Choosing and using preprocedural rinses

by Noel Kelsch, RDHAP
[email protected]

I always know when Thursday is. I have literally paid for not knowing. Thursday is the day the street sweeper cleans my street. There have been times that I have forgotten and remained in bed and left my car parked on the street. I have had one side of my car covered in mud with the windshield waiting for me to collect the $43 bill off it. There are consequences for not staying aware of street signs as well as information that is available to everyone.

In infection control, we need to stay abreast of the current information. One consideration that I would like you to think about is staying aware of current findings regarding preprocedural mouth rinses. In 2003, the CDC described preprocedural mouth rinses as antimicrobial mouth rinses used by patients before a dental procedure. The point and purpose of this rinse is to reduce the number of microorganisms that a patient might release in the form of aerosols and splatter that can contaminate the dental health care professional (DHCP) or patient.

These rinses would include products like chlorhexidine gluconate, essential oils, and povidone-iodine. By following label directions with these products, you can lower the microorganisms released in splatter and aerosols.

The other interesting part of this is that antimicrobial rinses were once thought to help reduce the number of microorganisms introduced into the patient’s bloodstream during invasive dental procedures and possibly bacteremias.¹ In 1997, antimicrobial rinses were even recommended by the American Heart Association (AHA) as a preventive measure for reducing the risk of developing bacterial endocarditis following bacteremia-inducing dental procedures for clients at risk.

In 2007, the AHA changed that recommendation. They reviewed the science-based studies and information, concluding that the use of antimicrobials was contraindicated with the regard to reducing the frequency, magnitude, or duration of bacteremias that were associated with dental procedures. The evidence suggested there is no clear benefit. The AHA no longer has preprocedural mouth rinses listed in their guidelines as a measure for preventing bacterial endocarditis.²

Should you be using antimicrobial rinses? In dentistry, there are many areas where we create aerosols and splatter that are very hard to limit. Rubber dams can be utilized in many situations — along with high-volume evacuation. These simple steps have been shown in science-based studies to be an effective way to reduce exposure to splatter and aerosols.³

Aerosols are of great concern since they can remain suspended in the air for a great length of time. Hygienists utilizing prophy cups and ultrasonic scalers need to focus on limiting splatter and aerosols as well as lowering the amount of bacteria. Simply having the client rinse with an antimicrobial has been shown to lower the amount of bacteria.4,5 This simple step will lower the amount of microorganisms that the DHCP and patients are exposed to.6

Last week, I almost slept in. My doorbell rang in the early hours. My sweet neighbor was reminding me to move my car off the street. I hope that each of you will remind your staff members to “follow the signs” and the current science-based recommendations for caring for our patients and keeping our staff safe. The simple step of having patients rinse with a preprocedural mouth rinse can lower the exposure to microorganisms found in splatter and aerosols.

Noel Brandon Kelsch, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists’ Association.

References

1. Guidelines of infection control in the dental setting 2003 MMWR, December 19, 2003: 52 (rr-17.)
2. Wilson W, Taubert KA, Gewitz M, Lockhart BP, et al. Prevention of infective endocarditis: Guidelines from the American Heart Association. Circulation 2007;116:1736-1754.
3. Cochran MA, Miller CH, Sheldrak MA. The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment. J AM Dent Assn 1989; 119:141-144.
4. Litsky BY, Mascis JD, Litshy W. Use of an antimicrobial mouthwash to minimize the bacterial aerosol contamination generated by the high speed hand drill. Oral Surg Oral Med Oral Pathol 1970;29;25-30.
5. Muir KF, Ross PW, MacPhee IT, Holbrook WP, Kowolik MJ. Reduction of microbial contamination from ultrasonic scalers. DR Dent J 1978;145:76-8.
6. Fine DH, Furgang D, Furgang D, et al. Reduction of viable bacteremia in dental aerosols by preprocedural rinsing with an antiseptic mouthrinse. AM J Dent. 1993;p219-221.