This is a promise which is impossible to keep, since having a practice audit or going through practice accreditation is no insurance for future errors that may occur. Both of these will build greater awareness within the staff about potential issues that could occur and so some preventive actions can be put into place. Hence, there is a lower risk, but not zero risk for the future.

A major area where those in the audit space can often be incorrect relates to the application of Australian standards. They often have no idea that the standards

D

24 oral|hygiene

undergo periodic major revision as well as occasional amendments and so maybe quoting standards that are out of date.

Even worse, they may not be aware that each standard has a very carefully worded section on its scope and that there is no application or relevance of a standard outside the scope. To give a particular example, the standards on instrument reprocessing are not relevant to matters such as personal protective equipment that is worn in the operatory, but they do discuss appropriate personal protective equipment for those undertaking tasks in instrument reprocessing, working within the sterilising room environment.

Changes in standards ver the past two decades, there have been significant developments in the scientific basis of methods used to evaluate methods for sterilisation using steam or other technologies. This point is highly relevant when considering what is in the 2006 instrument reprocessing standard (AS/NZS 4815) versus what is in more recent standards such as the 2014 standard (AS/NZS 4187) and what has been released in the public draft of the new reprocessing standard (DR AS 5369: 2021) which when completed will replace both of these earlier documents. Looking at the advertising materials for some who are involved in practice auditing, they have no understanding of the impending changes with the 5369 standard. Moreover, they make irrational and incorrect statements such as “Australian standards overrule all guidelines”. It is clear they are not aware that standards do not hold regulatory force until cited in a regulatory instrument, or that those who write the standards and those who write the guidelines are often the same people and are drawing on the same expert knowledge.

O

Conflicts and competence particular concern is when a company which is involved in infection control auditing is also involved in selling products, made by themselves or others.

I recently came across an example where a particular company advertised that a 30-minute audit would cost almost $3000 and that the company was then advising as a predetermined outcome of the audit that they would be advising that their

A

own products would then be used in the practice. Even worse, they claimed that some of these products would eliminate the need for biological indicators (spore testing) and other parts of validation.

They went on to give advice which was directly contradictory to the advice in the two reprocessing standards, regarding the use and interpretation of chemical indicators. This prompted me to think, as well as the obvious commercial conflict of interest, was there a degree of conspiracy or was this simply incompetence?

Further investigation including checking on social media posts revealed that some claims around the expertise of the auditors could not be substantiated. The point of this anecdote is that there are some individuals who will seek to prey upon dental practices in the period of uncertainty which will occur as a result of the change in the Dental Board policy.

It’s not conflicting or complex n an attempt to generate business, some in the audit space make statements such as “it’s all too complex” when in fact this is not the case at all. They also claim that “there is conflicting information” when in fact there is very close alignment between all the major reference documents produced at the national level, from ADA, from NHMRC and from the Australian Commission for Safety and Quality in Health Care. There are extensive resources provided by the ADA, with the fourth edition guidelines being effectively an implementation guide to a vast array of reference documents from multiple government bodies.

I

Cut-and-paste problems ractitioners need to be conscious that they might be paying for protocols and procedures which have simply been lifted verbatim from existing freely available resources. In addition to the obvious moral and legal issues around copyright infringement, a cut-and-paste signifies lack of expertise on the part of the auditor and a failure to deliver what has been promised. I have been involved in several situations where clinicians were subject to regulatory actions because the protocols or manuals which they had purchased from an auditor were grossly deficient and out of date.

P

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infection | CONTROL Red flags summary of common issues that have been encountered with practice auditing or advising services is presented in Table 1. While there are some in the auditing space who are providing a valuable service at a high level, there are also some rogues, who hold poorly formed opinions - and those opinions then masquerade as facts. This creates a problem when an incident occurs in the practice and a regulator becomes involved. The liability for substandard, outdated and incomplete procedures and documentation then falls back on the registrant, who discovers to their horror that those doing the audit actually had no formal relevant training, relevant qualifications or expertise.

A

Audit the auditor or an auditor, a clue to their knowledge in the field will be the nature of the statements which they make and whether they have relevant sources for those that will stand scrutiny. A good example will be claims around the efficacy of particular products used for environmental surface management, such as for cleaning and disinfection. Claims around disinfection are regulated by the TGA and are based on evidence. If a disinfectant is placed within a certain class, then claims cannot be made about it being in a superior class, or being the “best of the bunch” within a certain class. This is simply hyperbole and exaggeration and a sign of a lack of integrity on the part of the individual making that claim.

For those who are considering using an auditing service, think about whether the auditors actually have a track record of working within dental practices and are familiar with what actually happens in a dental practice. It is not the same as an audit for food hygiene in a restaurant, or a health audit for a nursing home. Consider whether the qualifications and experience of the auditor are relevant for dentistry.

Look carefully at the way the auditor presents themselves on social media.

This will often give insight into whether the individuals involved are making outrageous statements that run counter to mainstream requirements that are wellarticulated in the national guidelines. Of course, Australian consumer law requirements around integrity and advertising

F

26 oral|hygiene

Table 1. Aspects to be alert for when advice on infection prevention and control seems dubious n n

n

n n

n

n

Commercial conflict of interest No first hand knowledge of committee processes that generate guidelines and standards (within Standards Australia, NHMRC, ADA, etc) Auditors are not registrants with AHPRA; Lack understanding of regulatory frameworks for registrants (from DBA, public health regulators, role of the TGA, etc) Gaps in the basic knowledge including microbiology Misinterpreting existing guidelines and how they apply to the dental practice context References to documents are out of date; no awareness of impending changes Advice on risk management does not follow the hierarchy of controls

apply equally well to social media as they do to traditional websites, so one expects to see information in social media posts which is accurate and verifiable. Claiming false qualifications, using honorific titles (such as Dr) when these are not appropriate and the like, are all signs that the individuals involved are not trustworthy.

Future risk ast of all, advice which is inaccurate is not just a waste of time and money, but creates an issue for staff who will have adopted suboptimal practices based on the advice which has been given. This generates downstream risks for the practice, including risks of regulatory action for the clinicians and damage to the reputation of the practice should an incident attract attention in the local press or in online fora.

With the change in emphasis from 30 June 2022, more effort is needed on the part of registrants to make sure that they are working in line with current requirements. The onus of responsibility sits with each registrant to keep up-todate and to understand the totality of the regulatory space around infection control in which they work. This is the whole point of the new self-reflective tool - to enhance that awareness and help clinicians recognise and define their learning

L

goals and how they can stay in touch with this field as developments occur.

About the author Emeritus Professor Laurence J. Walsh AO is a specialist in special needs dentistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Dentistry, including 21 years as Professor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical microbiology. Laurie has served as Chief Examiner in Microbiology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years. His published research work includes over 330 journal papers, with a citation count of over 15,400 citations in the literature. Laurie holds patents in 7 families of dental technologies. He is currently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recognition of his contributions to dentistry.

May/June 2022

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practice | MANAGEMENT

READ ME FOR

CPD

Effective patient communication starts with social media Advice on how to create a social media plan that engages your patients and protects your revenue

F

ear has stopped about 20% of people in the U.S. from visiting the dentist. This statistic is pre-COVID-19, according to Mark S. Wolff, DDS, PhD, Dean, University of Pennsylvania, School of Dental Medicine. In a recent webinar, Dr Wolff shared, “Whether real or perceived, fear of the unknown, not knowing what to expect – not to mention fear of needles, pain, or uncomfortable procedures – has kept patients from dental care.

COVID-19 is expected to bring a higher level of dental practice fear and requires us to be more communicative than ever.”

28 oral|hygiene

You and your team know that safety starts with Personal Protective Equipment (PPE) and the other measures you’ve implemented to protect patients and staff, but are your patients aware of this? An April 2020 RDH Magazine survey of 2,200 dental hygienists in the United States found that 55% of patients were not being communicated with about changes in the dental practice.

Perhaps you’re struggling with what to say in your patient communication or wondering what the best method is to connect with patients.

If so, you’re not alone. With everything going on in the world, not to mention the new day-to-day protocols you and your team are getting used to in the world of living with COVID, it’s not surprising patient updates may have taken a back seat.

You may already know how vital patient relationships are to your practice.

If not, here’s a reminder.

Excellent communication is the number one way to...

• • • •

Reduce patient anxiety; Establish and grow trust; Increase patient satisfaction; and Grow strong relationships.

Trust and strong relationships allow patients to feel comfortable to...

• • • • •

Accept your treatment plans; Pre-pay for treatment; Share positive reviews; Refer friends and family; and Remain loyal to your practice.

The good news is that you have unprecedented opportunities to communicate with patients through tools like social media. Yes, you can call, email or text, but social media is where patients are spending a lot of their time – and now more than ever.

May/June 2022

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1 million visitors a year...

9,675 dental practices...

27,690 clinicians...

And counting...

Get listed today!

The easiest dental marketing you will ever do!

SCAN to Add or Update Your Practice

™ www.dentist.com.au

practice | MANAGEMENT If you find yourself lacking in the communication department, here are some tips you can use to get your social media connections back on track:

1. Identify hurdles oes your social media communication struggle due to time, skill set or interest? These are the three most common reasons dental teams aren’t able to keep up with patient communication on Facebook™ and Instagram™.

Once you know what the reason is for not maintaining your social media presence, you can explore solutions. Options might include full outsourcing, or using a more affordable software program that your team can help co-manage. There are also onetime options like coaching or consulting that your practice could benefit from.

D

“New patients in particular are going to do rigorous research before they schedule an appointment. They increasingly judge practices based on online reviews and this continues to heighten. They will scrutinise the cleanliness of your practice and be more in tune with the energy of you and your team because they can’t see your facial expressions behind the mask. Now is the time to take action. Put a plan in place to nurture, restore and reinvigorate patient relationships...”

2. Implement protocols any practices have protocols and systems in place for their practice operations. Do you have a protocol in place for your social media communication? This means you have specific tasks that need to be performed on a consistent basis.

For example: • Create a content calendar in advance of each month; • Include content that supports practice goals; • Schedule content so it posts automatically; • Boost content as needed throughout the month; and • Check social media for comments or messages that require attention.

These are all tasks that can be tracked for implementation, consistency and accountability.

Unfortunately, many teams manage social media on a spontaneous basis. They post when they might have a birthday to celebrate or they happen to have a good photo op – but strategy cannot exist without a plan in place. Social media management needs processes, forethought and follow-through in order to be successful.

M

30 oral|hygiene

Take action f you want to come back better than ever after the COVID-19 lockdowns of last year, you’ll need strong patient relationships. New patients in particular are going to do rigorous research before they schedule an appointment. They increasingly judge practices based on online reviews and this continues to heighten. They will scrutinise the cleanliness of your practice and be more in tune with the energy of you and your team because they can’t see your facial expressions behind the mask.

Now is the time to take action. Put a plan in place to nurture, restore and reinvigorate patient relationships.

I

IMS cassette isibility is more important than ever and social media is an essential tool for proactively demonstrating your commitment to your patients’ safety. For example, you can use social media to promote that new investment in an Instrument Management System (IMS™) or demonstrate updated sterilisation and room turnover protocol. These are necessary steps for achieving optimal infection prevention, but marketing those actions is equally important. More than ever, patients want to see and understand how you are protecting them and social media is the best way to accomplish that.

Don’t let fear of not knowing what to say or do hold you back.

Seek out a mentor for help, search for inspiration online and get into action today. The best way to ensure patients understand what you are doing to keep them safe, what new protocols to expect, and how much you truly care, is to continue to effectively communicate. With social media you can easily share effective, reassuring and valuable updates with patients. Just as your new PPE protects you and your team, effective and consistent communication will help protect your practice revenue.

V

About the author Rita Zamora is author of the book Get Found, Get Liked, Get Patients - Making the Most of Social Media. Known as Dentistry’s Social Media Expert, she and her team have offered highly customised “done for you” as well as “done with you” social media services for dental professionals across the globe since 2008. She graduated magna cum laude from the University of Colorado with a bachelor’s degree in business and marketing and has over 20 years of experience in the business of dentistry.

May/June 2022

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clinical | EXCELLENCE

READ ME FOR

CPD

How to talk about pedo crowns with your paediatric patients Explaining the benefits of pedo crowns

A

pplied to permanent molars, sealants can reduce the risk of cavities by 80%. But, what about deciduous teeth... and the caries that can sometimes show up? When it does happen, it’s common for parents to be upset and worried. And that anxiety can easily pass along to the child.

So, how can you help both parents and their children have a positive dental experience, even when the dentist finds a cavity?

The key is to approach those conversations as an opportunity for learning.

Let parents know that they’re not alone - tooth decay is the most common chronic disease in children and more than 40% of children will have dental caries by the time they reach kindergarten. Parents may not know that decay spreads quickly between deciduous teeth because that enamel is thinner than on permanent teeth.

Follow up with the good news. They have an excellent option for treatment when significant tooth loss has occurred as a result of rampant or very advanced caries: pedo crowns.

32 oral|hygiene

May/June 2022

YOUYOU REQUIRE MAXIMUM EFFICIENCY. YOU REQUIRE MAXIMUM EFFIC REQUIRE MAXIMUM EFFICIENCY. YOUYOU DEMAND COMPLETE ORGANIZATION. YOU DEMAND COMPLETE DEMAND COMPLETE ORGANIZATION. HUFRIEDYGROUP INTRODUCES HUFRIEDYG YOUYOU NEED ENSURED SAFETY. HUFRIEDYGROUP YOU NEED ENSURED S NEED ENSURED SAFETY. INTRODUCES ™ ™ YOU DESERVE INFINITE CONFIDENCE. YOU DESERVE HUFRIEDYGROUP INTRODUCES YOU DESERVE INFINITE CONFIDENCE. HUFRIEDYG HUFRIEDYGROUP INTRODUCES

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HFL-482AUS/1220 • Color-coded silicone rail system that reduces instrument contact and allows WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: forLOVE more water flow while the instruments WHY DENTISTS STAINLESS STEELprotecting PEDO CROWNS: WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: WHY DENTISTS STAINLESS STEEL PEDOwhile CROWNS: forLOVE more water flow while protecting the instruments during reproce moreOUR water flowSTAINLESS while protecting the instruments during during reprocessing reprocessing forOUR more water flow protecting the instrume WHYfor DENTISTS STEELprotecting PEDO CROWNS: forLOVE moreOUR water flow while the instruments during reprocessing • Ideal height and mesio-distal width • Easy-to-use, ergonomic latch that allows for one-handed opening Ideal height and mesio-distal mesio-distal width Easy-to-use, ergonomic latch that allows fortrademarks one-handed opening All company and product names are that trademarks of Hu-Friedy Mfg.one-h Co., LLC •• Ideal and width • Ideal height and mesio-distal width •• height Easy-to-use, ergonomic latch that allows for one-handed opening • Easy-to-use, ergonomic latch allows for All company and product names are of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted.

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To more about how IMS can Hu-Friedy Mfg. LLC, 1666 E. Touhy Ave., Desenhance Plaines, IL 60018 | Hu-Friedy.com VISIT USCo., ONLINE AT about HU-FRIEDY.COM/PerfectFit To learn learn more about how IMS enhance VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit To learn more howcan IMS can enhance All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit your practice visit Hu-Friedy.com/Infinity ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. your practice visit ©2016 Hu-Fried y Mfg. Co., LLC. All Hu-Friedy.com/Infinity rights reserved. its affiliates or related companies, unless otherwise noted. your practice visit Hu-Friedy.com/Infinity ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. ©2017 Mfg. Co., rights reserved. ©2021 Hu-Friedy Co.,All rights reserved. ©2017 Hu-Friedy Hu-Friedy Mfg.Mfg. Co., LLC. LLC. AllLLC. rightsAll reserved.

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Hu-Friedy is is now now a a proud proud member member of of Hu-Friedy Hu-Friedy is now a proud member of PER-Harmony-PrintAd-HFG-Introduces-HFL-482AUS-A4-2012.indd 1 Orders 0800 855 www.henryschein.co.nz OrdersOrders 0800 808 808 855 0800 808 www.henryschein.co.nz 855 www.henryschein.co.nz

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12/11/20 11:53 AM Orders 1300 65 88 22 www.henryschein.com.au 12/11/20 1 Orders OrdersOrders 0800 1300 808 65 88 855 22 88 www.henryschein.co.nz www.henryschein.com.au 1300 65 22 www.henryschein.com.au

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clinical | EXCELLENCE The dentist may get some pushback: “Why put a crown on a tooth that’s going to fall out anyway?” You know the reasons why, but young patients and their parents probably don’t, or they haven’t thought about them. So the dentist may ask you to help explain the benefits of these crowns.

So, here’s how to highlight the benefits of pedo crowns.

Why pedo crowns are better than extraction his is where hygienists can be the voice of education and comfort for paediatric patients and their parents.

T

Baby teeth are worth saving (and not just for the tooth fairy) rowns are also a great alternative to extracting teeth. Removing deciduous teeth too early creates space for neighbouring teeth to move in, making it nearly impossible for permanent teeth to come through the way they should.

Another unwanted result from extraction is that the resulting gap makes it hard for the child to chew. Parents work hard enough to get their kids to eat fruits and vegetables, most of which are crunchy in texture. If chewing is painful or uncomfortable, that hard work becomes even more difficult.

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Pedo crowns are different to adult crowns hen adults think of crowns, they think of their own crowns (or those of another adult they know) and assume it will be the same experience for their children.

But children typically struggle to sit still for long stretches and very quickly become scared. Their tolerance for even the slightest discomfort is low. So, crowns made specifically for children were designed to alleviate these issues as much as possible.

HuFriedyGroup Pedo Crowns were specifically created for paediatric situations, making procedures faster and more efficient. They’re also made from stainless steel that is pre-trimmed, crimped and contoured, which minimises the need for adjustments during placement.

W

34 oral|hygiene

Help parents prevent more cavities hile talking with the child and caregivers about paediatric crowns, don’t miss out on the opportunity to promote good oral health care practices.

We all know good dental hygiene starts at home. But, knowing and doing are two different things (raise your hand if you’re surprised when a patient is regularly flossing)!

W

“Removing deciduous teeth too early creates space for neighbouring teeth to move win, making it nearly impossible for permanent teeth to come through the way they should....”

Many parents want to develop healthy oral care in their children, but they’re not sure how to do it right.

A great recommendation from hygienist Debbi Viger is to demonstrate the “BOIT” system using a soft brush and a rice-sized blob of toothpaste.

BOIT brushing involves three circular passes starting in the upper-right side of the mouth: • “Bumpy” - Brush the biting surface.

• “Outside” - Brush the parts of teeth you see when the child smiles.

• “Inside” - Brush the tooth surfaces near the tongue.

• “Tongue” - Finish with a quick brushing of the tongue.

Also, take this opportunity to remind parents that sugary drinks, sticky sweets, juice and over-sweetened yogurt can damage young teeth.

Relief for anxious kids o matter how much you try to make children feel comfortable at the dental office, many of them will still have a lot of anxiety.

Nitrous oxide/oxygen sedation can calm anxiety and make a child’s experience much less stressful. While both reusable and disposable nasal masks are available, the pandemic-induced trend toward disposable does go a long way in preventing infection.

ClearView™ Nasal Masks are designed to match a child’s flow of breathing and the soft inner mask creates a better seal. Because the mask is clear, there’s no guessing whether a child is breathing through their nose - you can see for yourself. What kids really like about the ClearView Nasal Masks is how many colours and scents (like bubblegum and strawberry) are available. By letting young patients make some choices, they will feel more in control and comfortable during procedures and cleanings.

Hygienists play an important role in helping paediatric patients and their parents practice healthy oral care habits. By supporting the dentist when young patients need pedo crowns and conscious sedation, children can feel more comfortable at the dental office.

N

May/June 2022

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