Infection Control

Online course on
Infection Control in a Dental Practice

INFECTIOUS DISEASES
Classification

Further Content:

	Diseases with importance to dental operators:
Hepatitis	Hepatitis B
Herpetic infections	Herpes 1
Respiratory infections
Sexually transmissible disease	AIDS

Other disease of interest to the dental operator

The mechanism by which these diseases are transmitted are as follows:

AEROSOL*
SPATTER
DIRECT CONTACT
COMMON VEHICLE

General Concepts

Aseptic Techniques

Laboratory Asepsis

Infection Control Program

CPD

* Aerosols consist of invisible contaminants suspended in the air. They are generated by high speed water cooled hand pieces, ultrasonic scalers, use of the "prophy jet" type tooth cleaning devices and ultrasonic instrument cleaning machines Aerosols can be minimized by:

Use of high speed suction
Use of new electric high speed hand pieces
Proper air ventilation
Electronic air deionizers
Covers on ultrasonic cleaning machine

Hepatitis B

Caused by Hepatitis B Virus (HBV)

Infection manifests about equally among the following three differently clinical presentations: jaundice; mild to severe flu like symptoms; and asymptotic.

The "high risk" patient or those who indulge in "high risk" activities are most prone to developing this infection.

Although most patients recover, some become chronic carriers of the disease with no symptoms.

Hepatitis B carriers are extremely infectious, especially via saliva and blood. There are in excess of 200,000,000 carriers world wide.

A dental operator who becomes a carrier may transmit the disease to patients and his family. In some countries carriers are not allowed to practise.

The most severe consequence of becoming a carrier is the development of Hepatic cancer within 10 years.

The most severe consequence of Hepatitis B is death.

The most sever complication is supra infection with Delta Hepatitis, which requires the presence of HBV infection.

The Heptavax or Recombivax vaccines are effective in providing immunity against Hepatitis B and Delta Hepatitis.

A booster vaccine is recommended every 5 years.

Antibody testing should be done within 6 months of the last injection or booster.

Herpes 1

Caused by Herpes Simplex Virus (HSV)
.
Primary infection occurs during childhood or adolescence and is characterized by fever, malaise and a gingivostomatitis.

40% of patients will have recurring infections for the remainder of their lives.

The recurrent lesions consist of clusters of vesicles on the perilabial skin, lips, attached gingiva and hard palate.

The vesicular fluid is highly contagious, thus contact with lesions and saliva must be avoided.

HSV may infect finger(s) of dental operators. The wearing of gloves causes further spread of the vesicular fluid. During infections the dental operator cannot practice.

HSV may infect the eye and damage the cornea resulting in visual impairment.

(AIDS) Acquired immune deficiency syndrome

Caused by the Human Immunodeficiency Virus (HIV)

Currently there are 2 strains of HIV which may cause AIDS: HIV-1 and HIV-2

HIV-1 is the cause of most AIDS cases and is said to originate from Central Africa. HIV-2 originates from West Africa with 150 cases in Europe and several hundred cases in the USA.

HIV attacks the T-4 lymphocytes which results in the gradual loss of normal immune defensive mechanisms.

The "high risk" patients or those who indulge in "high risk" activities are most prone to develop this infection.

HIV infection manifests in 4 basic stages: Stage 1, asymptotic carrier; Stage 2, generalized lymphoadenopathy; Stage 3, AIDS related complex (ARC); and Stage 4, AIDS.

A carrier state exists in all patients from the moment of first infection until the final stage.

The most infectious state is Stage 1 and the least infectious is Stage 4. HIV is at least a thousand fold less infectious than HBV.

HIV positive patients are mainly infectious via their blood and the saliva may be contaminated.

Other disease of interest to the dental operator

Disease	Cause	Route of transmission	Potential Complications
AIDS	Virus	Saliva, blood	Death, Carrier state
Chicken pox	Virus	Saliva, blood	Conjunctivitis, shingles, encephalitis
Common cold	Virus	Saliva, blood	Temporary disability
Hepatitis A	Virus	Oral-fecal	Disability
Hepatitis B	Virus	Saliva, blood	Chronic disability, carrier state, hepatic cancer, death
Delta Hepatitis	Virus	Saliva, blood	Disability, death
Herpetic Conjunctivitis	Virus	Saliva, blood	Potential blindness, partial loss of vision
Herpes simplex	Virus	Saliva, blood	Painful lesions, disability, death in new-born children
Infectious mononucleosis	Virus	Saliva, blood	Temporary disability
Herpetic whitlow	Virus	Saliva, vascular fluid	Extreme pain, disability
Influenza	Virus	Saliva, spatter	Death
Measles	Virus	Saliva, nasal droplets	Temporary disability, encephalitis
Rubella	Virus	Saliva, nasal droplets	Congenital defects, infant death
Mumps	Virus	Respiratory	Temporary disability, sterility (men)
Pneumonia	Virus/ Bacteria	Respiratory droplets	Disability, death
Gonorrhoea	Bacteria	Sexual contact	Arthritis, female sterility, infant blindness
Staphylococcus infections	Bacteria	Saliva spatter	Skin lesions, osteomyelitis, death
Streptococcus infections	Bacteria	Saliva, blood	Rheumatic heart, kidney problems, death
Syphilis	Bacteria	Sexual contact, congenital	Central nervous damage, death
Tuberculosis	Bacteria	Saliva droplets	Disability, death

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