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CPD CENTRE
infection | CONTROL
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Figure 1. An example of proper adaptation of a respirator against the side of the face (Survivon P2 surgical respirator ARTG 384806).
Masks and respirators: The inside story
By Emeritus Professor Laurence J. Walsh AO
22 oral|hygiene The COVID-19 pandemic has brought much greater attention to the risk factors that operate in the dental clinical setting because of droplets and aerosols and thus the importance of respiratory protection as one of the layers of defence.1,2
Masks and respirators perform multiple functions. This article will explore each of these functions and then go on to discuss some new antimicrobial technologies used in masks and respirators.
Containment
Firstly, masks and respirators contain the secretions of the wearer and reduce the generation of droplets and aerosols into the immediate environment. This principle explains the use of these during pandemics to contain these on the face of the user, rather than having them dispersed into the environment where they can infect others. Over the last three years, research in aerobiology has shown clearly that infectious aerosols are generated by the act of breathing, with an increased load of viruses produced during speaking, shouting, singing, coughing and sneezing, in increasing orders of magnitude. For this first purpose of containment, it is essential that the mask or respirator is adapted closely to the face so that expired air does not leak in large amounts from the periphery. Due to variations in facial shape, some individuals are unable to be properly fit tested with a surgical respirator and achieve a fully airtight fit for their respirator. An example of proper adaptation is shown in Figure 1. Surgical masks are not designed to be airtight, but rather to be adapted closely against the skin of the face. Not folding the mask out fully and not adapting the insert that covers the bridge of the nose are two common errors that result in air being directed away from the face of the wearer and into the general environment.
September/December 2022 clinical | EXCELLENCE
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Figure 1. Characteristic appearance of enamel white spot lesions on the cervical aspect of maxillary incisors. This site has low resting salivary flow and poor access to stimulated saliva. The image has been taken 2 weeks after an intensive oral hygiene regimen has been introduced. This explains why the following 3 features can be seen: (1) there are no visible deposits of dental plaque; (2) there is no gingivitis; and (3) a small rim of healthy enamel is seen at the cervical aspect of the white spot lesions, apical to the lower margin of the white spot lesions.
Lessons from watching white spot lesions
By Emeritus Professor Laurence J. Walsh AO
In clinical dental practice, one of the most common things that we do is to detect white spot lesions and monitor their progress to determine if they are progressing towards cavitation, undergoing arrest, or regressing. This article summarises, from the perspective of the author, some of the main lessons about watching white spot lesions and provides a number of clinical hints in interpreting what is happening in these lesions.
Hidden beneath
An active white spot lesion will each day be undergoing numerous cycles of mineral loss followed by remineralisation.1-4 Because an active white spot is covered by a cariogenic dental plaque biofilm that is producing multiple organic acids, the fluid in direct contact with the surface is not the saliva of the patients mouth but rather the plaque fluid. If using technologies that can detect acid production by dental plaque, such as GC TriPlaque ID gel, active white spot lesions will be found beneath the plaque which is producing the highest amounts of acid following a challenge with sucrose or another suitable substrate.4,5
26 oral|hygiene September/December 2022
Question 1. The largest amounts of both splatter and aerosol are generated by: a. Air polishing and ultrasonic scaling b. Triplex syringe c. High-speed handpieces d. Low-speed handpieces
Question 2. Level 3 fluid resistance is... a. 60 mm Hg b. 120 mm Hg c. 180 mm Hg d. 240 mm Hg
Question 3. The antimicrobial properties of some masks is achieved by incorporating antimicrobial metals into their manufacture including: a. Selenium b. Silver or Gold c. Zinc d. Copper e. All of the above
Question 4. The outermost and innermost layers of modern masks and respirators are produced using: a. Injection moulding b. 3D printing c. Electrospinning d. Thermoforming
Question 5. To be rated as P2/N95, a surgical respirator must be able to filter particles of 0.2 µm in size by over: a. 90% b. 93% c. 95% d. 97% Question 6. What percentage of the buccolingual width of a tooth must be affected by mineral loss for it to appear on a biteway x-ray? a. 10% b. 17% c. 23% d. 33% e. 50%
Question 7. Once detected, white spot lesions should be monitored to determine if they are: a. Progressing towards cavitation b. Undergoing arrest c. Regressing d. All of the above
Question 8. The application of a high concentration fluoride product can cause a white spot lesion to: a. Progress towards cavitation b. Undergo arrest c. Regress d. Become “frozen in time” e. All of the above
Question 9. Subsurface regeneration of white spot lesions, leading to their visible reversal, can be achieved using: a. A high concentration fluoride product. b. CPP-ACP via various delivery systems. c. Fluoride varnish. d. Silver fluoride.
Question 10. An active white spot is covered by: a. Saliva b. A cariogenic dental plaque biofilm c. An invisible layer of benign plaque d. Oral mucosal transudate
infection | CONTROL
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Why IMS will improve your practice
Running a practice takes a lot of work. 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.
Reducing sharps injuries
Large organisations like Pacific Dental Services (PDS) are always looking for measurable, data-driven ways to improve safety and ensure regulatory compliance across their network of dental 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.
“Now that we’ve implemented these cassettes in approximately 100 locations, the feedback continues to be the same,” said one PDS compliance manager. “Staff really love the cassettes. They love the efficiencies of the cassettes.”
Keeping up with expansion
As Floss & Co. 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 better 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 were experiencing.
“We don’t have to think about the instruments,” Dr Naem said. “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 organization, the practice was able to continue expanding and saw a 40 percent 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 efficiency
When Dr Edward Lin and his team at Orthodontic Specialists 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.
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
For Dr Steven Koos of ORA Oral Surgery & Implant Studio, proper organisation is key to practice success. Since ORA specialises in various oral surgery procedures, 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.
Where can you improve?
Chairside efficiency is the key to a productive practice. Maximizing this efficiency is possible when the exact procedural set ups needed for each patient are always at your fingertips. Hu-Friedy’s dental Instrument Management System standardises and combines the cleaning, sterilisation, storage and organisation of instruments in one integrated cassette system, creating real results that can save your practice up to 5-10 minutes per procedure. There 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.
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.
32 oral|hygiene September/December 2022
Question 11. Using an Instrument Management System can: a. Reduce sharps injuries. b. Enhance organisation. c. Reduce costs due to reduced instrument damage. d. 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. implementing cassettes at ORA Oral Surgery & Implant Studio has made it easier to hire and train new team members and open new locations without affecting the quality of care provided to patients.
a. True b. False
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%
infection | CONTROL
READ ME FOR Get organised and be efficient CPD with Signature Series Procedure Tubs
Signature Series Tubs are designed to match Hu-Friedy IMS instrument cassette rail colours and feature antimicrobial product protection. Together, procedure tubs and cassettes create the most efficient and organised system for managing instruments and consumable products.
The time savings achieved by using IMS (Instrument Management System) cassettes and procedure tubs allow staff to spend time on more value-added activities in the dental practice.
IMS and Tub System
Procedure tubs can be used as portable operatory drawers to store, organise and transport consumable materials to and from the storage/sterilisation area and the operatory. All of the materials needed for a specific procedure can be stored in the tub. A different tub and colour can be used for each different procedure type (e.g. crown & bridge, composite, etc). The Signature Series procedure tubs are available in colours that match IMS cassette rails, which allow the staff to match the tubs and cassettes by procedure.
An example of how it works:
Blue cassette rails and a blue tub may represent a composite procedure. All of the consumable materials for composite procedures can be stored and organised in the blue tub and instrumentation stored in the cassette with blue rails, allowing for quick identification.
Microban® Antimicrobial Product Protection
Microban protection is integrated into the tub and tub components during the manufacturing process. Microban technology works by interrupting key cell functions that allow the microorganisms to function, grow and reproduce.
Microban protection begins to work as soon as the microorganism comes into contact with the product surface and works continuously to inhibit the growth of microbes that can cause stain, odours and product degradation - for the lifetime of the product.
Standardises material set-up for every type of procedure
The Hu-Friedy IMS and Tub System increases efficiency of materials management and eliminates time-consuming tray preparation for every procedure. Tubs may be configured to meet your practice needs or are available as a complete tub.
Procedure tub colours match Hu-Friedy IMS cassette rail colours...
• Increasing practice organisation and workflow efficiency. • Allowing for quick identification of consumable products. • Providing aesthetic integration with IMS cassettes.
Locking covers...
• Protect items from airborne materials during transportation to the operatory and storage. • Adhere to infection control standards Microban® Antimicrobial Product Protection. • Microban inhibits the growth of microorganisms that can cause stains, odours and product degradation. • Allow for storage in central sterilisation or each operatory. • Tubs can be transported to the operatory prior to each procedure, eliminating inventory management of materials in each operatory.
For more information, visit www.hufriedygroup.com
34 oral|hygiene September/December 2022
Question 16. Signature Series Tubs are designed to store: a. All the instruments required for a procedure type. b. All the materials required for a procedure type. c. Both the instruments and materials required for a procedure type.
Question 17. Microban technology interrupts key cell functions that allow microorganisms to function, grow and reproduce: a. True b. False
Question 18. Signature Series procedure tubs are available in: a. Primary and secondary colours only. b. Custom colours to match your practice. c. ISO standard colours for dental procedures. d. Colours that match IMS cassette rails.
Question 19. Signature Series procedure tubs are designed to: a. Increase practice organisation. b. Increase workflow efficiency. c. Save on procedure set-up times. d. Safely store materials. e. All of the above.
Question 20. Locking lids protect tub contents from airborne materials during transportation to the operatory and during storage: a. True b. False
dentevents presents... dentevents presents... Infection Control Infection Control BOOT CAMP 2020 BOOT CAMP BOOT CAMP 2020
ON DEMAND ONLINE LEARNING PROGRAMME ON DEMAND ONLINE LEARNING PROGRAMME 26 VIDEOS - 6+ HOURS OF EDUCATION 26 VIDEOS - 6+ HOURS OF EDUCATION INTERACTIVE Q&A SUPPORT WEBINARS INTERACTIVE Q&A SUPPORT WEBINARS Presented by Professor Laurence J. Walsh AO 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 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 6 6 months, including the new guidelines from NHMRC (May 2019), Hand Hygiene Australia months, including the new guidelines from NHMRC (May 2019), Hand Hygiene Australia HOURS CPD HOURS CPD (Sept 2019) and the CDNA (Dec 2018) as well as recent changes in Australian Standards (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 and TGA regulations that are relevant to infection control. The course will provide a summary of how those changes interlink with one another. 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 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 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. along your questions in writing or in person for one of the Q&A sessions that will be held during the day.
COURSE TOPICS COURSE TOPICS
This one day course will cover changes in regulations and guidelines from 2018 to 2020 including: This one day course will cover changes in regulations and guidelines from 2018 to 2020 including: n n Risk-based precautions. Risk-based precautions. n n Hand hygiene and hand care practices. Hand hygiene and hand care practices. n n Addressing common errors in personal protective equipment. Addressing common errors in personal protective equipment. n n Biofilm reduction strategies. Biofilm reduction strategies. n n Efficiency-based measures to improve workflow in instrument reprocessing and patient changeover. Efficiency-based measures to improve workflow in instrument reprocessing and patient changeover. n n Correct operation of mechanical cleaners and steam sterilisers. Correct operation of mechanical cleaners and steam sterilisers. n n Wrapping and batch control identification. Wrapping and batch control identification. n n Requirements for record keeping for instrument reprocessing. Requirements for record keeping for instrument reprocessing. n n Correct use of chemical and biological indicators. Correct use of chemical and biological indicators.
FULL FULL UPDATE! UPDATE! All the changes to All the changes to Infection Control Infection Control Guidelines in Guidelines in 2020 2020
Professor Laurence Walsh AO is a clinically active specialist in special needs den-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 tistry who is based at the University of Queensland in Brisbane. Laurie has been teaching infection control and clinical microbiology for over 25 years at postgrad-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 uate 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 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 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 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 equip-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 ment; 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. 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 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. to various protocols, guidelines and checklists and manuals used in Australia.
REGISTRATION FEES REGISTRATION FEES
Dentists Dentists $660 inc$660 inc gst gst Others Others $330 inc$330 inc gst gst
n n On-Demand access to 26 Online Learning Videos On-Demand access to 26 Online Learning Videos (Over 6 hours of education). (Over 6 hours of education). n n Online Learning Companion Booklet. Online Learning Companion Booklet. n n Suggested Reading Material Booklet. Suggested Reading Material Booklet. n n Access to regular Q&A Webinar(s). Access to regular Q&A Webinar(s). n n Online Questionnaire to earn 6 Hours of CPD. Online Questionnaire to earn 6 Hours of CPD.
Infection Contol Boot Camp is presented by Dentevents, a division of Main Street Publishing Pty Ltd ABN 74 065 490 655 • www.dentevents.com • info@dentist.com.au Infection Contol Boot Camp is presented by Dentevents, a division of Main Street Publishing Pty Ltd ABN 74 065 490 655 • www.dentevents.com • info@dentist.com.au 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 LtdTel: (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
