Diagnosis sheet # 1 - Abdallah al-Oweidi

Oral Diagnosis lec. 1 By Abdallah al-Oweidi
Introduction to oral diagnosis
Infection control in health care continues to be the subject of intensive research and debate. Implementing safe and realistic infection control procedures requires the full compliance of the whole dental team.
Aims to protect the dental team: 1- the Dentist
2- The Patient
3-The Nurse/Assistant or other Persons.
A full dental history should be obtained for all patients at the first visit and updated regularly as the first step in cross infection control.
We are concerned about the main infectious disease that can be transmitted, ex: hepatitis B & C mainly
So a universal precaution principles should be used on ALL patients & ALL the time, you have to consider ALL patients as infectious until proven otherwise, so a good medical history is the basic principle that you have to stick to.
You should divide your clinic into a clean & dirty area.
Displaying an infection control statement can help you gain the patients confidence.
Steps to help in protection from infection transmission:
Medical history
Vaccination: health care workers should be vaccinated specially those involved with the invasive procedures.
After 5 years from taking the vaccination a follow-up booster dose should be taken to maintain a high titer for antibodies in the blood , and every 2-4 months a check-up on the titers should be done to insure your protection ( as a normal protocol )
While in needle-stick injury if the patient is a hepatitis B carrier then a therapeutic regime should be taken.
Titer recommendation by international experts should be >100 of international units U/ mL, as to provide protection against hepatitis B.
So, 1- Vaccination 2- Take Booster dose 3- check-up on titer

Protection practice : 1- Eye protection/face protection ( face shield ) protects from splatter
2- Gloves: before wearing gloves hands should be washed
This leads us to differentiate between Sterilization & disinfection,
Sterilization: the complete absence of microbes
Disinfection: to decrease the load of the microbes

Sterilization is required when you’re doing an operation; different operations require different levels of cross infection control.

Replace the gloves between patients and when there is a tear in them.
Presence of a detergent is necessary for cleaning the surfaces.
Most common method of sterilization in this industry is Autoclave.
Two types of instruments:
disposable instruments ( the current trend in dentistry- instruments for single use - ) , ex: saliva ejector
Disadvantage: it’s really expensive
2- Re-useable instruments: ex: surgical instruments / examination set.
- should be cleaned first by using an ultrasonic device (the ideal way though it’s not present in our hospital we use a normal washing procedure under running water -) which dislodges derbies through sound waves vibrations.

Clinical waste should be discarded in its appropriate disposal bag or box according to its type.
Eye protection & heavy duty gloves should be used when handling & cleaning used instruments
All instruments that have been potentially contaminated should be re-sterilized.
Sterilized instruments should be stored in covered trays or pouches
Working areas that have instruments placed on them during treatment will be kept minimum
Clean the unit with the suitable detergent before and after dental visit.
Needles, scalpel blades, local anesthesia cartridges, burs, matrix bands ….etc should be disposed in the yellow sharps container.
One of the main rules is to avoid re-sheeting (re-capping) of the needles as most needle-stick injuries are due to re-sheeting.
Once the sharps container reached two thirds full, it should be emptied.
Clinical waste should be placed in its appropriate sacks provided in each clinic.
All dental impressions must be rinsed until visibly clean and then disinfected .
Sterilization is either Hot or Cold , Hot sterilization : mainly Autoclave
In case of a needle stick –injury:
don’t allow the wound to close and squeeze out the blood immediately, let it bleed out
rinse it thoroughly with water, and cover it with water proof dressing
report the injury .




before dental treatment protocols :
insure that the instruments has been sterilized or adequately disinfected
Put the disposable coverings in the place; place only the appropriate instruments on the practice table.
obtain the patient medical history
During the treatment Protocols:
Treat all patients as potentially infectious, you have to wear gloves, mask, protective eye glass, protective clothing.
You have to provide eye protection for the patient
Wash hands before a new pair of gloves should be used.
You have to use the rubber dam, high volume suction.
The atmosphere should be well ventilated for the dentist and for the patient.
After the Treatment Protocols:
Dispose the sharps in the sharps container.
Segregate and dispose of clinical waste.
clean and inspect instruments ( visibly clean ) before placing it in the washer or ultrasonic cleaner ( and always stick to the manufacturer rules )
You have to own a disinfectant to keep all surfaces clean.
The risk of disease transmission:
The only exception is the sweat since it has no rule in disease transmission.
Universal precautions apply to all patients, all personal, all the time.
possibility of infection if patient is infected with ( transmission )
HBV if it’s HBs Ag+ (positive) & HBe Ag+ the chance is 22% (very high chance to get infected)
If it’s HBs Ag+ & HBe Ag- (negative) the chance is 1-6% (still high chance to get infected)
HCV the chance is 1.8 %
HIV the chance is 0.3% (low chance because it’s a viable virus – can be killed by normal detergent)

Protozoa (Most resistant)
Bacterial spores
Non-enveloped viruses
TB organisms
Enveloped viruses
Fungi
Vegetative bacteria (Least resistant)