Oral Hygiene Jan/Feb 2022 by dentalcommunity

oral hygiene , therapy , infection control , management and more ... VOL.32 NO.1

JANUARY/FEBRUARY 2022

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VOLUME 32 | NUMBER 1 JANUARY/FEBRUARY 2022

OH | CONTENTS

On the cover... The Piksters Eco range utilises biodegradable and sustainably grown bamboo and is presented in 100% recycled biodegradable packaging.

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CPD

4 6 16 20

BRIEFS NEWS & EVENTS CPD CENTRE ABSTRACTS

28 12

RECOGNISING REACTIONS TO GLOVE WEARING AND CONTEMPORARY HAND CARE PRACTICES

It is well recognized that intact skin is a major barrier against infection explains Emer. Prof. Laurie Walsh

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CPD

INTO 2022 AND THE NEXT PHASE OF THE COVID-19 PANDEMIC Emer. Prof. Laurie Walsh provides a summary of current thinking on the progress of the COVID-19 pandemic and the likely issues that will surface during the 2022 calendar year

facebook.com/auxiliarynow

Annual Subscriptions: Australia or NZ: OralHygiene $22.00 p.a. Overseas: A$38.00 p.a. Australasian Dental Practice (including OralHygiene) $99.00p.a. SUBSCRIBE ONLINE at http://shop.dentalpractice.com.au

twitter.com/auxiliarynow Publisher & Editor: Joseph Allbeury

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CPD

INSTRUMENT MANAGEMENT SYSTEMS IMPROVE YOUR PRACTICE Four case studies explore the benefits of making the switch

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CPD

TIPS FOR DENTAL HYGIENISTS TO RELIEVE AND PREVENT COMMON ACHES AND PAINS Dental hygiene has always been a taxing profession both on the mind and the body. And hygienists who scale by hand instead of using ultrasonics may be noticing a few more physical aches and pains, especially if hand scaling

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

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

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

news | EVENTS

in | BRIEF

New Optic White Dentist Exclusive kit now available

New uses for existing drugs and their activity against variants of concern

olgate has launched a Dentist-Exclusive Optic White Light Up Pen and matching LED device in a take-home whitening kit that will make your teeth “up to 7 shades whiter in 5 days” if used as directed. The precision applicator pen supplied in the kit contains a patented 6% hydrogen peroxide (HP) whitening serum that is applied to the tooth surface. Once dried, the serum forms a concentrated hydrogen peroxide film on the tooth. The unique chemistry of the serum, when paired with the powerful indigo LED device, delivers enriched whitening and optimum results. The patented LED device accelerates whitening with a 410 nm wavelength of light for faster, better results (vs the serum alone). It also utilises a shorter peak wavelength than other blue light LED whitening devices. The rechargeable LED device is designed for comfort with over 700 printed indigo LED lights for even whitening. The device accelerates whitening with a short 10 minute wear time - No impressions or custom trays are required. A single, thin layer of serum is applied to each tooth and after 10-15 seconds, a clear coating forms. The LED device is then turned on and carefully placed in the mouth for 10 minutes. Once finished, the patient simply goes to bed with the dried serum staying on and allowing teeth to continue to whiten overnight. The patient then brushes off the whitening serum in the morning. The process is repeated for 5-10 days. The patented HP formula is designed for no tooth sensitivity and no gum irritation and effectively whitens teeth overnight without mess. The precision pen contains enough serum for four complete 10-day whitening cycles (upper and lower arches) - enough for one year. The kit includes the LED teeth whitening device and charging case, a USB-A charging cord and the whitening pen containing 60mg/g (6% w/w) hydrogen peroxide serum. Available from Henry Schein.

A-dec offers biofilm testing device -dec has introduced a useful new product to accurately and easily test the microbiological quality of dental unit water lines and surfaces. The 2-Min Water Control System rapidly and accurately determines the presence of biofilm in dental unit waterlines, to enable monitoring and action as required, eliminating incubation periods or the need to send samples to a laboratory. A water sample is taken from the dental unit waterline and by adding a few drops of reagents, produces a result which is immediately interpreted and displayed on a Lumitester Smart device. When high counts are found, the waterlines can then undergo additional shock or sanitising treatments. Contact A-dec on 1800-225-010 for more information.

4 oral|hygiene

Recent studies have explored approved drugs that exhibit off label antiviral activities against SARS-CoV-2. These could be useful for treatment, especially if they are not impacted by SARS-CoV-2 mutations emerging in variants of concern. When coronaviruses replicate inside a cell, the virus hijacks the host cell stress response in the endoplasmic reticulum to modulate protein translation and protein folding. The receptors which control this known as sigma-1 and sigma-2 can be blockaded. This laboratory study evaluated the use of the antihistamine diphenhydramine as this can block the sigma receptors and may be able to inhibit drug resistant variants resulting from mutations. The study also explored whether antiviral activity could be improved by combining a sigma receptor ligand with lactoferrin, a naturally derived antiviral agent that binds distinct targets. We found that co-administration of lactoferrin with diphenhydramine in cell cultures of Vero E6 cells reduced SARS-CoV-2 induced cytotoxicity. The antiviral enhancement effects of lactoferrin were more apparent at lower, therapeutically relevant concentrations of diphenhydramine. Combining lactoferrin with diphenhydramine resulted in synergistic effects on antiviral activity against SARS-CoV-2. Compounds we found effective in Vero E6 were also able to reduce infectious SARS-CoV-2 production following infection of human lung epithelial cells. These laboratory data suggest that sigma receptor ligands may have the potential to inhibit virus infection and/or decrease recovery time from COVID and could represent a potential therapeutic avenue for COVID-19 prevention and treatment. A limitation of this research is that there is no direct evidence of the relationship between viral infectivity in cell cultures and virus transmissibility in humans. It may be that cell culture-based testing is too sensitive a method to adequately represent what happens with viral transmission in humans. Ostrov DA et al. Highly specific sigma receptor ligands exhibit anti-viral properties in SARS-CoV-2 in all infected cells. Pathogens 2021; 10: 1514.

January/February 2022

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in my | SURGERY

In my surgery...

By Tabitha Acret

hilst I actually still use normal toothpaste for myself, I did do some research on toothpaste tablets for patients who wanted to reduce packaging. There are many toothpaste tablets there are many toothpaste tablets on the market but unfortunately a lot of them do not contain fluoride. Whilst I was researching, however, I found Tooth Chews. These are a toothpaste tablet containing fluoride in a recyclable packet invented and made by an Australian dentist - so a double win!

ental practices are not always environmentally friendly locations due to the amount of disposable products that we use but each of us can do small things to make a difference to what we throw out and ends up in land fill. Below I have listed three products I use or recommend. Washable scrub hats

ToothChews toothpaste tabs hilst I actually still use normal toothpaste for myself, I did do some research on toothpaste tablets for patients who wanted to reduce packaging. There are many toothpaste tablets on the market but unfortunately a lot of them do not contain fluoride. Whilst I was researching, however, I found Tooth Chews. These are a toothpaste tablet containing fluoride in a recyclable packet invented and made by an Australian dentist - so a double win! I also recommend these to patients who are travelling or camping/hiking.

Bamboo rinsing cups ith the preprocedural rinse now the standard across the country, there are now tens of thousands of plastic cups being thrown away by dental surgeries every single day. Making a swap from plastic to bamboo fibre cups makes a huge difference in the impact we make to the environment. The bamboo cups from Piksters hold hot or cold liquid and are 100% sustainable and biodegradable which includes the packaging as well.

About the author Figure 1. Me with my dental nurse, both in scrub hats from Ondemand professionals. ne of the few positives of the COVID-19 pandemic is that a lot more dental professionals are thinking about personal protective equipment and as part of that, covering their hair. Ondemand Professional is a small business ran by Australian dental hygienist Shida Dole that sells a range of washable scrub hats. There is a huge range of colours and patterns and by not wearing disposable scrub hats that would end up in land fill, it’s a huge benefit to the environment. Ondemand Professional scrub hats also look way better than the disposable ones!

6 oral|hygiene

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.

January/February 2022

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For clinical evidence confirming water flossing effectiveness, see these articles from peer reviewed dental journals– 1. *Oral irrigator removes 99.9% of plaque 2.

Gorur A et al. Biofilm removal with a dental water jet. Compend Contin Ed Dent 2009; 30 (Suppl 1):1 - 6.

**Oral irrigator is a more effective alternative to traditional dental floss for reducing gingival bleeding and improving oral health.

Pulse mode comfortably flexes gums to dislodge food particles.

Easy to use around dental bridges, braces and crowns, wires & splints.

Powerful jet removes bacteria deep below the gumline & between teeth.

Rosema NAM et al. The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol 2011; 13(1):2-10.

Oral irrigator and brushing up to 3X as effective for removing plaque around braces vs. string floss. Sharma NC et al. The Effect of a Dental Water Jet with Orthodontic Tip on Plaque and Bleeding in Adolescent Orthodontic Patients with Fixed Appliances. Am J Ortho Dentofacial Orthop 2008; 133(4):565-571.

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

Magnuson B et al. Comparison of the Effect of Two Interdental Cleaning Devices Around Implants on the Reduction of Bleeding: a 30-day Randomized Clinical Trial. Compend of Contin Ed in Dent 2013; 34(Special Issue 8):2-7.

Cordless and s s e waterproof l d Cor d - use it in the an oof shower! pr REFER YOUR PATIENTS TO THE STOCKISTS BELOW: ater w se it in Woolworths,Terry White Chemmart, Blooms, Cincotta, r! - u oweReplacement Pharmacy Online, Wizard Warehouse, Chempro & heads pack h s the selected independent pharmacies and piksters.com $9.95 EPLHPOIN less d r o s s C le TO ORDER Cord d and f n a o f piksters.com | sales@piksters.com High value ro products proaoterp rquality watesew in T. 1800 817 155 n t i i r! e it -u

news | EVENTS

Dental Economics 2022 designed to help you and your practice grow

ental Economics is a brand new major event for 2022 that is designed to help your private dental practice GROW.

The event is perfect for principal dentists, employed dentists, new graduates, senior clinicians, practice managers, dental hygienists, oral health therapists and clinical and business support team members. After two years of uncertainty, 2022 and beyond is the time to start getting back on track - growing your practice, starting a new practice, building your revenue, honing your systems, adding more chairs or opening in new locations. Whatever your plan, Dental Economics 2022 will provide you with the tools, ideas and inspiration from the absolute best in the business to go to the next level. Dental Economics 2022 is a 2-day multi-stream event that allows you to create your own program - on the fly. The event is staged at the Novotel Sydney Brighton Beach - close to Sydney Airport with ample parking and easy access. Throughout the two days, you can choose from over 50 different lectures, workshops and forums to tailor a program to meet your exact requirements (or bring your entire team to cover all the bases). Dental Economics 2022 offers a total of 12 hours of CPD organised into six concurrent education streams under the topics of:

Leadership n this interactive forum, hear Australian practitioners who are running large private practices over multiple locations, group practices and a range of unique business models and concepts be interviewed on stage, give insight and answer your questions.

8 oral|hygiene

Gain first hand insight into how large successful dental practices have overcome challenges to grow, evolve and prosper.

Practice Management articipate in lectures, workshops and forums with the best dental management consultants in Australia who will offer advice from decades of experience working with private dental practices in Australia.

Finance nderstand how to navigate the unique financial and legal requirements of dental practices from legal, accounting and financial advisers who create dental practice structures for large group and corporate practices. Sessions on trusts, insurances, superannuation, buying and selling practices and premises and more will be featured.

Marketing arketing your dental practice successfully is a key driver for growth. Hear from clinicians, business owners and consultants about what works and what doesn’t. Sessions on websites, social media, video marketing, advertising and more will all be incorporated into a range of fun and interactive educational sessions.

Hygiene Department or the first time in Australia, this program for dental hygienists, oral health therapists and hygiene coordinators will present a range of sessions from inspiring clinicians and consultants that will change the way you view your career and your clinical practice. From looking at concepts for growing hygiene revenue and clinical engagement, to the exploration of the dental spa concept to mobile dentistry and domicillary care models, a broad range of topics will be covered designed to help dental hygienists and oral health therapists rethink their role in the practice and their overall dental career.

Communications ommunication is the key to starting and growing a practice. This stream will offer insight, tips and advice on a range of techniques and technologies that can help your practice grow, increase your efficiency and reduce your overheads. Dental Economics 2022 will deliver unprecedented access to the most knowledgeable and entrepreneurial clinicians, business owners and consultants in Australia today.

The lecture program will feature over 60 education sessions and the program is evolving on a daily basis at www.dentaleconomics.com.au.

Attention entrepreneurial dental hygienists and oral health therapists ental Economics 2022 is looking for dental hygienists and oral health therapists who are taking advantage of independent practice and want to share their story with their colleagues. Or if you have a business model that your peers can participate in or have ideas on how to take the hygiene department to the next level, then please contact Joseph Allbeury at joseph@dentist.com.au to start a conversation about presenting at Dental Economic 2022.

January/February 2022

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news | EVENTS

Waterpik® Water Flosser: Unequivocally proven safe in clinical studies over 5 decades Safety of a Water Flosser: A literature review Jolkovsky DL et al. Compendium of Continuing Education in Dentistry 2015; 36(2):2-5.

Objective ince the introduction of the first Waterpik Water Flosser in 1962, over 60 clinical trials have been published. Collectively, the studies demonstrate significant plaque removal, reduction of gingival bleeding and reversal of inflammation (gingivitis). The majority of the studies are randomised controlled trials and published in peerreviewed journals providing the reader with the best evidence to make informed clinical decisions. This literature review was designed specifically to address the safety of a Water Flosser.

Methodology

his review was divided into four sections: histological findings; subgingival pathogens; probing pocket depth and clinical attachment levels; and bacteremia.

Results l Histological findings: Studies showed a significant reduction in inflammation on the cellular level compared to non-treated sites which showed varying levels of inflammation. This confirms that a Waterpik Water Flosser is safe for the periodontal pocket tissue. l Subgingival pathogens: Studies show significant removal of subgingival pathogens, even in deep pockets, with the use of a Waterpik Water Flosser. This was not generally seen in non-water flossed sites. This addresses the concern that bacteria might be driven deeper into pockets. l Pocket depths and clinical attachment levels: Studies show a significant improvement in probing pocket depth and clinical attachment levels or no change. These studies address the concern that a Waterpik Water Flosser might break the epithelial attachment. l Bacteremia: Research shows the incidence of bacteremia is the same for tooth brushing, flossing, wood sticks, water flossing and mastication.

Conclusion The Waterpik Water Flosser has been proven safe.

Findings from clinical studies on the safety of the Waterpik Water Flosser • • • • • • •

Histological reduction in inflammation; Reduction or stability of probing pocket depth; Improvement or stability of clinical attachment levels; Removal of subgingival pathogenic bacteria; Improvements in morphological subgingival flora; No adverse effects reported; and Clinical changes demonstrating a reduction in gingivitis, inflammation and plaque.

To try Waterpik yourself, take advantage of the 60% discount Professional Trial Offer at www.waterpik.com.au/shop* (*terms and conditions apply, whilst stocks last, visit www.waterpik.com.au/shop for further details)

10 oral|hygiene

January/February 2022

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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

infection | CONTROL

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CPD

Recognising reactions to glove wearing and contemporary hand care practices By Emeritus Professor Laurence J. Walsh AO

t is well recognized that intact skin (i.e. with no exudative lesions, cuts or abrasions) is a major barrier against infection. All recent guidelines on hand care stress the importance of keeping the skin healthy, both at work and at home, by avoiding exposure of bare skin to solvents and detergents and by the frequent use of an emollientcontaining moisturising cream. Poor hand care practices, particularly insufficient use of moisturiser, leads to a breakdown in the normal protective functions of the lipid fatty acid layer of the skin and disrupts the skin commensal bacterial flora. Unnecessary trauma to the hands

12 oral|hygiene

should be avoided. Zealous use of scrubbing brushes is no longer recommended as this abrades the skin, as can forceful use of poor quality paper toweling for drying the hands. To minimise chapping of hands, warm water should be used for handwashing (not hot water) and the hands dried by patting them to blot away the moisture, rather than by rubbing them, which will abrade the skin surface (Table 1).

Irritant contact dermatitis rritant contact dermatitis in response to wearing disposable gloves (Figure 1) is a common problem in dental staff. It is caused primarily by detergents (such as sodium lauryl sulphate), when excessive amounts of handwash solution are used. Residues left on the skin are then held in contact with the outermost layers of the skin because of the occlusive action of glove materials.

January/February 2022

infection | CONTROL

Figure 1. Irritant dermatitis. Note the skin surface beginning to break down near the natural skin folds. Irritant dermatitis can also be caused in some individuals by excessive exposure to water for prolonged periods of time. Water combined with antiseptics and detergents removes the protective lipid layer on stratum corneum of the skin and as a consequence, liquids can spread onto and penetrate into the skin itself. The loss of lipid also increases the rate of trans-epidermal water loss and makes the skin more susceptible to subsequent irritants. This is why the condition becomes self-perpetuating. Dental staff typically notice an improvement during vacations, however the problem re-appears when they return to work. The history may reveal that non-occupational factors are contributing, for example, exposure to detergents and solvents domestically can exacerbate the condition. This is the reason why gloves should also be worn when washing dishes by hand after meals. The appearance of irritant contact dermatitis is typically dry fissured skin, which may then become itchy. The outer layers of the skin can break down and begin to peel into layers. If this develops, the staff member should check their hand care protocol and reduce the use

January/February 2022

Figure 2. Delayed type hypersensitivity to glove materials, with a raised vesicular surface that crusts over.

Table 1. Recommended handcare practices • Operate hot and cold water taps in a “no-touch” fashion, for example using sensor controls or elbow, knee or foot controls. • Use a neutral pH liquid handwash solution for regular handwashing rather than antimicrobial soap. Ideally, the handwash dispensing systems should have a fully disposable reservoir and nozzle. If using a refillable dispenser, prevent contamination with water-borne opportunistic pathogens (such as Pseudomonas aeruginosa) by never topping up handwash. Instead, when empty the container must be washed thoroughly and left to dry overnight before filling with the new solution. • Apply liquid handwash for 10-15 seconds onto wet hands. • Rinse off all traces of detergent under running water. • Dry the hands gently using a blotting action with paper towel. Do not rub, to avoid chapping. • Ensure that traces of water are removed, particularly between the fingers. • Apply moisturiser at periodic intervals - more often for individuals with dry skin. of irritant handwash whilst improving rinsing and drying of the hands before gloving (to remove traces of detergent), as detailed in Table 1. When choosing a water-based emollient hand cream for use in the clinical workplace, ensure that it is compatible with the alcohol-based hand rub products that are

being used. The moisturiser should have low levels of fragrances, emulsifiers and other additives, as these could in themselves cause irritation. Avoid oil-based hand preparations at work, as traces of these on the skin may cause latex gloves to deteriorate and may leave oily residues on items handled with bare hands.

oral|hygiene

infection | CONTROL

Figure 3. The GAMMEX Non-Latex Sensitive range are made from neoprene rather than latex and importantly, are chemical accelerator-free, offering an unsurpassed combination of sensitivity and durability.

Contact dermatitis hile it is both harmless yet annoying, irritant contact dermatitis should not be ignored since its effects on the skin, namely reduced skin barrier function and impaired skin integrity, can enhance direct absorption of glove materials, which could accelerate the onset of a true immunological reaction to polymerising agents or to latex itself.

Allergic reactions to glove materials round 85% of true allergies to glove materials are to the polymerising agents (such as thiurams) rather than to natural rubber latex itself. Some clues to this pattern of causes follow. An individual with a reaction to a cross-linking or polymerising agent may show a reaction to a range of different glove materials, since cross-linkers are used in most gloves (Figure 2). However, switching to hypoallergenic (acceleratorfree) is recommended as this will prevent the reaction, since these gloves have been through additional processing steps involving washing to elute all traces of the polymerising agents. An individual with a true allergic reaction to natural rubber latex (NRL) will show this response to skin contact with any number of materials in the workplace or home containing NRL. They may also mount allergic responses to foods that

14 oral|hygiene

have similar proteins antigens (e.g. to the fruits (and seeds) of banana, pineapple, avocado, chestnut, kiwi fruit, mango, passionfruit, fig, strawberry, papaya, apple, melon, celery, potato, tomato, carrot and soy). Reactions to such foods may range from itching right up to life-threatening anaphylaxis reactions. Approximately 30-50% of individuals who are allergic to NRL will also have this hypersensitivity to certain plant-derived foods (“latex-fruit syndrome”). It is not always clear whether latex sensitisation precedes or follows the onset of a food allergy. As there is no cure for NRL allergy, affected individuals must avoid NRL as well as allergenic (and suspect) foods. Changing to another glove material (such as nitrile, neoprene or polyisoprene) is essential, however all other NRL sources must also be avoided in the practice (dental dam, etc), as well as in the domestic setting (elastic bands, rubber utility gloves, balloons, etc). Hypoallergenic gloves containing natural rubber latex may contain substantial amounts of IgE-binding proteins and therefore such gloves will not address the problem of latex allergy, rather their inappropriate use may provoke a serious allergic reaction. Both the irritant and allergic skin reactions can co-exist, which can complicate the assessment and management of the condition. Staff who have skin problems such as exudative lesions or weeping dermatitis must seek medical advice and must be removed from direct patient care until the condition resolves. A true allergy to

NRL can be diagnosed by a dermatologist using a skin patch test, although a negative test result does not rule out a latex allergy. They can also determine whether other agents being placed on the skin, such as excipients in hand gels, which are hard-toavoid weak allergens, may be acting.

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.

January/February 2022

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oral|hygiene CPD CENTRE infection | CONTROL

infection | CONTROL

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CPD

Recognising reactions to glove wearing and contemporary hand care practices

Into 2022 and the next phase of the COVID-19 pandemic

By Emeritus Professor Laurence J. Walsh AO

Poor hand care practices, particularly insufficient use of moisturiser, leads to a breakdown in the normal protective functions of the lipid fatty acid layer of the skin and disrupts the skin commensal bacterial flora. Unnecessary trauma to the hands

By Emeritus Professor Laurence J. Walsh AO

12 oral|hygiene

The discussion begins with considering where we have come from and where we are at today. This is summarised succinctly in Figure 1 which shows data for COVID-19 deaths and COVID-19 vaccinations

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January/February 2022

Question 1. Irritant contact dermatitis is mainly caused by: a. The detergent in handwash solutions. b. An alkaline pH in handwash solutions. c. Latex allergy. d. IgE-binding proteins contained in gloves. Question 2. Topping up handwash dispensers can result in:

for Australia. Severe cases, defined as those requiring hospitalisation, are around 14% of all confirmed cases for viral variants before omicron.

Naturally circulating coronaviruses et us now consider the four endemic coronavirus strains that circulate globally: HCoV-229E, HCoV-OC43, HCoV-HKU1 and HCoV-NL63.1,2 The profile of symptoms that these viruses cause are similar to human influenza viruses and include fever, cough, headache and muscle aches.3 These coronaviruses were first discovered in 1966, with the most recent of the four strains being discovered in 2014.4,5 Along with human influenza viruses, coronaviruses typically cause human respiratory tract infections during the winter months, which coincides with the time of year when people are more likely to spend long periods of time indoors.

January/February 2022

A UK study showed that in people over 80, the Pfizer vaccine had a reduction in effectiveness after 20 weeks of: a. 4% b. 15% c. 23% d. 30%

a. Significant cost savings when assessed annually. b. Reduced effectiveness due to oxidation. c. Contamination with water-borne pathogens. d. Increased effectiveness due to concentration of the active ingredients.

Question 7. SARS-CoV-2 has a close similarity to the bat coronavirus:

Question 3. The majority of true allergies to glove materials is caused by reactions to:

Question 8. Which coronavirus is not considered a globally circulating endemic strain:

a. Natural rubber latex. b. Cornstarch powder. c. Polymerising agents. d. Contamination during manufacture.

a. HCoV-229E b. HCoV-OC43 c. HCoV-HKU1 d. HCoV-ME12 e. HCoV-NL63

Question 4. In hand hygiene, it is no longer recommended to: a. Zealously use a scrubbing brush. b. Forcefully use paper towels for drying. c. Use hot water for handwashing. d. All of the above. Question 5. When choosing an emollient hand cream for use in the clinical workplace, ensure that it is: a. Compatible with any alcohol-based hand rubs being used. b. Free of fragrances, emulsifiers and other additives. c. Water-based. d. All of the above.

a. Rc-o319 b. RaTG13 c. RmYN02 d. All of the above

Question 9. Approximately 1% of individuals with COVID-19 have an incubation period of more than: a. 7 days. b. 10 days c. 14 days d. 21 days Question 10. University of Queensland halted trials of a vaccine candidate because recipients were falsely testing positive for: a. HPV b. HAV c. HIV d. HBV e. HCV

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 Jan/Feb 2022 questionnaire and then click START. A score greater than 80% is required to PASS and receive CPD.

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

clinical | EXCELLENCE

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Tips for dental hygienists to relieve and prevent common aches and pains

Instrument management systems improve your practice Four case studies explore the benefits of making the switch

For many practices, switching to an Instrument Management System (IMS®) provides innumerable benefits; however, practices may be reluctant to switch. Practices may have to reconfigure their sterilisation area, purchase new instruments or retrain employees, but the return is worth the investment. Whether it’s reduced sharps injuries, enhanced organiaation, cost reductions, increased patient counts or another benefit, practices that adopt IMS see measurable results. Over the years, Hu-Friedy has profiled dental practices that implement IMS to explore the variety of ways that it positively impacts practices. Here are a few examples:

Reducing sharps injuries at PDS

orporates like Pacific Dental Services (PDS) are always looking for measurable, data-driven ways to improve safety

That pain is also not just in the hands, wrists and arms; hand scaling can also take a toll on the back, neck, shoulders and legs. Dental hygienists are at risk for conditions such as carpal tunnel syndrome, repetitive motion injuries and even chronic headaches. This pain can strike at any point during a hygienist’s career: Between 64% and 93% of dental professionals experience general musculoskeletal pain. In fact, musculoskeletal disorders are the leading reason for early retirement among dental clinicians. The New Year gives us all the opportunity to take a step back and revisit how we work and what we can change to

and ensure regulatory compliance across their network of practices. To better understand the impact of IMS, PDS identified two practices with an opportunity to reduce sharps injuries to trial the cassette-based system. After implementing IMS in those practices, PDS compared the results after a year with equivalent control practices. The findings were unmistakable. Not only were sharps injuries reduced to zero for the two practices during the trial period, but both practices experienced improved efficiency, as instruments were reprocessed eight minutes faster on average, freeing up time to spend with patients. Following this successful experiment, PDS expanded it to more locations to verify the findings, which generated identical results. With such positive outcomes, Hu-Friedy worked with PDS to implement IMS in over 100 practices.

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make our working lives better. So with this in mind, from body positioning to ergonomic instrumentation, here are a few options to help relieve pain in 2022.

Musculoskeletal pain Cause verage everyday hand scaling leads to repetitive motions, often in awkward positions, a recipe for pain and physical disorders that can derail a career.

Prevention ental hygienists can avoid pain and repetitive stress injuries with the following tips:

Better Positioning (for hygienists AND patients) he less bending, hunching, twisting, craning, leaning or reaching an hygienist does, the less tension they’ll put on their muscles, joints and bones. The proper position for working with a patient is seated, with the spine in a

neutral position and shoulders relaxed. Working as close to the patient as possible avoids overextending the arms or back and always facing the patient. Hygienists should also keep their feet flat on the floor and adjust the stool’s height so the thighs slope slightly downward. Weight should be evenly distributed between each foot and your buttocks, similar to a tripod. If the procedure calls for a better view of the patient’s oral cavity, hygienists can ask the patient to turn their head and use HD mirrors to improve visibility. Keeping instruments at roughly arm’s height and within a half-metre radius is ideal. The patient’s body position also has a tremendous impact on ergonomics. According to RDH Magazine, the patient should ideally be positioned supine for treating the upper arch and semi-supine for the lower arch, but this practice is often impractical due to time constraints. Instead, they recommend positioning the back of the patient’s chair at a 10- to 15-degree angle from the floor. Then, use a contoured dental neck cushion to achieve the proper orientation of the occlusal plane.

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January/February 2022

Question 11. Using an Instrument Management System can:

Question 16. To reduce musculoskeletal pain...

a. Reduce sharps injuries. b. Enhance organisation. c. Reduce costs due to reduced instrument damage. d. All of the above.

a. Work with your spine in a neutral position and shoulders relaxed. b. Work as close to the patient as possible. c. Avoid overextending your arms or back and always face the patient. d. Keep your feet flat on the floor and adjust the stool’s height so the thighs slope slightly downward. e. All of the above.

Question 12. After implementing an Instrument Management System, Pacific Dental Services’ sharps injuries were reduced to: a. 0 b. 1 per month c. 1 per year d. 2 per year Question 13. After implementing an Instrument Management System, Pacific Dental Services reprocessed instruments faster on average by: a. 3 minutes b. 5 minutes c. 8 minutes d. 11 minutes Question 14. Using an Instrument Management System, Floss & Co improved process efficiencies per patient by: a. 8 minutes b. 10 minutes c. 12 minutes d. 15 minutes Question 15. Thanks to improved efficiency and organisation from using an Instrument Management System, Floss & Co’s new patients increased by: a. 10% b. 20% c. 30% d. 40%

To retrieve your FREE Dental Community Login:

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

Question 17. To improve ergonomics... a. Position the patient supine for treating the upper arch. b. Position the patient semi-supine for treating the lower arch. c. Positioning the back of the dental chair at a 10-15˚ angle from the floor and use a contoured dental neck cushion to achieve the proper orientation of the occlusal plane. d. All of the above. Question 18. Harmony Scalers and Curettes reduce pinch force up to: a. 35% b. 45% c. 55% d. 65% Question 19. Harmony Scalers and Curettes reduce pressure on the tooth by: a. 17% b. 27% c. 37% d. 47% Question 20. When compared to competitors, Harmony Scalers and Curettes with EverEdge™ 2.0 Technology remain: a. 30% sharper after 500 strokes b. 40% sharper after 500 strokes c. 50% sharper after 500 strokes d. 60% sharper after 500 strokes

dentevents presents...

Infection Control

BOOT CAMP 2020 BOOT CAMP ON DEMAND ONLINE LEARNING PROGRAMME

26 VIDEOS - 6+ HOURS OF EDUCATION INTERACTIVE Q&A SUPPORT WEBINARS Presented by Professor Laurence J. Walsh AO

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. 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. n n

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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On-Demand access to 26 Online Learning Videos (Over 6 hours of education). Online Learning Companion Booklet. Suggested Reading Material Booklet. Access to regular Q&A Webinar(s). Online Questionnaire to earn 6 Hours of CPD.

Infection Infection Contol Contol Boot Boot Camp Camp is is presented presented by by Dentevents, Dentevents, aa division division of of Main Main Street Street Publishing Publishing Pty Pty Ltd Ltd ABN ABN 74 74 065 065 490 490 655 655 •• www.dentevents.com www.dentevents.com •• info@dentist.com.au info@dentist.com.au ™ ™ and Dentevents™ ™ are trademarks of Main Street Publishing P/L © 2020 Main Street Publishing Pty Ltd Tel: (02) 9929 1900 • Fax: (02) 9929 1999 • Infection Contol Boot Camp Tel: (02) 9929 1900 • Fax: (02) 9929 1999 • Infection Contol Boot Camp and Dentevents are trademarks of Main Street Publishing P/L © 2020 Main Street Publishing Pty Ltd

abstracts | 2022

Oral Hygiene Abstracts 2022

By Emer. Prof. Laurence Walsh AO

Monoclonal antibodies in COVID tests and treatments

COVID-19 has caused a serious global health concern due to its rapid spread, high morbidity and economic challenge in the health sector across numerous countries. There is great scope for further research in discovering cost-effective and safer therapeutics, vaccines and strategies to ensure equitable access to COVID-19 prevention and treatment services. Early diagnosis, effective treatment and preventive measures form the cornerstones in disease containment. A rapid and specific diagnostic approach is essential in identifying COVID-19 positive cases. This would allow prompt isolation and early treatment initiation to such patients in designated centres, rapid antigen tests (RAT) detect the presence of SARS-CoV-2 nucleocapsid protein antigen on the viral surface in saliva and in nasopharyngeal and oropharyngeal swab samples. This test relies on specific monoclonal antibodies to bind to specific viral antigens in fluid samples, using a user-friendly fluorescence lateral flow assay. However, due to its lower detection sensitivity and specificity than PCR, RAT are not considered a gold standard in the diagnosis of COVID-19. In terms of treatment agents, tocilizumab is a recombinant humanized monoclonal antibody directed against the IL-6 receptor. It is currently used to treat rheumatoid arthritis, giant cell arteritis and in cases of life-threatening cytokine storm conditions. Tocilizumab reduces the mortality rates, ICU admissions and also lowered the risk of ventilation in severe COVID-19 patients. Other monoclonal antibodies of interest are baricitinib, a selective JAK1/2 kinase inhibitor used in the treatment of rheumatoid arthritis and psoriatic arthritis. It prevents the occurrence of immune mediated respiratory distress in severe COVID-19 cases. Ruxolitinib and anakinra are other immunomodulatory drugs used in the on-going clinical trials for treating COVID-19 patients. Despite these advances, due to numerous challenges encountered across many countries in controlling COVID-19 through existing preventive measures, an effective and economical vaccine remains the only retort to combat COVID-19 successfully. Umakanthan S et al. A rapid review of recent advances in diagnosis, treatment and vaccination for COVID-19. AIMS Public Health 2021; 8(1): 137-153.

Optimising the use of rapid antigen tests for those with respiratory symptoms

SARS-CoV-2 rapid antigen tests (RAT) have attracted attention as a supplement or alternative to PCR testing because of the possibility of rapid on-site testing (“point of care test” or POCT). Rapid SARS-CoV-2 antigen testing is considered a promising method for containing and combatting the SARS-CoV2 pandemic. Since the POCT tests are to be used as mass tests in certain occupational sectors, it is necessary to take a closer look at them from an evidence-based and test-theoretical point of view. We performed model calculations on the possible use of RAT as mass tests, for a base model of 1,000,000 SARS-CoV-2-rapid point-of-care tests per week using various sensitivities and specificities reported in the literature, followed by sequential testing of the test positives obtained by a SARS-CoV-2 PCR test. Assuming for Germany 1,000,000 tests per week at a prevalence of 0.5%, a high number of false positive test results, a low positive predictive value, a high negative predictive value and an increase in the 7-day incidence due to the additional antigen rapid tests of approximately 5/100,000 were obtained. Both rapid antigen tests and the SARS-CoV-2 PCR test method should only be used if there is a corresponding high pre-test probability, i.e. with a corresponding diagnostic hypothesis. In effect, this means that they should be used on people suffering from respiratory symptoms and not on symptom-free people, because, even if the disease disappears completely, there will be a tail of false positive results. This could be incorrectly interpreted by the political mandate holders as a worsening of the infectious situation because the positive rate is used by politicians as an indicator of the severity of the epidemic situation. Ideally, a differential diagnosis should use a multiplex PCR test (e.g. SARS-CoV-2-qPCR Plus). This would detect the coronavirus as well as influenza A and B and respiratory syncytial virus (RSV) and other particularly frequently encountered respiratory tract pathogens, instead of just screening for the one pathogen. In the diagnosis of SARS-CoV-2, the WHO points out that testing for other pathogens should also be carried out. Co-infections with other pathogens do not exclude COVID-19 and vice versa. Current data on the global Infection Fatality Rate (IFR) for COVID-19 is 0.15%, which means that 99.85% of those with a COVID-19 infection survive the disease. In view of such a comparatively low mortality rate and correspondingly high survival rate, mass testing of large population groups is not expedient from an epidemiological aspect and is not justified. SARS-CoV2-rapid point-of-care tests as well as PCR tests should both be used exclusively in the presence of corresponding respiratory symptoms and not in symptom-free persons. Those who are administering RAT must assess each result in the context of the timing of sample collection, type of sample, clinical observations, patient history, confirmed contacts and epidemiological information. Hirsch O et al. Methodological problems of SARS-CoV-2 rapid point-of-care tests when used in mass testing AIMS Public Health 2021; 9(1): 73-93.

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January/February 2022

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infection | CONTROL

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CPD

Into 2022 and the next phase of the COVID-19 pandemic By Emeritus Professor Laurence J. Walsh AO

uring the summer of 2021-2022, Australian borders reopened, and at the same time, the omicron variant of the SARS-CoV-2 coronavirus (CoV) entered the country and began to spread rapidly. This article provides a summary of current thinking on the progress of the COVID-19 pandemic and the likely issues that will surface during the 2022 calendar year. The discussion begins with considering where we have come from and where we are at today. This is summarised succinctly in Figure 1 which shows data for COVID-19 deaths and COVID-19 vaccinations

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for Australia. Severe cases, defined as those requiring hospitalisation, are around 14% of all confirmed cases for viral variants before omicron.

January/February 2022

infection | CONTROL These 4 endemic coronaviruses cause widespread infection during childhood. By adulthood, most individuals are likely to have been exposed to these 4 coronaviruses multiple times. Some level of protection comes from repeated exposure during childhood, with longitudinal studies suggesting that it takes some 12-18 months before adults become susceptible to reinfection.6-10 The situation has been described as an “endemic equilibrium” between human coronavirus infection and human immunity,11,12 where the rate of decay of immune memory against coronaviruses is balanced by regular reinfection which causes boosting of immune responses. Due to waning immunity over time, at any one point in time, there are sufficient numbers of people who have lost their immunity and become prone to infection. Hence, viral infection can continue in the community at low rates and then surge during times when people are in close proximity to one another. This pattern of waning immunity is highly relevant to issues around the spread of COVID-19 in Australia, which has reached a high rate of vaccination by global standards.

Some 10 years later, Middle East respiratory syndrome coronavirus (MERS-CoV) emerged from its natural host animals (including camels) to cause human infections with high rates of severe infections and fatalities. MERS spread from the Middle East to Europe, having first appeared in Saudi Arabia in 2012.15,16 As with SARS, MERS also caused acute respiratory distress as well as extrapulmonary manifestations. Since both SARS and MERS had a short incubation period and a high infectivity, identification of infected persons and tracing their contacts was straightforward. Appropriate isolation and quarantine arrangements were effective public health measures. Moreover, the predominant mode of transmission was

2. Individuals who are presymptomatic carry sufficient virus to spread the illness, being particularly infectious from 2 days before clinical symptoms appear. The virus is present in saliva as well is in respiratory secretions. 3. With COVID-19, many patients are asymptomatic and cannot be identified from their symptom profile. This allows the disease to spread within the community from people who appear to be quite well, but who nevertheless are shedding the virus. 4. Spread of SARS-CoV-2 can occur via droplet, contact and aerosol routes. Aerosol transmission is the reason why only transient or fleeting contact between individuals has led to transmission events.

via droplets and to a lesser extent via the contact route. This meant that the application of droplet precautions, including the use of P2/N95 respirators by healthcare workers, was quite effective. The hyperinflammatory state caused by both SARS and MERS has strong parallels to COVID-19, however there are several important differences that have made control of SARS and MERS relatively straightforward, but problematic with SARS-CoV-2, the virus which causes COVID-19. 1. With COVID-19, the incubation period is longer, with approximately 1% of individuals having an incubation period of more than 14 days. This is why there have been numerous cases reported in the media of individuals who had an incubation period greater than 14 days, as they went through a two-week period of quarantine but then subsequently became positive.

5. SARS-CoV-2 not only infects cells of the respiratory tract, but spreads elsewhere through the body causing a wide range of persisting systemic conditions, which are now referred to as LONG COVID, as well as organ failures in those hospitalised with severe disease.17 6. As the infection progresses, shortness of breath develops and viral infection of the lungs makes the patient prone to superinfections of bacterial origin, followed by a hyper-inflammatory state involving the lower respiratory system which causes the classic symptom of shortness of breath. At this stage, multiple organ failures can occur.17 7. The SARS-CoV-2 virus is neurotrophic, which explains why it has caused permanent loss of smell as well as impacts on mood and energy over the long term after people have recovered from the symptomatic illness.

Zoonotic infections with coronaviruses of pandemic concern ats are the major natural reservoir for coronaviruses. Transmission to humans can occur following contact with bats, but most often occurs via an intermediate host animal.13 At least three highly virulent coronaviruses of animal origin have spread via zoonotic pathways from their bat animal hosts to infect humans, causing outbreaks of disease. The first well-recognised example was severe acute respiratory syndrome coronavirus (SARS-CoV). This disease emerged in 2002 in Guangdong, China and spread throughout Asia and to North America, resulting in more than 750 deaths.14 Once infected, individuals suffered from respiratory symptoms such as shortness of breath, with a hyperinflammatory state (a cytokine storm) and organ damage. The disease had a very short incubation period, making tracing of infected contacts relatively easy.

January/February 2022

oral|hygiene

infection | CONTROL Coronaviruses in animals here is a large body of evidence that indicates that coronaviruses are hosted in several species of horseshoe bats (Rhinolophus affinis, R. malayanus, R. cornutus, R. acuminatus) found in various countries in Asia including China, Thailand and Japan. These bat coronaviruses have been responsible for the emergence of SARS in 2002, MERS in 2012 and COVID-19 in 2019 as pandemics, as well as multiple “near miss” events where there was a small cluster of infection in humans that did not spread to become a pandemic. With regard to SARS-CoV-2, molecular studies have revealed close similarity between this virus and the bat coronaviruses RaTG13 and RmYN02, which are found in bat species living in the Yunan province of China18,19 and in Thailand,20 as well as the Rc-o319 bat coronavirus from Japan.21

The impact of vaccination campaigns he prime driver for vaccination campaigns for COVID-19 is to prevent severe disease, hospitalisation and death. Over recent months, greater attention has been placed on other benefits that may arise from vaccination, including a reduced viral load in the saliva and in

Figure 1. A snapshot of COVID-19 in Australia, using data as at 17 January 2022 from “Our World in Data” to create customised charts. A: COVID-19 deaths over time shown as a cumulative plot. B: A plot of excess mortality during the pandemic compared to typical deaths for the same period averaged over the past five years. The section above the line highlighted in pink represents deaths above the normal rate. C: The proportion of eligible people in the Australian community who have received at least one dose of a COVID-19 vaccine. D: The number of people in Australia who are fully immunised against COVID. E: A global ranking for immunisation rates for the population showing the position of Australia versus other countries. F: A global plot showing individual countries and the proportion of the population that is fully vaccinated against COVID-19.

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January/February 2022

infection | CONTROL

respiratory secretions and less shedding of virus should there be a breakthrough infection despite vaccination. There are several studies which indicate that viral loads may be reduced as much as four-fold in those with breakthrough infection following vaccination, compared to infected persons who have not been vaccinated. This suggests that vaccinated people would be less likely to shed the virus into the environment, where it could cause infections for others - e.g. in the household setting, in public places and in the workplace.22-24 This is important to consider, given the reopening of state borders and international travel. As more people are vaccinated, they have travelled more and this increases their interactions with others, which changes the potential number of people who are being exposed to the virus. There is strong evidence that the currently authorised vaccines in Australia (Astra, Pfizer, Moderna) are highly effective at preventing severe disease and death, as well as reducing the likelihood of symptomatic disease in individuals.25-30

Is it time to retire the herd immunity concept? he recent literature is beginning to question whether the concept of “herd immunity” is going to be possible, given the emergence of new variants and surges of disease, combined with vaccine hesitancy and the delayed introduction of vaccinations for children.31 A combination of waning immunity after vaccination if the booster program is not adequate and further rounds of viral antigenic variation may allow for continued circulation of the virus in the community. It is likely that the concept of “living with COVID” will be part of the “new normal” for the foreseeable future, with SARS-CoV-2 adding to the existing four coronavirus strains in circulation as endemic diseases. A failure to completely eradicate the virus from a particular jurisdiction or even globally does not mean that excess death, illness, lockdowns, restrictions or social isolation will occur at the same scale as seen during different waves of the pandemic. Influenza and four human coronaviruses have been endemic for many years, but the combination of annual influenza vaccines and some short-lived acquired immunity means

T D

January/February 2022

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infection | CONTROL that societies across the world have been able to tolerate the seasonal deaths and illnesses from these without requiring lockdowns, masks and social distancing.32 It may well be that as further mutation of the virus occurs, the virus will become far more contagious but much less virulent. This is certainly what the early information for the omicron variant is suggesting.

The UQ vaccine efforts he University of Queensland developed a protein subunit vaccine candidate, v451, using proprietary “molecular clamp” technology. This vaccine generated a strong protective response to the virus and displayed a good safety profile in a phase I clinical trial.33 There were antibodies also directed against fragments of gp41 protein, which is an ingredient used to stabilise the vaccine. The risk of a partial immune response to this gp41 was known beforehand and trial participants were informed of it. The extent of this immune response would not interfere with the interpretation of HIV tests. There were no HIV components used in the vaccine and having the vaccine did not present a risk for acquiring HIV infection and this was confirmed in routine follow-up tests.34 However, UQ halted the progress of this vaccine towards phase II/III trials, citing the need for significant modifications in well-established HIV testing protocols in the healthcare sector before moving further with the project. In April 2021, UQ undertook re-engineering of the vaccine to circumvent the issues raised earlier.35,36

Impact of vaccination campaigns ince their introduction, over 9 billion vaccine doses have been administered around the world since the first vaccine was given on December 8, 2020 in the UK. At the time of writing, over 60% of the world population has received at least one dose of a COVID-19 vaccine and over 30 million vaccine doses are now being administered each day.37 The emergence of the Delta variant and then of the Omicron variant has raised the issue of how well vaccines from 2020 would be effective against variants of concern that are circulating in 2022. There is evidence of reduced severity of infection and hospitalisation as a result of vaccination.38,39

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Could we end up back here again?

Duration of immunity n relation to the duration of protection, a detailed report on the level of protection afforded by vaccines against clinical disease was published by Public Health England on 6 September 2021.40 The data presented compared vaccine effectiveness over time. For the key metric of preventing hospital admissions, this UK study showed that after 20 weeks there was: • A 4% reduction in effectiveness of Pfizer in over-65s (98.3% to 94.6%); • A 15% reduction in effectiveness of AstraZeneca in over-65s (93.7% to 78.6%); • A 23% reduction in effectiveness of Pfizer in clinically extremely vulnerable over-65s (94.6% to 71.4%); • A 20% reduction in effectiveness of AstraZeneca in clinically extremely vulnerable over-65s (79.3% to 59.4%); and • A 30% reduction in effectiveness - to about 70% - of Pfizer in over-80s, many of who received this vaccine with a three-week interval between doses. With the Pfizer vaccine, a vaccine effectiveness of around 95% continues to be seen beyond 20 weeks after vaccination. With the AstraZeneca vaccine, there appears to be some waning to just under 80% vaccine effectiveness against hospitalisation from 20-plus weeks. Ultimately, these UK data show that two doses of the vaccine continue to provide strong protection against death from COVID-19. Similar to protection against hospitalisation, there appears to only be limited waning of vaccine effectiveness against death. Thus, both the Pfizer and AstraZeneca COVID vaccines protect against disease, hospitalisation and death, with the level of protection extending more than 20 weeks (5 months) after completing the course of 2 injections. Further evidence of a sustained serological response was seen in a study of 767 healthcare workers in Italy who had received mRNA vaccines. These individuals showed a sustained antibody response lasting at least 4 months, with levels of antibody decaying over time. An important concept which comes from this study is a role for screening immune responses to the vaccine in healthcare workers. This would identify those with low antiSARS-CoV-2 immunity, who would benefit from an earlier booster injection.41

t seems likely that further zoonotic coronavirus infections of bat origin may occur in the future. Future planning should therefore consider not only pandemics of the human influenza viruses, but also future pandemics of coronaviruses. The inherent risk posed by coronaviruses that are hosted in bats was recognised by Australian scientists over 20 years ago and this spawned a concerted research effort, particularly within the specially built PC4/ BSL4 laboratories in Geelong, Victoria to investigate these viruses and the potential implications for human health. Given the vacillating nature of the virus attack and host defence, it is likely that SARS-CoV-2 will become one of the endemic coronaviruses circulating globally into the future. To that end, there would be considerable value in having a vaccine that combines protection against the dominant strains of human influenza virus together with the current circulating variants of SARS-CoV-2. This combination vaccine would then become part of annual immunisation protocols for the community.

January/February 2022

infection | CONTROL References 1. Woo PC et al. Characterization and complete genome sequence of a Novel CORONAVIRUS, Coronavirus HKU1, from patients with pneumonia. J Virol. 2005;79(2): 884-895. 2. Lau SK et al. Coronavirus HKU1 and other coronavirus infections in Hong Kong. J Clin Microbiol. 2006; 44(6): 2063-2071. 3. Ye ZW et al. Zoonotic origins of human coronaviruses. Int J Biol Sci. 2020; 16(10):1686-1697. 4. Hamre D & Procknow JJ. A new virus isolated from the human respiratory tract. Exp Biol Med. 1966; 121(1): 190-193. 5. Su S et al. Epidemiology, genetic recombination, and pathogenesis of coronaviruses. Trends Microbiol. 2016; 24(6):490-502. 6. Callow KA. Effect of specific humoral immunity and some non-specific factors on resistance of volunteers to respiratory coronavirus infection. J. Hyg. 1985; 95: 173-189. 7. Callow KA et al. The time course of the immune response to experimental coronavirus infection of man. Epidemiol. Infect. 1990; 105: 435-446. 8. Lepiller Q et al. High incidence but low burden of coronaviruses and preferential associations between respiratory viruses. J. Clin. Microbiol. M2013; 51:3039-3046. 9. Edridge AWD et al. Seasonal coronavirus protective immunity is short-lasting. Nat. Med. 2020; 26: 1691-1693. 10. Galanti, M. & Shaman, J. Direct observation of repeated infections with endemic coronaviruses. J. Infect. Dis. 2020; 223: 409-415. 11. Lavine JS et al. Immunological characteristics govern the transition of COVID-19 to endemicity. Science 2021; 371:741-745. 12. Cromer D et al. Prospects for durable immune control of SARS-CoV-2 and prevention of reinfection. Nature Rev Immunol. 2021; 21:395-404. 13. Kim DS et al. Will SARS-CoV-2 infection elicit long lasting protective or sterilising immunity? Implications for vaccine strategies (2020). Frontiers Immunol 2020; 11:571481. 14. Cheng VC et al. Severe acute respiratory syndrome coronavirus as an agent of emerging and re-emerging infection. Clin Microbiol Rev. 2007;20(4): 660-694. 15. Hilgenfeld R & Peiris M. From SARS to MERS: 10 years of research on highly pathogenic human coronaviruses. Antiviral Res. 2013; 100(1): 286-295. 16. Gao H et al. From SARS to MERS: Evidence and speculation. Front Med. 2016; 10(4): 377-382. 17. Shi Y et al. COVID-19 infection: The perspectives on immune responses. Cell Death Different. 2020; 27(5): 1451-1454. 18. Zhou P. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579(7798): 270-273. 19. Latinne A et al. Origin and cross-species transmission of Bat coronaviruses in China. Nature Commun. 2020; 11(1): 4235. 20. Wacharapluesadee S et al. Evidence for SARSCoV-2 related coronaviruses circulating in bats and pangolins in Southeast Asia. Nature Communic. 2021; 12(1):972. 21. Murakami S et al. Detection and characterization of bat sarbecovirus phylogenetically related to SARS-CoV-2, Japan. Emerg Infect Dis. 2020; 26(12): 3025-3029. 22. McEllistrem MC et al. Single dose of an mRNA severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) vaccine is associated with lower

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nasopharyngeal viral load among nursing home residents with asymptomatic coronavirus disease 2019 (COVID-19). Clin Infect Dis 2021; 73:e1365–7. 23. Levine-Tiefenbrun M et al. Initial report of decreased SARS-CoV-2 viral load after inoculation with the BNT162b2 vaccine. Nat Med 2021; 27:790-792. 24. Adamson C et al. Lower severe acute respiratory syndrome coronavirus 2 viral shedding following coronavirus disease 2019 Vaccination among healthcare workers in Los Angeles, California. Open Forum Infect Dis. 2021; 8(11): ofab526. 25. Lopez Bernal J et al. Effectiveness of the PfizerBioNTech and Oxford-AstraZeneca vaccines on covid-19 related symptoms, hospital admissions, and mortality in older adults in England: test negative case-control study. BMJ. 2021;373:n1088. 26. Vasileiou E et al. Interim findings from firstdose

33. U.S. National Institutes of Health. ClinicalTrials. gov A study on the safety, tolerability and immune response of SARS-CoV-2 Sclamp (COVID-19) vaccine in healthy adults. ClinicalTrials.gov Identifier: NCT04495933. https://clinicaltrials.gov/ct2/show/ NCT04495933. 34. The University of Queensland. Update on UQ COVID-19 Vaccine. https://www.uq.edu.au/news/ article/2020/12/update-uq-covid-19-vaccine 35. University of Queensland COVID-19 Vaccine Still in Redevelopment, but Won’t Be Available Soon. https://www.abc.net.au/news/health/2021-04-26/ university-queensland-covid-19-vaccine-researchmolecular-clamp/100050240 36. Kandimalla R et al. Counting on COVID-19 vaccine: insights into the current strategies, progress and future challenges. Biomedicines 2021;9:1740.

mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study. Lancet. 2021;397(10285):1646-57. 27. Ismail SA et al. Effectiveness of BNT162b2 mRNA and ChAdOx1 adenovirus vector COVID-19 vaccines on risk of hospitalisation among older adults in England: an observational study using surveillance data. PHE Preprints. 2021. 28. Pritchard E et al. Impact of vaccination on SARSCoV-2 cases in the community: a population-based study using the UK’s COVID-19 Infection Survey. medRxiv. 2021:2021.04.22.21255913. 29. Hyams C et al. Effectiveness of BNT162b2 and ChAdOx1 nCoV-19 COVID-19 vaccination at preventing hospitalisations in people aged at least 80 years: a test-negative, case-control study. Lancet Infect Dis. 2021. 30. Lopez et al. Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant. New Engl J Med. 2021;385(7):585-94. 31. Aschwanden C. Why herd immunity for Covid is probably impossible. Nature 2021; 591: 520-522. 32. Phillips N. The coronavirus will become endemic. Nature 2021; 590:382-284.

37. Ledford H. Six months, 1.7 billion doses: what we’ve learnt about Covid vaccines. Nature 2021; 594: 164-167. 38. Pouwels KB et al. Impact of Delta on viral burden and vaccine effectiveness against new SARS-CoV-2 infections in the UK. medRxiv. 2021:2021.08.18.21262237 39. Stowe J, et al. Effectiveness of COVID-19 vaccines against hospital admission with the Delta (B.1.617.2) variant 2021 [Available from: https://khub.net/web/phe-national/publiclibrary/-/document_library/v2WsRK 3ZlEig/ view/479607266. 40. Public Health England. Duration of protection of COVID-19 vaccines against clinical disease. 9 September 2021. https://assets. publishing.service.gov.uk/government/uploads/ system/uploads/attachment_data/file/1017309/ S1362_PHE_duration_of_protection_of_COVID-19_ vaccines_against_clinical_disease.pdf 41. Brisotto G et al. IgG antibodies against SARSCoV-2 decay but persist 4 months after vaccination in a cohort of healthcare workers. Clin Chim Acta 2021; 523:476-482.

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Instrument management systems improve your practice Four case studies explore the benefits of making the switch

unning a dental practice takes a lot of work and whether it’s a private practice or part of a corporate, finding ways to save time, maximise efficiency and see more patients is a universal objective. Although all practices are different and face unique challenges, one common issue is optimal instrument management. For many practices, switching to an Instrument Management System (IMS®) provides innumerable benefits; however, practices may be reluctant to switch. Practices may have to reconfigure their sterilisation area, purchase new instruments or retrain employees, but the return is worth the investment. Whether it’s reduced sharps injuries, enhanced organisation, cost reductions, increased patient counts or another benefit, practices that adopt IMS see measurable results. Over the years, Hu-Friedy has profiled dental practices that implement IMS to explore the variety of ways that it positively impacts practices. Here are a few examples:

Reducing sharps injuries at PDS

orporates like Pacific Dental Services (PDS) are always looking for measurable, data-driven ways to improve safety

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January/February 2022

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You deserve the peace of mind and confid innovator of thefor cassette-based instrument management system, Hu-Friedy ispredictable proud innovator to bring of thethe cassette-based instrument manage you the outcomes modern design and functionality of the InfinitySteel Series Cassettes which include: that you are employing most contemporary method of processing Ensure predictable your littlest patients with Hu-Friedy Stainless Pedo Crowns. Ensure outcomes for your littlest patients with Hu-Friedy Stainle innovator of the cassette-based management system, Hu-Friedy is proud toLearn bring How to Scale in Perfeci You’ll quickly discover why dentists favor our impeccable fit.instrument Perfect for your patients. Easy for you.Crowns. Ensure predictable your littlest patients Pedo you the modernoutcomes designfor and functionality ofwith theHu-Friedy InfinityStainless Series Steel Cassettes which include: yououtcomes the modern design andHu-Friedy functionality of theCrowns. Infin innovator of the cassette-based instrument management system, Hu-F Ensure predictable for yourdentists littlest patients Stainless Pedo • An open hole pattern that promotes water flow throughout the cassette you the modern design and functionality of the Infinity Series Cassettes which include: You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. You’ll quickly discover why favorwith our impeccable fit.Steel Perfect for you BecauseYou’ll whenquickly it comes to thewhy perfect fit,favor Hu-Friedy is just right. you the modern design and functionality of the Infinity Series Cassette discover dentists our impeccable fit. Perfect offorHu-Friedy your patients. Easy for you. Hu-Friedy.com/Harmony You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. All company and product names are trademarks Mfg. Co., LLC, its affiliates or related companies, unless otherwise All company noted. and product names are trademark Anitopen holethe pattern that promotes water flow throughout the cassette •affiliates Anitopen hole pattern that promotes water flow th Because ••when comes perfect fit,system Hu-Friedy is right. Because toAll the perfect fit, Hu-Friedy isofjust right. All company andjust product names arereduces trademarks of Hu-Friedy Mfg. Co., LLC, its when orcomes related companies, unless otherwise noted. company and are trademarks Hu-Friedy Co., LLC Color-coded silicone rail significantly instrument contact •when Anitto open hole pattern promotes water flow throughout the cassette •when An open hole pattern that promotes water flow throughout the casse Compared tothat other leading scaler Data on file. Available upon request. 1)product Compared to other leading scaler Mfg. designs. D Because comes to 1)the perfect fit, that Hu-Friedy isdesigns. just right. Because itand comesallows to the perfect fit, Hu-Friedy isnames just right. 1) Compared to other leading scaler designs. Data on file. Available upon req 1) Compared to other leading scaler designs. Data on file. Available upon request. WHY DENTISTS STAINLESS STEEL PEDOMfg. CROWNS: Hu-Friedy Co., significantly LLC. All rights reserved. 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. HFL-482AUS/1220 • Color-coded silicone rail Hu-Friedy systemMfg. that reduces instrumen ©2020 Hu-Friedy Mfg. Co., significantly LLC. All rights reserved. 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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. All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, VISIT US AT HU-FRIEDY.COM/PerfectFit your practice visit Hu-Friedy.com/Infinity ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. its affiliates or related companies, unless otherwise noted.member of ©2017 Hu-Friedy Mfg. Co., LLC. Allis rights reserved. Hu-Friedy now a proud your practice visit Hu-Friedy.com/Infinity ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. Hu-Friedy is now a proud member of ©2021 Hu-Friedy Co.,AllLLC. rights reserved. ©2017 Hu-Friedy Mfg.Mfg. Co., LLC. rightsAll reserved.

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infection | CONTROL “Now that we’ve implemented these cassettes in approximately 100 practices, the feedback continues to be the same,” said one PDS compliance manager. “They really love the cassettes. They love the efficiencies of the cassettes.”

Keeping up with an expanded practice

Cassettes were fundamental to enabling Dr Lin’s practice to successfully expand: “To work without the Hu-Friedy IMS System would be pure chaos,” Dr Lin said. “I couldn’t tolerate it because instruments are going to get lost. Instruments will get damaged. It would be physically impossible to be able to see the number of patients that we see in a clinical day without the IMS System.

Simplifying complexity with implants

s Floss & Co in Chicago began to get busier, staff struggled at first to manage an increase in patients. There were simply not enough scalers to keep up and all instruments were either in use or in reprocessing. At first, Dr Izzy Naem looked to solve the problem by purchasing more instruments, but the real issue wasn’t the number of instruments. It was about improving process efficiencies and finding better ways to keep instruments organised. So, when Dr Naem instead decided to switch to the IMS system, the practice was able to save 15 minutes per patient per chair, relieving some of the stress that the staff was experiencing. “We don’t have to think about the instruments,” said Dr Naem. “Where they’re at, where to put them, where to store them. It’s all in the cassette. It was safer and it was easier. With improved efficiency and organisation, the practice was able to continue expanding and saw a 40% increase in new patients. By switching to IMS, Dr Naem was able to increase revenues and provide a better experience for his staff and growing patient base.

Improving practice efficiency at Green Bay

or Dr Steven Koos of ORA Oral Surgery & Implant Studio in Chicago, proper organisation is key to practice success. Since ORA specialises in various oral surgeries, it’s important to have setups ready for each unique procedure and organising the correct instruments can be complicated and time-consuming. Adopting IMS simplified instrument prep with the introduction of versatile and customisable cassettes that keep instruments organised and in one place for each procedure, from chairside to cleaning to storage. “My surgical team has really embraced the Hu-Friedy IMS Cassette System because it’s enabled them to combine the cleaning and sterilisation and organisation and storage of a vast array of instruments into one integrated package and it works well,” Dr Koos said. Additionally, implementing cassettes has made it easier to hire and train new team members and open new locations without affecting the quality of care provided to patients. “From a business perspective, when you’re increasing efficiency, when you’re increasing patient flow and you’re decreasing waste, you’re actually increasing your bottom line,” Dr Koos concluded.

Where can your practice improve? here are numerous advantages to adopting IMS and while each practice profiled here chose to make the switch for different reasons, the results are universal: better efficiency, improved safety, enhanced patient experience and an increased bottom line. Instrument management does not always get the attention it deserves from practice owners, but practices that commit to IMS experience the benefits in tangible, measurable ways. If your practice does not already use an instrument management system, you can request more information from a Hu-Friedy representative on how a cassette-based system can directly benefit your practice.

T hen Dr Edward Lin and his team at Orthodontic Specialists of Green Bay expanded from three doctors to four, the number of instruments used in their facility rose accordingly. Additionally, Dr Lin was concerned about protecting his investment in premium instruments. After trying other solutions with unsatisfactory results, the team began using IMS, enabling them to see 60 to 120 patients a day efficiently.

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For more information, visit www.hu-friedy.com/ims or contact Henry Schein on 1300-658-822 on in NZ call 0800-808-855.

January/February 2022

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Tips for dental hygienists to relieve and prevent common aches and pains

ental hygiene has always been a taxing profession both on the mind and the body. And hygienists who scale by hand instead of using ultrasonics may be noticing a few more physical aches and pains, especially if hand scaling. That pain is also not just in the hands, wrists and arms; hand scaling can also take a toll on the back, neck, shoulders and legs. Dental hygienists are at risk for conditions such as carpal tunnel syndrome, repetitive motion injuries and even chronic headaches. This pain can strike at any point during a hygienist’s career: Between 64% and 93% of dental professionals experience general musculoskeletal pain. In fact, musculoskeletal disorders are the leading reason for early retirement among dental clinicians. The New Year gives us all the opportunity to take a step back and revisit how we work and what we can change to

32 oral|hygiene

make our working lives better. So with this in mind, from body positioning to ergonomic instrumentation, here are a few options to help relieve pain in 2022.

Musculoskeletal pain Cause verage everyday hand scaling leads to repetitive motions, often in awkward positions, a recipe for pain and physical disorders that can derail a career.

Prevention ental hygienists can avoid pain and repetitive stress injuries with the following tips:

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clinical | EXCELLENCE Hygienists should be sure to ask their patients to position their heads at the end of the headrest to eliminate the need to reach over the empty space on the headrest.

“Harmony Scalers and Curettes reduce pinch force up to 65% and pressure on the tooth by 37%...”

Ergonomic equipment rgonomics should be a key consideration when choosing dental instruments and equipment.

The operator stool rom an ergonomic perspective, the operator stool is the most important chair in the treatment room. Proper positioning begins by adjusting the stool first and the patient second. A stool should be adjustable, with adequate lumbar, thoracic and arm support. It should allow for a space of three finger-widths behind the knee. If the stool has a tilting feature, tilt the seat forward between 5 and 15 degrees (If not, use an ergonomic wedge cushion). Saddle-seat stools may be the ideal option for dental hygienists - especially shorter people. This type of stool maintains the pelvis in a neutral position and allows the optimal curve of the spine.

Magnification and lighting nother helpful piece of ergonomic equipment is a loupe with a built-in headlight. Loupes provide magnification, so hygienists don’t have to bend to see the patient’s oral cavity better. Headlights move with the head, eliminating the need (and annoyance) to continually readjust the overhead light.

Tips for how hygienists can relieve and prevent common aches and pains Instrumentation nstruments can also make a significant difference. Hygienists should look for an instrument with an ideal weight and large diameter that provides a textured grip surface. These instruments will be easier to manoeuvre and cause less hand fatigue while probing, scaling and root planing. The science behind ergonomic design matters too. The new Harmony™ Ergonomic Scalers and Curettes (Hu-Friedy) are a good example.

34 oral|hygiene

The result of a cutting-edge iterative research and development process that analysed over 2.8 million data points, the Harmony Scalers and Curettes reduce pinch force up to 65% and pressure on the tooth by 37%. The handle features a recessed double-helix texture for optimal tactile sensitivity with less tactile fatigue. The silicone grips are extended by 30% to provide a secure and nimble grasp. Another essential factor in instrument ergonomics is the sharpness of the blade. Sharp scalers require less force to do the same amount of work, which can help both clinician and patient be more comfortable. Harmony Scalers and Curettes feature EverEdge™ 2.0 Technology with working ends that are 72% sharper out-of-the-box than the next leading competitor and remain 50% sharper after 500 strokes.

Simple wellness exercises efore undertaking any physical activity - from a morning run to a day of treating patients - it’s always a good idea to warm up the joints and muscles. Dental hygiene blogger Whitney DiFoggio (writing as “Teeth Talk Girl”) recommends a set of daily stretches for dental professionals that target the wrists, neck, shoulders and back.

DiFoggio writes that she tries to stretch as often as possible, between appointments and any time there’s a chance to move around. “A great time to stretch is when you’re going in and out of the room to take an x-ray,” she says. A regular yoga practice can also help maintain fitness for work without attending in-person classes to reap the benefits. Countless high-quality yoga videos are available for free online, such as the popular Yoga With Adrienne series on Amazon Prime. Notably, this series includes a video of yoga tips for the hands. Additionally, the Dental Yogis have written about the role of yoga within dentistry, posing the question, “Is Mindfulness the New Secret Weapon in Dentistry?”

Conclusion usculoskeletal pain is not rare nor even uncommon. There’s no shame in feeling pain as a dental hygienist, as it is fairly common for hygienists to experience this. The good news is that a few changes to your routine, posture, instruments or fitness regimen can do wonders for the body and can potentially extend your career by years of injury-free practice.

January/February 2022

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