- Email: [email protected]
Reporting beliefs and behaviors
surfaces. Statistically, only the type of restoration and the cavity size significantly influenced the fracture rate of the teeth evaluated. Discussion.—Endodontically treated teeth that were restored with prosthetic restorations had a significantly lower mean fracture rate than those restored with fillings. In addition, the number of surfaces involved with caries altered the fracture rate of the tooth, with teeth having cavities on up to three surfaces successfully restored using composite filling material. Metal posts did not improve fracture rates.
Clinical Significance.—The restorations and fillings discussed included amalgam, gold, GIC, and composite. All gold partial crowns achieved results comparable to full-coverage crowns. GIC was used as a temporary filling after endodontic treatment, and teeth restored with GIC showed a significantly higher fracture rate than other restored teeth, with just 63.0% of those restored with GIC surviving 9.7 years without fracture. The second-highest mean fracture rates were noted with amalgam, perhaps because these
materials cannot stabilize the tooth or the cavities prepared for amalgam restorations require undercuts that can weaken tooth structure. Composites offer adhesion that protects teeth more effectively from fracturing compared to non-adhesive materials. The fracture resistance of teeth with composite restorations was greater than for those filled with amalgam. Awareness of the performance of the various materials will help clinicians determine the best choice of restoration or filling. Further studies are needed to assess the performance of newer materials and methods.
Dammaschke T, Nykiel K, Sagheri D, et al: Influence of coronal restorations on the fracture resistance of root canal-treated premolar and molar teeth: A retrospective study. Austral Endod J 39:48-56, 2013 Reprints available from T Dammaschke, Dept of Operative Dentistry, Albert-Schweitzer-Campus 1, Bldg W 30, Waldeyerstr 30, 48149, M€ unster, Germany; e-mail: [email protected]
Occupational Exposures Reporting beliefs and behaviors Background.—Exposure-prone procedures are invasive procedures that carry the risk of injury to a healthcare worker or patient involving the exposure to blood or other infectious fluids or materials. Most of the procedures carried out by dentists, dental hygienists, and other dental workers are exposure prone, so it is important that all are aware of the risk and that all practice safe methods to minimize occupational exposures. The evidence indicates that dental professionals may be under-reporting occupational exposures, although the reasons for this under-reporting are unclear. Dentists’ current reporting behaviors and their beliefs about reporting occupational exposures to blood and other oral fluids were evaluated through a cross-sectional survey. Methods.—Questionnaires were mailed to a random sample of dentists in Scotland. These surveys assessed occupational exposure policies and procedures as well as recent occupational exposure incidence and current management. The dentists’ beliefs regarding the reporting of occupational exposures to blood or saliva were measured using theoretical constructs based on the theory of planned
behavior, which have demonstrated an ability to influence behavior in general dental practice. Forty-two percent of the dentists responded to the survey. Results.—The responses revealed all practices had a protocol or procedure in place to report sharps injuries suffered by the dental team. Dentists were not as familiar with protocols that handle specific types of exposures, such as mucocutaneous versus blood splash protocols. Eighty-two percent of respondents had protocols for mucocutaneous blood exposures, and 66% had protocols for other blood splash exposures. Fifty-eight percent of the practices had mucocutaneous saliva exposure protocols, and 50% had protocols for other mucocutaneous saliva exposures. Forty-eight percent of practices had protocols for reporting patients’ exposures to blood or saliva from dental staff members (Fig 1). Eighty-four percent of the dentists had no exposures to patient blood or saliva in the preceding 12 months. Seventeen dentists had one or more exposures, and two
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Fig 1.—Percentage of practices with protocols by exposure type. (Courtesy of Leavy P, Templeton A, Young L, et al: Reporting of occupational exposures to blood and body fluids in the primary dental care setting in Scotland: An evaluation of current practice and attitudes. Br Dent J 217:E7, 2014.)
had occupational injuries that may or may not have included exposure to blood or saliva. Six of the dentists who had exposures did not report the exposure to anyone, six reported it to their practice manager and local occupational health service, two reported it only to the practice manager, and three filed reports with various combinations of the above plus hospital accident and emergency personnel. Respondents also rated the importance, need, ease, and practicality of reporting their exposures. Reporting patient exposures were viewed as important, necessary, and practical. Dentists viewed their intention to report patient exposures as significantly more important than their intention to report personal exposures. They did not believe that reporting exposures would result in their colleagues losing faith in their competence. Dentists had no strong feelings about their ability to find the time to report, to assess the source patient’s risk of communicable disease, or to assess the risk of disease transmission based on the type of exposure. The process of reporting was seen as fairly easy. Thirtyeight dentists also completed a free-text section, with most discussing risk assessment, risk management, and concerns about occupational health services. Concerns related to risk management focused on efforts to prevent and minimize occupational exposures through the use of personal protective equipment, safe techniques, and clear protocols. There was some degree of
222
Dental Abstracts
confusion about how the occupational health service operates, the purpose of reporting the exposures, and the view that occupational health services do not offer any help or advice beyond what dentists can provide themselves. Discussion.—Dentists tend to have positive beliefs about reporting occupational exposures, but their practices did not always match up to their intentions.
Clinical Significance.—Dentists are just one part of the equation. Additional surveys should include dental hygienists and other dental staff to determine a more accurate picture of exposure incidents and reporting philosophies and practices. It is important to understand what barriers to reporting may exist and to improve reporting behaviors.
Leavy P, Templeton A, Young L, et al: Reporting of occupational exposures to blood and body fluids in the primary dental care setting in Scotland: An evaluation of current practice and attitudes. Br Dent J 217:E7, 2014 Reprints available from P Leavy, Abban St Dental Clinic, 22A Abban St, Inverness, IV3 8HH; e-mail: [email protected]
Clinical Significance.—The restorations and fillings discussed included amalgam, gold, GIC, and composite. All gold partial crowns achieved results comparable to full-coverage crowns. GIC was used as a temporary filling after endodontic treatment, and teeth restored with GIC showed a significantly higher fracture rate than other restored teeth, with just 63.0% of those restored with GIC surviving 9.7 years without fracture. The second-highest mean fracture rates were noted with amalgam, perhaps because these
materials cannot stabilize the tooth or the cavities prepared for amalgam restorations require undercuts that can weaken tooth structure. Composites offer adhesion that protects teeth more effectively from fracturing compared to non-adhesive materials. The fracture resistance of teeth with composite restorations was greater than for those filled with amalgam. Awareness of the performance of the various materials will help clinicians determine the best choice of restoration or filling. Further studies are needed to assess the performance of newer materials and methods.
Dammaschke T, Nykiel K, Sagheri D, et al: Influence of coronal restorations on the fracture resistance of root canal-treated premolar and molar teeth: A retrospective study. Austral Endod J 39:48-56, 2013 Reprints available from T Dammaschke, Dept of Operative Dentistry, Albert-Schweitzer-Campus 1, Bldg W 30, Waldeyerstr 30, 48149, M€ unster, Germany; e-mail: [email protected]
Occupational Exposures Reporting beliefs and behaviors Background.—Exposure-prone procedures are invasive procedures that carry the risk of injury to a healthcare worker or patient involving the exposure to blood or other infectious fluids or materials. Most of the procedures carried out by dentists, dental hygienists, and other dental workers are exposure prone, so it is important that all are aware of the risk and that all practice safe methods to minimize occupational exposures. The evidence indicates that dental professionals may be under-reporting occupational exposures, although the reasons for this under-reporting are unclear. Dentists’ current reporting behaviors and their beliefs about reporting occupational exposures to blood and other oral fluids were evaluated through a cross-sectional survey. Methods.—Questionnaires were mailed to a random sample of dentists in Scotland. These surveys assessed occupational exposure policies and procedures as well as recent occupational exposure incidence and current management. The dentists’ beliefs regarding the reporting of occupational exposures to blood or saliva were measured using theoretical constructs based on the theory of planned
behavior, which have demonstrated an ability to influence behavior in general dental practice. Forty-two percent of the dentists responded to the survey. Results.—The responses revealed all practices had a protocol or procedure in place to report sharps injuries suffered by the dental team. Dentists were not as familiar with protocols that handle specific types of exposures, such as mucocutaneous versus blood splash protocols. Eighty-two percent of respondents had protocols for mucocutaneous blood exposures, and 66% had protocols for other blood splash exposures. Fifty-eight percent of the practices had mucocutaneous saliva exposure protocols, and 50% had protocols for other mucocutaneous saliva exposures. Forty-eight percent of practices had protocols for reporting patients’ exposures to blood or saliva from dental staff members (Fig 1). Eighty-four percent of the dentists had no exposures to patient blood or saliva in the preceding 12 months. Seventeen dentists had one or more exposures, and two
Volume 60
Issue 4
2015
221
Fig 1.—Percentage of practices with protocols by exposure type. (Courtesy of Leavy P, Templeton A, Young L, et al: Reporting of occupational exposures to blood and body fluids in the primary dental care setting in Scotland: An evaluation of current practice and attitudes. Br Dent J 217:E7, 2014.)
had occupational injuries that may or may not have included exposure to blood or saliva. Six of the dentists who had exposures did not report the exposure to anyone, six reported it to their practice manager and local occupational health service, two reported it only to the practice manager, and three filed reports with various combinations of the above plus hospital accident and emergency personnel. Respondents also rated the importance, need, ease, and practicality of reporting their exposures. Reporting patient exposures were viewed as important, necessary, and practical. Dentists viewed their intention to report patient exposures as significantly more important than their intention to report personal exposures. They did not believe that reporting exposures would result in their colleagues losing faith in their competence. Dentists had no strong feelings about their ability to find the time to report, to assess the source patient’s risk of communicable disease, or to assess the risk of disease transmission based on the type of exposure. The process of reporting was seen as fairly easy. Thirtyeight dentists also completed a free-text section, with most discussing risk assessment, risk management, and concerns about occupational health services. Concerns related to risk management focused on efforts to prevent and minimize occupational exposures through the use of personal protective equipment, safe techniques, and clear protocols. There was some degree of
222
Dental Abstracts
confusion about how the occupational health service operates, the purpose of reporting the exposures, and the view that occupational health services do not offer any help or advice beyond what dentists can provide themselves. Discussion.—Dentists tend to have positive beliefs about reporting occupational exposures, but their practices did not always match up to their intentions.
Clinical Significance.—Dentists are just one part of the equation. Additional surveys should include dental hygienists and other dental staff to determine a more accurate picture of exposure incidents and reporting philosophies and practices. It is important to understand what barriers to reporting may exist and to improve reporting behaviors.
Leavy P, Templeton A, Young L, et al: Reporting of occupational exposures to blood and body fluids in the primary dental care setting in Scotland: An evaluation of current practice and attitudes. Br Dent J 217:E7, 2014 Reprints available from P Leavy, Abban St Dental Clinic, 22A Abban St, Inverness, IV3 8HH; e-mail: [email protected]