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This paper discusses the use in dental practices of quaternary ammonium compounds (QAC) and alcohol-based disinfectants in relation to bactericidal efficacy against mycobacteria. QAC disinfectants are commonly used in dental practices, although there are concerns about their efficacy against tuberculosis-causing bacteria. The paper discusses a recent study where two QAC products (ready-to-use and saturated wipe liquor presentations) were tested, using a recognized suspension test, at the manufacturer's recommended concentration, under simulated ‘clean’ and ‘dirty’ conditions. The test data indicated that, after a 10-minute contact time, suitable kill of the test organism was not obtained. These findings raise questions about the suitability of QAC disinfectants for dental practices.
CPD/Clinical Relevance: Tuberculosis, a disease caused by Mycobacterium tuberculosis, is increasingly becoming a communicable disease of concern. It is important that dental practices ensure that a suitable level of decontamination takes place between patients. QAC disinfectants may not be suitable for this purpose and alternative biocides, like alcohol, may need to be considered.
Article
Within dental practices there is a concern about the transfer of pathogens between patients.1 A pathogenic organism where the level of alert has recently increased is with the causative agent of tuberculosis: Mycobacterium tuberculosis.2 Reports suggest that cases in the UK have increased in the past 15 years; moreover, incidents in the UK are above the Western European average: 14 per 100,000 people for the UK and 12 per 100,000 throughout Western Europe.3,4 This prevalence is complicated by a global increase in multi-drug resistant types of the bacterium.5
Tuberculosis infection occurs through inhalation of the bacterium, which then travels to the alveoli of the lungs. Most people who carry the bacterium do not show any symptoms (latent tuberculosis); however, the condition can become serious for people with weak immune systems.6 Here symptoms include fever, fatigue and, in some cases, the coughing up of blood. Although the disease remains rare, dentists need to be aware of the possible occurrence of oral lesions of tuberculosis and consider them in the differential diagnosis of suspicious oral ulcers. Patients who have pulmonary or laryngeal tuberculosis pose a risk of infection, especially if they are coughing due to the generation of aerosols;7 furthermore, dental equipment coming into contact with the mouth is potentially contaminated and this contamination can be transferred where items come into contact with work surfaces (Figure 1).
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