flatfish
11-20-2006, 02:23 PM
Subject: CJD SURGICAL INCIDENT REPORTING FORM UPDATE NOVEMBER 2006
Date: November 18, 2006 at 9:05 am PST
CJD SURGICAL INCIDENT REPORTING FORM UPDATE NOVEMBER 2006
snip...
7. Which tissues were involved?
Please tick Please circle or underline where appropriate
Any notes/details?
Brain
CNS / Spinal cord
Posterior eye / anterior eye / cornea
Olfactory epithelium
Tonsil / appendix / spleen / thymus
Other lymphoid tissue
Peripheral nerve
Dental pulp / gingival tissue / Blood / bone marrow / CSF / Placenta / Urine
Other or not know (please give available details):
8. How many instruments were used, and what were they?
(Please continue overleaf or attach details if necessary)
9. What type of decontamination procedures are used for these instruments?
10. How many times have the instruments been used and decontaminated since this procedure?
10. Can you trace the instruments?
(e.g. all / some / none / disposable / don?t know)
11. Where are the instruments now?*
(e.g. all are quarantined / some are quarantined / none are quarantined / not applicable/ don?t know)
12. How many people might have been exposed to the instruments (or pool of instruments)?
13. Other comments (Please continue overleaf or attach if necessary)
snip.....
http://www.hpa.org.uk/infections/topics_az/cjd/SI_formNov06.doc
Subject: CJD: update for dental staff
Date: November 12, 2006 at 3:25 pm PST
1: Dent Update. 2006 Oct;33(8):454-6, 458-60.
CJD: update for dental staff.
Scully C,
Smith AJ,
Bagg J.
Eastman Dental Institute, University of London.
It is almost a decade since the recognition of the emergence of a new infectious disease termed variant Creutzfeldt-Jakob disease (vCJD) caused by prions (PrPTSE), abnormal variants of a normal human cell surface protein (PrP).This disease has a number of similarities to other forms of CJD--lethal disorders characterized by a prolonged incubation period, and progressive mental deterioration. In relation to oral tissues, PrPTSE have been found in neural, gingival, pulpal, lingual, lymphoreticular and salivary gland tissue in animal models. In both sporadic and variant CJD, PrPTSE is detectable in the trigeminal ganglion and, in vCJD, in lymphoreticular tissues, but infectivity has not been tested in other human oral tissues. CLINICAL RELEVANCE: PrPTSE is much more resistant to the common methods of inactivation than conventional pathogens, and it adheres avidly to steel whilst retaining its infectivity. Particular attention must be paid to cleaning and sterilizing re-usable dental instruments. Single-use devices, such as endodontic files and matrix bands, must never be re-used. Advice on the reprocessing of dental instruments used on known CJD patients must be obtained from local infection control teams. Research into effective methods of prion inactivation appears promising, although further work on the applicability to general dental practice is required.
PMID: 17087448 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17087448&query_hl=1&itool=pubmed_docsum
Evidence For
CJD/TSE Transmission
Via Dental Instruments
>From Terry S. Singletary, Sr
flounder@wt.net
1-24-3
J Hosp Infect 2002 Jul;51(3):233-5 Related Articles, Links [Click here to read]
Contaminated dental instruments.
Smith A, Dickson M, Aitken J, Bagg J.
Infection Research Group, Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow, UK. a.smith@dental.gla.ac.uk
There is current concern in the UK over the possible transmission of prions via contaminated surgical instruments. Some dental instruments (endodontic files) raise particular concerns by virtue of their intimate contact with terminal branches of the trigeminal nerve. A visual assessment using a dissecting light microscope and scanning electron microscopy of endodontic files after clinical use and subsequent decontamination was performed. The instruments examined were collected from general dental practices and from a dental hospital. Seventy-six per cent (22/29) of the files retrieved from general dental practices remained visibly contaminated, compared with 14% (5/37) from the dental hospital. Current methods for decontaminating endodontic instruments used in dentistry may be of an insufficient standard to completely remove biological material. Improved cleaning methods and the feasibility of single use endodontic instruments require further investigation.
PMID: 12144804 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12144804&dopt=Abstract
J Gen Virol 1999 Nov;80 ( Pt 11):3043-7
Transmission of the 263K scrapie strain by the dental route.
Ingrosso L, Pisani F, Pocchiari M
Laboratory of Virology, lstituto Superiore di Sanita, Viale Regina Elena 299, 00161 Rome, Italy.
Apart from a few cases of iatrogenic and familial human transmissible spongiform encephalopathies (TSEs) or prion diseases, the cause of Creutzfeldt-Jakob disease (CJD) remains unknown. In this paper we investigated the possibility that dental procedures may represent a potential route of infection. This was assessed by using the experimental model of scrapie in hamster. In the first part of this study we found that after intraperitoneal inoculation, oral tissues commonly involved in dental procedures (gingival and pulp tissues) bore a substantial level of infectivity. We also found high scrapie infectivity in the trigeminal ganglia, suggesting that the scrapie agent had reached the oral tissues through the sensitive terminal endings of the trigeminal nerves. In the second part of the study we inoculated a group of hamsters in the tooth pulp and showed that all of them developed scrapie disease. In these animals, we detected both infectivity and the pathological prion protein (PrPsc) in the trigeminal ganglion homolateral to the site of injection but not in the controlateral one. This finding suggests that the scrapie agent, and likely other TSE agents as well, spreads from the buccal tissues to the central nervous system through trigeminal nerves. Although these findings may not apply to humans affected by TSEs, they do raise concerns about the possible risk of transmitting these disorders through dental procedures. Particular consideration should be taken in regard to new variant CJD patients because they may harbour more infectivity in peripheral tissues than sporadic CJD patients.
PMID: 10580068
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10580068&dopt=Abstract
CONTINUED........
Date: November 18, 2006 at 9:05 am PST
CJD SURGICAL INCIDENT REPORTING FORM UPDATE NOVEMBER 2006
snip...
7. Which tissues were involved?
Please tick Please circle or underline where appropriate
Any notes/details?
Brain
CNS / Spinal cord
Posterior eye / anterior eye / cornea
Olfactory epithelium
Tonsil / appendix / spleen / thymus
Other lymphoid tissue
Peripheral nerve
Dental pulp / gingival tissue / Blood / bone marrow / CSF / Placenta / Urine
Other or not know (please give available details):
8. How many instruments were used, and what were they?
(Please continue overleaf or attach details if necessary)
9. What type of decontamination procedures are used for these instruments?
10. How many times have the instruments been used and decontaminated since this procedure?
10. Can you trace the instruments?
(e.g. all / some / none / disposable / don?t know)
11. Where are the instruments now?*
(e.g. all are quarantined / some are quarantined / none are quarantined / not applicable/ don?t know)
12. How many people might have been exposed to the instruments (or pool of instruments)?
13. Other comments (Please continue overleaf or attach if necessary)
snip.....
http://www.hpa.org.uk/infections/topics_az/cjd/SI_formNov06.doc
Subject: CJD: update for dental staff
Date: November 12, 2006 at 3:25 pm PST
1: Dent Update. 2006 Oct;33(8):454-6, 458-60.
CJD: update for dental staff.
Scully C,
Smith AJ,
Bagg J.
Eastman Dental Institute, University of London.
It is almost a decade since the recognition of the emergence of a new infectious disease termed variant Creutzfeldt-Jakob disease (vCJD) caused by prions (PrPTSE), abnormal variants of a normal human cell surface protein (PrP).This disease has a number of similarities to other forms of CJD--lethal disorders characterized by a prolonged incubation period, and progressive mental deterioration. In relation to oral tissues, PrPTSE have been found in neural, gingival, pulpal, lingual, lymphoreticular and salivary gland tissue in animal models. In both sporadic and variant CJD, PrPTSE is detectable in the trigeminal ganglion and, in vCJD, in lymphoreticular tissues, but infectivity has not been tested in other human oral tissues. CLINICAL RELEVANCE: PrPTSE is much more resistant to the common methods of inactivation than conventional pathogens, and it adheres avidly to steel whilst retaining its infectivity. Particular attention must be paid to cleaning and sterilizing re-usable dental instruments. Single-use devices, such as endodontic files and matrix bands, must never be re-used. Advice on the reprocessing of dental instruments used on known CJD patients must be obtained from local infection control teams. Research into effective methods of prion inactivation appears promising, although further work on the applicability to general dental practice is required.
PMID: 17087448 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17087448&query_hl=1&itool=pubmed_docsum
Evidence For
CJD/TSE Transmission
Via Dental Instruments
>From Terry S. Singletary, Sr
flounder@wt.net
1-24-3
J Hosp Infect 2002 Jul;51(3):233-5 Related Articles, Links [Click here to read]
Contaminated dental instruments.
Smith A, Dickson M, Aitken J, Bagg J.
Infection Research Group, Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow, UK. a.smith@dental.gla.ac.uk
There is current concern in the UK over the possible transmission of prions via contaminated surgical instruments. Some dental instruments (endodontic files) raise particular concerns by virtue of their intimate contact with terminal branches of the trigeminal nerve. A visual assessment using a dissecting light microscope and scanning electron microscopy of endodontic files after clinical use and subsequent decontamination was performed. The instruments examined were collected from general dental practices and from a dental hospital. Seventy-six per cent (22/29) of the files retrieved from general dental practices remained visibly contaminated, compared with 14% (5/37) from the dental hospital. Current methods for decontaminating endodontic instruments used in dentistry may be of an insufficient standard to completely remove biological material. Improved cleaning methods and the feasibility of single use endodontic instruments require further investigation.
PMID: 12144804 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12144804&dopt=Abstract
J Gen Virol 1999 Nov;80 ( Pt 11):3043-7
Transmission of the 263K scrapie strain by the dental route.
Ingrosso L, Pisani F, Pocchiari M
Laboratory of Virology, lstituto Superiore di Sanita, Viale Regina Elena 299, 00161 Rome, Italy.
Apart from a few cases of iatrogenic and familial human transmissible spongiform encephalopathies (TSEs) or prion diseases, the cause of Creutzfeldt-Jakob disease (CJD) remains unknown. In this paper we investigated the possibility that dental procedures may represent a potential route of infection. This was assessed by using the experimental model of scrapie in hamster. In the first part of this study we found that after intraperitoneal inoculation, oral tissues commonly involved in dental procedures (gingival and pulp tissues) bore a substantial level of infectivity. We also found high scrapie infectivity in the trigeminal ganglia, suggesting that the scrapie agent had reached the oral tissues through the sensitive terminal endings of the trigeminal nerves. In the second part of the study we inoculated a group of hamsters in the tooth pulp and showed that all of them developed scrapie disease. In these animals, we detected both infectivity and the pathological prion protein (PrPsc) in the trigeminal ganglion homolateral to the site of injection but not in the controlateral one. This finding suggests that the scrapie agent, and likely other TSE agents as well, spreads from the buccal tissues to the central nervous system through trigeminal nerves. Although these findings may not apply to humans affected by TSEs, they do raise concerns about the possible risk of transmitting these disorders through dental procedures. Particular consideration should be taken in regard to new variant CJD patients because they may harbour more infectivity in peripheral tissues than sporadic CJD patients.
PMID: 10580068
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10580068&dopt=Abstract
CONTINUED........