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hygiene tribune Dental Tribune Middle East & Africa Edition | May-June 20156B cording to the researchers, the project achieved a caries reduc- tion of up to 34 per cent for all schools included in the study and a reduction in new cari- ous lesions of up to 41 per cent for the most compliant schools. This points to the positive effect of the use of fluoridated tooth- paste administered by school- teachers via an enhanced school oral health programme. “This project emphasises the ne- cessity of engaging the school as well as family and schoolteach- ers,” said lead researcher Prof. Poul Erik Petersen, from the De- partment for Global Oral Health and Community Dentistry at the university’s School of Dentistry. “Globally, very few school health programmes are evaluated sci- entifically. This research project has provided sound information and will thus contribute to the promotion of preventive meas- ures in school oral health pro- grammes,” Petersen concluded. According to Petersen, the ex- perience gained from the study could offer new insight into the global fight against poor oral health in children. Further- more, he expressed the hope that the research results would assist ministries of health, pub- lic health administrators and oral health planners in low- and middle-income countries in Asia in developing evidence-based school health programmes. In Asia, the number of children suffering pain and discomfort resulting from poor oral health, in addition to missing school lessons, is increasing. High lev- els of tooth decay in developing countries such as Thailand are primarily related to poor living conditions, the high intake of sugars, poor oral hygiene prac- tices, low exposure to fluoride for disease prevention, as well as limited availability of and ac- cessibility to preventive dental health services. According to figures of the FDI World Dental Federation, be- tween 60 and 90 per cent of schoolchildren worldwide have caries but the majority of dental decay remains untreated due to inappropriate, unaffordable or unavailable oral health care services. The study, titled “School-based intervention for improving the oral health of children in south- ern Thailand”, was published in the March issue of the Commu- nity Dental Health journal. By Eve Cuny, USA M ore than three decades have passed since the emergence of human immunodeficiency virus (HIV) as a global pandemic. More than any other infection, it is possible to single out HIV as the primary stimulus for changing infection control practices in dentistry. Prior to the mid-1980s, it was uncommon for dentists and allied professionals to wear gloves during routine dental procedures. Many dental clin- ics did not use heat sterilisation, and disinfection of surfaces was limited to a cursory wipe with an alcohol-soaked gauze sponge. This was despite our knowledge that hepatitis B virus (HBV) had been spread in clusters in the offices and clinics of infected dentists and that dentists were clearly at occupational risk for acquiring HBV. Today, many take safe dental care for granted, but there is still reason to remain vigilant in ensuring an infection-free environment for providers and patients. HIV has fortunately proven to be easily controlled in a clinical environment using the same precautions as those ef- fective for preventing the trans- mission of HBV and hepatitis C virus.[1] These standard precau- tions include the use of personal protective attire, such as gloves, surgical masks, gowns and pro- tective eyewear, in combination with surface cleaning and disin- fection, instrument sterilisation, hand hygiene, immunisations and other basic infection control precautions. Sporadic reports of transmission of blood-borne diseases associated with den- tal care continue, but are most often linked to breaches in the practice of standard precautions. [2] Emerging and re-emerging in- fectious diseases present a real challenge to all health care pro- viders. Three of the more than 50 emerging and re-emerging infectious diseases identified by the Centers for Disease Control and Prevention and the World Health Organization (WHO) in- clude Ebola virus disease (EVD), pandemic influenza and severe acute respiratory syndrome. [3, 4] These previously rare or unidentified infectious diseases burst into the headlines in the past several years when they ex- hibited novel or uncharacteristic transmission patterns. Concern about emerging infec- tious diseases arises for several reasons. When faced with a par- ticularly deadly infectious dis- ease such as EVD, which can be spread through contact with an ill patient’s body fluids, health care workers are naturally con- cerned about how to protect themselves if an ill patient pre- sents to the dental clinic. With diseases such as pandemic in- fluenza and severe acute res- piratory syndrome, which may be spread via inhalation of aero- solised respiratory fluids when a patient coughs or sneezes, the concern is whether standard precautions will be adequate. In addition to standard precau- tions, treating patients with these diseases requires the use of transmission-based precau- tions. These encompass what are referred to as contact, drop- let and airborne precautions for diseases with those specific routes of transmission. Trans- mission-based precautions may include patient isolation, placing a surgical mask on the patient when he or she is around other people, additional protective at- tire for care providers, and in some cases the use of respira- tors and negative air pressure in a treatment room. In most cases, patients who are contagious for infections requiring droplet or airborne precautions should not be treated in a traditional dental clinic setting. Updating a patient’s medical history at each visit will assist dental health professionals in identifying patients who are symptomatic for infectious dis- eases. Patients with respiratory symptoms, including productive cough and fever, should have their dental treatment delayed until they are no longer sympto- matic. Additionally, health care professionals who are sympto- matic should refrain from com- ing to work until they have been free of fever without taking fe- ver-reducing medication for 24 hours. In most cases, a patient with symptoms as severe as those experienced with EVD will not present for dental care and therefore extraordinary screen- ing and protection protocols are not recommended. If a patient is suspected of having a highly contagious disease, he or she should be referred to a physi- cian, hospital or public health clinic. Dental professionals should take action to remain healthy by be- ing vaccinated according to ac- cepted public health guidelines, understanding that the recom- mendations may differ accord- ing to country of residence. Performing hand hygiene pro- cedures at the beginning of the day, before placing and after re- moving gloves, changing gloves for each patient, wearing a clean mask and gown or laboratory coat, and wearing protective eyewear are all positive actions that help prevent occupational infections. In addition, clean- ing and heat sterilisation of all instruments and disinfection of clinical surfaces ensure a safe environment for patients. There is solid evidence that dental care is safe for patients and provid- ers when standard precautions are followed, but patients and dental health care workers are placed at risk when precautions are compromised and breaches occur. Editorial note: A complete list of references is available from the publisher. Infection control in an era of emerging infectious diseases Infection control in the dental practice includes washing hands, wearing gloves, using disposable supplies, and disinfect- ing reusable materials properly. (Photograph: Bork/Shutterstock) ByDentalTribuneInternational C OPENHAGEN, Den- mark: Researchers from the University of Copen- hagen have examined the bene- fits of enhanced oral health pro- motion combined with a closely supervised toothbrushing pro- gramme in schools in southern Thailand. The two-year study aimed to establish an effective model for the fight against the increasing burden of tooth de- cay among children in Asia. The research project, which was based on the World Health Organization’s Health-Promot- ing Schools concept, focused on increasing awareness of the im- portance of oral health in order to foster a healthy school envi- ronment and encourage regu- lar dental care habits in young children, including the use of effective fluoridated toothpaste. Over 24 months, the researchers compared the effects of closely supervised toothbrushing with a toothpaste containing 1,450 ppm fluoride and 1.5% argi- nine to customary oral hygiene practices in the control group. The study was conducted in the Songkhla province in Thai- land and involved 15 schools and 3,706 preschool students, of whom 1,940 were in the inter- vention group and 1,766 in the control group. During the course of the study, dental plaque scores significant- ly improved among the children in the intervention group. Ac- Tackling poor oral health around the globe The research project in southern Thailand focused on increasing awareness of the importance of oral health in order to foster a healthy school environment and encourage regular dental care habits in young children. (Photograph: Stephane Bidouze/Shutterstock)