Introduction - Infectious diseases in oral care practice
During the treatments in oral care there is very close contact between the practitioners plus the assistants on the one hand and the patients on the other. It is sometimes said: 'no profession is as intimate as that of a dental care provider'. This statement is not only based on the very small physical distance between therapist and patient, but also on the basis of arguments from psychology can be mentioned a high degree of intimacy during treatments. The mouth is bacteriologically the most 'flowery' part of the human body and saliva is therefore also considered the 'superinfection diffuser'. Saliva sometimes contains as many as 108 bacteria per ml and this amount contains tens to hundreds of different species. The risk of infection due to direct contact with the patient's saliva is therefore great for the therapist or assistant. In addition, rotary instruments are often used during the treatment, so that the saliva enters the formed aerosol simultaneously with the spray cooling. It is therefore inevitable that the members of the dental team during the treatments come into close contact with the most diverse pathogens. It is therefore a well-known phenomenon that people who start working in oral health care practice often have a cold or flu in the first months to six months. This is known as the period of starter infections. The body of the care provider is suddenly 'bombed' with an excessive amount of germs in the new work situation. Mostly, it is fortunately not too threatening microorganisms. Usually it will be colds or flu-like conditions that can be transferred from the patients to the team via the aerosol. After the period of the starter infections, a large part of the infectious diseases of the pathogens that occur in this new work environment have been passed through and the part of them that is based on viruses will be known and remain with the immune system. If there is another infection with one of these viruses, then there will be no more disease. Moreover, due to the 'bombardment' of microorganisms, the natural immune system has been activated and prepared in such a way that microorganisms are no longer given the chance to cause symptoms.
That patients also run the risk of becoming infected with infections from previous patients via the aerosol will also be clear. In a small number of cases, the patient and the treatment team know which germs they have to deal with in a diagnosed disease. Unfortunately, a significant proportion of the pathogens can not be diagnosed when patients are in the treatment chair. This applies to subclinical infections, during the incubation period of an infectious disease and also during carriage. In all these situations it is unclear who brings in the treatment room which germs. That is why the following creed applies:
All patients should be treated as a diagnosed source of infection.
Contrary to the uncertainty about which patient carries which microorganisms and how they may be spread in oral care practice, there is more certainty about contamination probabilities by micro-organisms from the water supply system of the treatment unit. In case of inadequate hygiene of these plastic water pipes there is a chance of contamination with Legionella pneumophila, which can lead to Legionnaires disease, or with Pseudomonas aeruginosa, which can cause serious wound infections (up to osteomyelitis).
The chapter of the Infection Prevention Directive in oral care practices discusses in detail the policy that applies to care providers and patients who carry certain diseases. A sketch is given of the clinical picture and attention is also paid to the possibilities of vaccination. An important addition is the meaning of the blood results (titer determination), which indicate after the vaccination to what extent a person is protected (or not).
The following is a list of practical information about some known and less well-known infectious diseases that pose a risk of contamination in the treatment room of oral care practice.