Dental hygiene work in a clinical trial.

UNLABELLED: Dental hygiene activities were developed as part of a randomized clinical trial designed to assess the safety of low-level mercury exposure from dental amalgam restorations. Along with dental-hygiene clinical work, a community programme was implemented after investigators noticed the poor oral hygiene habits of participants, and the need for urgent action to minimize oral health problems in the study population. OBJECTIVES: Clinical and community activity goal was to promote oral health and prevent new disease. Community activities involved participants and their fellow students and were aimed at providing education on oral health in a school environment. METHODS: Dental hygienists developed clinical work with prophylaxis, sealants application and topical fluoride and implemented the community programme with in-class sessions on oral health themes. Twice a month fluoride mouthrinses and bi-annual tooth brushing instructional activity took place. Participation at dental-hygiene activities, sealed teeth with no need of restoration and dental-plaque-index were measures used to evaluate success of the programme for the participants. RESULTS: Improvement in dental hygiene is shown by the decrease in dental plaque index scores (P < 0.0001); also sealants integrity is achieved in 86.3% of teeth. 888 (13.7%) teeth with sealants had to be restored or were lost. Children participated actively on dental hygiene activities. Teachers became aware of the problem and included oral-health in school curricula. CONCLUSION: Dental hygiene activities have shown to be helpful to promote dental hygiene, promote oral health and to provide school-age children with education on habits that will be important for their future good health.

Evaluation of a 7-year school-based community dental hygiene programme in Portugal by high school teachers.

OBJECTIVES: To obtain high school teachers evaluation of a Community Dental Hygiene programme, developed as part of a clinical trial designed to assess the safety of low-level mercury exposure from amalgam restorations. METHODS: A questionnaire to assess programme evaluation, personal opinion on programme relevance and satisfaction with activities was distributed among teachers. It had a total of 22 questions organized into three groups. RESULTS: A total of 25 questionnaires were obtained from teachers who participated in the programme. Ninety-two per cent of the respondents had a positive opinion concerning the existence of the programme. Eighty-eight per cent of the teachers believed that the programme changed student's knowledge about dental hygiene. Ninety-two per cent of teachers supported the existence of the programme and 88% of them disagreed with a statement that participation in the programme was a waste of time. Teachers who did not collaborate actively with dental hygiene activities indicated belief that the programme affected school activities (P = 0.003). Teachers who actively participated in the programme believe that dental hygiene activities were important for students (P = 0.005). CONCLUSIONS: Teacher evaluations of this kind of programme are critical for the development of school-based Dental Hygiene Education programmes. Teachers believe that Dental Hygiene Education is crucial for students' well-being.

Vancomycin use in a Brazilian University Hospital: comparison with Hospital infection control practices advisory committee guidelines

Emergence of vancomycin-resistant bacteria is of concer. In an effort to reduce this danger, guidelines to ensure proper prescribing of vancomycin have been proposed to the Hospital Infections Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control. To evaluate use of vancomycin at Uberlândia University Hospital in Brazil, each patient who received the drug during a 10 month period had nasal and recal cultures done within 48 hours of initiation of therapy, then at weekly intervals until discharge. Their hospital records were reviewed to obtain demographic and clinical data, and each was scored as to whether or not HICPAC guidelines were followed. Thirty-one patients were enrolled in the study; 15 of whom had been approved for vancomycin by the hospital infectious diseases (ID) specialist, and 16 who had the drug given without approval. During the study, 4 strains of VRE (Vancomycin Resitant Enterococci) and 8 strains of MRSA (Methicillin Resistant S.aureus) emerged. The use of vancomycin did not follow HICPAC guidelines in 21/31 patients (68 percent), in that the drug was prescribed empirically without prior documenation of need. This occurred 13 of 16 (81 percent) times when no approval by an ID specialist was provided, and 8 of 15 times (53 percent) after approval by a ID specialist. In 6 of 8 patients (75 percent), empirical use of vancomycin was approved by an ID specialist in patients with severe illnesses, each of whom subsequently died. his could be considered appropriate use, although outside the guidelines. Only 3 of 13 patients (23 percent) were severely ill when vancomycin was used without ID approval. Most of the vancomycin use which did not follow HICPAC guidelines occurred on the medicine service in patients moderately ill with pneumonia or bacteremia, and associated with invasive procedures. We conclude that there is a special need to improve education regarding the appropriate use of vancomycin and to increase review of its use by an ID specialist, particularly on medicine services of our hospital.