Infection Control Today: pandemicals

By Roger P. Freeman, DDS

How could the little guy have suspected, when he invaded Russia in 1812 with a half of a million men strong, he would lose nearly onethird of his troops to something even smaller, the common, er... louse. Lice are ectoparasites that tend to lease — long-term — on the outside of their hosts. They were known to have found Napoleon’s troops particularly tasty. Recent findings by a French research team, as reported in the online edition of the Journal of Infectious Diseases, conclusively identified several forms of the wingless insects among troop clothing remnants found during construction at a former army barracks in Vilnius. Additional evidence of the event was also found in the dental pulp of unerupted teeth of 35 soldiers. Lice can transmit both trench fever and typhus, plagues historically well known to thin out and devastate armies. Had the pointy-hatted one visited the local nursery school, he might have anticipated the problem, don’t you think?

Ever wonder about that tsunami launching from your mouth while on the working end of your dentist’s drill or hygienist’s ultrasonic scaler? Fortunately, most dentists wonder a lot about it, and take precautions to tame that mushroom cloud of water, saliva, blood, tooth particles, bacteria, and potential viruses. For the record, aerosols are particles less than 50 micrometers in diameter, and are able to remain airborne for extended periods, potentially lodging in nooks and crannies of the lung. TB and measles are classic examples of tiny culprits that can waft about for hours, ending up in most unwelcome locales. Splatter, on the other hand, describes airborne particles bigger than 50 micrometers that behave in a ballistic manner, scudding in droplets, ejecting forcibly from an operating site and arcing similar to a bullet. You get the picture.

With this appetizing background, imagine for a moment, the war zone around your personal la vida boca. While it’s impossible to control all airborne material during dental procedures, dentists reduce the collateral damage by three primary means: First, by the use of standard precautions (i.e., barrier protection) for hands, eyes, and nose. (This, of course, helps the dentist; it doesn’t always do as much for you). Second, by the use of a preoperative rinse with antiseptic mouthwash. (This will reduce bacterial count, but it won’t have much effect on biofilm organisms found in plaque, below the gums, or migrating from the nasopharynx). Third, by the use of a high-volume evacuator, that oral Oreck used by an assistant, which often gobbles up everything not tied down. (But what if working alone?) Aerosol and splatter, a messy dilemma ... and now you know. (With thanks to Drs. Harrel and Molinari, Journal of the American Dental Association, April 2004.)

Hypodermic needles do not make for fun times, at least for most of us. Adding insult to sharp-o-phobia, now we’re being told needles probably should be longer, or else their therapeutic load may fall short of the target. According to a study conducted in Dublin, Ireland, standard one-and-a-quarter inch needles failed to reach the bullseye buttock muscle in 23 of 25 women, making for a lot of medicine frittered away in fat. This means that two-thirds of test patients ended up with less than optimal dosages of the meds typically administered “rearly” (e.g., painkillers, anti-nausea drugs, and others. There’s also the question of what the shortfall does, exactly, while bubbled up in fat tissue. Guys, maybe it’s just a girl thing!

The stats, according to a UNAIDS AIDS Epidemic Update:

• People currently living with HIV and AIDS: 40.3 million
• New HIV cases in 2005: 4.9 million
• AIDS deaths in 2005: 3.1 million

How is this possible?

Jack Snow was a split-end for the Los Angeles Rams for 11 years during the 1960s and 1970s. At 6-foot-2 and 210 pounds, he caught 340 passes for 6,012 yards and had 45 touchdowns. He was fearless, his signature route taking him into the jaws of the defensive secondary and an open invitation to annihilation from all sides. Many more times than not, he held on to the football, challenging the defense to shake his courage and skill. It never happened. Snow died on Jan. 9, 2006, at the age of 62, from a resistant staph infection he had been battling for two months post-operative. Staph ... It’s such a tiny little thing...