INFECTION CONTROL: ASPECT OF CONCERN

Sir, Dr Woods’ Editorial (Australian Dental Journal

1987;32:5) is a reminder of an inescapable factor in infection control. I am encouraged by your footnote to write in regard to another ‘aspect of control’.

The disposable glove can protect the operator and provide a barrier against transmission which is much appreciated by the patient. However, to paraphrase an old comment about the stethoscope, a glove is of value only if there is no significant contamination of the surface, no hole in the rubber (or vinyl), and no prejudice in the mind of the wearer.

The surface of some disposable gloves is adversely affected by wetting and they cannot be washed on

the hands before use. Therefore they must be clean upon removal from the container. Having located a brand of glove with minimal interference to tactile sense the writer employed a device from student days and filled fifty of the gloves with water. Seven of them leaked through holes unlikely to be detected in use.

Clearly there is a need for the testing and certif- ication of gloves to ensure that they are clean and safe.

As for prejudice in the mind of the wearer, one must do one’s best.

170 North Terrace, Adelaide, SA, 5000. 18 November 1987.

CARDIAC PACEMAKERS AND DENTAL EQUIPMENT

Sir, In Australia large numbers of patients are now

having cardiac pacemakers implanted for a variety of cardiac disorders including slow and fast heart rhythms. There has been for many years concern within the dental profession about the use of dental equipment which may interfere with cardiac pacemaker function. Although such interference has been reported, modern pacemaker systems are generally unaffected by dental equipment. Sophis- ticated electronic filters and metal encapsulation prevents such interference from causing inhibition of pulse generators.

Various precautions, however, are necessary with pacemaker patients. The dental surgeon should know that the patient has a pacemaker and at least have an idea of the indication for the device in that patient and their dependence on the system. The dental equipment when used should be kept well away from the pacemaker pulse generator implant site as it is still possible for interference to occur if the equipment lies within millimetres of the pulse generator or lead. If there is concern regarding any specific form of dental equipment then the patient’s

J. F. LAWS

pulse should be monitored whilst the equipment is in operation. In the rare situation of pulse generator inhibition, application of a pacemaker magnet over the pulse generator site will revert the pulse generator to the fured rate mode. In this mode no sensing can occur and pacing will continue in a regular manner.

Another frequently asked question is the import- ance of bacterial endocarditis prophylaxis in patients with implanted pacemaker systems. Bacterial endocarditis in the right heart coming from a pacemaker lead is extremely rare particularly following dental procedures. Routine bacterial endocarditis prophylaxis is therefore not indicated except in patients who have had previous endocarditis or have other indications for such prophylaxis.

HARRY MOND, MD, FRACP, FACC, DDU. (Cardiologist)

GEOFFREY BOWELL, MDSC, LDS, FRACDS.

(Dental Surgeon) 81 Collins Street, Melbourne, Vic., 3000. 27 November 1987.

62 Australian Dental Journal 1988:33:1,