Pathogens in dentistry: Dental assisting

Pathogens are disease producing microorganisms and are commonly present in the dental office. As a dental assistant, you need to be aware of the types of microorganisms found in the blood, saliva, and other body fluids of patients, understand how they spread, and how to use infection control procedures to protect your patients, yourself, and the dental team by helping break the chain of infection.

Now, the 3 major groups of microorganisms found in the dental office are bacteria, viruses, and fungi, and each group has specific structures, modes of transmission, and reproductive processes.

Let's start with bacteria. Bacteria are single-celled microorganisms that come in a variety of shapes, including spheres, rods, and spirals.

They can survive and reproduce on their own when conditions are right. Most pathogenic bacteria thrive at normal body temperature, which is 98.6 °F or 37 °C, and they prefer a dark and moist environment.

Some bacteria, referred to as aerobes, need oxygen to survive, while anaerobes grow without oxygen. Other bacteria called facultative anaerobes can grow with or without oxygen.

There are also some bacteria that can survive under harsh environmental conditions by changing into spores, which are extremely difficult to destroy.

Next are viruses. Compared to bacteria, viruses are much smaller, and in contrast to bacteria, they're unable to survive outside of a host cell.

Instead, viruses must enter a host cell and take over its normal function so the virus can replicate or make copies of itself.

After replication, the virus is released from the host cell, which is destroyed in the process. Last are fungi.

Fungi are commonly referred to as molds and yeasts. Now, we all have a wide variety of normal flora, or beneficial non-pathogenic bacteria, viruses, and fungi in and on our bodies that help protect us from pathogenic microorganisms by competing with them for space and nutrients.

For example, if the bacteria normally found in the mouth are destroyed by a broad-spectrum antibiotic, candidiasis, an opportunistic infection, can occur.

All right. Next, let's focus on some of the common pathogenic bacteria you'll encounter in the dental setting and the diseases they cause.

The most common bacterial diseases you'll see in your patients are dental caries and periodontal disease. These involve the formation of dental biofilm or dental plaque that's made up of communities of bacteria.

The bacteria grow and multiply as they feed upon the food and drinks we consume. In the process, they create acids that damage the teeth and cause inflammation in the periodontal tissues.

If dental caries or periodontal disease go untreated, you may see an abscess, which is a collection of pus or an accumulation of fluid composed of bacteria, dead cells and tissue.

OK, let's switch gears and look at some common viral pathogens, including herpes simplex virus or HSV, human immunodeficiency virus or HIV, viral hepatitis, and COVID-19.

There are two types of herpes simplex virus. In general, type 1 tends to cause infections above the waist and typically affects the lips, called herpes labialis, while type 2 tends to cause infections below the waist and involves the genitals, called herpes genitalis.

The oral lesions, commonly called cold sores or fever blisters, are highly contagious, can spread through saliva or direct contact, and pose a significant risk in dental settings.

Human immunodeficiency virus causes acquired immunodeficiency syndrome or AIDDS. HIV attacks the immune system, increasing susceptibility to opportunistic infections.

Many individuals with HIV appear healthy and have no visible symptoms. In the dental setting, transmission can occur through direct contact with blood or other secretions through an open cut, needle stick, or mucous membranes, such as the eyes or nasal mucosa.

Another common infection is viral hepatitis, which refers to inflammation of the liver caused by hepatitis viruses. There are 5 main types A, B, C, D, and E.

Transmission depends on the type. Hepatitis A&E are spread through the fecal-oral route that typically involves transmission through contaminated food, water, and hands, while hepatitis B, C, and D are spread through contact with infected blood or bodily fluids.

Notably, hepatitis B and C can survive on surfaces outside the body for extended periods under certain conditions. Lastly, COVID-19 is a highly contagious disease that predominantly affects the respiratory tract and is caused by the SARS-COVID-2 virus.

It's most often spread from person to person through tiny aerosolized particles and larger droplets, which are expelled when an infected individual talks, sneezes, or coughs, or when aerosols and droplets are generated by dental procedures.

The most common fungal pathogen you'll see in the dental setting is oral candidiasis. Candidiasis is an opportunistic infection caused by Candida albicans, a yeast that is commonly present in the mouth.

Risk factors for infection include patients who are very young or very old and those with weakened immune systems, such as those with certain chronic diseases like diabetes, cancer, or HIV.

Other risk factors include xerostomia or dry mouth, wearing dentures, and medications such as broad-spectrum antibiotics, and those that suppress the immune system, such as inhalers containing corticosteroids.

Candidiasis often appears as a white film on the tongue or oral mucosa. When removed, the underlying surface may be red, raw, or bleeding.

The lesions may have a cottage cheese-like appearance. As a dental assistant, you are on the front lines of controlling infections to protect your patients, yourself, and the members of the dental team.

As part of your role in infection control, you'll be responsible for screening patients for potentially infectious diseases by reviewing patient medical histories and communicating with the dental team.

You'll also ensure adherence to established standards and protocols, such as following standard precautions with every patient interaction, regarding blood, saliva, and other body fluids as potentially infectious, proper use of personal protective equipment or PPE, and reducing potentially infectious aerosols with use of high velocity evacuation and air filtration systems.

Other important infection control practices include proper sterilization of contaminated instruments, implementing techniques to prevent needle sticks, and staying up to date on immunizations, including hepatitis B and COVID-19.

All right, as a quick recap, pathogens are disease-producing microorganisms and are commonly present in the dental office.

As a dental assistant, you need to be aware of the types of microorganisms found in the blood, saliva, and other body fluids of patients, understand how they spread, and how to use infection control procedures to protect your patients, yourself, and the dental team.