Oral Hygiene Jul/Aug 2021

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

JULY/AUGUST 2021

PRINT POST NO. 100003758

VOL.31 NO.4

A brand by

munglobal.com.au

“

IF YOU DON’T HAVE CHANNEL D, I THINK YOU’RE NUTS...

Almost every day, a patient says to me....

“I love your videos” . Then they tell me something that they never knew before, or ask me a question.

That’s how the conversation starts, and those conversations inevitably lead to more work.

It’s like having a dental guru sitting next to each and every patient in reception, whispering ideas and planting questions in their head. They walk into the operatory interested in the right topics.

Without these conversations, we wouldn’t be doing half the treatments we do.

Look at the maths. I have 2-3 extra relevant conversations per day. That’s 10-15 per week.

40-60 per month. 480-720 per year. This all adds up to a ton of work and many personal referrals. The patients all think I created the content and I get compliments about it because it’s so personal.

This is nothing like boring dental videos showing scary procedures.

It’s a significant business builder and the cost is peanuts. Speaking of peanuts, that leads me back to my original statement, “if you don’t have Channel D, I think you’re nuts”.

Dr Brett Taylor, Sydney General dentist and super happy Channel D user

Try ChannelD for FREE and see the difference it can make to your practice... Sign up at ChannelD.com and use Promo Code AM58

www.channeld.com

VOLUME 31 | NUMBER 4 JULY/AUGUST 2021

OH | CONTENTS

On the cover...

In a major step forward for the environment, the revolutionary GloveOn Avalon nitrile gloves are fully biodegradable - details on page 8

READ ME FOR

CPD

4 BRIEFS 6 NEWS & EVENTS 16 CPD CENTRE 20 ABSTRACTS

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HOW HORMONAL CHANGES THROUGHOUT A WOMAN’S LIFE CAN INCREASE THE RISK OF GUM DISEASE AND TOOTH DECAY Being a woman at any age means contending with certain unique health risks. As a dental health care professional, you can help your female patients better manage these risks

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CPD

22

WASHER DISINFECTORS FOR DENTAL PRACTICE - WHAT DOES THE EVIDENCE SAY? Automated cleaning using a washerdisinfector has the major advantage of being reproducible and able to be tested and repeated explains Emer. Prof. Laurie Walsh

facebook.com/auxiliarynow

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

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

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

twitter.com/auxiliarynow Publisher & Editor: Joseph Allbeury

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CPD

KEY THINGS TO KNOW ABOUT STERILISATION POUCHES? Sterilisation pouches are single-use, peel-open pouches designed to hold items during sterilisation... but not all pouch materials are suitable for use in all types of sterilisation processes

32

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CPD

ARE YOUR DIAGNOSTIC INSTRUMENTS OVERDUE FOR A CHECKUP? Think back: When was the last time you updated your diagnostic instrumentation? Your old instruments may truly no longer be in optimal condition to advance efficient and vital dental diagnoses

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 © 2021. 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

in | BRIEF

New “easy add” and update for www.dentist.com.au

Pfizer vaccine results are affected by age

t’s now easier than ever to add or update your dental practice on Australia’s #1 find-a-dentist website - www.dentist.com.au. A new option allows you to add all your information using a simple form with your practice being added or updated within 24 hours of submission. “If you have a login to the Dental Community website, then adding and updating practices has always been easy,” said Joseph Allbeury, publisher of this magazine and dentist.com.au. “However, if you’re checking out your information on the web and end up on dentist.com.au, then how to add or update your details was less straighforward. “By adding this form, it alleviates the need to email or call us and it captures all the information that we need.” Around a million searches a year are made on dentist.com.au by the public looking for a dentist. Ensuring your practice is listed and the information is correct will directly result in more patients in your dental chair. “Dentist. com.au is such a success because it lists every dental practice and every dental practitioner in Australia [and New Zealand on dentist.co.nz],” Mr Allbeury said.

“There is no charge to be listed and our goal is to list every private practice, corporate practice, health fund clinic, public dental clinic and denture clinic.”

Every dental professional in Australia and New Zealand is entitled to a free login to www.dentalcommunity.com.au where you are able to control your presence on dentist.com.au (and dentist.co.nz). To obtain a free login, click the Sign In button on www.dentalcommunity.com.au or to use the “easy add” function, visit dentist.com.au/information-for-dentists

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New Colgate recyclable Trial Bags olgate Professional Oral Care has introduced new environmentally-friendly recyclable Trial Bags that are ideal for dental practices to use in their oral health promotion. The Trial Bags are supplied complimentary with a minimum order of 144 product “sets” comprising Colgate Plax Mouthwash 60mL; a Colgate toothbrush; Colgate Total fluoride toothpaste 40g; and Colgate Total Dental Floss travel size. Practices can also opt to customise the products included in the pack based on their individual requirements. Once the patient no longer has a use for the Trial Bag, they can help the environment by placing it in their kerbside recycling bin. Available from Henry Schein on Tel: 1300-658-822 or see www.henryschein.com.au.

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4 oral|hygiene

The COVID-19 pandemic has led to an urgent need for vaccines, particularly among persons at high risk for severe disease and death, such as the elderly.

However, only 4.3% of participants in the Pfizer vaccine efficacy trial were >75 years of age. Given the elderly generally have weaker immune responses after vaccination, more detailed investigation is necessary. We investigated SARSCoV-2–specific antibodies, maturation of IgG avidity, and interferon-γ (IFN-γ) release of SARS-CoV-2–specific T cells in 2 cohorts of young and elderly persons in berlin after vaccination with Pfizer. The first cohort consisted of 123 healthcare workers (median age 34 years), while the second cohort consisted of 71 elderly residents of an assisted living facility (median age 81 years). There was a substantial delay and overall reduced antibody response in elderly participants. In addition to antibody responses, we assessed SARSCoV-2 spike-specific T cell responses by an IFN-γ release assay (IGRA). IFN-γ release was significantly decreased in the elderly compared to younger participants. In summary, vaccination with Pfizer (BNT162b2) induces both arms of adaptive immunity: SARSCoV-2–specific antibodies and SARSCoV-2–specific T cells. However, we observed delayed and less robust cellular and humoral immune response among the elderly than among younger adults.

Therefore, strategies focused solely on vaccination of high-risk groups might be insufficient to protect those at risk for severe disease. For the elderly, vaccination of caregivers and close contacts should be prioritized. Moreover, a booster vaccination, altered vaccine dose, or different COVID-19 vaccines should be considered for the elderly if further evidence demonstrates high rates of breakthrough infections despite 2-dose Pfizer vaccination.

Schwarz T et al. Delayed antibody and T-cell response to BNT162b2 vaccination in the elderly, Germany. Emerging Infection Diseases 2021; 27(8), August 2021. https://wwwnc.cdc.gov/eid/ article/27/8/21-1145_article

July/August 2021

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in my | SURGERY

In my surgery...

By Tabitha Acret

O

H

ften at work, we have our head down and hands in someone’s mouth with little time to look at new or different products that can help make the day a little easier. In my role with the DHAA and as a KOL for a couple of dental companies, I get a lot of tips from colleagues and I also get to see a lot of new products early on. So for each edition of Oral Hygiene, I’ve been asked to share with my fellow clinicians some products, new and old, that I think we all should be using to make life easier for us, better for our patients and ideally, both!

ow many times have you seen dental appliances come in filthy and with mold on them (yuck)? It happens way too often but have we been giving good advice so patients know what to do? For this in my surgery, I’ve highlighted two must-have products for keeping dentures and appliances clean as well as an option for mouthguards for those who cannot access custom-made.

Neomorph Mouthguards

HyGenie sport hat do we know about mouthguards?

They are often lost, not cleaned and come in full of mould! Yuck!!

I recently came across a fantastic range of products that I can recommend to patients to keep their mouthguards clean. The HyGenie sport is a simple solution for cleaning, storing and protecting a mouthguard.

After each use, the patient simply places their mouthguard inside HyGenie Sport with the DentaFresh cleansing gel, twist and let the rotating brushes clean the mouthguard, ensuring its clean after every use. It’s also great for dentures.

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Dr Mark’s Dental Fresh Cleansing Gel r Mark’s DentalFresh® is an easy-to-use, scented cleansing gel. Think of it as SOAP for washing your Sports Mouthguard (or dentures, night guard or clear aligners). DentalFresh cleans dental appliances by washing away biofilms and attacking all the other nasties that collect on your mouthguard in practice or competition, giving you protection against harmful germs and bacteria. This helps stop mouthguards from becoming mouldy and transferring bacteria to your patients mouths.

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hile there is no denying that custom-made mouthguards are the gold standard, we all know these are not always possible. In patients with orthodontics or where finances don’t allow, many patients need to turn to a boil-and-bite mouthguard in order to protect their teeth during sporting activities.

It’s important we know what’s available and direct our patients to options that are safe. Neomorph Mouthguards are mouldable mouthguards that are a hybrid combination of preprofessional with the convenience of “boil-and-bite”. Made in Australia and designed by a dental hygienist, the Neomorph Mouthguard is a triple-layered, mouldable mouthguard unique in performance, protection and fit. The technology allows for a secure custom fit with the capability to absorb and disperse (spread the load) impact energy - which means Neomorph can protect for a wide variety of impacts typically encountered in contact sports. For more information, visit www.neomorphmouthguards.com

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About the author Tabitha Acret graduated from Newcastle University with a Bachelor of Oral Health and is currently studying her Masters in Public Health. She was previously the National VicePresident for the DHAA. Tabitha currently works as a clinical educator for implant maintenance and non-surgical periodontal therapy and lectures nationally and internationally on motivating patients, implant maintenance, disease prevention and periodontal therapy. Outside of her busy work life of lecturing and working clinically in private practice, Tabitha enjoys volunteering both locally and internationally to raise awareness and education of the benefits of good oral health.

She was the winner of the 2018 leadership award in dental hygiene and 2019 award for clinical excellence.

July/August 2021

news | EVENTS

Revolutionary new biodegradable nitrile gloves an environmental game-changer

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itrile exam gloves, used by the hundreds of millions every year in Australian dental and medical practices, end up in landfill and take hundreds of years to break down. In a major step forward for the environment, Mun Global, a subsidiary of Hartalega, the world leader in Nitrile glove manufacturing, has introduced revolutionary biodegradable nitrile gloves to its range.

“Our new GloveOn Avalon range of nitrile exam gloves are a real game changer for the environment,” said Leonard Brown, General Manager of Mun Global Australia. “The Avalon range has been specially formulated to include an organic additive which attracts microbes found exclusively in landfill and anaerobic environments that break down polymers naturally. This mineralisation process only begins once the gloves are surrounded by the microbes present in landfill environments. Under these conditions, the gloves biodegrade up to 30% in less than 7 months and up to 90% in less than 18 months in optimum anaerobic conditions.

“This process only triggers once the gloves are exposed to these specific conditions. Other than that, the gloves perform clinically like any other nitrile glove and can be stored for long periods of time without degrading.

“I should stress that the breakdown of the gloves is a natural, organic process that does not damage the environment,” Mr Brown said. “There are other products on the market claiming biodegradability, but these are only breaking down into micro particles of nitrile rubber which can then end up in our food supply. The technology we have so far incorporated into

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“Once Avalon gloves are in landfill, they biodegrade up to 30% in less than 7 months and up to 90% in less than 18 months in optimum anaerobic conditions...”

the GloveOn Avalon range results in a complete organic breakdown that is both natural and safe.”

Mr Brown said that the adoption of this technology was driven by customer feedback at the environmental harm caused by the thousands of tonnes of medical waste being generated each year.

“Wearing gloves is a cornerstone of standard precautions in infection control and gloves must be changed between patients. The amount of waste being generated is not lost on clinicians and these concerns are regularly voiced to us.

Incorporating this technology into our gloves gives clinicians peace of mind that impact to the environment is being reduced without impacting the efficacy of their infection control regime.”

Mr Brown said that the company intends to incorporate this organic

technology into its entire portfolio of nitrile gloves as a priority and without increasing prices.

“This will be the standard moving forward for all of our nitrile gloves,” Mr Brown said. “We see it as a moral obligation to reduce the environmental impact of our products and there is and never will be any premium to the price of our gloves to adopt a biodegradable product.

If you have a choice of two brands of gloves at the same price and one option is biodegradable, then our customers are telling us they will make the right choice for the environment.”

Mun’s GloveOn Avalon range of biodegradable nitrile exam gloves are now exclusively available from Dentavision. Call 1800-806-640 to order or visit www.dentavision.com.au

July/August 2021

A brand by

munglobal.com.au

news | EVENTS

My patient will not floss. Now what?

A

re you still telling your patients they need to floss? Maybe it’s time to try a different approach. It’s clear that dental flossing is not a favourite pastime and most people would rather do an unpleasant task like cleaning the toilet than flossing their teeth.1 What if a patient said to you, “I’m not going to floss. What else can you suggest?”

Do you have an informed answer?

It’s time to shift from telling our patients they need to floss to “It’s important to clean between your teeth and here are some of the ways you can accomplish that task”. Some of you may think flossing is the gold standard but let’s look at the facts. A 2019 systematic review2 reported: • Dental floss - some evidence it may be more effective at reducing gingivitis (GI) but no clear difference in bleeding sites compared to brushing alone; • Interdental brush - some evidence they are more effective at reducing gingivitis (GI) but no clear difference in bleeding sites compared to brushing alone; • Wooden sticks - may reduce bleeding sites compared to brushing alone; and • Elastomeric interdental sticks - no difference for gingivitis or bleeding compared to brushing alone.

The studies used in the systematic review provided very low or low-certainty evidence. You can recommend floss if the patient is proficient with the technique. You can recommend interproximal brushes if the interdental space is large enough for it to fit. Keep in mind it may require multiple sizes to clean all areas. Tooth picks or wood sticks are not designed to reach through the interproximal space and anatomy impedes cleaning the convex surface.

Did you ever consider a Waterpik® Water Flosser? ecently, the Waterpik Water Flosser was paired with a manual, sonic and oscillating rotating tooth brush.3-5 Regardless of toothbrush used, adding the Water Flosser was more effective than brushing alone for removing plaque and reducing gingival inflammation and bleeding (see www.waterpik.com.au).

There are several choices for your patients. Find the right combination for their needs and abilities. If you have not tried a Waterpik Water Flosser, it’s time to see - and feel - for yourself what all the talk is about. The evidence is unequivocal; only the Waterpik Water Flosser is clinically proven more effective than flossing, interdental brushes and air floss for improving oral health.6

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Get all the benefits of power brushing and water flossing in one convenient device - Introducing the Waterpik Sonic-Fusion®.

To try Waterpik yourself at up to 60% off, please visit the online shop at www.waterpik.com.au/shop for details.

10 oral|hygiene

References 1. American Academy of Periodontology. National Survey. 2015. Available at https://www.perio.org/consumer/quarter-of-adults-dishonest-with-dentists 2. Worthington HV, MacDonald L, Poklepovic Pericic T et al. How use of interdental cleaning devices, in addition to tooth brushing, for preventing and controlling periodontal diseases and dental caries. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No.: CD012018. DOI: 10.1002/14651858.CD012018. pub2. Available at https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.

CD012018.pub2/full 3. Goyal CR, Qaqish JG, Schuller R, Lyle DM. Evaluation of the addition of a water flosser to manual brushing on gingival health. J Clin Dent 2018; 29(1):81-86.

4. Goyal CR, Lyle DM, Qaqish JG, Schuller R. The addition of a water flosser to power tooth brushing: effect on bleeding, gingivitis, and plaque. J Clin Dent 2012; 23(2):57-63.

5. Lyle DM, Goyal CR, Qaqish JG, Schuller R. Efficacy of the use of a water flosser in addition to an electric toothbrush on clinical signs of inflammation: 4-week randomized controlled trial. Comp Contin Ed Det 2020; 41(3):170-177.

6. Study information available at www.waterpik.com.au

July/August 2021

The Easy and Most Effective Way to Floss!™

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Clinically Proven Results Untreated

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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

news | EVENTS

Load your videos on Dentevents.TV

V

ideos on anything to do with dentistry can now be loaded by anyone through the Dental Comminity portal for streaming on Dentevents.TV. “Since we launched Dentevents.TV last year in response to the first of the COVID-19 lockdowns, we’ve painstakingly loaded hundreds of videos onto the platform on behalf of others,” said Joseph Allbeury, publisher of this magazine and Dentevents.TV. “Now we’ve released new functionality within www.dentalcommunity.com.au to allow anyone to DIY. You simply login, click Manage Your Videos and then Add Video to begin the upload process.

“With this next natural evolution of Dentevents.TV, we’re hoping to attract a more diverse range of content for the platform and in doing so, attract an even larger and more diverse audience.

New Dentevents.TV features include... n Ability

to upload your own videos for streaming on www.dentevents.tv n Content can be anything dental! n Engage with your viewers like never before n Allocate CPD for watching your videos with or without a CPD quiz n Create your own channel and build an audience n Create your own private education platform n Monetise your videos to earn $$$ “To date, the content is largely based on recorded webinars and information relating to dental products,” Mr Allbeury said. “And we have also started producing our own content series as well, but we need much more. By allowing anyone to upload videos, we hope to be able to help content creators build their profiles.

“Educational content creators will have a platform to stream videos, issue CPD certificates to viewers or ask CPD quizzes.

Content can also be monetised on a payper-view or subscription basis if desired.”

Organising a dental event, l show or we New Expresscongress, Listings for trade dentevents.com Sign in to www.dentalcommunity.com.au and you can start adding videos today!

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entevents.com, the dental from that for webinar organisers, and A link will be emailed to you that can profession’s go-to source indeed all event organisers, is that more be used to edit the event if required, again of upcoming post-gradand more dental professionals will check without the need to login. uate dental education and Dentevents.com when looking to find out “Express Listings are not designed to events, has added a new replace Standand and Premium listings,” EXPRESS Listing option Mr Allbeury said. “Express Listings that can be used to rapidly add events to include less information than traditional the calendar without the need to login Dentevents listings and do not include links with a username and password. to the organiser, venue and speaker infor“Overall, we’ve added the new Express mation pages. Express listings also cannot Listing facility to Dentevents.com to accept registrations and payments for increase the number of events being listed events. The Express listings are designed on the calendar by making it a quick to rapidly add events to the calendar if 2-minute process,” said Dentevents.com you do not have a login. For everything publisher, Joseph Allbeury. “And more else, the traditional pathway applies.” specifically, we’re targeting webinar Mr Allbeury said the new Express Listevents with the Express Listing because ings were part of the ongoing evolution of the cycle of these events is far more rapid about upcoming events because the inforDentevents.com to provide a platform to than traditional face-to-face events. mation available is so comprehensive.” help event organisers reach greater audi“We’re seeing webinars promoted a To use the Express Listing, simply ences for their events as well as providing few days to a few weeks ahead of broadvisit www.dentevents.com, select Adding tools to accept registrations and payments, cast and so by facilitating rapid listing Events and then Express Listing. A form manage delegates and allocate CPD. onto Dentevents.com, we will see moreIf you’re is organising then displayed and once completed, any kind of post-graduate dental education, event or webinars being added. The outcome webinar, your eventyour will event be reviewed and posted.

For more information, see dent.events listing on the dentevents.com continuing education

GO EXPRESS»»»»» calendar is now easier than ever.

12 oral|hygiene

July/August 2021 No username, no password and no need to login - add your event

STREAMING NOW ON-DEMAND

Dentevents.TV is a brand new dental video streaming service Watch a growing list of hundreds of videos related to dentistry all in one place

www.dentevents.tv

clinical | EXCELLENCE

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CPD

How hormonal changes throughout a woman’s life can increase the risk of gum disease and tooth decay

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eing a woman at any age means contending with certain unique health risks.

As a dental health care professional, you can help your female patients manage these risks by refamiliarising yourself with the direct connections between a woman’s oral health and her overall health.

The teeth and gums hold vital clues to body-wide conditions. And poor oral health can increase the risk of certain fatal diseases – some of which, such as heart disease, affect women disproportionately. By learning to recognise the warning signs of systemic illness and by encouraging good oral health habits, you can help the women in your care enjoy longer, healthier lives.

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In the following sections, we’ll explore some of the oral health issues your female patients may encounter at different stages of their lives - many of them driven by natural hormonal cycles - and how those issues connect to overall health.

Oral health considerations after menstruation begins hanging hormone levels can cause a woman’s gums to swell and become irritated. This may happen during ovulation and a few days before a woman starts her period when progesterone levels are high.

Women are also more susceptible to getting aphthous ulcers during their menstrual periods.

Hormonal contraception (including oral birth control, patches, vaginal rings and hormonal intrauterine devices) can raise estrogen and progesterone levels, making gums sensitive, red or swollen.

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The higher hormone levels associated with birth control can also prevent blood clots from forming after teeth are removed.

One study found that oral contraceptive use may increase the incidence of painful dry socket in women after impacted mandibular third-molar extraction.

It’s crucial for women to develop good oral health habits and get regular cleanings and dental checkups. As you know, gum disease often goes unnoticed until it reaches an advanced state and it is associated with several potentially deadly health conditions: • People with periodontal disease are two to three times as likely to have a heart attack, stroke or other dangerous cardiovascular events. Experts speculate that the relationship may have to do with periodontal disease increasing the body’s burden of inflammation. Heart disease is the number-two killer of women in Australia (behind Dementia).

July/August 2021

clinical | EXCELLENCE • Gum disease may increase the risk of developing diabetes, possibly by making it more difficult for people to control their blood sugar levels. Gum disease is also a complication of diabetes; people with diabetes are more likely to develop severe periodontal disease. Diabetes increases the risk of heart disease in women by about four times and puts women at risk for blindness, kidney disease and depression.

• Bacteria that grow in the oral cavity can migrate to the lungs, triggering respiratory diseases such as pneumonia.

People with gum disease are especially vulnerable to this phenomenon.

For example, low levels of estrogen can decrease the amount of saliva women generate. A dry mouth (xerostomia) can cause a number of oral health issues, such as sore and sensitive gums, cavities, ulcers, infections and tooth decay.

After menopause, women face a higher risk of osteoporosis, which causes bones to weaken and break easily. Women with osteoporosis are three times as likely to lose teeth as those without.

An article from Dimensions of Dental Hygiene1 offers some guidelines for treating patients with osteoporosis and periodontitis. They include:

A 2019 CUNY study2 explained that changes in periodontal health may be associated with the variations in hormones that accompany either feminising or masculinising hormone therapy.

And even if hormone therapy isn’t in the picture, transgender people who were assigned female at birth may fly under the radar of dental professionals, particularly if they present as very masculine.

For this reason, it’s important to touch base with all patients, no matter what you assume their gender to be and ask them if there are any existing hormonal issues that you should know about so as to

• Routine dental hygiene care and periodontal assessments; • More frequent radiographs; • Evaluation for temporomandibular disease; • Promotion of a well-balanced diet with plenty of calcium and vitamin D; • Counseling your patients to avoid tobacco, vaping, cannabis and carbonated soft drinks; and • Recommending the use of a power or soft-bristled toothbrush and flossing.

provide more accurate care. Keep in mind that many trans people may be reluctant to come out to medical professionals due to fear of bias and discrimination, so clearly communicating that your practice is LGBTQ-friendly will go a long way toward encouraging that openness.

Oral health considerations during pregnancy o protect their own health and that of their babies, pregnant women should continue regular dentist visits and receive all necessary dental treatments. Women should let their dental care providers know that they are pregnant. Dental practices may choose not to x-ray pregnant women out of an abundance of caution, although the risks to the unborn baby are small.

Many pregnant women may not realise that they can pass cavity-causing bacteria on to their babies during and after pregnancy. This can lead to early childhood cavities and extensive dental care at a young age. Children whose mothers have multiple untreated cavities or tooth loss are more than three times as likely to have cavities themselves.

In addition, a quarter of women of childbearing age have untreated cavities and as much as three-quarters of pregnant women have gingivitis. If you have pregnant patients, it is vitally important to instruct them that more than their own health rides on their oral hygiene routine.

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Oral health considerations during menopause uring menopause, a woman’s estrogen levels drop significantly.

This can have an impact on oral health and comfort.

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Oral health considerations for transgender people hen considering the implications of oral health for women, it’s important to not limit these considerations to cisgender women only. Transgender people also may face unique oral health needs related to hormonal changes.

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Your professional role any women might not think much about how their biology impacts their oral health or that it would be any different for them than for men. It’s up to dental professionals to instruct their female patients on the need to take their oral health seriously. In most practices, dental hygienists are uniquely positioned for this educational role, as hygienists are the people patients spend the most time with and they often establish trusting relationships with their patients.

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1. Rothmund, WL. Oral Health Implications of Menopause. Dimensions of Dental Hygiene 2019. https://dimensionsofdentalhygiene.com/article/oral-health-implications-menopause

2. Macri, DV, Wolf, K. My preferred pronoun is she: Understanding transgender identity and oral health care needs.

City University of New York 2019. https://academicworks.cuny.edu/ho_pubs/79

July/August 2021

oral|hygiene

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oral|hygiene CPD CENTRE clinical | EXCELLENCE

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CPD

CPD

How hormonal changes throughout a woman’s life can increase the risk of gum disease and tooth decays

B

eing a woman at any age means contending with certain unique health risks.

As a dental health care professional, you can help your female patients manage these risks by refamiliarising yourself with the direct connections between a woman’s oral health and her overall health.

The teeth and gums hold vital clues to body-wide conditions. And poor oral health can increase the risk of certain fatal diseases – some of which, such as heart disease, affect women disproportionately. By learning to recognise the warning signs of systemic illness and by encouraging good oral health habits, you can help the women in your care enjoy longer, healthier lives.

In the following sections, we’ll explore some of the oral health issues your female patients may encounter at different stages of their lives - many of them driven by natural hormonal cycles - and how those issues connect to overall health.

Oral health considerations after menstruation begins hanging hormone levels can cause a woman’s gums to swell and become irritated. This may happen during ovulation and a few days before a woman starts her period when progesterone levels are high.

Women are also more susceptible to getting aphthous ulcers during their menstrual periods.

Hormonal contraception (including oral birth control, patches, vaginal rings and hormonal intrauterine devices) can raise estrogen and progesterone levels, making gums sensitive, red or swollen.

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14 oral|hygiene

The higher hormone levels associated with birth control can also prevent blood clots from forming after teeth are removed.

One study found that oral contraceptive use may increase the incidence of painful dry socket in women after impacted mandibular third-molar extraction.

It’s crucial for women to develop good oral health habits and get regular cleanings and dental checkups. As you know, gum disease often goes unnoticed until it reaches an advanced state and it is associated with several potentially deadly health conditions: • People with periodontal disease are two to three times as likely to have a heart attack, stroke or other dangerous cardiovascular events. Experts speculate that the relationship may have to do with periodontal disease increasing the body’s burden of inflammation. Heart disease is the number-two killer of women in Australia (behind Dementia).

July/August 2021

Washer disinfectors for dental practice - what does the evidence say?

By Emeritus Professor Laurence J. Walsh AO

I

ntra-oral dental procedures involve contact of a medical device or surgical instrument with a patient’s oral mucous membranes and in some cases, with their sterile soft or hard tissues. A major risk of any such procedure is the introduction of pathogens that can lead to infection. A failure to properly reprocess instruments could cause pathogens to be introduced into a site and also spread pathogens from one patient to another.1-3

Ensuring items are clean is an essential requirement before they are packaged for sterilisation. All manual procedures are subject to operator variation as a result of time constraints or tiredness. Automated cleaning using a washer-disinfector (WD) has the major advantage of being reproducible and able to be tested and repeated.

Multiple studies in many countries have documented that failures to comply with scientifically-based guidelines has led to such events. Deficiencies leading to infection have occurred either from failure to adhere to scientifically based guidelines, or misuse of disinfection or sterilisation processes.4-6 The elimination of problems associated with manual cleaning, such as poor performance, brushing splatter, a high risk of skin-puncture injuries and low efficiency, is the reason why mechanical cleaning is advocated in reprocessing

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Question 1. If a patient has osteoporosis and periodontitis, treatment should include:

Question 6. Infection control guidelines advocate the use of automated washer disinfectors because:

a. More frequent radiographs. b. Evaluation for temporomandibular disease. c. Dietary advice to include plenty of calcium and vitamin D. d. Counselling to avoid tobacco, vaping, cannabis and soft drinks. e. All of the above.

a. All manual procedures are subject to operator variation. b. The process is reproducible and able to be tested and repeated. c. Skin-puncture injuries are reduced. d. All of the above.

Question 2. Sensitive, red or swollen gums can be a result of: a. Increased estrogen levels. b. Increased progesterone levels. c. Hormonal contraception. d. Periodontal disease. e. All of the above..

Question 3. During menopause, a woman’s estrogen levels drop significantly which can decrease the amount of saliva generated: a. True b. False Question 4. A cisgender woman is: a. A woman who was assigned male at birth. b. A woman who has a personal sense of their own gender. c. A woman whose gender identity matches their sex assigned at birth. d. A person who does not identify only as a man or a woman.

Question 5. The number one killer of women in Australia is: a. Lung cancer. b. Dementia. c. Coronary heart disease. d. Cerebrovascular disease.

Question 7. A soil test to check the efficacy of a washer disinfector should: a. Only contain animal blood. b. Represent light soiling conditions. c. Only contain Synthetic polymers. d. Represent worst-case conditions.

Question 8. A type of test “soil” used to assess the cleaning performance of a Washer Disinfector is called: a. Heparinized 10% goat’s blood. b. Hucker’s soil. c. Milson’s soil. d. Glasgow soil. e. All of the above.

Question 9. Commercial tests for Washer Disinfector efficacy include: a. The Browne STF Load Check Indicator. b. gke Clean-Record. c. Chemdye ‘SPLAT’ test. d. Getinge Wash-Checks. e. All of the above.

Question 10. A washer disinfector is not suitable for cleaning: a. Dental burs. b. Tubing used in the circuits for relative analgesia. c. Hand endodontic files. d. Surgical instruments with hinges. e. Any of the above.

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 Jul/Aug 2021 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 infection | CONTROL

infection | CONTROL

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CPD

Are your diagnostic instruments overdue for a checkup?

Key things to know about sterilisation pouches?

S

aterilisation pouches are single-use, peel-open pouches designed to hold items during sterilisation.

Not all pouch materials are suitable for use in all types of sterilisation processes, so different pouches are required depending on the sterilisation processes available. For example, special pouches are needed for hydrogen peroxide gas plasma sterilisation. These differ from those used for steam sterilisation.

Plastic/paper pouches are used for steam sterilisation. The plastic side of the pouch allows clear visualisation of the contents and the chemical indicator. The paper side allows air removal and the sterilant to enter the pouch.

Sterilisation pouches have four primary objectives: 1. They must allow penetration of the chosen sterilant and be compatible with any other requirements of the sterilisation process;

Recommended use

2. They must be able to maintain the sterility of package contents until opened;

terilisation pouches are recommended for smaller, lightweight, low profile items. They are available in various sizes and configurations to enclose loose groups of instruments and offer various types of built-in chemical indicators. If an instrument appears to be too heavy or large for a pouch, another packaging method should be used.

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28 oral|hygiene

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hink back: When was the last time you updated your diagnostic instrumentation?

A diagnostic instrument’s useful lifespan can extend for years. There may be probes and explorers in use right now in some dental practices that performed exceptionally well over time but are truly no longer in optimal condition to advance efficient and vital dental diagnoses.

High-quality diagnostic instruments are indeed durable. But so are teeth and you wouldn’t advise a patient to skip routine prophylaxis appointments simply because their teeth look and feel fine. The same logic applies to diagnostic instruments.

Regular check-ups are as essential for maintaining an effective dental armamentarium as they are for maintaining oral health.

3. They must create a package that can be opened without contaminating the contents by the user; and

Why diagnostic instrument quality matters

4. They must permit the contents to be sterile at the point of use.

ental professionals like you depend on diagnostic instruments to help assess tooth decay, detect caries and calculus, explore hard-to-access areas, measure periodontal pockets, and, in general, form a complete picture of each patient’s oral health.

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Pouches should also be “tamper evident” so that a pouch opened in error cannot be resealed without complete reprocessing.

If your diagnostic instruments are not in good working order, the diagnoses may not be entirely accurate. And as you know, the results can include underdiagnosis, where crucial warning signs of disease are not recognised, or overdiagnosis, with potential overtreatment of asymptomatic conditions. Neither is optimal for you or your patients.

As pandemic regulations loosen and vaccine distribution accelerates, a large number of patients may be returning to your practice after having postponed professional dental care for a year or more. Many of them will have symptoms of periodontal disease, decay and other issues that require immediate attention.

By ensuring your diagnostic instruments are in top shape, you can help these returning patients get back on track and back to optimal dental health as quickly as possible.

How often should you perform a diagnostic instrument checkup? t’s always a good idea to regularly inspect all your instruments and other dental equipment for damage and defects. We recommend inspecting your diagnostic instruments at least once a year and after any incident that may inflict damage (such as dropping an instrument). If your practice is currently using any diagnostic instruments that are over one year old, we suggest performing a thorough check-up on them immediately.

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Question 11. Medical-grade paper used in sterilisation pouches has controlled porosity and has no pinholes larger than:

Question 16. It is recommended to inspect diagnostic instruments for damage and defects:

a. 0.5 mm b. 0.4 mm c. 0.3 mm d. 0.2 mm e. 0.1 mm

a. At least once a year. b. After the instrument is dropped. c. If it is performing poorly. d. All of the above.

Question 12. The shelf life of a processed sterilisation pouch is:

a. By other instruments in sterilisation in pouches. b. Being dropped. c. Wrapping mirror heads in gauze. d. All of the above.

a. 6 months b. 1 year c. 18 months d. 2 years e. Based on how it is stored and handled.

Question 13. At a minimum, a sterilisation pouch should be labelled with: a. Steriliser used b. Cycle/load/batch number c. Date of sterilisation d. All of the above.

Question 14. Pouches used for steam sterilisation should have a built in: a. Class 1 chemical indicator. b. Class 2 chemical indicator. c. Class 3 chemical indicator. d. Class 4 chemical indicator.

Question 15. Paper bags/wraps used for steam sterilisation are required to conform to:

Question 17. Mirrors can be scratched and damaged by:

Question 18. The markings on Hu-Friedy Qulix™ Probes: a. Chip, flake and fade easily. b. Are laser-etched. c. Are ingrained in the metal. d. Twist on for easy replacement.

Question 19. The cowhorn, Shepherd’s hook and TU17 are types of: a. Scaler b. Probe c. Explorer d. Curette Question 20. Hu-Friedy HD mirrors are: a. 30% brighter than other front surface mirrors. b. 50% brighter than other front surface mirrors. c. 80% brighter than other front surface mirrors. d. 113% brighter than other front surface mirrors.

a. AS/NZS 4815:2006 b. AS 1079.3-1994 c. AS 1410-2003 d. AS/NZS 4179:2014

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Learn firsthand from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control that have come in over the past 12 months, including the new guidelines from NHMRC (May 2019), Hand Hygiene Australia HOURS CPD (Sept 2019) and the CDNA (Dec 2018) as well as recent changes in Australian Standards and TGA regulations that are relevant to infection control. The course will provide a summary of how those changes interlink with one another.

The course will cover practical implementation of the new requirements and what it means for everyday dental practice. Hear about the why and the how and keep up-to-date with the changes that are happening. Bring along your questions in writing or in person for one of the Q&A sessions that will be held during the day.

COURSE TOPICS This one day course will cover changes in regulations and guidelines from 2018 to 2020 including: n n Risk-based precautions. n n Hand

hygiene and hand care practices. n n Addressing common errors in personal protective equipment. n n Biofilm

reduction strategies. n n Efficiency-based measures to improve workflow in instrument reprocessing and patient changeover. n n Correct

operation of mechanical cleaners and steam sterilisers. n n Wrapping and batch control identification. n n Requirements

for record keeping for instrument reprocessing. n n Correct use of chemical and biological indicators.

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FULL UPDATE! All the changes to Infection Control Guidelines in 2020

Professor Laurence Walsh AO is a clinically active specialist in special needs dentistry who is based at the University of Queensland in Brisbane. Laurie has been teaching infection control and clinical microbiology for over 25 years at postgraduate level and has been the chief examiner in microbiology for the RACDS for the past 20 years. He has presented invited courses and lectures on infection control across Australia and internationally. Laurie has written over 60 articles on infection control and in addition published over 320 journal papers and a further 190 technical reports and literature reviews. He serves on two committees of Standards Australia (personal protecting equipment; and instrument reprocessing) and in recent years has been an adviser to the Communicable Diseases Network of Australia and the Australian Commission on Safety and Quality in Health Care.

Laurie has been a member of the ADA Infection Control Committee since 1998. He has contributed to various protocols, guidelines and checklists and manuals used in Australia.

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abstracts | 2021

Oral Hygiene Abstracts 2021

By Prof. Emer. Laurence Walsh AO

A periodontal cytokine storm and its implications in a pandemic

Periodontitis has long been attributed to having its pathophysiology rooted in a cytokine response. COVID-19 infection can cause adverse outcomes related to the establishment of a cytokine storm, with elevated serum levels of IL-1, TNF, IL-7, IL-10, IL-17, and other cytokines, and elevated Th17 pathways. Many of these components are shared in common with the cytokine expression profile of periodontitis. This similarity between COVID-19 and periodontal disease argues for stressing maintenance of oral hygiene in the COVID era, and “red flags” patients with periodontitis as having an increased risk of more severe adverse outcomes from COVID infection. Elevated levels of cytokines detected in periodontal sites mirror those in the systemic circulation. Non-surgical periodontal treatment leads to a fall in the levels of inflammatory cytokines such as IL-17 both in the gingival crevicular fluid and in the serum of patients with periodontal disease. Understanding this local and systemic cytokine association underscores the importance of keeping periodontal disease under check, and the value of maintaining meticulous oral hygiene in the COVID-19 era.

Sahni V, Gupta S. COVID-19 & periodontitis: The cytokine connection. Med Hypotheses 2020;144:109908. doi: 10.1016/j. mehy.2020.109908.

Plaque control and bacterial superinfections

This paper investigates the potential link between SARS-CoV-2 and bacterial load, questioning whether bacteria may play a role in bacterial superinfections and complications such as pneumonia, acute respiratory distress syndrome and sepsis. The four main comorbidities associated with an increased risk of complications and death from COVID-19 are also associated with altered oral biofilms and periodontal disease, hence why the link between poor oral health and COVID-19 complications is suggested. Periodontopathic bacteria are implicated in systemic inflammation, bacteraemia, pneumonia and even death. Periodontopathic bacteria are present in high levels in patients severely infected with SARS-CoV-2. Bacterial superinfections are common in patients suffering from a severe case of COVID-19, with more than 50% of deaths exhibiting bacterial superinfections. Respiratory viruses predispose patients to bacterial superinfections, hence oral hygiene and pre-existing oral disease could alter the severity and mortality risk of COVID-19.

We recommend that oral hygiene be maintained, if not improved, during a SARS-CoV-2 infection in order to reduce the bacterial load in the mouth and the potential risk of a bacterial superinfection.

Sampson V et al. Could there be a link between oral hygiene and the severity of SARS-CoV-2 infections? British Dental Journal 2020;228(12):971-975.

Not getting the point – sharps injuries during dental education

A percutaneous exposure incident (PEI) involves an exposure of cutaneous or mucous membranes to blood and bodily serum, often as a result of a needlestick or sharps injury. This exposure may then lead to the transmission of a bloodborne virus (BBV). The dental setting poses a constant risk of sustaining a PEI due to the common use of sharp instruments, a small operating field coupled with frequent patient movement. The aim of this study was to retrospectively examine trends in PEIs at an Australian dental school, and to explore underreporting rate of PEIs, current attitudes, and awareness of PEI safety protocols by clinical staff and students in 2019. Retrospective data were collected from deidentified archival incident reports from 2009 to 2019 from a central incident reporting system. As well, cross-sectional data were collected via validated PEI questionnaires completed by clinical staff and students in 2019. There were a total of 1156 injuries reported in the 11-year period, including 618 PEIs. Of the PEIs, some 82.0% occurred in clinics, 12.5% occurred in the preclinical lab setting, and 5.5% in the sterilisation area. Some 79.9% of the reported PEIs involved students. Local anaesthetic-related procedures were the most common cause, resulting in skin penetrating injuries to one finger. Meanwhile, for staff members there was a sustained reduction in incident reports since 2015, which coincided with relocation to a newly constructed clinical facility that had an improved design, including larger sharps containers, instrument cassettes, and mechanised cleaning processes to reduce handling of loose instruments. For the survey, the response rate was 70.8%, with 345 respondents completing the questionnaire. There were 38 PEI exposures in the past 2 years, but only 22 of these were reported, giving an under-reporting rate of 42.1%. The most common reasons for not reporting were the injury was minor (38.9%), the sharp item was clean and unused (16.7%) and dissatisfaction with delays and injury follow-up procedures (16.7%). Overall, students were at a much higher risk of sustaining a PEI than staff members. Reported knowledge of PEI classification and prevention is inadequate, suggesting that further education on prevention of PEI is needed. Some 80.3% of respondents were receptive to such further education. This present an opportunity for dental schools to provide greater training on sharps handling such as annual safety reviews, to increase awareness and compliance.

Huynh R et al. Identifying trends of percutaneous injuries at an Australian dental school. International Dental Journal 2021: 1-7 (early view online)

20 oral|hygiene

July/August 2021

E E Y R R F T EN

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Washer disinfectors for dental practice - what does the evidence say?

By Emeritus Professor Laurence J. Walsh AO

I

ntra-oral dental procedures involve contact of a medical device or surgical instrument with a patient’s oral mucous membranes and in some cases, with their sterile soft or hard tissues. A major risk of any such procedure is the introduction of pathogens that can lead to infection. A failure to properly reprocess instruments could cause pathogens to be introduced into a site and also spread pathogens from one patient to another.1-3

22 oral|hygiene

Ensuring items are clean is an essential requirement before they are packaged for sterilisation. All manual procedures are subject to operator variation as a result of time constraints or tiredness. Automated cleaning using a washer-disinfector (WD) has the major advantage of being reproducible and able to be tested and repeated.

Multiple studies in many countries have documented that failures to comply with scientifically-based guidelines has led to such events. Deficiencies leading to infection have occurred either from failure to adhere to scientifically based guidelines, or misuse of disinfection or sterilisation processes.4-6 The elimination of problems associated with manual cleaning, such as poor performance, brushing splatter, a high risk of skin-puncture injuries and low efficiency, is the reason why mechanical cleaning is advocated in reprocessing

July/August 2021

infection | CONTROL guidelines around the world. Given this background, the purpose of this article is to lay out the evidence around best practice for use of a washer disinfector in dental practice.

Sources of contamination and the challenge of bioburden t the end of a procedure, different levels of microbial contamination will be present on instruments. The microorganisms could belong to the patient’s microbiota, or could be derived from dental unit and equipment waterlines, the staff providing the clinical care, the airconditioning system or the working environment.7-9 It is not possible to guarantee a 100% microorganism-free environment in any clinical practice environment.

Bioburden that remains on instruments after the cleaning process is complete will impair the effectiveness of sterilisation, because microorganisms will be protected by residues of blood, saliva or tissue debris remaining on instruments. An effective cleaning process must lead to complete removal of adsorbed organic material as well as microorganisms.10 Blood is more difficult to remove than saliva.11

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The washer disinfector concept he concept of combining mechanical instrument cleaning with thermal disinfection has been discussed in the literature for over 40 years. The concept is mentioned in standard textbooks of hospital infection control procedures from the 1970s. The thought process at the time for the reprocessing of used surgical instruments was that disinfection should be intrinsically linked to the cleaning procedure. This would protect staff working in central sterile supply departments (CSSD) as they were handling the instruments to package them for sterilisation and prevent their hands from becoming contaminated.

That same logic remains true today.

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Microbial reduction uring a WD cycle, elimination of microorganisms occurs by physical removal (e.g. fluid movement, detergents) and thermal inactivation. A classic study from 198112 measured the bioburden of used surgical instruments before sterilisation, after cleaning only or after cleaning

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July/August 2021

and thermal disinfection. The study was performed using 808 instruments from 109 operations performed in the Huddinge Hospital in Sweden. The instruments were from trays selected at random by the operating nurses after general surgical, gynaecological, orthopaedic or ENT operations. The automated WD used at the time employed a final rinse with water at a temperature of 85°C. This WD was found to be highly efficient for treating surgical instruments. A cycle reduced the microbial load dramatically, with 80% of instruments having less than 10 bacteria remaining and 98% of instruments having less than 100 bacteria remaining.

A 2014 study that tested the efficacy of a WD in eliminating selected healthcare-associated pathogens (vancomycin-resistant Enterococcus [VRE], methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa from surgical instruments showed that a WD cycle gave greater than a 7- log10 (10 million fold) reduction in vegetative and in spore-forming bacteria from the surfaces of experimentally contaminated instruments.13 Overall, these results were similar to previous studies published in 1988 and 2007 that showed a 7-log10 reduction in Pseudomonas aeruginosa and Acinetobacter calcoaceticus and in bacteriophage Felix 0114 and an 8-log10 reduction of Enterococcus species.15 It is important to note that such impressive levels of microbial inactivation will not be seen in an instrument washer, such as the Hydrim C51w (SciCan, Canada), because these units, unlike a WD, have no thermal disinfection cycle.

Cleaning performance compared to an ultrasonic bath he elimination of problems associated with manual cleaning, such as poor performance, brushing splatter, a high risk of skin-puncture injuries and low efficiency is the reason why mechanical cleaning using an ultrasonic cleaner or a WD is advocated in reprocessing guidelines around the world. There is strong evidence to support using a WD as a decontamination method for dental instruments. A WD can handle a range of items that are unsuitable for an ultrasonic cleaner, including the tubing used in the circuits for relative analgesia and certain brands of dental handpieces.

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Several studies have shown that WD are a very effective method of cleaning small items such as dental burs, whilst at the same time destroying vegetative microorganisms.16-18 There is parallel evidence for WD supporting their routine use for surgical instruments (including those with hinges) in the hospital setting.19-20 When individual instruments are being cleaned, they need to be held securely, such as being clamped into place in an instrument. This arrangement also prevents possible sharps injuries to staff during handling. The cassette or other holder must also have an open-sided structure to allow water penetration. A WD is not suitable for cleaning hand endodontic files, which are classified as a single patient use item, to be discarded immediately after use.21

Handling items after processing in the WD n current practice, soiled instruments that have been processed through a washer disinfector (WD) are considered decontaminated and safe to be handled for packaging for terminal sterilisation. They are rendered free of organic matter which may contain or support the growth of pathogenic microorganisms, with less than 6.5 micrograms of protein per square centimetre of the instrument surface.22,23 Special methods have been developed to detect such low levels of protein on instruments.24,25 The first phase of the WD cycle, which rinses the load items with cold or room temperature water, is designed to prevent coagulation and adhesion of proteins.

This initial rinse must not be done with hot water because this would cause proteins to coagulate, making them more difficult to remove.

Later phases of the automated cycle of the WD ensure cleaning and thermal disinfection, after which the items are dried.

The instruments leave the chamber totally dry due to the action of the rinse aid used before the final rinse.15,26,27 WD cycle programs typically have a low temperature prerinse, a wash cycle that includes the use of alkaline detergent (at temperatures between 55 and 85°C), a hot tap water rinse and a final rinse at an elevated temperature (55 to 95°C) to provide thermal disinfection. Depending on the type of instruments to be reprocessed, the WD cycle parameters may include

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23

infection | CONTROL

Figure 1. The MOCOM Tethys washer disinfector range includes both the benchtop H10 (left) and underbench models in two widths. more than one wash cycle, may use purified water (including deionised or reverse osmosis water) rather than tap water for the final rinse and may have a drying cycle that runs at an elevated temperature.

Instrument management he concept of pre-cleaning involves the wiping of instruments at the chairside to remove blood, cements and other materials that would otherwise set on or adhere to instruments. If gross contamination is not removed chairside, subsequent decontamination will be more difficult.

Once they have left the surgery, instruments should not be left to dry, as this will make residues more difficult to remove. The longer the time interval between leaving the surgery and being loaded into the WD, the more difficult it will be to effectively remove the proteinaceous contaminants on the surfaces of dental instruments. Several studies have demonstrated the importance of keeping surgical instruments in a moist state prior to loading them into a WD.28,29 This underscores the importance of using an instrument soaking solution when it is not possible to load the items into the WD immediately. Bear in mind that a soaking solution will not remove all proteins from the services of instruments, even when it contains enzymatic agents.29,30

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24 oral|hygiene

When performing a routine inspection of instruments, using the un-aided eye is not recommended, because visual assessment of cleaning in this way is fraught with possible error. Large amounts of contamination could pass undetected, especially when present in the box joint of hinged instruments such as artery forceps.31 The haem pigment found in haemoglobin from human blood can easily be seen even at levels as low as 10 mg/cm2, while bodily fluids without pigments (such as saliva with no blood contamination) are extremely difficult to see, even when present in large quantities.32,33 Using magnification combined with flicker-free illumination (LED light) can give improved performance for the examination of simple instruments (i.e. without hinges). Simple instruments tend to have similar patterns of soiling levels across different regions of the instrument. In contrast, hinged instruments typically show variations between different regions, with the inner hinge region receiving the greatest attention. Discolouration of the instrument surface occurs more readily within the inner hinge region due to a combination of proteinaceous contaminants, corrosion by-products, residues of detergent, scoring of the surface through normal use. When inspecting items, pay particular attention to blood and dental materials (especially cements) that have been trapped in the holes, hinges and serrations of instruments.

A comprehensive process for checking items at the end of a WD cycle involves evaluating not only cleanliness but also completeness (no missing parts), correct alignment, surface integrity, sharpness of cutting edges, correct functioning, absence of damage (corrosion, pitting, burrs, nicks and cracks) and the absence of wear and chipping of plating. Bear in mind that older instruments will be more challenging to clean well than new ones, because of small surface defects created by corrosion or scratching after repeated cycles of use and reprocessing.34,35

Evaluating performance he use of a WD is a preferred method for cleaning dental instruments, because the device uses an automated process that can be validated.36,37 A wide range of test soils have been used to assess the cleaning performance of a WD, including 10% serum, heparinized 10% sheep blood or coagulated blood, Hucker’s soil, Miles soil and Edinburgh soil.

The test soil used should represent worst-case conditions and reflect the type of soil to which the device would be exposed during clinical use. Many of the test soils that have been developed contain blood constituents and are designed to be difficult to remove. The more adhesive a test soil is to an instrument or device, the more difficult it will be to wash off.38-43

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infection | CONTROL

Figure 2. The MELAG MELAtherm 10 delivers fast, automated cleaning of instruments as a precursor to sterilisation. The load size closely matches the volume of a typical dental autoclave for the optimal streamlined instrument reprocessing workflow.

A range of commercial soil tests that use synthetic polymers with properties similar to coagulated blood are available to verify the performance of a WD. These are regarded as a suitable method for monitoring the cleaning efficacy of each cycle. A key characteristic for such test strips is that the soil is not removed when exposed to room temperature water, but rather is only removed fully after exposure to highly alkaline detergent at a temperature of at least 60°C.22 Existing tests will detect problems such as a suboptimal amount of detergent, low water pressure, overloading, insufficient cleaning time, low temperature or inactive spray arms.44 The Browne STF Load Check Indicator (Albert Browne International Ltd, UK) (Figure 3. A), is claimed to be equivalent to the cleaning efficacy soil test and to be appropriate for checking a WD in accordance with ISO 15883.5. Although its detailed composition is unknown, the lipid and polysaccharide protein-containing red glue deposited on the polymer-structured thin film is not hazardous for dental staff or devices. Studies have confirmed that the STF works properly for load checking in a regular under-bench WD used in dentistry, such as the Miele G7881 automatic WD (93°C, 10-minute cycle using Neodisher; Miele & Cie, Denmark).45,46 Other commercial tests for WD include (Figure 3):

July/August 2021

B. VERIFY All Clean Test (STERIS Corporation; USA). This bright red test soil contains protein, lipids and endotoxin. The mesh design of the holder mimics difficult-to-clean surfaces.

C. Wash-Checks (Getinge Group; USA).

This red test soil mimics the removal of blood and tissue from surgical instruments. The design of the holder mimics a surgical instrument joint.

D.Chemdye ‘SPLAT’ test (Gallay Medical & Scientific; Mulgrave, VIC). This uses organic components that are red in colour. The design of the holder creates a cleaning challenge.

E. gke Clean-Record (gke GmbH; Germany). This uses a coloured synthetic soil on plastic carriers. Different coloured indicators assess various cleaning challenges. The design of the holder does not create a cleaning challenge.

F. TOSI (Getinge; Sweden). This uses a blood-based red test soil containing haemoglobin, albumin and fibrin. The design of the holder creates a challenge by mimicking the uneven surfaces of surgical instruments.

Feed water he water used for the final rinse must not contain high levels of bacteria, as contaminated rinse water will leave contamination on the instruments.47 It is also important that the water used for the

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final rinse of instruments does not contain high levels of bacterial endotoxin, as this could cause remnants to be left behind on the instruments. Endotoxins are notoriously resistant to the action of heat and hence the instrument once sterilised could still, when used in a surgical procedure, trigger an acute inflammatory reaction in the tissues and also systemically. Such reactions may resemble responses to surgical interventions and hence will not be recognised.48,49 If biofilm formation has occurred in the water supply lines leading to the WD, or within the WD itself, this will elevate the levels of endotoxin that remain on instruments at the end of the cycle.50,51

Implementation experience econtamination equipment represents a significant capital outlay and contributes to practice overheads, due to ongoing costs for utilities (electricity and water), testing, consumables (cleaning chemicals and test strips) and service contracts. While cost may be an initial barrier to adopting a WD, this can be overcome by perceived advantages around efficiency. In larger clinics with more chairs operating simultaneously, the longer time it takes to reprocess instruments will likely not be an issue, as staff will adapt their sterilising room working practices to accommodate it.

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Figure 3. Commercial performance tests for washer disinfectors. These monitor performance and also can identify problems in loading the chamber. A, Browne STF indicator and its special holder. B, Verify indicator, showing an unused strip and a strip with a fail result. C, TOSI test sticks. D, SPLAT indicator. E, Wash-Check indicators. Those with a red dot are designed for WDs. Those with a blue dot are intended for ultrasonic cleaners but the manufacturer also states that they can be used in WD. F, gke Clean-Record system, with indicators with varying levels of difficulty in removal of the coloured material.

Useful insight into the use of WD in dental practice can be gained from experiences in the United Kingdom. Use of a WD has been mandatory in both Scotland and Northern Ireland since 2013 and is commonplace (but not mandatory) in both England and Wales. In part, this was

26 oral|hygiene

driven by concerns around transmissible prion disease (variant Creutzfeldt-Jakob disease) in the UK. The UK adopted the ISO 15883 series of technical standards and they were incorporated into clinical decontamination technical guidance documents to help dental practices achieve a

safe and effective standard of instrument decontamination (e.g. HTM 01-05 and in Scotland, SHTM 2010 and SDCEP Decontamination into practice). Best practice guidelines in the UK for instrument decontamination stipulate the need for a dedicated reprocessing room and the

July/August 2021

infection | CONTROL use of a validated washer disinfector to replace manual cleaning wherever possible. Manual cleaning of instruments is restricted to those items incompatible with automated washing. This includes using a handpiece-cleaning device for older handpieces that are not compatible with a WD cycle.

Note that many modern contra-angle or straight low speed and air turbine high speed handpieces are designed to be tolerant for a WD cycle and they are marked permanently with the WD-safe symbol. In the WD is the relevant couplings and plug-in connectors that link to the internal lumens. The handpieces need to be lubricated with service oil after the WD cycle, as per the manufacturer’s instructions.

Surveys of UK dentists52 have shown that dentists saw the WD as a benefit to staff safety compared with other cleaning methods. As well, the workflow in the practice could adapt to the longer cycle time of the WD than an ultrasonic cleaner. This could free up dental assisting staff from the sterilising room to do other tasks.

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.

July/August 2021

References 1. Rutala WA, Weber DJ. CDC Guideline for disinfection and sterilization in healthcare facilities, 2008.

2. Rutala WA, Weber DJ. Sterilization, high-level disinfection, and environmental cleaning. Infect Dis Clin N Am. 2011; 25:45-76.

3. McDonnell G, Burke P. Disinfection: is it time to reconsider Spaulding? J Hosp Infect. 2011; 78:163-170.

4. Rutala WA, Weber DJ. How to assess risk of disease transmission to patients when there is a failure to follow recommended disinfection and sterilization guidelines. Infect Control Hosp Epidemiol. 2007; 28:146-155.

5. Weber DJ, Rutala WA. Assessing the risk of disease transmission to patients when there is a failure to follow recommended disinfection and sterilization guidelines. Am J Infect Control 2013; 41:S67-S71.

6. Dirlam Langlay AM et al. Reported gastrointestinal endoscope reprocessing lapses: The tip of the iceberg. Am J Infect Control 2013; 41:1188-1194.

7. Chu NS et al. Levels of naturally occuring microorganisms on surgical instruments after clinical use and after washing. Am J Infect Control 1999; 27:315-319.

8. Rutala WA et al. Centers for Disease for Control and Prevention. Guideline for disinfection and sterilization in healthcare facilities. 2008. pp.1-158.

9. Pinto FMG et al. Analysis of the microbial load in instruments used in orthopedic surgeries. Am J Infect Control 2010; 38:229-333.

10. Rutala WA, Weber DJ. Creutzfeldt-Jakob disease: recommendations for disinfection and sterilization. Clin Infect Dis. 2001; 32:1348-1356.

11. Zuhlsdorf B, et al. Cleaning efficacy of nine different cleaners in a washer-disinfector designed for flexible endoscopes. J Hosp Infect 2002; 52:206-211.

12. Nystrom, B. Disinfection of surgical instruments. J Hosp Infect 1981; 2:363-368.

13. Rutala WA et al. Efficacy of a washer-disinfector in eliminating healthcare-associated pathogens from surgical instruments. Infect Control Hosp Epidemiol. 2014; 25(7):883885.

14. Jettte LP, Lambert NG. Evaluation of two hot water washer disinfectors for medical instruments. Infect Control Hosp Epidemiol. 1988; 9(5):194-199.

15. Nicholas G et al. Comparison of the efficiency of cleaning, disinfection and drying of three washer disinfectors: Steris T21, Steris T840 and Getinge 9128. J Hosp Infect. 2007; 67:268270.

16. Miller CH et al. Cleaning dental instruments: measuring the effectiveness of an instrument washer/disinfector. Am J Dent.

2000; 13:39-43.

17. Whitworth CL et al. A comparison of decontamination methods used for dental burs. Br Dent J. 2004; 197:635-640.

18. Van Eldik DA et al. A SEM evaluation of debris removal from endodontic files after cleaning and steam sterilization procedures. Aust Dent J. 2004; 49:128-135.

19. Alfa MJ et al. Manual methods are suboptimal compared with automated methods for cleaning of single-use biopsy forceps. Infect Control Hosp Epidemiol. 2006; 27:841-846.

20. Alfa MJ, Nemes R. Manual versus automated methods for cleaning reusable accessory devices used for minimally invasive surgical procedures. J Hosp Infect. 2004; 58:50-58.

21. Perakaki K et al. Comparison of an ultrasonic cleaner and a washer disinfector in the cleaning of endodontic files. J Hosp Infect. 2007; 67:355-359.

22. ISO 15583-5. Washer-disinfectors; test soils and methods for demonstrating cleaning efficacy. ISO 15883-5. 2005.

23. Smith A et al. Reducing the risk of iatrogenic CreutzfeldtJakob disease by improving the cleaning of neurosurgical instruments. J Hosp Infect. 2018; 100:e70-e76.

24. Smith A et al. Dental handpiece contamination: a proteomics and surface analysis approach. Biofouling 2014; 30(1):29-39.

25. Herve RC et al. Improved surveillance of surgical instruments reprocessing following the variant Creutzfeldt Jakob disease crisis in England: findings from a three-year survey. J Hosp Infect 2021; 110:15-25.

26. ISO 15883-1. Washer-disinfectors - Part 1: General requirements, definitions and tests. 2006.

27. ISO 15883-2. Washer-disinfectors; requirements and tests for washer-disinfectors employing thermal disinfection for surgical instruments, anaesthetic equipment, bowls, dishes, receivers, utensils, glassware, etc. 2006.

28. Secker TJ et al. Adsorption of prion and tissue proteins to surgical stainless steel surfaces and the efficacy of decontamination following dry and wet storage conditions. J Hosp Infect.

2011; 78:251-255.

29. Lipscomb IP et al. Effect of drying time, ambient temperature and pre-soaks on prion-infected tissue contamination levels on surgical stainless steel: concerns over prolonged transportation of instruments from theatre to central sterile service departments. J Hosp Infect. 2007; 65:72-77.

30. Howlin RP et al. Application of a fluorescent dual stain to assess decontamination of tissue protein and prion amyloid from surgical stainless steel during simulated washer-disinfector cycles. J Hosp Infect. 2010; 75:66-71.

31. Lipscomb IP et al. Comparison between visual analysis and microscope assessment of surgical instrument cleanliness from sterile service departments. J Hosp Infect 2008; 68:52-58.

32. Quality task group. Cleaning (part 2) - validation of cleaning efficacy. Zentral Steril 2002; 10:60-66.

33. Lipscomb IP et al. Rapid method for the sensitive detection of protein contamination on surgical instruments. J Hosp Infect.

2006; 62:141-148.

34. Wichelhaus A et al. Corrosion of orthodontic pliers using different sterilization procedures. J Orofac Orthop. 2004; 65:501-511.

35. Wu G, Yu X. Influence of usage history, instrument complexity, and different cleaning procedures on the cleanliness of blood-contaminated dental surgical Instruments. Infect Control Hosp Epidemiol 2008; 30(7):702-704.

36. Sanchez E, Macdonald G. Decontaminating dental instruments: testing the effectiveness of selected methods. J Am Dent Assoc 1995; 126:359-362.

37. Scottish Dental Clinical Effectiveness Programme.

Decontamination Into Practice. Part 1—Cleaning of Dental Instruments. 2007.

38. Ransjo U et al. A test for cleaning and disinfection processes in a washer-disinfector. APMIS 2001; 109:299-304.

39. Fruh B, Pfeifer M. Verification of cleaning efficacy in washer-disinfectors during routine operation. Zentr Steril 2003; 11:41-52.

40. Zuhlsdorf B et al. Suitability of the German test method for cleaning efficacy in washer-disinfectors for flexible endoscopes according to prEN ISO 15883. J Hosp Infect. 2005; 61:46-52.

41. Franz A et al. Reprocessing of dental instruments in washer disinfectors: does a representative test soil exist in dentistry?

GMS Krankenhhyg Interdiszip 2012; 7. Doc13.

42. Azizi J et al. Doubt and proof: the need to verify the cleaning process. Biomed Instrum Technol 2012; (Suppl):49-54.

43. Alfa MJ, Olson N. Physical and composition characteristics of clinical secretions compared with test soils used for validation of flexible endoscope cleaning. J Hosp Infect. 2016; 93:83-88.

44. Alfa MJ, Olson N. Comparison of washer-disinfector cleaning indicators: Impact of temperature and cleaning cycle parameters Am J Infect Control 2014; 42:e23-e26.

45. De Blasio A, Barenghi L. Pitfalls of cleaning controls in ultrasonic washers. Am J Infect Control 2015; 43:1374-1375.

46. Alfa MJ. Medical instrument reprocessing: current issues with cleaning and cleaning monitoring. Am J Infect Control 2019; 47:A10-A16.

47. The van Doornmalen Gomez Hoyos JPCM et al. Variability of ATP amount in last rinse water of automated washer disinfectors demands monitoring of every load. J Hospital Infect.

2015; 91: 87-99.

48. Goveia VR et al. Endotoxins in surgical instruments of hip arthroplasty. Rev Esc Enferm USP 2016; 50(3):405-410.

49. Costa DD et al. Reprocessing safety issues associated with complex-design orthopaedic loaned surgical instruments and implants. Injury 2018; 49(11):2005-2012.

50. Lipscomb IP et al. Comparative study of surgical instruments from sterile-service departments for presence of residual gram-negative endotoxin and proteinaceous deposits. J Clin Microbiol. 2006; 44:3728-3733.

51. Alfa MJ et al. Cleaning efficacy of medical device washers in North American healthcare facilities. J Hosp Infect. 2010; 74:168-177.

52. Stankiewicz N. The experience of dental practices that use automatic washer disinfectors. J Infect Prevent. 2019; 20(1):25-31.

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Key things to know about sterilisation pouches?

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terilisation pouches are single-use, peel-open pouches designed to hold items during sterilisation.

Not all pouch materials are suitable for use in all types of sterilisation processes, so different pouches are required depending on the sterilisation processes available. For example, special pouches are needed for hydrogen peroxide gas plasma sterilisation. These differ from those used for steam sterilisation.

28 oral|hygiene

Plastic/paper pouches are used for steam sterilisation. The plastic side of the pouch allows clear visualisation of the contents and the chemical indicator.

The paper side allows air removal and the sterilant to enter the pouch.

Recommended use terilisation pouches are recommended for smaller, lightweight, low profile items. They are available in various sizes and configurations to enclose loose groups of instruments and offer various types of built-in chemical indicators. If an instrument appears to be too heavy or large for a pouch, another packaging method should be used.

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Sterilisation pouches have four primary objectives: 1. They must allow penetration of the chosen sterilant and be compatible with any other requirements of the sterilisation process; 2. They must be able to maintain the sterility of package contents until opened; 3. They must create a package that can be opened without contaminating the contents by the user; and 4. They must permit the contents to be sterile at the point of use.

Pouches should also be “tamper evident” so that a pouch opened in error cannot be resealed without complete reprocessing.

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infection | CONTROL

Choosing a sterilisation pouch hen choosing a sterilisation pouch made of paper and plastic (transparent polypropylene or polyester), ensure it is of adequate size to accommodate the instruments to be sterilised. Paper bags/wraps used for steam sterilisation are required to conform to AS 1079.31994 Packaging of items (sterile) for patient care, Part 2: Non-reusable papers - For the wrapping of goods undergoing sterilisation in health care facilities or Part 5: Single-use, non-woven wrapping materials – For goods undergoing sterilisation in health care facilities.

Medical-grade paper used in sterilisation pouches has controlled porosity and has no pinholes larger than 0.5 mm.

These factors are critical to allowing steam to enter, whilst also maintaining the sterility of the pouch contents during storage.

Additional considerations may include: • Ease of use; • Ease of storage; • Cost; • Puncture and tear resistance; • Lack of toxic ingredients; and • Non-linting material.

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July/August 2021

Selecting pouch size t is important to select the appropriate pouch size. A pouch should be large enough to allow the contents to move from side-to-side without compromising the seams or risking punctures. It must also allow the changes in pouch size that occur during sterilisation without causing breaches in the seal. A pouch that is too small may also cause overcrowding that prevents adequate steam penetration and air removal, which could affect drying of instruments. A pouch that is too large may allow excessive movement of the instruments that results in punctures and tearing. For that reason, it is a good idea to have a variety of pouch sizes on hand.

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Loading a sterilisation pouch o load a sterilisation pouch, the pouch should be laid flat on a countertop and the instruments should be arranged in a single layer with at least 5 mm of clearance on each side for package contraction and proper circulation.

To allow easy removal and ensure aseptic presentation of the instruments when opening the pouch, position instruments in the pouch as follows:

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• Place instruments with handles on one end (such as elevators) so the handles can be grasped when the pouch is peeled open. Put the working tip at the pre-sealed end of the pouch; • Hinged instruments should be placed in an open position; • Curved instruments like artery clamps should be placed with the curved end toward the plastic side; and • On instruments with sharp tips, use vented tip protectors to prevent punctures through the pouch.

Sealing a sterilisation pouch terilisation pouches are either selfsealing or manually heat-sealed. When using a self-sealing pouch, it is important to carefully follow the fold lines provided by the manufacturer to prevent overlapping and small openings between the package and the sealant. Also, the seal’s fold must be free of wrinkles or creases.

When manually sealing a pouch, ensure that there is ample space at the end of the pouch for users to use their thumb to open the package and present its contents aseptically to the sterile field.

This will prevent the contamination of the pouch contents during delivery.

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When using a heat-sealed pouch, it is important to follow the manufacturer’s instructions, including proper temperature ranges for the heat sealer.

Loading pouches hen placing loaded and sealed pouches in the steriliser, it is important to ensure that they do not overlap. Many sterilisers have racks that allow pouches to be placed on their edges (like toast in a vertical toaster).

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Pouch labelling t a minimum, sterile pouches should be labelled with the following: • Steriliser used; • Cycle/load/batch number; and • Date of sterilisation.

To write on pouches, only use inkbased permanent non-toxic ink markers.

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Chemical indicators ouches used for steam sterilisation should have built in Class 1 chemical indicators.

If not, use Class 1 autoclave tape, which will change colour on exposure to heat.

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Some types of pouches also have builtin internal indicators that are Class 4 or greater in their performance.

Medicom SafeSeal® Quattro selfsealing sterilisation pouches have internal multiparameter indicators, which confirm that exposure to the sterilisation variables of time, temperature and steam has been adequate.

Storing sterilised pouches roper storage and handling of processed pouches is necessary to maintain the sterility of their contents.

Storage temperatures should not be excessive as this causes degradation of pouches. A range from 18°C - 22°C is suitable. As well, the relative humidity should not be too high. A suitable range is from 35%-68%. Refer to the 4th edition (July 2021 version) of the ADA Guidelines for Infection Prevention and Control for more information on the storage of sterilised items.

The area used to store sterile instruments must be clean, dry and dust-free.

Dedicated containers, cupboards and drawers are typically used to protect items from environmental contamination.

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Pouches should always be inspected before opening to confirm that they have been through steam sterilisation (by checking the external indicator and any internal indicators). Never use items when the packaging has been compromised (e.g. wet, torn or punctured) during storage.

Shelf life of processed pouches he shelf life of a processed sterilisation pouch is event-related, not time-related and depends on proper handling and storage. It also depends on the quality of the pouch material, the conditions under which the pouch is stored and the amount of handling. A sterile product will remain sterile if the packaging does not become wet, torn, soiled or otherwise damaged.

Over time, degradation of the pouch will occur so it is good practice not to have packages of items kept for extended periods of time (e.g. beyond 2 years). This is in keeping with the typical instructions from the manufacturer regarding the stability of the packaging material over time once it has been through a steam sterilising process. Always rotate sterile stock to prevent older stock from reaching such time limits.

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July/August 2021

COMPLIES TO

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COMPLIES TO A

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Performance with Protection The Medicom SafeSeal Quattro sterilisation pouches are engineered to provide reliable colour change and seal performance. Made from high quality medical grade paper, they are designed to ensure successful sterilisation processing you can trust.

Every Medicom SafeSeal Quattro Sterilisation Pouch Provides: • Secure, extra wide chevron seal for protection against instrument breaching • Internal and external process indicator for added quality assurance • Thumb notch, perforated fold and wide self-sealing adhesive strip for ease of use • Lightly blue tinted film for easy breach identification

Contact us: 1300 818 168 | cs@medicom-australia.com | www.medicom-australia.com 21072021-DN-AD-024-MAU V1

infection | CONTROL

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CPD

Are your diagnostic instruments overdue for a checkup?

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hink back: When was the last time you updated your diagnostic instrumentation?

A diagnostic instrument’s useful lifespan can extend for years. There may be probes and explorers in use right now in some dental practices that performed exceptionally well over time but are truly no longer in optimal condition to advance efficient and vital dental diagnoses.

High-quality diagnostic instruments are indeed durable. But so are teeth and you wouldn’t advise a patient to skip routine prophylaxis appointments simply because their teeth look and feel fine. The same logic applies to diagnostic instruments.

Regular check-ups are as essential for maintaining an effective dental armamentarium as they are for maintaining oral health.

Why diagnostic instrument quality matters ental professionals like you depend on diagnostic instruments to help assess tooth decay, detect caries and calculus, explore hard-to-access areas, measure periodontal pockets, and, in general, form a complete picture of each patient’s oral health.

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32 oral|hygiene

If your diagnostic instruments are not in good working order, the diagnoses may not be entirely accurate. And as you know, the results can include underdiagnosis, where crucial warning signs of disease are not recognised, or overdiagnosis, with potential overtreatment of asymptomatic conditions. Neither is optimal for you or your patients.

As pandemic regulations loosen and vaccine distribution accelerates, a large number of patients may be returning to your practice after having postponed professional dental care for a year or more. Many of them will have symptoms of periodontal disease, decay and other issues that require immediate attention.

By ensuring your diagnostic instruments are in top shape, you can help these returning patients get back on track and back to optimal dental health as quickly as possible.

How often should you perform a diagnostic instrument checkup? t’s always a good idea to regularly inspect all your instruments and other dental equipment for damage and defects. We recommend inspecting your diagnostic instruments at least once a year and after any incident that may inflict damage (such as dropping an instrument). If your practice is currently using any diagnostic instruments that are over one year old, we suggest performing a thorough check-up on them immediately.

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July/August 2021

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HFL-482AUS/1220 ©2020 Hu-Friedy Mfg. Co., LLC. All rights reser • Color-coded silicone rail system that reduces instrument contact • and Color-coded allows silicone rail system that significantly forLOVE moreOUR water flow©2020 while protecting the instruments during reprocessing ©2020 Co., significantly LLC. All rights reserved.

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HFL-482AUS/1220 • Color-coded silicone rail system that reduces instrument contact and allows WHY DENTISTS LOVE 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 for moreOUR water flowSTAINLESS while the instruments during reprocessing forOUR more water flow protecting the instrume WHY DENTISTS LOVE OUR STEEL PEDO CROWNS: • Ideal andfor mesio-distal widthflow • height Easy-to-use, ergonomic latch thatprotecting allows forthe one-handed opening more water while instruments during reprocessing • Ideal height and mesio-distal width • Easy-to-use, ergonomic latch that allows for one-handed opening All company and product names are that trademarks of Hu-Friedy Mfg.one-h Co., LLC •• Ideal height and mesio-distal width • Ideal height and mesio-distal width • Easy-to-use, ergonomic latch that allows for one-handed opening • Easy-to-use, ergonomic latch allows for ™ unless otherwise Pre-trimmed pre-crimped for simple placement All company and product trademarks ofone-handed Hu-Friedy LLC, its affiliatesInfinity or related companies, All company noted.scaler anddesigns. product are trademark Performing at your best means having confidence in youMfg. do.Co., Experience Series Cassettes, and improve • Ideal height and mesio-distal width • and Easy-to-use, ergonomic latchnames thatare allows forwhat opening 1) Compared to other leading Datanames on file. Available req • Pre-trimmed and pre-crimped for simple All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. in at your best meansplacement having confidence what you designs. do.upon Expe 1) Compared to other leading scaler designs. Data on file. Available upon request. •Performing 1) Mfg. Compared torights otherreserved. leading scaler D Co., LLC. placement All HFL-482AUS/1220 ™ ©2020 Hu-Friedy •• Pre-trimmed and pre-crimped for simple placement Pre-trimmed and pre-crimped for simple Cassettes, and improve Performing your best means having indesigns. what patients, youondo.

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Learn How to Scale in Perfect Harmony at Hu-Friedy.com/Harmony Hu-Friedy.com/H Hu-Friedy.com/Harmony

To learn more about how IMS can enhance VISIT USCo., ONLINE AT HU-FRIEDY.COM/PerfectFit Hu-Friedy Mfg. LLC, 1666 how E. Touhy Ave., Desenhance Plaines, IL 60018 | Hu-Friedy.com To learn more about IMS your practice visit Hu-Friedy.com/Infinity VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit ToHu-Fried learn more about howcan IMS can enhance ©2016 y Mfg. Co., LLC.ONLINE All rights reserved.

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infection | CONTROL What to look for in a diagnostic instrument check Mirrors o diagnose a dental issue, you need to see it. A good mirror helps you do just that, providing a clear, detailed view of all intraoral surfaces, reflecting light into dark crevices, functioning as a retractor and enabling transillumination.

Over time and in everyday use, dental mirrors can get scratched. Sterilisation in pouches, rather than cassettes, readily allows sharp instruments to bump into mirrors resulting in scratching of the reflective surface. Wrapping mirror heads in gauze can allow rough fibers to scratch the mirror surface.

Drops and other accidents can cause scratches as well. Investing in an instrument management system like IMS™ Cassettes (Hu-Friedy) can provide optimal protection and advance the longevity of your mirror heads.

Mirrors lose some of their reflectivity with each scratch, providing less light to work with along with incomplete or distorted images, all of which can compromise the diagnoses.

And, you’ll work harder using a scratched mirror as you’re apt to constantly reposition the mirror and refocus in order to try and get the best, clearest view.

Mirror heads are easily replaceable - allowing you to readily have better visibility and efficiency. If your mirror heads are scratched, we recommend seeking out replacements that offer exceptional levels of brightness, clarity and reflectivity.

Hu-Friedy’s High Definition Mouth Mirrors are an excellent choice. They feature a proprietary coating that provides superior brilliance and colour for increased visibility in all dental procedures. In tests, these HD mirrors have demonstrated a 113% reflection factor and are 50% brighter than other front surface mirrors. HD mirrors come in single or double-sided versions and are scratch-resistant. Additionally, Hu-Friedy HD Black Line Mirrors feature a Diamond Like Carbon coating that reduces glare up to 80% when compared to the non-coated stainless-steel mirror head and handle for enhanced visual acuity.

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Probes robes are the workhorses of the diagnostic dental instrument world since they are used on nearly every patient to gather vital data for determining a diagnosis, such as periodontal pocket depth, attachment level, anatomy configuration and

P

gingival bleeding.

Probe tips are tapered in order to provide optimal access to narrow pockets. However, thin probe ends can bend or even break by jostling against other instruments in sterilisation pouches, improper placement in cassettes, or due to mishandling and accidents. Using a bent probe is like using a bent ruler; you won’t be able to get an accurate reading.

34 oral|hygiene

Among the most important features of a dental probe are the markings on the tips, which are finely calibrated for precise measurements. Hu-Friedy Qulix™ Probes have accurate, smoothly finished black markings which will not chip, flake or fade. Rather than being laser-etched, the markings are ingrained in the metal - providing for a long-lasting durable instrument.

Alternatively, you might consider opting for resin probe tips which can provide superior visibility and are safe on restorations but do need routine replacement as the markings can fade over time.

HuFriedyGroup offers Colorvue™ Probes, which feature vivid yellow tips with black markings for enhanced contrast to intraoral structures in both natural and implant dentition. The probe tips are safe for use with implants and feature a twist-on design for easy replacement of worn tips. Colorvue Markings will wear with normal use and tips should be replaced about every 30 sterilisation cycles.

Explorers xplorers, necessary in all procedural set-ups, are instruments for which tactile sensitivity is paramount as they are used to detect caries, calculus (especially on subgingival tooth surfaces), determine pocket characteristics and inspect restorations.

While seemingly delicate, a high-quality explorer is both strong and flexible. An explorer should be able to “spring back” to its original shape if, for example, the tip becomes stuck in an occlusal pit and requires extra force to remove. While several types of designs are common, such as the cowhorn, Shepherd’s hook, or TU17, all explorer technique focuses on using the last 1-2mm of the working end. Using a deformed or broken explorer may compromise tactile sensitivity, inhibit adaptation to tooth surfaces and be uncomfortable for the patient - all affecting optimal diagnoses and favourable treatment outcomes.

Like mirrors and probes, explorers can be damaged, deformed or broken during instrument reprocessing and the best solution to ensure longevity is use of protective cassettes. Explorer tips are particularly vulnerable during reprocessing. If they break, their finely-honed edges can transform into blunt surfaces that can be painful for patients.

Hu-Friedy explorers are hand-crafted from Duraspond steel, a specially-blended metal alloy that provides flexibility and resilience for even the most precise diagnostic procedures.

E

Plan your diagnostic instrument checkup now e all know how frustrating it can be when patients push back routine dental visits until their problems are too big to ignore. The earlier you can help patients detect dental health issues, the easier it is to prevent minor conditions from becoming lifelong challenges.

The same goes for your diagnostic instruments. Setting aside an hour or two now and on a regular basis, to inspect your mirrors, probes and explorers will ensure that your instruments are in proper working condition, allowing you to provide the most comprehensive and accurate diagnoses and treatments for your patients.

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July/August 2021

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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