Bacterial contamination and decontamination of toothbrushes after use

Article (PDF Available)inThe New York state dental journal 73(3):20-2 · May 2007with366 Reads
Source: PubMed
The purpose of this study was to determine the extent of bacterial contamination of toothbrushes after use and the efficacy of chlorhexidine and Listerine in decontaminating toothbrushes. The effectiveness of covering a toothbrush head with a plastic cap in preventing contamination was also evaluated. It was found that 70% of the used toothbrushes were heavily contaminated with different pathogenic microorganisms. Use of a cap leads to growth of opportunistic microorganisms like Pseudomonas aeruginosa, which may cause infection in the oral cavity. Overnight immersion of a toothbrush in chlorhexidine gluconate (0.2%) was found to be highly effective in preventing such microbial contamination.
4 NYSDJ • APRIL 2007
something of a cliché, having been bantered around in practically
every dental publication and in many of the presentations and forums
we attend. There is no doubt that the development of clinical protocols
that are based upon meaningful investigations, investigations that
meet the gold standard” of fundamental research design and imple-
mentation, is a priority on dentistry’s agenda.But this admirable quest
is fraught with potential problems and challenges, while still holding
out hope of benefits to both the dental practitioner and to our patients.
Identifying areas of clinical practice that merit further investi-
gation must rely upon input from clinicians themselves to maxi-
mize the benefits to individual patients and/or the profession at
large.The so what?”criteria should be met so that measurable dif-
ferences that might potentially be found in clinical outcomes—if
that is what is being investigated—represent a meaningful state-
ment that could and should have an impact upon cogent recom-
mendations for changes in clinical treatment protocols.
The role of the clinician as an important member of the
research team now becomes more important than ever.As such, the
clinical dentist and dentist researcher/academic and biostatistician
must have an unprecedented dialogue and relationship.
Dental education on the predoctoral and postdoctoral levels
will also have an opportunity to broaden research design perspec-
tives and will be a significant benefit for all of us. While the ability
to critically assess the professional literature found in our peer
reviewed publications has always been and will continue to be an
important responsibility of all dentists, editors and editorial
boards, the expectations for clinician participation in small and
large research projects will undoubtedly be raised.
The National Institute of Dental and Craniofacial Research
(NIDCR) has taken a bold and proactive position in forging a new
model for clinical research in dentistry. Practice-based research net-
works (PBRNs) have been utilized in medicine, and this has result-
ed in significant clinical protocol changes. Similarly, the PBRN
structure, as envisioned by the NIDCR, is an inclusive concept that
combines the rigorous standards of academic research with the
practical demands of clinical practice.As such, the NIDCR commit-
ted approximately $75 million, over seven years, to three dental
PBRNs. Each PBRN will be mandated to recruit at least 100 general
dental practitioners as participants in the PBRN investigation pro-
jects. This unprecedented hybrid structure of clinical investigation
represents the ultimate meeting of “town and gownin dentistry.
One of the three dental PBRNs is based in the Northeast and
was awarded to New York University College of Dentistry and The
EMMES Corp. from Rockville, Maryland. It is referred to as the
PEARL Network, an abbreviation for Practitioners Engaged in
Applied Research and Learning. I am certain we will be hearing a
great deal more about all of these dental PBRNs in the near future.
As the dental profession charts its course of continued excellence
and relevance to the public in this millennium, clinical research will
play a powerful role in the process. Indeed, the rules of engagement
have been profoundly changed.What an exciting time for all of us!
Clinical Research in Dentistry
Everything is up for change, from research design to treatment protocols.
The times couldn’t be more challenging, or exciting.
D.D.S. M.Sd
Steven Gounardes, President
351 87th St., Brooklyn 11209
Stephen B. Gold, President Elect
8 Medical Drive, Port Jefferson Station 11776
Michael R. Breault, Vice President
1368 Union St., Schenectady 12308
John Asaro, Secretary-Treasurer
2707 Sheridan Drive, Tonawanda 14150
Alfonso J. Perna, Immediate Past President
Sixth District Dental Society, 55 Oak St.
Binghamton, 13905
Roy E. Lasky, Executive Director
121 State St., Albany 12207
William R. Calnon, ADA Trustee
3220 Chili Ave., Rochester, NY 14624
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28 Beverly Rd., Great Neck 11021
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80 Maple Ave., #206, Smithtown 11787
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Suffolk Oral Surgery Associates, 264 Union Ave., Holbrook 11741
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1668 Williamsbridge Rd., Bronx 10461
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20 Squadron Blvd., New City 10956
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Brooklyn, NY 11243-2907
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Hospital Dentistry
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Dental Practice
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Newburgh, NY 12550
Membership &
Deborah A. Pasquale
391 Manhattan Ave.,
Brooklyn 11211-1422
New Dentist
David C. Bray
18 Leroy St., Binghamton 13905
Alfonsa J. Perna
Sixth District Dental Society
55 Oak St., Binghamton, NY 13905
Peer Review &
Quality Assurance
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New York 10020-2003
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General Counsel
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Assistant Executive Director
NYSDJ • APRIL 2007 5
Foundation to Recognize
Annual Deans Award aimed at bolstering oral
health workforce in New York State.
ENSURING A GROWING and sustainable oral
health workforce is crucial to expanding the
availability of oral health services to all New
Yorkers, particularly the underserved and mem-
bers of the state’s growing culturally diverse
communities. To help address this critical issue,
the New York State Dental Foundation has estab-
lished a Deans Award, which will be present-
ed annually to graduating students or post-
doctoral trainees who have demonstrated an
exceptional level of achievement as measured
by the following criteria:
Outstanding academic performance.
A demonstrated commitment to enhancing
and improving the oral health of under-
served populations.
Membership in the American Dental Student
Candidates for the NYSDF Deans Award,
valued at $5,000, must be nominated by the
dean of each of the following academic dental
institutions: Columbia University College of
Dental Medicine; New York University College
of Dentistry; University at Buffalo School of
Dental Medicine; Stony Brook University
School of Dental Medicine; and the University
of Rochester Eastman Dental Center. Upon
review by the Foundation Board, the deans'
candidates will each be presented with a
$5,000 check at their respective commence-
ment ceremonies.
“This is such a wonderful opportunity for
the Foundation to partner with the state’s den-
tal schools,” said Foundation Chair Edward J.
Downes. “At the same time, we are promoting
the value of organized dentistry, making this
new program a remarkable win-win for every-
body involved.”
Winners of the 2007 Deans awards are
expected to be announced soon.
12 NYSDJ • APRIL 2007
THE BOARD OF TRUSTEES of the New York State Dental Foundation
has approved a request for funding in the amount of $10,000 from the
Chemung County-Corning Coalition for Water Fluoridation.
The Chemung County-Corning Coalition for Water Fluori-
dation is an affiliation of advocates for completion of the 25-mile
corridor of municipal water fluoridation from Chemung County to
Painted Post.The eastern portion of Chemung County has been flu-
oridated since 1953, a system that currently serves 70,000 of the
92,000 residents of the county. To the west, Painted Post has fluori-
dated since 1976, serving 9,100 residents. In the intervening years,
from initial fluoridation to today, many studies have shown that
children in the non-fluoridated 25-mile corridor exhibited elevated
numbers of decayed, missing and filled teeth.
Following a decades-long struggle against vitriolic anti-fluori-
dationists, public health advocates were able to successfully lobby
the Corning Board of Health and the Corning City Council to agree
to fluoridate the remaining water supply. The one catch was that the
Chemung County-Corning Coalition for Water Fluoridation would
have to come up with $100,000, half of the capital costs to start
water fluoridation, hence, the request for funding from the New
Yo r k S t a te D e nt a l F ou n d a t i on .
“We were greatly impressed by the level of support garnered
for this project from all possible stakeholders but most notably
from the local dental communities, said Foundation Vice
Chairman Robert Raiber.By the time the coalition made its appeal
the NYSDF, it had already received $11,000 in pledges from indi-
vidual, local dentists; a $2,500 donation from the Steuben County
Dental Society; and a $10,000 donation from the Seventh District
Dental Society. In addition, the Ferraioli Dental Lecture has
pledged $5,000.
Among the NYSDF’s missions is the goal of increasing public
understanding of and access to dental services. Clearly, fluorida-
tion is an essential aspect of oral health. The Centers for Disease
Control has called fluoridation one of the 10 greatest public health
achievements of the 20th century. In its MMWR Weekly, the CDC
“Fluoridation of drinking water began in 1945 and in 1999
reached an estimated 144 million persons in the United States.
Fluoridation safely and inexpensively benefits both children and
adults by effectively preventing tooth decay, regardless of socioeco-
nomic status or access to care. Fluoridation has played an important
role in the reductions of tooth decay (40% - 70% in children) and of
tooth loss in adults (40% - 60%).
The Foundation commends the hard work and efforts of the
Chemung County-Corning Coalition for Water Fluoridation and is
thankful for the opportunity to support and assist efforts to
improve the oral health of all New Yorkers.
Foundation Honors Eisenbud
The Board of Trustees of the New York State Dental Foundation
recently honored the memory and outstanding achievements of Dr.
Leon Eisenbud, with a contribution of $1,000 to a campaign to ren-
$10,000 for Fluoridation
NYSDJ • APRIL 2007 13
ovate and rename the dental department at Long Island Jewish
Medical Center in his honor.
“Dr. Eisenbud, said Foundation Chair Edward Downes, “will
long be remembered by members of our Board as well as the lead-
ership of the New York State Dental Association as the ‘father of the
modern dental residency program.’”
In a letter written in the fall of 2002 to NYSDA Executive
Director Roy E.Lasky, Dr.Eisenbud called passage of the PGY-1 leg-
islation a grand achievementand referred to the State Board exam
process as archaic and unfair”:
“…I am writing now to congratulate you on this grand
achievement, which indeed was only a dream. The substitution of a
residency for the unfair and archaic state board exam is the most
important step forward for the profession in my lifetime. I congrat-
ulate you because I know the way you guide things through the leg-
islative system. I think maybe this would not have happened with-
out you.
“Dr. Eisenbud’s impeccable reputation and his ability to
instruct and inform others without a doubt helped NYSDA in its
efforts to remove the exam requirement in New York State, Dr.
Downes said.
A committee has been formed at Long Island Jewish Medical
Center to spearhead the campaign to rename the dental department
in Dr. Eisenbuds memory. It is the committees hope that everybody
in the dental community will do what he or she can to ensure that
Dr. Eisenbud’s legacy will be appropriately memorialized.
Excellence in Community Service
& Corporate Leadership
Save The Date
Awards Luncheon
Friday October 12, 2007 12:00 noon to 2:00 p.m.
The St. Regis Two East 55
Street At Fifth Avenue, NYC
14 NYSDJ • APRIL 2007
A NEW AND EXCITING TREND in dental research is embodied by
the inauguration of three practice-based research networks funded
by the National Institute for Dental and Craniofacial Research, an
arm of the National Institutes of Health. One is based in the
Northwest, a second in the Southeast,and the third, closer to home,
at the New York University College of Dentistry. This last, the
PEARL Network— PEARL stands for Practitioners Engaged in
Applied Research and Learning—has since its inception in 2005
enrolled more than 100 practitioner-investigators and has eight
studies either underway or in the planning stages.
Practice-based research networks (PBRNs), which have exist-
ed in the United States since the 1980s but until recently only
among physicians, generate research of immediate relevance to the
profession by combining the expertise of a central academic
research center with the savvy of the practitioner working “in the
trenches.The PBRN concept arose from recognition of the fact that
while the majority of clinical research is conducted in academic
health centers, only a minority of patients receive their medical or
dental care there.
In contrast, in the PBRN model, network participants—clini-
cians involved in private practice, who represent 70 percent of the
profession—submit their own ideas for research to a coordinating
academic center, where NIH-approved protocols are developed and
in turn are implemented by these same practitioners.Improvements
in clinical practice traditionally have proceeded in a top-down man-
ner: a study begins in a laboratory or academic site and ends at an
academically based faculty practice.The PBRN model seeks to com-
plement this process by including the primary means of achieving
the greatest impact in terms of change: the general practitioner.
The PBRN model furthermore seeks to make up for the lack of
data available for clinical decision making and to create a mecha-
nism for comparing clinical outcomes reported by practitioners
who have decades of experience with findings generated by acade-
mic research centers.
Dentists Make Good Candidates
In terms of the practical implementation of such a model, experi-
ence has demonstrated that private-practice dentists and their
office staff are uniquely suited to participate in network-based
research, for several reasons. They include the following:
The research focus of PBRNs is primarily problem based.
Dentists are trained to be detail oriented and in control of the
office environment.
The essential elements of clinical research are mirrored by the
dentists experience with implementing a treatment plan.
Dedicated private-practice staff are familiar with the team
approach to clinical care, which parallels the environment
required for research coordination.
A typical dental PBRN study may last anywhere from one
month to three years, although most are of six months duration. It
is an observational study that addresses a fundamental clinical
question: Why we do what we do; and how can we do it better? All
studies relate to the day-to-day clinical needs of private dentists
and their patients and involve minimal additional work on the part
of the practitioner. Current topics under investigation by NYUCD
PEARL Network practitioner-investigators, for example, include:
Practice-Based Research Networks
A Win-Win for Private-Practice Dentists and the Future of Dentistry
Analia Veitz-Keenan, D.D.S.; Gary S. Berkowitz, D.D.S.; Irene Brandes, D.D.S., P.C.;
Kenneth L. Goldberg, D.M.D.; David A. Hamlin, D.M.D.; Robert Margolin, D.D.S.; Kay Oen, D.D.S.
NYSDJ • APRIL 2007 15
Causes of postoperative hypersensitivity in Class I composite
restorations; and
The effects of partial vs. complete caries removal on patient
Studies in the planning stages deal with:
The effects of endodontic therapy and restoration on tooth
longevity; and
The effects of sealing vs.restoration on caries extending into dentin.
Time Well Spent
While the individual dentists involvement in a PBRN involves a
substantial personal commitment of time and effort, most practi-
tioner-investigators regard the rewards of their participation as
more than commensurate. For example:
Participation in cutting-edge research has a positive impact on
the practitioner-investigators practice in addition to leading
to improvements in the practice of dentistry.
The Network practitioner-investigator gains training in the
methods and ethics of clinical research from specially trained
Network personnel—a gift that keeps on giving.
Network administration assumes the burden of paperwork
necessary for study approval and reporting, thereby freeing up
the practitioner-investigator to concentrate on the nuts and
bolts of the study.
The private-practice dentist, who is typically isolated from the
research environment, enjoys a new collegiality with other
practitioner-investigators, with a prestigious academic center
and with NIH. The PBRN acts as a link connecting dental
offices, integrating these offices into a larger organization and
uniting practitioners and academic researchers.
Participation in a Network study helps satisfy the practition-
er’s continuing education requirements.
Multiple Rewards
More and more dentists are viewing PBRNs as a means for becom-
ing involved with the advancement of the profession by applying
scientific guidelines to generate significant—and practice-applica-
ble—clinical data. PBRNs function at the interface between
research and quality improvement. They have the potential to have
a substantial impact on dentistry by adding a learning dimension
to the dental practice while improving primary dental care and cre-
ating a connected learning community.They provide opportunities
to address patient-centered issues that previously were neglected.
The ultimate measure of the success of dental PBRNs will be
their ability to influence dentistry, to change clinical procedures on
the basis of objective and reproducible evidence gathered by multi-
ple practitioners representing a wide range of patients, clinical
expertise and office locations.
The authors are all practitioner-investigators in the PEARL network and members of
the PEARL Practitioner Advisory Group. More information on the PEARL Network
is available at