Chapter. 19 Disease Transmission and Infection Prevention

Question 1

The Chain of Infection

Answer 1

Infectious agent
Reservoir
Portal of exit
Mode of transmission Portal of entry
Susceptible host

Question 2

Infectious Agent

Answer 2

A pathogen must be present (e.g.,
bacterium, virus, fungus, parasite,
prion)
* Organism must also be virulent
* Virulence: The degree of pathogenicity, or
the strength of the organism in its ability to
cause disease

Question 3

Reservoir

Answer 3

A place where microorganisms normally
live and reproduce
 Examples: Humans, animals, food,
water, bioburden, contaminated
surfaces
 Maintaining excellent hand hygiene and
thorough cleaning and disinfection of
contaminated surfaces will minimize
reservoirs for microorganisms

Question 4

Portal of Entry

Answer 4

To cause infection, a pathogen must
have a portal of entry (or means of
getting into the body)
 The portals of entry for airborne
pathogens are the mouth and nose
 Blood-borne pathogens must have
access to the blood supply to gain entry
into the body
 This occurs through a break in the skin
caused by a needle stick, a cut, or even a
human bite
 Can also occur through mucous membranes of nose oral cavity

Question 5

Susceptible Host

Answer 5

A person who is unable to resist infection
by the pathogen
 An individual who is in poor health,
chronically fatigued, under extreme stress,
or who has a weakened immune system is
more likely to become infected
 Staying healthy, washing hands frequently,
and keeping immunizations up-to-date will
help members of the dental team resist
infection and stay healthy

Question 6

Types of Infections

Answer 6

Acute infection: Symptoms are often quite
severe and appear soon after the initial
infection occurs
 Chronic infection: The microorganism is
present for a long period; sometimes for
life
 Latent infection: Persistent infection in
which symptoms come and go (e.g., cold
sores)
 Oral herpes simplex and genital herpes are
latent viral infections
 Opportunistic infection: Caused by

Question 7

Modes of Disease Transmission

Answer 7

Direct transmission
 Occurs when someone comes into direct
contact with the infectious lesion or infected
body fluids (e.g., blood, saliva, semen,
vaginal secretions)
 Indirect transmission
 Involves the transfer of organisms to a
susceptible person through, for example,
the handling of contaminated instruments
or touching of contaminated surfaces and
then touching the face, eyes, or mouth
Copyright © 2021 by Elsevier, Inc. All rights reserved. 12
Modes of Disease Transmission
(Slide 2 of 2)
 Airborne transmission
 Also known as droplet infection, involves spread of
disease through droplets of moisture containing
bacteria or viruses
 Aerosols, sprays, and spatter
 Contain saliva, blood, and microorganisms and are
created with the use of the high-speed handpiece,
air-water syringe, and ultrasonic scaler during dental
procedures
 Mists: Droplet particles larger than those in aerosol
spray
 Spatter: Large droplet particles contaminated with
blood, saliva, and other debris
 Happens during a dental procedure when the mucosa
(mouth or eyes) or nonintact skin is splashed with blood or blood contaminated saliva.

Question 8

Other Modes of Transmission

Answer 8

Parenteral transmission
 Can take place through needle stick injuries, human
bites, cuts, abrasions, or any break in the skin
 Blood-borne transmission
 Involves direct or indirect contact with blood and other
body fluids
 Food and water transmission
 Occurs when contaminated food that has not been
cooked or refrigerated properly or water that has been
contaminated with human or animal fecal material is
consumed
 Fecal-oral transmission
 Occurs when proper sanitation procedures, such as
handwashing after use of the toilet, are not followed and
one of the many pathogens present in fecal matter is transmitted when a infected person touch another.

Question 9

The Immune System

Answer 9

The human body receives resistance to
communicable diseases from the immune
system
 A communicable disease is one that can be
transmitted from one person to another or
by contact with the body fluids from
another person
 Inherited immunity is present at birth
 Acquired immunity is developed over a
person’s lifetime
Copyright © 2021 by Elsevier, Inc. All rights reserved. 15
The Immune System
(Slide 2 of 2)
 Naturally acquired immunity occurs
when a person has contracted and is
recovering from a disease
 Active immunity
 Passive immunity
 Artificially acquired immunity
 Antibodies are introduced into the body by
means of immunization or vaccination

Question 10

Disease Transmission
in the Dental Office

Answer 10

Every dental office should have an
infection control program designed to
prevent the transmission of disease
from:
 Patient to dental team
 Dental team to patient
 Patient to patient
 Dental office to community (including dental
team’s family)
 Community to dental office to patient

Question 11

Patient to Dental Team

Answer 11

Most common route is through direct
contact (touching) of the patient’s blood
or saliva
 Droplet infection occurs through
mucosal surfaces of the eyes, nose, and
mouth
 Can occur when the dental-team member
inhales aerosol generated by the dental
handpiece or air-water syringe
 Indirect contact occurs when the team
member touches a contaminated
surface or instrument
Copyright © 2021 by Elsevier, Inc. All rights reserved. 18
Patient to Dental Team
(Slide 2 of 2)
 Ways to prevent disease transmission
from the patient to the dental team
member
 Gloves
 Handwashing
 Masks
 Rubber dams
 Patient mouth rinses

Question 12

Dental Team to Patient

Answer 12

Very unlikely to happen
 Can result if the dental team member has
lesions on the hands, or if the hands are
cut while in the patient’s mouth, permitting
the transfer of microorganisms
 Infection control measures that help to
prevent team-to-patient transmission
include:
 Masks
 Gloves
 Handwashing
 Immunization

Question 13

Patient to Patient

Answer 13

Has occurred in the medical field, but no cases
have been documented in dentistry
 Although such transmission is possible,
contamination from instruments used on one
patient must be transferred to another patient
for this to occur
 Infection control measures that can prevent
patient-to-patient transmission include:
 Instrument sterilization
 Surface barriers
 Handwashing
 Gloves
 Use of sterile instruments

Question 14

Dental Office to Community

Answer 14

Microorganisms can leave the dental office
and enter the community in a variety of
ways
 Contaminated impressions sent to the
dental lab
 Contaminated equipment sent out for repair
 In theory, transportation of microorganisms
out of the office on the dental team’s
clothing or hair
 The following measures can prevent this
type of disease transmission:
 Handwashing
 Changing clothes before leaving the office
disinfecting impressions and contamcatied

Question 15

Community to Dental Office to Patient

Answer 15

Microorganisms enter the dental office
through the municipal water that
supplies the dental unit
 Waterborne organisms colonize the inside of
the dental unit waterlines and form biofilm
 As water flows through the handpiece, air-
water syringe, and ultrasonic scaler, a
patient could swallow contaminated water

Question 16

Roles and Responsibilities of the
CDC and OSHA in Infection
Control

Answer 16

Federal agencies that play important
roles in infection control for dentistry
 The Centers for Disease Control and
Prevention (CDC)
 The Occupational Safety and Health
Administration (OSHA)
 The CDC is not a regulatory agency
 Issues specific recommendations based on
sound scientific evidence on health-related
matters
 Establishes a standard of care for the dental
profession

 OSHA is a regulatory agency
 Issues specific standards to protect the health
of employees in the United States
 In 1991, based on the CDC guidelines, OSHA
issued the Blood-Borne Pathogens Standard
(BBP)
 As a dental assistant, it is imperative to follow
all of OSHA’s guidelines and
recommendations

Question 17

CDC Guidelines for Infection Control
in Dental Healthcare Settings Part 1

Answer 17

 Released in December of 2003 by the CDC
 Guidelines expanded upon the existing OSHA
Blood-Borne Pathogens Standard and have
included some areas that were not already
covered
 Guidelines are based on scientific evidence and
are categorized on the basis of existing scientific
data, theoretical rationale, and applicability
 Guidelines apply to all paid or unpaid dental
health professionals who might be
occupationally exposed to blood and body fluids
by direct contact or through contact with
contaminated environmental surfaces, water, or
air

Question 18

CDC Guidelines for Infection Control
in Dental Healthcare Settings Part 2

Answer 18

2016 CDC Dental Infection Prevention
Summary (March 2016)
 An easy-to-understand/read summary of the
2003 guidelines
 Includes additional topics and information
relevant to dental infection prevention and
control since 2003, including the following:
* Infection prevention program administrative
measures
* Infection prevention education and training
* Respiratory hygiene and cough etiquette
* Updated safe infection practices
* Administrative measures for instrument processing
CDC Guidelines for Infection Control
in Dental Healthcare Settings
(Slide 2 of 3)

Question 19

CDC Guidelines for Infection Control
in Dental Healthcare Settings Part 3

Answer 19

CDC Rankings of Evidence
 Category IA
 Category IB
 Category IC
 Category II
 Unresolved issue

Question 20

OSHA Blood-Borne
Pathogens Standard (BBP)

Answer 20

 The most important infection control
law in dentistry
 Designed to protect employees against
occupational exposure to blood-borne
pathogens, such as hepatitis B, hepatitis C,
and human immunodeficiency virus (HIV)
 Employers are required to protect their
employees from exposure to blood and
other potentially infectious materials (OPIM)
in the workplace and to provide proper care
to the employee if an exposure should occur
Copyright © 2021 by Elsevier, Inc. All rights reserved. 29
OSHA Blood-Borne
Pathogens Standard (BBP)
(Slide 2 of 2)
 The BBP applies to any type of facility in
which employees might be exposed to
blood and/or other body fluids, which
include:
 Dental and medical offices
 Hospitals
 Funeral homes
 Emergency medical services
 Nursing homes
 OSHA requires that a copy of the BBP be
present in every dental office and clinic

Question 21

Exposure Control Plan

Answer 21

Clearly describes how the office
complies with the standard
 Universal Precautions is referred to in
the OSHA Blood-Borne Pathogens
Standard

Question 22

Standard and Universal
Precautions

Answer 22

Universal Precautions are based on the concept
that all human blood and body fluids (including
saliva) are to be treated as if known to be infected
with one of the blood-borne diseases, HBV, HCV,
or HIV
 The CDC expanded the concept and changed the
term to Standard Precautions
 Standard Precautions integrate and expand the elements of
Universal Precautions into a standard of care designed to protect
healthcare providers from pathogens that can be spread by blood or
any other body fluid, excretion, or secretion
 It is not possible to identify those individuals who are infectious, so
infection precautions are used for all healthcare personnel and their
patients

Question 23

Categories of Employees

Answer 23

The OSHA BBP Standard requires
employers to categorize tasks and
procedures during which an employee
might experience occupational
exposure
 BBP defines an occupational exposure
as “any reasonably anticipated skin,
eye, mucous membrane contact, or
percutaneous injury with blood or any
other potentially infectious materials”

Question 24

Postexposure Management

Answer 24

Accidents happen!
 Before an accident occurs, the BBP
requires the employer to have a written
plan
 This plan explains exactly what steps
the employee must follow after the
exposure incident occurs and the type
of medical follow-up that will be
provided to the employee at no charge

Question 25

Employee Training

Answer 25

The BBP Standard requires the dentist/
employer to provide training in infection
control procedures and safety issues to all
personnel who may come in contact with
blood, saliva, or contaminated
instruments or surfaces
 Employer must keep records of all training
sessions
 The record must include the date of the
session, the name of the presenter, the
topic, and the names of all employees
who attended

Question 26

Hepatitis B Immunization

Answer 26

OSHA requires the dentist to offer the
hepatitis B virus (HBV) vaccination series
to all employees whose jobs include
category I and II tasks
 Vaccine must be offered within 10 days of
employment
 The dentist/employer must obtain proof
from the physician who administered the
vaccination
 Employees have the right to refuse the
HBV vaccine; however, they must sign an
informed refusal form that is kept on file
The vaccine is administered in a series
of three injections
 Most common vaccination schedule is 0, 1,
and 6 months
 The preferred injection site is in the
deltoid muscle (on the arm)
 The seroconversion rate (development of
immunity) is higher than when the vaccine
is administered in the buttocks

Question 27

Postvaccine Testing

Answer 27

Between 1 to 2 months after the series
has been completed, a blood test should
be performed to ensure that the
individual has developed immunity
 A physician should evaluate individuals
who have not developed immunity to
determine the need for an additional dose
of HBV vaccine
 Individuals who do not respond to the
second 3-dose series of the vaccine
should be counseled regarding their
susceptibility to HBV infection and

Question 28

Preventing Needle Sticks

Answer 28

Never recap used needles by using both
hands or any other technique that
involves directing the point of a needle
toward any part of the body
 Always use the single-handed scoop
technique or some type of safety device

Question 29

Postvaccine Testing

Answer 29

Between 1 to 2 months after the series
has been completed, a blood test should
be performed to ensure that the
individual has developed immunity
 A physician should evaluate individuals
who have not developed immunity to
determine the need for an additional dose
of HBV vaccine
 Individuals who do not respond to the
second 3-dose series of the vaccine
should be counseled regarding their
susceptibility to HBV infection and

Question 30

Employee Medical Records

Answer 30

The dentist/employer must keep a
confidential medical record for each
employee
 These records are confidential and must
be stored in a locked file
 The employer must keep these records
for 30 years

Question 31

Managing Contaminated Sharps

Answer 31

Contaminated needles and other disposable
sharps (e.g., scalpel blades, orthodontic wires,
and broken glass) must be placed into a
sharps container
 The sharps container must be puncture-
resistant, closable, leak-proof, and color-
coded or labeled with the biohazard symbol
 Sharps containers must be located as close as
possible to the place of immediate disposal
 Do not cut, bend, or break the needles before
disposal
 Never attempt to remove a needle from a
disposable syringe

Question 32

Preventing Needle Sticks

Answer 32

Never recap used needles by using both
hands or any other technique that
involves directing the point of a needle
toward any part of the body
 Always use the single-handed scoop
technique or some type of safety device

Question 33

Learning Objectives
Lesson 19.2: Infection Control
in the Dental Office

Answer 33

Explain the importance of infection control
practices for dental assistants, including the
following:
* Explain proper hand hygiene for dental assistants.
* Explain the advantages of alcohol-based hand rubs.
* Discuss the types of PPE needed for dental assistants
and demonstrate the proper sequence for donning and
removing personal protective equipment.
* Identify the various types of masks, eyewear, and
gloves used in a dental office.
9. Give examples of the infection control
considerations needed to protect high-tech
equipment in the dental office.

Question 34

Hand Hygiene: Handwashing
Guidelines

Answer 34

Wash your hands each time before you
put on gloves and immediately after you
remove gloves
 Wash your hands when you
inadvertently touch contaminated
objects or surfaces while barehanded
 Always use liquid soap during
handwashing
 Bar soap should never be used because
it may transmit contamination

Question 35

Hand Hygiene: Handwashing
Guidelines

Answer 35

For most routine dental procedures,
such as examinations and nonsurgical
procedures, an antimicrobial soap can
be used
 For surgical procedures, you should use
a germicidal surgical scrub product
 Dry hands well before donning gloves

Question 36

Additional Handwashing
Guidelines

Answer 36

Keep nails short and well-manicured
 Rings (except for wedding rings),
fingernail polish, and artificial nails are
not to be worn at work
 Dental personnel with open sores or
weeping dermatitis must avoid activities
involving direct patient contact and
handling contaminated instruments or
equipment until the condition on the
hands is healed

Question 37

Alcohol-Based Hand Rubs

Answer 37

Waterless antiseptic agents are alcohol-
based products available in gels, foams, or
rinses
 The product is applied to the hands, which
are then rubbed together to cover all
surfaces
 These products are more effective at
reducing microbial flora than is plain soap
 Concentrations of 60% to 95% are the most
effective
 They contain emollients that reduce the
incidence of chapping, irritation, and drying

Question 38

Hand Care Recommendations

Answer 38

For most routine dental procedures, such
as examinations and nonsurgical
procedures, wash your hands with either
a nonantimicrobial or antimicrobial soap
and water
 If your hands are not visibly soiled, you
may use a waterless alcohol-based hand
rub
 For surgical procedures, you should
perform a surgical scrub using either a
nonantimicrobial or antimicrobial soap
and water, dry your hands, and apply an

Question 39

Protective Clothing

Answer 39

Protects the skin and underclothing from
exposure to saliva, blood, aerosol, and other
contaminated materials
 Types of protective clothing include:
 Smocks, slacks, skirts, laboratory coats, surgical
scrubs (hospital operating room clothing), scrub
(surgical) hats, pants, and shoe covers
 The type of protective clothing you should
wear is based on the degree of anticipated
exposure to infectious materials
 The BBP prohibits the employee from taking
protective clothing home to be laundered

Question 39

Personal Protective Equipment (PPE)

Answer 39

OSHA requires the employer to provide
employees with the appropriate PPE
without charge to the employee
 Examples of PPE
 Protective clothing
 Surgical masks
 Face shields
 Protective eyewear
 Disposable patient-treatment gloves
 Heavy-duty utility gloves

Question 40

Handling Contaminated Laundry

Answer 40

Protective clothing may be laundered in
the office if the equipment is available
and if Standard Precautions are followed
for handling and laundering the
contaminated clothing
 Contaminated linens that are removed
from the office for laundering should be
placed in a leakproof bag with a
biohazard label or an appropriately color-
coded label
 Disposable gowns must be discarded
daily and more often if visibly soiled

Question 41

Protective Clothing
Requirements

Answer 41

Protective clothing should be made of fluid-
resistant material
 As a means of minimizing the amount of
uncovered skin, clothing should have long
sleeves and a high neckline
 The design of the sleeve should allow the
cuff to be tucked inside the band of the
glove
 During high-risk procedures, protective
clothing must cover dental personnel at
least to the knees when seated
 Buttons, trim, zippers, and other
ornamentation should be kept to a minimum

Question 42

Protective Masks

Answer 42

Worn over the nose and mouth to
protect you from inhaling possible
infectious organisms spread by the
aerosol spray of the handpiece or air-
water syringe and accidental splashes
 A mask with at least 95% filtration
efficiency for particles 3 mm to 5 mm in
diameter should be worn whenever
splash or spatter is likely
 The two most commonly used types of
masks are dome-shaped and flat

Question 43

Guidelines for the Use of Masks

Answer 43

Masks should be changed for every
patient or more often (CDC guideline)
 To handle a mask, touch the side edges
only; avoid contact with the more
heavily contaminated body of the mask
 The mask should conform well to the
face
 The mask should not make contact with
the mouth while being worn because
the moisture that is generated will
decrease filtration efficiency
 A damp or wet mask is not an effective

Question 44

Protective Eyewear

Answer 44

Worn to protect eyes against the danger of
damage caused by aerosolized pathogens
 Also prevents spattered solutions or caustic
chemicals from injuring the eyes
 OSHA requires the use of eyewear with both
front and side protection (solid side shields)
during exposure-prone procedures
 If you wear contact lenses, you must wear
protective eyewear with side shields or a face
shield
 After each treatment or patient visit, clean
and decontaminate protective eyewear in
accordance with manufacturer’s instructions

Question 45

Face Shields

Answer 45

A chin-length plastic face shield may be
worn as an alternative to protective
eyewear
 A shield cannot be substituted for a face
mask because it does not protect
against inhalation of contaminated
aerosols
 When splashing or spattering of blood
or other body fluids is likely during a
procedure (such as surgery), a face
shield is often worn in addition to a
protective mask

Question 46

Patient Eyewear

Answer 46

Patients should be provided with
protective eyewear because they also
may be subject to eye damage during
the procedure
 This may result from:
 Handpiece spatter
 Spilled or splashed dental materials,
including caustic chemical agents
 Airborne bits of acrylic or tooth fragments

Question 47

Gloves

Answer 47

Because dental personnel are most likely to
come into contact with blood or
contaminated items with their hands,
gloves may be the most critical PPE
 You must wear a new pair of gloves for
each patient, remove them promptly after
use, and wash your hands immediately to
avoid the transfer of microorganisms to
other patients or the environment (CDC
guideline)
 Consult with the glove manufacturer
regarding the chemical compatibility of the

Question 48

Guidelines for the Use of Gloves

Answer 48

All gloves used in patient care must be
discarded after a single use
 These gloves may not be washed,
disinfected, or sterilized; however, they
may be rinsed with water to remove
excess powder
 Latex, vinyl, or other disposable medical-
quality gloves may be used for patient
examinations and dental procedures
 Torn or damaged gloves must be
replaced immediately

Question 49

Guidelines for the Use of Gloves

Answer 49

Do not wear jewelry under gloves
 Change gloves frequently
 Remove contaminated gloves before
leaving the chairside during patient care
and replace them with new gloves
before returning to patient care
 Hands must be washed after glove
removal and before regloving

Question 50

Gloves Damaged During
Treatment

Answer 50

Gloves are effective only when they are
intact (not damaged, torn, ripped, or
punctured)
 If gloves are damaged during treatment,
they must be changed immediately
 The procedure for regloving is:
 Excuse yourself and leave the chairside
 Remove and discard the damaged gloves
 Wash hands thoroughly
 Reglove before returning to the dental
procedure

Question 51

Gloves Damaged by Dental
Materials

Answer 51

The chemicals you come in contact with
on a daily basis may damage your
gloves
 Because so many dental materials are
available on the market, you should
consult the glove manufacturer about
the compatibility of the glove material
with various chemicals

Question 52

Guidelines for Use of Overgloves

Answer 52

Overgloves are not acceptable alone as a
hand barrier or for intraoral procedures
 Overgloves must be worn carefully to avoid
contamination during handling with
contaminated procedure gloves
 Overgloves are donned before the
secondary procedure is performed and
removed before the patient treatment that
was in progress is resumed
 Overgloves are discarded after a single use

Question 52

Examination Gloves

Answer 52

Usually made of latex or vinyl
 Referred to as exam gloves or
procedure gloves
 These are worn by dental professionals
during patient care
 Available in sizes S to XL

Question 53

Overgloves

Answer 53

Also known as food handler gloves; are
made of lightweight, inexpensive clear
plastic
 These may be worn over contaminated
treatment gloves (overgloving) to
prevent the contamination of clean
objects handled during treatment

Question 54

Sterile Surgical Gloves

Answer 54

Sterile gloves should be worn for
invasive procedures involving the
cutting of bone or significant amounts
of blood or saliva, such as oral surgery
or periodontal treatment
 Sterile gloves are supplied in
prepackaged units to maintain their
sterility before use
 They are provided in specific sizes and
are fitted to the left or right hand

Question 55

Utility Gloves

Answer 55

Utility gloves are not used for direct
patient care
 Utility gloves must be worn:
 When the treatment room is being cleaned
and disinfected between patients
 While contaminated instruments are being
cleaned or handled
 For surface cleaning and disinfection
 Utility gloves may be washed, disinfected,
or sterilized and reused
 Used utility gloves must be considered
contaminated and handled appropriately

Question 56

Non–Latex-Containing Gloves

Answer 56

Healthcare providers or patients may
experience serious allergic reactions to
latex
 For the person who is sensitive to latex,
there are gloves made from vinyl,
nitrile, and other non–latex-containing
materials

Question 57

Maintaining Infection
Control While Gloved

Answer 57

During a dental procedure, it may be
necessary to touch surfaces or objects
such as drawer handles and material
containers
 If you touch these objects with a gloved
hand, both the surface and glove
become contaminated
 To minimize the possibility of cross-
contamination, use an overglove when
it is necessary to touch a surface
Opening drawers and cabinets
 Set up instruments, medications, and
impression materials ahead of time and use
disposable and unit-dose items whenever
possible
 Opening containers
 When opening a container, use overgloves,
a paper towel, or a sterile gauze sponge to
remove the lid or cap
 Use sterile cotton pliers to remove an
item from the container

Question 58

High-Tech Equipment

Answer 58

Every aspect of dentistry is entering the
arena of high-technology equipment
and devices
 You must carefully consider what
infection control procedures are needed
to make each piece of equipment safe
to use
 Always follow the manufacturer’s
infection control recommendations for
every device and piece of equipment

Question 59

Latex Allergies

Answer 59

The use of natural-rubber latex gloves has
proved to be one of the most effective
means of protecting the dental worker and
the patient from the transmission of
disease
 The number of healthcare workers and
patients who have become hypersensitive
to latex has increased dramatically
 The CDC guidelines include
recommendations for contact dermatitis
and latex hypersensitivity

Question 60

Latex Allergies

Answer 60

Three common types of allergic
reactions to latex
 Irritant dermatitis
 Type IV allergic reaction
 Type I allergic reaction
 Two types involve an immune reaction
and one type involves only surface
irritation

Question 61

Irritant Dermatitis

Answer 61

A nonimmunologic process (does not
involve the body’s immune system)
 Caused by contact with a substance
that produces chemical irritation of the
skin
 The skin becomes reddened, dry,
irritated, and, in severe cases, cracked
 Irritant dermatitis can be reversed by
identifying and correcting the cause of
the problem

Question 62

Type IV Allergic Reaction

Answer 62

The most common type of latex allergy
 Is a delayed contact reaction and involves
the immune system
 It may take as long as 48 or 72 hours for the
red, itchy rash to appear
 Reactions are limited to the areas of contact and
do not involve the entire body
 An immune response is produced by the
chemicals that are used to process the latex
used in manufacturing the gloves, not by the
proteins in the latex

Question 63

Type I Allergic Reaction

Answer 63

Most dangerous type of latex allergy;
can result in death
 Comes in response to the latex protein
in the glove (in contrast to the reaction
to chemical additives in type IV
reactions)
 A severe immunologic (immune system)
response usually occurs 2 to 3 minutes
after the latex allergens make contact
with the skin or mucous membrane

Question 64

Treatment of Latex Allergies

Answer 64

There is no specific cure for latex allergy
 The only options are prevention,
avoidance of latex-containing products,
and treatment of the symptoms
 Anyone who suspects an allergy to latex
should see a qualified healthcare
provider to have a test to confirm the
allergy
 Once a latex allergy has been
diagnosed, the affected person should
practice latex avoidance in all aspects
of his or her personal and professional
Copyright © 2021 by Elsevier, Inc. All rights reserved. 78
Treatment of Latex Allergies
(Slide 2 of 2)
 When a latex allergy has been
diagnosed in one employee in the
dental office, all staff members should
use practices to minimize the use of
latex-containing products
 Practices include the wearing of powder-
free gloves by all dental staff members
to minimize the risk of airborne latex
particles

Question 66

Waste Management in the Dental
Office

Answer 66

Dental practices are subject to a wide
variety of federal, state, and local
regulations concerning waste management
issues
 The Environmental Protection Agency (EPA)
and most state and local regulations do not
categorize saliva or saliva-soaked items as
infectious waste
 Because of the high probability that blood
may be carried in saliva during dental
procedures, CDC guidelines and OSHA
regulations consider saliva in dentistry a

Question 67

Classification of Waste

Answer 67

General waste
 All nonhazardous, nonregulated waste
should be discarded in covered containers
 Examples include disposable paper towels,
paper mixing pads, and empty food
containers
 Contaminated waste
 Waste that has had contact with blood or
other body fluids
 Examples include used barriers and patient
napkins

Hazardous waste
 Poses a risk to human beings and the
environment
 Toxic chemicals and materials are hazardous
waste
 Examples include scrap amalgam, spent
fixer solution, and lead foil from x-ray film
packets
Copyright © 2021 by Elsevier, Inc. All rights reserved. 82
Classification of Waste
(Slide 3 of 3)
 Infectious or regulated waste
(biohazard)
 Contaminated waste that is capable of
transmitting an infectious disease
 Some items, such as extracted teeth with
amalgam restorations, may be both
hazardous waste (because of the amalgam)
and infectious waste (because of the blood)
 Most dental offices are exposed to the
following types of infectious waste:
 Blood and blood-soaked materials
 Pathologic waste
 Sharps

Question 68

Handling Contaminated Waste

Answer 68

Contaminated items that may contain body
fluids, such as gloves and patient napkins,
should be placed in a lined trash receptacle
 A receptacle for contaminated waste should
be covered with a properly fitted lid, opened
by a foot pedal
 Keep the lid closed to prevent air movement
and the spreading of contaminants
 Red bags or containers should not be used for
unregulated waste
 Check the specific requirements of your local
state or county health department

Question 68

Handling Extracted Teeth

Answer 68

Dispose of extracted teeth as regulated
medical waste unless being returned to
the patient
 When teeth are returned to the patient,
the provisions of the standard no longer
apply
 Do not dispose of extracted teeth
containing amalgam in regulated medical
waste that will be incinerated
 Because of the mercury in amalgam
fillings, you should check with state and
local authorities for regulations regarding

Question 71

Handling Medical Waste

Answer 71

Medical waste is any solid waste generated
in the diagnosis, treatment, or
immunization of human beings or animals
in research
 Infectious waste
 A subset of medical waste
 Containers of infectious waste (regulated waste)
must be labeled with the universal biohazard
symbol, identified in compliance with local
regulations, or both
 Containers used for holding contaminated items
must be labeled

Question 72

Disposal of Medical Waste

Answer 72

Once contaminated waste leaves the
office, it is regulated by the EPA and by
state and local laws
 Under most regulations, the manner of
disposal is determined by the amount
(weight) of infectious materials requiring
disposal
 The average dental practice is categorized
as a “small producer” of infectious waste,
and disposal is regulated accordingly
 The law requires the dentist to maintain
records of the final disposal of this medical
waste, including documentation of how,

Question 73

CDC Guidelines:
Special Considerations

Answer 73

Saliva ejectors
 Do not advise patients to close their lips
tightly around the tip of the saliva ejector to
evacuate oral fluids
 Many patients have become accustomed to
closing their lips around the suction

Question 74

Additional Infection Control
Practices

Answer 74

OSHA Blood-Borne Pathogens Standard
 Never eat, drink, smoke, apply cosmetics or lip
balm, or handle contact lenses in any area of the
dental office where contamination is possible,
such as the dental treatment rooms, dental
laboratory, sterilization area, or the area for the
processing of x-rays
 Never store food or drink in a refrigerator that
contains any potentially contaminated items
 You can minimize the amount of splash and
spatter contamination produced during
dental procedures with the skillful use of a
dental dam and high-volume evacuation

Question 75

CDC Guidelines:
Dental Laboratory

Answer 75

Use PPE when handling items in the laboratory
until they have been decontaminated
 Clean, disinfect, and rinse all dental prostheses
and prosthodontic materials (e.g., impressions,
bite registrations, occlusal rims, and extracted
teeth)
 Consult with manufacturers regarding the stability
of specific materials (e.g., impression materials)
relative to disinfection procedures
 Clean/heat-sterilize heat-tolerant items used in
mouth
 Follow manufacturers’ instructions for cleaning,
sterilizing, or disinfecting items that become
contaminated but do not normally come into

Question 76

CDC Guidelines:
Preprocedural Mouth Rinses

Answer 76

Intended to reduce the number of
microorganisms released in the form of
aerosol or spatter
 Can decrease the number of
microorganisms introduced into the
patient’s bloodstream during invasive
dental procedures
 Scientific evidence that preprocedural
mouth rinsing prevents clinical infections
among dental health professionals or
patients is inconclusive
 This is an unresolved issue, and no

Question 77

CDC Guidelines:
Mycobacterium tuberculosis (TB)

Answer 77

For patients with known or suspected
active TB, the CDC recommends that
elective dental treatment be delayed
until the patient is noninfectious
 For patients who require urgent dental
care, the CDC recommends referring the
patient to a facility with TB engineering
controls and a respiratory protection
program

Question 78

CDC Guidelines: Creutzfeldt-Jakob
Disease (CDJ) and Other Prion
Diseases

Answer 78

CJD belongs to a group of rapidly progressive and
invariably fatal degenerative neurologic disorders
 Affects both human beings and animals and is
thought to be caused by infection with prions
 Prion diseases have an incubation period of years
but are usually fatal within 1 year of diagnosis
 Infectivity of oral tissues in CJD patients is an
unresolved issue
 No recommendation is offered regarding the use
of special precautions in addition to Standard
Precautions in the treatment of patients with
known CJD (unresolved issue)

Question 79

CDC Guidelines: Laser/Electrosurgery
Plumes or Surgical Smoke

Answer 79

In surgical procedures involving the use of
a laser or electrosurgical unit, a smoke by-
product is created during the thermal
destruction of the tissue
 Laser plumes and surgical smoke pose a
risk to dental healthcare professionals
 The effect of the exposure (e.g., disease
transmission or adverse respiratory
effects) on dental healthcare professionals
resulting from the use of lasers in
dentistry has not been adequately
evaluated (unresolved issue)