A questionnaire study was conducted among 245 dental students from Bhopal city, Central India, to determine their level of knowledge, attitudes, and practice regarding infection control measures and if any correlation exists among the knowledge, attitudes, and practice scores. The self-administered questionnaire consisted of three parts: knowledge, attitudes, and practice. Analysis of Variance (ANOVA) was used to compare mean of knowledge, attitudes, and practice scores and Kendall's test to compute the correlation between knowledge, attitudes, and practice scores. A p value of ≤0.05 was considered significant for all statistical analyses. We found that 61.2 percent of the dental students had not been vaccinated with hepatitis B. Use of face mask, gloves, eyewear, and protective clothing as standard infection control measures was practiced only by two students. Mean knowledge, attitude, and practice scores were 3.75 (1.01), 3.40 (0.75), and 3.35 (1.04), respectively. Significant linear correlation was seen between attitude and practice scores (r=0.20, p≤0.01). The level of knowledge and practice of infection control measures was poor among dental students. The attitude towards infection control measures was positive, but a greater compliance was needed. We recommend rigorous training on infection control measures prior to graduation and mandatory hepatitis B immunization of students before exposure to clinical practice.

The study compared the attitudes and behavior of 4th-year dental students regarding infection control rules in 1995 and 2005. Self-administrated questionnaires were applied to 592 students at 5 different dental schools in 1995 (n=350) and in 2005 (n=242). The chi-square and Fisher's exact tests were used for statistical analysis of data. Significance level was set at p<0.05. The response rate was 90.3% in 1995 and 81.0% in 2005. There was no improvement in the use of rubber gloves (p=0.316), face masks (p=0.572) or gowns (p=0.862) between 1995 and 2005. There was a lesser frequency of the use of protective eyewear in 2005 (p<0.001). No student used the individual protection equipment correctly. There was a decrease in the sterilization of burs in 2005 when compared to 1995 (p<0.001). No student could describe the correct use of the autoclave. Disinfection and use of a dental chair barrier were done correctly by a minority of students in 1995 (2.8%) and 2005 (6.1%)(p=0.069). Most students correctly discarded perforating/cutting instruments in both years (p=0.749). The attitudes and behavior of dental students concerning infection control are worrisome. There was no improvement and, for some parameters, there was a worsening in the procedures over the time period evaluated.

AIM To investigate variations in the root canal systems of first and second permanent mandibular molar teeth in a Sudanese population using a clearing technique. METHODOLOGY Two hundred extracted first and second permanent mandibular molars from three cities in the state of Khartoum were studied. Access cavities were prepared and pulp tissue was removed by immersion in 5% sodium hypochlorite under ultrasonication; Indian ink was then injected into the root canal systems assisted by a vacuum applied apically. The teeth were rendered clear by demineralization and immersion in methyl salicylate before evaluation. The following observations were made (i) number of roots and their morphology;(ii) number of root canals per tooth;(iii) number of root canals per root and (iv) root canal configuration. RESULTS Overall 59% of mandibular first molars had four canals with 3% having a third distolingual root. Seventy-eight per cent of second mandibular molars had two separate flat roots, whilst 10% were C-shaped. The most common canal system configurations were type IV (73%) and type II (14%). Inter-canal communications were more common in the mesial roots. The prevalence of inter-canal communications was 65% in first molars and 49% in second molars. CONCLUSIONS In this sample of Sudanese teeth, 59% of the mandibular first permanent molars had four root canals whilst 10% of the mandibular second molars had C-shaped roots/canals.

All 250 children presenting with diarrhoea at 2 teaching hospitals in Mosul, Iraq over a 9-month period were studied for the presence of Yersinia spp. in stools by cold-enrichment culture at 4 degrees C for 21 days. Pathogenicity of the isolated Yersinia was determined. Antibodies to Y. enterocolitica were raised for rapid Yersinia detection in the stool. Yersinia spp. were isolated from the stools of only 4 patients; 3 isolates were identified as Y. enterocolitica and 1 was Y. pseudotuberculosis. The blood culture was also positive for Y. enterocolitica in 1 case. The antibiogram test for the isolated Yersinia was determined. Cross-reaction between Y. pseudotuberculosis and Salmonella typhi or S. paratyphi B, and between Y. enterocolitica and Brucella was detected serologically.

The aim of this study was to assess the effect of fluoride on the severity of caries among children exposed to different concentrations of fluoride in the drinking water and living in rural areas in the Sudan. Permanently resident schoolchildren (n = 299) aged 11-13 years from three villages were clinically examined under field conditions. The caries criterion was teeth in need of extraction or extracted; only molars were recorded. Dental fluorosis was scored on all buccal tooth surfaces by the Thylstrup and Fejerskov index. The fluoride concentrations of the drinking water were assessed in samples (n = 25) collected from wells and households. Predictors of caries were assessed by logistic regression analyses. There was no significant difference regarding age and gender distribution between the areas (P > 0.05, df = 2, Kruskal-Wallis test). The socio-economic conditions in these villages were presumed to be equal. Significantly different fluoride concentrations in the drinking water were verified by the severity of dental fluorosis. Children in Abu Delaig, drinking water with 1.0-2.0 mg fluoride/L (median = 1.8), had significantly higher caries prevalence (21% versus 8%) than in a 0.4 mg fluoride area. Area was the only significant predictor for caries; odds ratio 3.7 for children in Abu Delaig compared with the low fluoride area. There was no difference in caries prevalence between the lowest and the highest fluoride (2.9 mg) area. This study failed to demonstrate an effect of fluoride in drinking water on caries experience when the end point was molars indicated for extraction or missing because of caries.

A panel of eight tests was used to study 200 cases of acute brucellosis, 200 patients negative for brucella as a control group and 200 apparently healthy individuals as a second control group. The best diagnostic test was the rose Bengal test using an imported reagent (BioMérieux, France) and 2 local reagents. This test was improved from being a screening test to be a titrable one. The best two tests used together were the tube agglutination test with Coomb-like test. The indirect fluorescent antibody test had no advantages over the use of other tests. The 2-mercaptoethanol test and C-reactive protein test were useful in checking the brucellosis activity. Normal numbers of E-rosette forming cells and inefficient neutrophils in phagocytosis were found in peripheral blood during acute brucellosis.

AIM The aim of this study was to evaluate the practice and depth of knowledge of root canal treatment by dental practitioners in Khartoum, the capital city of Sudan, in order to improve the current status of endodontic therapy. METHODOLOGY A questionnaire was posted to 55 registered dental practitioners. Completed questionnaires were analysed in term of simple summary statistics. RESULTS A total of fifty-two (95%) practitioners responded. Eighty-five per cent of the respondents indicated that they performed root canal treatment for their patients. Of these, 84% included molars in their activity. Amongst those who carried out root canal treatment, only one practitioner used rubber dam for isolation, whilst the remainder used cotton wool rolls. The majority of respondents (80%) used hydrogen peroxide to irrigate canals during treatment. Three-quarters of practitioners used formocresol as an inter-appointment medicament. The stepback preparation technique was the method of choice for 98% of respondents. All practitioners used hand instruments to prepare root canals and all used gutta-percha for obturation; three-quarters of them used cold lateral condensation for all or some cases. The average number of radiographs routinely taken for root canal treatment was three. Only 73% used radiographs for measuring the working length. Ninety-five per cent of respondents indicated that they usually completed a root filling in three or more visits. Three-quarters of practitioners restored the teeth permanently immediately after the obturation and one-quarter preferred waiting for 1 or 2 weeks. CONCLUSIONS In Sudan, there are no dental practices limited to endodontics and no postgraduate training programmes. This survey shows the importance of establishing higher specialist training or continuing dental education for practitioners to update their knowledge.

BACKGROUND: Survey data on the prevalence of use of oral snuff (toombak) and cigarette consumption according to various demographic factors are needed in the Sudan. METHODS: A house to house cross-sectional survey of a random population sample of 4,535 households was performed. Of the 23,367 household members identified, 21,648 (92.6%) eligible individuals were questioned about tobacco use. RESULTS: Among children and adolescents (4-17 years) prevalence of tobacco use was quite low (2%, range 1-2%), but there was an abrupt increase up to 25% in late adolescence. Among the adult population aged 18 years and older the prevalences of toombak use (34%) and cigarette smoking (12%) among males were significantly higher than among females (2.5 and 0.9%, respectively). The prevalence of toombak use among the male population aged 18 years and older was significantly higher in the rural than in the urban areas (35% vs 24%), while cigarette smoking had a higher prevalence in urban areas (18% vs 12%). The highest rates of toombak use were found in rural areas among the male population ages 30 years and older (mean 46.6%, range 45-47%). CONCLUSIONS: In view of the high prevalence of tobacco use, especially of toombak, among the population surveyed, there is an urgent need to educate the public on the health consequences of these habits.

Histological and ultrastructural features of 25 oral snuff dipper's lesions with distinctive subepithelial hyaline deposits were investigated. Periodic acid-Schiff reaction with and without diastase digestion demonstrated the presence of glycogen and other carbohydrates, but histochemical stains for normal collagen, elastin and fibrin showed a weak variable reactivity of the deposit. Although in 7/25 cases the deposit was in close proximity to labial salivary glands and on occasions ducts were found within the deposit, the presence of mucin was not a consistent feature. Congo red staining and immunohistochemical investigation with an anti-amyloid antibody did not support the previous contention that such deposits were amyloid in nature. Immunohistochemically, collagen antibodies also provided negative results, but ultrastructural features of three biopsies studied suggest that the bulk of this deposit is made up of collagen, as typical cross-striated fibrils were found. The pathogenesis of this deposit could therefore be interpreted as over-production and/or reduced turnover of collagen by resident fibroblasts, which is further altered by the ingredients of toombak. The deposit does not appear to be a secretory product.

The purpose of this study was to assess the caries prevalence of children living in areas with either 0.25 or 2.5 ppm fluoride in the drinking water, and to relate caries experience to the severity of dental fluorosis. The children, aged 6-16 years (mean 11.3 years), were lifelong residents of their rural villages. The severity of dental fluorosis in the maxillary central incisors, assessed by Deans index, was 1.4 +/- 0.9 (n = 59) and 2.3 +/- 0.9 (n = 65) in the 0.25 and 2.5 ppm areas, respectively. There was no significant difference in DMFT between children from the two areas (2.6 +/- 2.3 n = 59 versus 2.1 +/- 2.3, n = 65). In the low-fluoride area 75% of the children had decayed permanent teeth compared to 66% in the high-fluoride area. In the primary teeth, however, both the caries prevalence and the dmft were significantly lower in the 2.5 ppm area than in the low-fluoride area. Stepwise, multiple, linear regression analyses, including all children, showed a significant effect of age on DMFT (30% of the variance explained), but no explanatory effect of fluoride in drinking water, severity of dental fluorosis, or gender. Regression analyses based on children in the 2.5 ppm area alone, showed significantly higher DMFT by increased severity of dental fluorosis. In children with a mixed dentition (n = 66), there was no association between caries in the primary and permanent teeth.

Dental fluorosis is endemic in Eastern Africa and a high prevalence has been found even in low-fluoride (approximately 0.5 ppm) areas. Substantial seasonal changes in the fluoride content of water have also been reported. The aim of the present study was to ascertain, through one year, the fluoride concentration in water from two underground reservoirs in Sudan, in Treit el Biga (TeB) and Abu Groon (AG), and to assess dental fluorosis in children aged 7-16 years who had been lifelong residents. The water in one of the reservoirs (TeB) was shown to have a low, very stable fluoride concentration (0.25 ppm SD 0.04) whereas the other (AG) had a tenfold higher, and slightly varying, fluoride concentration (2.56 ppm SD 0.26). Dental fluorosis was recorded on maxillary central incisors according to Dean's index. In TeB 91% of the children showed signs of dental fluorosis whereas in AG all children had fluorotic teeth. The Community Fluorosis Index in TeB and AG was 1.40 and 2.44, respectively. There was a significantly higher degree of fluorosis in boys than in girls in the low-fluoride area. In TeB, older boys tended to have more fluorosis than younger boys; the difference, however, was not statistically significant. No significant sex or age differences in fluorosis were found in AG. In both villages great inter-individual variations in dental fluorosis were recorded. The prevalence and severity of dental fluorosis in TeB was higher than that previously reported in areas with similar fluoride concentrations in the drinking water.

Clinical (n = 281) and histopathological (n = 141) characteristics of toombak-associated oral mucosal lesions detected in an epidemiological study in northern Sudan in 1992/93 are described. The lesional site in the majority of toombak users was the anterior lower labial groove and the lower labial mucosa. 4 degrees (1-4) of clinical severity of lesions, similar to those used to characterise Swedish snuff-dipper's lesion, were applied. An association between the severity of mucosal lesions and a longer lifetime duration (> 10 years) of toombak use was found, but the severity was not related to the daily frequency of the habit. Parakeratosis, pale surface staining of the epithelium and basal cell hyperplasia were commonly observed, but epithelial dysplasia was infrequent (10/141). The most significant observation was a PAS-positive amorphous deposit between the lamina propria and the submucosa, found in 25/141 biopsies. The clinical and histopathological features of toombak lesions are closely similar to Swedish moist snuff-dipper's lesions and this may reflect the high alkalinity of these products, resulting in an alkaline burn on the oral mucosa following chronic exposure. The low prevalence of epithelial dysplasia implies a low risk of malignant transformation. Nevertheless, the high concentrations of tobacco-specific nitrosamines present in toombak, and the high prevalence of oral cancer in Sudan, mandate biopsy and careful histopathological analysis of any such lesions detected in habitues.

OBJECTIVES This study aimed to survey changes in practices of infection control (IC) procedures by dentists in Beijing between 2000 and 2010. METHODS Data were based on the feedback of 592 and 769 dentists surveyed in 2000 and 2010, respectively. Statistical analysis was conducted using Pearson's chi-squared test. RESULTS Response rates of 95%(2000) and 94%(2010) were achieved. The percentages of dentists who had received training in IC were 62.96%(2000) and 76.21%(2010). Improvements in practices in 2010 over those in 2000 included increases in: the percentage of vaccination for hepatitis B virus from 32.66% to 68.14%; the routine use of gloves from 73.31% to 99.73%; the use of face shields or eyewear as protection against splatter during dental treatment from 13.94% to 95.45%; the use of protective gowns from 14.51% to 54.23%; the use of high-volume suction from 11.19% to 74.34%; routine changing of gloves between patients from 63.25% to 99.22%; pressured steam sterilisation of dental handpieces between patients from 41.24% to 96.10%, and the flushing of dental unit waterlines after each treatment from 42.01% to 73.49%. CONCLUSIONS   Although compliance with recommended IC practices by dentists in Beijing improved between 2000 and 2010, not all dentists are properly familiar with IC procedures. Education in IC in dental schools and in continuing training in hospitals, and mandatory regulations are needed to improve IC practices in dental health care settings.

Objectives: To investigate the knowledge, attitudes and behaviour of dentists working in dental clinics and dental hospitals regarding biomedical waste management and cross-infection control. Methods: A national survey was conducted. Self-administered questionnaires were sent to 800 dentists across India. Results: A total of 494 dentists responded, giving a response rate of 61.8%. Of these, 228 of 323 (70.6%) general dentists reported using boiling water as a sterilising medium and 339 (68.6%) dentists reported disposing of hazardous waste such as syringes, blades and ampoules in dustbins and emptying these into municipal corporation bins. Conclusions: Dentists should undergo continuing education programmes on biomedical waste management and infection control guidelines. Greater cooperation between dental clinics and hospitals and pollution control boards is needed to ensure the proper handling and disposal of biomedical waste.

Context: Management of waste generated in any health-care facility is a critical issue as it poses a direct threat to human health as well as to the environment. The biomedical waste generated in the dental scenario includes sharps, used disposable items, infectious waste (blood-soaked cotton, gauze, etc.), hazardous waste (mercury, lead), and chemical waste (such as spent film developers, fixers, and disinfectants). A major concern in our field is management and disposal of mercury. Aims: To obtain information about the knowledge, attitude, and practices of dental institutions and dental practitioners in the disposal of waste. Settings and design: A self-administered questionnaire, composed of 50 questions was designed. Materials and Methods: The questionnaire was distributed among the participants, chosen randomly, including dental students, faculty from dental colleges and private practitioners in and around Delhi, India. Statistical analysis used: The percentage response for each question from all the participants was obtained and the data was calculated. Results: Many dentists have knowledge about the waste management but they lack in the attitude and practice. Conclusions: There is need for education regarding hazards associated with improper waste disposal at all levels of dental personnel. It is imperative that waste should be segregated and disposed off in a safe manner to protect the environment as well as human health.

In a country where the prevalence of infectious diseases ranks among the highest in the world, infection control in health care facilities should not be debatable. This unfortunately does not seem to be the case in South African oral health care facilities. This study is a systematic review of available literature on the adherence of South African oral health care professionals to infection control recommendations. Nine focus areas were investigated with regard to infection control practices: knowledge of infectious occupational hazards; personal hygiene and care of hands; correct application of personal protective equipment; use of environmental barriers and disposable items; sterilisation (recirculation) of instruments and handpieces; disinfection (surfaces) and sound housekeeping; management of waste disposal; quality control of dental unit waterlines, biofilms and water; as well as other special considerations. Although South African studies are limited and most of them relied on self-reports, which could have resulted in a serious overestimation of compliance, even these studies indicate serious shortcomings with regard to infection control practices in oral health care facilities in this country. This review highlights opportunity for improvement. Furthermore, it identifies possibilities for future research in infection control and also opportunities to improve infection control education for all oral health care workers in the country.

OBJECTIVES: The objective of this study was to investigate the knowledge, attitudes and behavior of Turkish dentists in Samsun City regarding cross-infection control. MATERIAL AND METHODS: A questionnaire was designed to obtain information about procedures used for the prevention of cross-infection in dental practices and determine the attitudes and perceptions of respondent dental practitioners to their procedures. The study population included all dentists in the city of Samsun, Turkey, in April 2005 (n=184). The questionnaire collected data on sociodemographic characteristics, knowledge and practice of infection control procedures, sterilization, wearing of gloves, mask, use of rubber dam, method of storing instruments and disposal methods of contaminated material, etc. Questionnaire data was entered into a computer and analyzed by SPSS statistical software. RESULTS: From the 184 dentists to whom the questionnaires were submitted, 135 participated in the study (overall response rate of 73.36%). As much as 74.10% dentists expressed concern about the risk of cross-infection from patients to themselves and their dental assistants. Forty-three percent of the participants were able to define 'cross-infection' correctly. The greatest majority of the respondents (95.60%) stated that all patients have to be considered as infectious and universal precautions must apply to all of them. The overall responses to the questionnaire showed that the dentists had moderate knowledge of infection control procedures. CONCLUSIONS: Improved compliance with recommended infection control procedures is required for all dentists evaluated in the present survey. Continuing education programs and short-time courses about cross-infection and infection control procedures are suitable to improve the knowledge of dentists.

BACKGROUND Many diseases including HIV/AIDS can be transmitted in the dental setting when effective infection control procedures are ignored. The aim of this study, therefore, was to evaluate the infection control knowledge and practices of Nigerian dentists in the era of HIV/AIDS. METHODOLOGY Information on knowledge of transmission of HIV, occupational vulnerability, infection control practices, and opinion on adequacy of infection control facilities were gathered from dentists through a self-administered questionnaire. Knowledge was assessed on a total score of 20 questions. RESULTS Only 3.6% of the dentists had poor knowledge. Younger males and dentists working in teaching hospitals had significantly better knowledge than their counterparts. While 40.8% believed HIV could be transmitted through saliva, only 43.2% knew it could be transmitted through the conjunctiva. Most (93.2%) wore gloves routinely and the most common barrier to glove use was non-availability. Most (79.2%) used autoclaves for sterilization; however, chemical disinfectants and boiling were also used. The majority (72.4%) believed the facilities for infection control in their centres were inadequate. Close to half of the respondents (47.6%; n = 118) rated the occupational risk of becoming infected with HIV as high. CONCLUSION The results of this study have shown that while the level of knowledge of the dentists was generally acceptable, there were still some misconceptions on the transmission and occupational vulnerability of HIV. It also indicates only partial compliance with recommended infection control procedures among Nigerian dentists as a result of inadequate supplies.

OBJECTIVES To assess whether dentists in Jordan are employing recommended infection techniques in their clinics and to identify the level of compliance of dentists with the recommended infection techniques commonly found in western countries. PARTICIPANTS Dentists in Jordan (n = 300). METHODS Aquestionnaire incorporating information regarding: infection control practices, vaccination, personal barrier protection, instrument sterilisation and disinfection, were distributed to 300 dentists in private and public practices. RESULTS A (93%) response rate (n = 279) was available for analysis. Gloves were used by 73.3% of dentists; masks by 69.5%, protective eye wear by 43.8% and white coats worn by 75.9%. About 25% recorded patient medical histories. Offices in Jordan were found to be in compliance with respect to the use of disposable anaesthetic needles and carpules but only 27% use plastic containers for sharps; 72.6% of dentists had been vaccinated against hepatitis B viruses; approximately 70% use an autoclave for sterilisation but only 15% always use plastic bags for packing sterilised instruments. CONCLUSIONS The majority of dental practitioners were found to be in compliance with most of the recommended infection control regulations. In this study the overall compliance with infection control procedures was 61.17% among dentists in Jordan. Further education may be appropriate in taking a medical history of each patient before treatment, wearing of masks and protective glasses and the use of plastic bags to wrap sterilised instruments.

Infection control practices which increase the risk of blood-borne virus transmission with associated dental practice in one South African province were studied. All 24 state dental clinics were observed for adequate provision to carry out good infection prevention and control (IPC) practice, 75 staff including dentists, nurses and dental assistants were interviewed to assess IPC knowledge and 23 dental procedures were observed. Significant findings were the difference between knowledge and practice, despite adequate provisions for safe infection control practice. The lack of protective eye wear during a dental procedure, not washing hands between patients, not disassembling an item prior to disinfection or sterilization, and not using a sterile drill for each patient were identified. A rapid method for detection of occult blood was used as a marker for inadequate IPC practice. Contaminated dental items of equipment just prior to patient use in 25% of equipment tested and 37% of surfaces and surrounding areas in the dental clinics and units were recorded. This study concludes that, despite provision for safe dental practice available in state dental clinics, there was a lack of knowledge application in clinical practice. The risk of blood-borne virus transmission in a population with high human immunodeficiency virus (HIV) prevalence cannot be ignored.

BACKGROUND With the global rise in the number of people infected with hepatitis B and C and HIV viruses, cross infection has become of paramount concern to dental health care workers and their patients. The objective of this study was to assess the infection control practice in the private dental sector in Riyadh, Saudi Arabia. SUBJECTS AND METHODS The study was conducted through a cross-sectional survey of private dental practices in the city of Riyadh. A total sample size of 132 dental units was chosen using the proportional allocation method. Three hospitals, 45 clinics and 39 centers were selected randomly. A self-administered questionnaire was completed by dentists working in the selected settings. RESULTS Of the 206 questionnaires sent, 203 (98.5%) were completed. The mean age of the responding dentists was 36.8+/-6.7 years. A total of 139 dentists (68.5%) were general practitioners and 64 (31.5%) were specialists. A total of 129 (63.5%) stated that they had been vaccinated against hepatitis B virus and 189 (93.1%) stated that they always took a medical history of each patient before treatment. All the studied dentists reported that they always used gloves for every patient during dental treatment, and 90.6% stated that they always wore a face mask during dental treatment. The primary source of infection control information for the studied dentists was from the colleges (78.3%). Only 37.9% of the dentists sterilized their handpieces by autoclaving, while the other 53.7% used disinfectant. About 56% disposed of used needles and sharp instruments in special safety containers. Multivariate logistic regression analysis revealed that working in clinics, age >40 years and knowledge of correct sterilization steps were independent promoting factors for adherence to infection control practice (OR=3.8, CI=1.2-12.1; OR=10.2, CI=1.61-64.8; OR=5.6, CI=1.04-29.9, respectively). CONCLUSION The development of infection control manual for dental practices, in addition to a campaign of health education for dentists in the private sector, is recommended.

Of the 309 private dental practitioners in Fars, Iran, surveyed most, 77.7% believed they had a professional duty to treat HIV-positive patients, with 61.4% expressing some level of discomfort about treating these patients, and 75.1% believed they should be treated at a specialist practice. Gloves and masks were not always worn, 15.8% and 9.7%, respectively, and 70.2% of dentist washed their hands before treatment and 60.2% after treatment. Elementary standard precautions were not routinely implemented in private dental practices, despite high levels of concerns about transmission of infection.