Ludzkie koronawirusy - autor: Krzysztof Pyrć z Zakładu Mikrobiologii, Wydział Biochemii, Biofizyki i Biotechnologii, Uniwersytet Jagielloński, Kraków

Zastanawiasz się, jak wydać pracę doktorską, habilitacyjną lub monografię? Chcesz dokonać zmian w stylistyce i interpunkcji tekstu naukowego? Nic prostszego! Zaufaj Wydawnictwu Borgis – wydawcy renomowanych książek i czasopism medycznych. Zapewniamy przede wszystkim profesjonalne wsparcie w przygotowaniu pracy, opracowanie dokumentacji oraz druk pracy doktorskiej, magisterskiej, habilitacyjnej. Dzięki nam nie będziesz musiał zajmować się projektowaniem okładki oraz typografią książki.

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© Borgis - Nowa Stomatologia 1/2019, s. 27-33 | DOI: 10.25121/NS.2019.24.1.27
*Alicja Porenczuk1, Bartłomiej Górski2, Wioletta Bielas1, Dariusz Gozdowski3, Agnieszka Mielczarek1
The application of restorative material packed in blisters in cross infection control in restorative dentistry
Zastosowanie materiału wypełnieniowego pakowanego w blistry w zapobieganiu zakażeniom krzyżowym w stomatologii zachowawczej
1Restorative Dentistry Department, Medical University of Warsaw
Head of Department: Agnieszka Mielczarek, MD, PhD
2Department of Periodontology and Oral Diseases, Medical University of Warsaw
Head of Department: Professor Renata Górska, MD, PhD
3Faculty of Agriculture and Biology, Department of Experimental Design and Bioinformatics, Warsaw University of Life Sciences
Head of Department: Krzysztof Polanowski, PhD
Streszczenie
Wstęp. Procedury stomatologiczne są obarczone ryzykiem transmisji patogenów prowadzącej do wystąpienia zakażenia krzyżowego. Podejmowane są metody zapobiegawcze niedopuszczające do bezpośredniego kontaktu z zakażonymi tkankami pacjenta. Mniejszą uwagę przykłada się do zagrożeń pośrednich, takich jak zakażenie drobnoustrojami materiałów wypełnieniowych. Materiały wypełnieniowe porcjowane i pakowane w jednorazowe blistry mogą skutecznie wyeliminować zagrożenie wynikające z niezmierzonej transmisji mikroorganizmów do opakowania materiału.
Cel pracy. Celem badania była ocena wiedzy i podejścia polskich studentów stomatologii dotyczących ryzyka zakażenia materiałów wypełnieniowych podczas zabiegów rekonstrukcyjnych.
Materiał i metody. Przeprowadzono badanie ankietowe wśród studentów Wydziału Lekarsko-Dentystycznego Warszawskiego Uniwersytetu Medycznego, którzy otrzymali jednorazowe opakowanie materiału odtwórczego do wypełnienia wybranego ubytku w trakcie zajęć praktycznych.
Wyniki. Wszyscy studenci nabyli wiedzę teoretyczną dotyczącą problematyki zakażeń krzyżowych w czasie studiów. Mniej niż połowa z nich deklaruje zainteresowanie dodatkowymi zajęciami z tego tematu. Prawie wszyscy (96%) potwierdzili, że transmisja patogenów może nastąpić podczas zabiegu przy użyciu tego samego nakładacza do pobierania materiału wypełnieniowego ze strzykawki i jego nakładania do ubytku, choć jedynie 68% z nich stosuje odrębne nakładacze podczas zabiegu rekonstrukcyjnego. 100% studentów uważa, że pakowanie materiału wypełnieniowego w blistry może przyczynić się do zwiększenia bezpieczeństwa zabiegu poprzez zmniejszenie ryzyka zakażenia materiału wypełnieniowego.
Wnioski. Polscy studenci stomatologii wymagają dodatkowych zajęć poświęconych tematyce kontroli zakażeń krzyżowych w stomatologii zachowawczej. Materiały wypełnieniowe porcjowane i pakowane w jednorazowe blistry mogą przyczynić się do zwiększenia bezpieczeństwa pacjenta podczas zabiegów rekonstrukcyjnych.
Summary
Introduction. Dental procedures bear risk of pathogens transmission leading to cross--infection. Means of protection aim at preventing direct contact with patient’s infected tissues. Less attention is paid to indirect threats, such as the restorative material’s infection during treatment. Restorative materials portioned and packed in disposable blisters may effectively eliminate the risk of material’s contamination.
Aim. The aim of the study was to assess the knowledge and attitude of polish dental students on infection of dental restorative materials during treatment.
Material and methods. A survey was conducted among students of the Faculty of Dentistry at the Medical University of Warsaw, who were given disposable packages of the restorative material for cavity reconstruction during practical classes.
Results. All students gained theoretical knowledge on cross-infection control. Less than half declared need for more classes in this field. Almost all of them (96%) admitted that pathogens transmission may occur during restorative treatment where one spatula is used for both picking the material from the syringe and placing it in the cavity. Only 68% of them actually use separate instruments during restorative treatment. All of them think that packing of the material in separate blisters may increase safety during treatment through minimizing risk of the material contamination.
Conclusions. Polish dental students need more classes concerning cross-infection control in restorative dentistry. Restorative materials packed in disposable blisters may increase patients safety during restorative treatment.
Słowa kluczowe: zakażenia krzyżowe, stomatologia zachowawcza, materiały wypełnieniowe
Key words: cross-infection, restorative dentistry, restorative materials
Introduction
Dental procedures bear high risk regarding transmission of pathogens, such as bacteria, viruses and fungi, as both the dental staff and the patients may have contact with blood, saliva and respiratory secretions (1). The human hepatitis B/C virus (HBV/HCV), human immunodeficiency virus (HIV) and herpes simplex virus (HSV) may be listed among the most dangerous microorganisms, which can be transferred in a dental office. All patients should therefore be treated as potential bearers of infectious diseases, which would help to implement safety standards. Dental procedures involve direct and/or indirect contact with blood and other tissue fluids of the human organism. As a result, a transmission of contagious biological material from one patient to another, patient to the dental staff and vice versa and between members of the dental staff may occur (2). Such incidence is called cross-infection. Most practitioners pay attention to preventing cross-infection caused by direct contact with patient’s secretions, particularly blood and saliva. In restorative dentistry, the direct exposure may take place when using non-sterile instruments, not changing of burs, handpieces, endodontic files or other instruments, and/or injuries caused by non-sterile instruments during and after dental procedure, ex. used needles, scalpel blades, tip of endodontic file. The indirect contact with the infected material takes place through water spray created during the procedure and may be even more risky for both the patients and the dental staff than the direct exposure. The aerosol containing the patient’s secretions and pathogens scatters around the dental office and its closest environment, while water droplets settle on dental instruments and all surfaces bearing risk of cross-infection. To prevent both the direct and indirect risk factors of cross-infection, means of surface disinfection, disposable materials (needles, blades, syringes and other), means of personal protection (disposable rubber gloves, eyewear and masks) and other (protective sheets for the dental unit and handpieces) are used. Moreover, disinfection and sterilization of the non-disposable instruments, dental unit and working surfaces are applied after each procedure. Implementing knowledge among the dental staff on ways of transmission of the pathogens and their elimination is indispensable (3). Such training should be a part of an undergraduate dental course, as students’ understanding of the paths of transmission of infectious diseases would establish a well-protected environment in the future. Unfortunately, the knowledge and attitude towards cross-infection control vary between dental schools and countries, which is illustrated in table 1. A study conducted in Saudi Arabia (4) showed satisfactory knowledge and positive attitude of the students of dentistry regarding cross-infection. They were able to recognize risks of percutaneous injuries with infected needles and could identify means of self-protection, such as gloves, masks and eyewear (4). In the restorative dentistry, the operating area should be well protected from the scatter by means of a rubber dam, which significantly reduces the level of the spread microorganisms (1). It also protects dental instruments from touching other parts of the oral cavity than the lesion. Although there is a high degree of acceptance of the rubber dam, it’s not used on a routine basis in restorative dentistry (5). A study proceeded by Kumar et al. (1) showed that only 29.8% of the students in India routinely used rubber dam during restorative procedures. Likewise, as much as 49.6% of students in Malaysia do not use a rubber dam during treatment (6). Although the students of dental schools are well aware of the risk caused by transmission of the pathogens, there is a risk for abandoning of the taught procedures after graduation. A study conducted in British dental offices showed that more than 50% of the British post-graduates stops using rubber dam after leaving school (7). The majority of the Irish and the Welsh dentist (63%) do not use a rubber dam for any restoration (7). Similar situation has developed in Turkey, where rubber dam isolation is used in 23.7% of cases (8). Therefore, mandatory training on cross-infection control should be implemented during undergraduate training, with an impact on post-graduate regular updates.
Tab. 1. Percentage share of used and not used means of protection against cross infection in restorative dentistry in the opinion of respondents
Author, year of publicationMeans of protection against cross-infectionPercentage share of positive responses (use means of protection)Percentage share of negative responses (do not use means of protection)
Kumar et al., 2009 (1)Wearing disposable rubber gloves99.30.7
Wearing face mask96.53.5
Changing hand pieces after every patient16.383.7
Changing saliva ejector after every patient69.530.5
Changing burs after every patient20.679.4
Rubber dam isolation29.870.2
Shah et al., 2009 (3)Wearing disposable rubber gloves1000
Wearing face mask6535
Single-use burs5941
Disposable coverings for suction cables, light curing lamps and light handles7921
Al-Essa and AlMutairi, 2017 (4)Wearing disposable rubber gloves98.1-1000-1.9
Wearing face mask98.1-1000-1.9
Wan Noorina et al., 2016 (6)Wearing disposable rubber gloves99.60.4
Wearing face mask97.12.9
Rubber dam isolation50.449.6
The reconstruction of tooth’s tissues involves using resin-based materials, built of a matrix, containing an organic blend of monomers, and an inorganic filler. Their setting is based on a reaction of polymerization, which is initiated by light of a specific wave length. Due to the fact that the restorative material may spontaneously set by a visible light, they are packed in a syringe containing 2-5 g of the material, which provide good isolation from the outer environment. During restorative treatment blood, saliva and other tissue fluids can get transmitted to a syringe containing the restorative material, especially when the same spatula is used for collecting and placing the material it in the patient’s mouth. This seems to be a forgotten factor of cross-infection, as there is no research conducted on it. The literature shows a method of the instruments’ tips decontamination during the restorative treatment. The disinfection of the instruments should be performed with disinfection agents, such as 70% ethanol or 2% glutaraldehyde. This method’s concept establishes that the tip of the instrument is disinfected each time before picking of a new material’s portion from the syringe (9). However, the immersion time seems to be too long for the clinical conditions. Also, the effectiveness of the disinfection solutions proved not to be satisfactory. Both mentioned factors suggest this technique is time consuming and unreliable (9). Using two separate spatulas, each for collecting and placing of the material in the cavity, is still recommended for preventing of the restorative material from infection. It requires a presence of an active dental assistant and more attention from the dental staff, so as not to swap the instruments. It may also increase the treatment cost, as additional instruments need to be disinfected and sterilized. The materials science provides new solutions to eliminate problems concerning potential infection of the restorative materials. Recently introduced light-cured resin-based restorative material Next (DENTAL LIFE SCIENCES (mfg Ltd., Wigan, UK)), can be used for all cavity classes reconstruction. The material is portioned and packed into disposable small packages called blisters (fig. 1). The composition of the material is made of a mixture of dimethacrylates (bis-GMA, TEGDMA, UDMA, bis-EMA), aluminum-barium-silicon glass, pyrogenic silica, photo initiators, stabilizers and pigments. The amount of the added filler is 78 wt. %. Its uniqueness is expressed in its sterile, disposable packaging. The material is accessible in portions of 0.07 and 0.2 g, and is dedicated for a single patient only.
Fig. 1. Resin-based restorative material Next packed in disposable blisters, both sides view
Aim
The aim of the study was to evaluate the knowledge and attitude of the Polish students of the Faculty of Dentistry and Medicine, Medical University of Warsaw regarding methods of preventing cross-infections of the restorative materials during treatment.
Material and methods

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Piśmiennictwo
1. Kumar S, Sharma J, Duraiswamy P, Kulkarni S: Infection control practices among undergraduate students from a private dental school in India. Rev Odonto Ciênc 2009; 24(2): 124-128.
2. Centers for Disease Control and Prevention: Guidelines for Infection Control in Dental Health-Care Settings 2003. MMWR 2003; 52(No. RR-17): 1-76.
3. Shah R, Collins JM, Hodge TM, Laing ER: A national study of cross infection control: “Are we clean enough?”. Brit Dent J 2009; 207(6): 267-274.
4. Al-Essa NA, AlMutairi MA: To what extent do dental students comply with infection control practices? Saudi J Dent Res 2017; 8: 67-72.
5. Feierabend SA, Matt J, Klaiber B: A comparison of conventional and new rubber Dam systems in dental practice. Oper Dent 2011; 36(3): 243-250.
6. Wan Noorina WA, Abdullah D, Goo CL, Rahman MM: Practice of infection control amongst clinical dental students of three public universities in Malaysia. Eur J Dent Med 2016; 8(1-3): 6-11.
7. Mala S, Lynch CD, Burke FM, Dummer PMH: Attitudes of final year dental students to the use of rubber dam. Int. Endodontic J 2009; 42: 632-638.
8. Yüzbasioglu E, Saraç D, Canbaz S et al.: A survey of cross-infection control procedures: knowledge and attitudes of Turkish dentists. J Appl O Sci 2009; 17(6): 565-569.
9. Lopes LG, Máximo AA, Taveira CT et al.: How to avoid cross contamination during handling resin composites with spatulas. Rev Odontol Bras Central 2016; 25(72): 94-97.
10. Werle SB, Santos RCV, Dotto PP: Contamination of composite resins in dental clinics of a teaching institution. Pesqui Bras Odontopediatria Clin Integr 2012; 12: 473-476.
11. Ferreira RO, Caires NCM: Assessment of contamination of composite resins tubes in Dental School Clinics in a private university at Manaus-AM. J Health Sci Inst 2012; 30: 206-210.
otrzymano: 2018-11-12
zaakceptowano do druku: 2019-01-30

Adres do korespondencji:
*Alicja Porenczuk
Zakład Stomatologii Zachowawczej Warszawski Uniwersytet Medyczny
ul. Miodowa 18, 00-246 Warszawa
tel.: +48 (22) 502-20-32
sekretariat.zachowawcza@wum.edu.pl

Nowa Stomatologia 1/2019
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