Percutaneous injuries in practicing dentists. A prospective study using a 20-day diary.

A novel diary study of 2,304 practicing U.S. dentists examined the frequency and nature of percutaneous injuries over one dentist-month. Burs were responsible for most extraoral injuries (40 percent), and syringe needles accounted for most intraoral injuries (32 percent). The annualized mean injury rate was 3.35, which represents about a threefold decrease since 1987.

Factors associated with hepatitis B vaccine response among dentists.

The objective of this study was to evaluate personal and immunization factors associated with serologic evidence of hepatitis B virus (HBV) vaccine response. A study was conducted using data from United States dentists participating from 1987 to 1991 in the Health Screening Program of the American Dental Association's annual session. This study included dentists (n = 507) who (1) received their most recent dose of HBV vaccine within the previous 10 months, (2) completed a core questionnaire, and (3) were tested for HBV markers (HBsAg, anti-HBs, and anti-HBc) and were found not to have evidence of past or present infection. Non-responders were defined as dentists testing negative for all three markers (n = 100). Responders were defined as dentists having serological evidence of anti-HBs alone (n = 407). Logistic regression models were used to assess the relationship of vaccine response to the variables sex, age, number of vaccine doses, site of vaccination, type of vaccine, and history of hepatitis. Vaccine response was most strongly associated with sex, age, and number of doses. Factors unrelated to vaccine response included type of vaccine and history of hepatitis. Adherence to the recommended number of doses and early vaccination are critical to adequate protection against hepatitis B infection of dentists, who are often exposed to blood and other body fluids.

Infectious disease in dental practice--professional opportunities and obligations.

This article presents one author's view of the dentist's obligations to patients, to the community, to the profession, and to the principles of ethics in a highly troubling time of serious infectious diseases. It essentially is an optimistic view that, while the epidemic of AIDS will continue and tuberculosis may become a graver problem in certain health care settings, the dental profession possesses the education, ethical insights, and technical training needed to meet with grace and authority the challenges of practice in this era of infectious disease.

Human immunodeficiency virus type I. Infection among dentists.

The largest collection yet assembled of year-to-year data on the seroprevalence of antibody to HIV in practicing dentists confirms that dentists--along with other health care workers--remain at low risk for occupationally acquired HIV infection.

The dentist and infectious diseases: a national survey of attitudes and behavior.

Two national surveys of infection control practices in 1986 and 1988 suggest several trends. A massive educational effort has brought about impressive acceptance and use of the hepatitis vaccine. Dramatic changes have occurred in respect to use of gloves and other barrier techniques. However, increased understanding of HIV infection has not, in the years surveyed, totally eradicated irrational fears about this disease.

Geriatric pharmacology for the dentist. An overview.

The information presented in this article suggests that the drug responses of the elderly may be greater than those in the young or essentially the same. We have presented evidence that the pharmacokinetics in the elderly would probably tend toward prolonging the half-life and delaying the clearance of many drugs. Pharmacodynamic changes are more ambiguous, increasing sensitivity to some drugs and decreasing sensitivity to others. Compliance errors, from whatever cause, lead to unpredictable intake of drugs. Psychosocioeconomic factors contribute to compliance errors and no doubt also lead to increased intake of combination of drugs. Multiple diseases are common among the elderly, but it is not clear how disease states, per se, affect drug responses unless the specifically diseased organ is focally important in the handling of drugs. Alterations in perception of pain and in reflex and immune competence will produce changes in all directions. Use of multiple drugs almost certainly will create an environment favorable to drug interactions and adverse reactions. What is the dentist to do with these conflicting effects of aging in drug therapy? There are a few, and only a few, rules that can be said to have a solid basis in fact. Elderly patients seem to be more sensitive to the depressant effects of drugs. It is wise, therefore, to reduce the dosage of such drugs as the benzodiazepines, general anesthetics, analgesics, and sedative-hypnotics in the elderly. Old people are apparently more sensitive to certain drugs, for example, the neuromuscular blocking drugs. It would be wise to reduce the dosage of these for the older patient. The geriatric person appears to be less sensitive to pain; it would be wise to prescribe analgesics for such patients in lower doses. Elderly patients are known to have lost some of their reflex ability to maintain homeostasis. This should be taken into consideration when drugs that affect blood pressure, heart rate, and smooth muscle tone are used. Elderly patients are almost certain to be taking multiple medications. Drug interactions, as well as adverse drug reactions (which are exaggerated in the elderly), are likely to occur in this polypharmaceutical setting. It is critical that the dentist be continually informed of the pharmacologic status of each patient and be aware of the likelihood of interactions between drugs prescribed by the dentist, drugs-prescribed by the physician, and drugs that are self-administered.

Faculty approaches to combating professional burnout.

The peculiar stresses of the dental educator make him or her a prime candidate for burnout and at the same time offer rather special protection against this phenomenon. The dental teacher, especially the clinical teacher, is required to spend virtually all of his time in intimate contact with students, whom he instructs, and with patients in the clinic, for whom he has responsibility. In addition, this same dental educator will probably have some kind of private practice. He will also be required, if he expects to advance in academic rank, to do research, to be cognizant of the latest developments in his field, to publish, to give presentations to his peers and to the community. This adds up to a lot that is expected of one person. Many people have expectations of him, many people crowd in on him with their demands. The situation sounds ideal for burnout. Yet, I believe that if the dental educator does what is expected, if he laces this diet of teaching and patient contact with research and library work, if he sets aside time (you may ask where he is to find it) for contemplation, for good works in the community, for hobbies, for reading, for cultural activities, then in fact the chance of burnout seems lower. And finally, if the dental educator pursues the possibilities that exist for leaves, for time away, for refreshment of his career by new contacts, new ideas, new ways of doing things, and new commitments, he will push away and hold at bay the dangers of burnout.