I’m sure everyone is familiar with the hand washing protocols being recommended by all levels of government during the current Pandemic. The fact is, these protocols are only part of a much more comprehensive infection control program that has been used in every BC Dental office for years now, along with the regular donning and doffing of Face masks and gloves in between all patients.
The challenge has been determining what constitutes appropriate hand washing? Is the use of plain soapy warm water adequate or does it require the use of Antimicrobial soaps which contain either PCMX, Triclosan or CHG or does it involve the use of Soap Free Hand Sanitizers containing IsoPropyl Alcohol or Ethanol? These decisions are also heavily impacted by the concern over Antimicrobial Resistance. Another problem with these Antimicrobial Agents is that they commonly contain chemical preservatives which can severely dry out the hands and cause red, dry, cracked, peeling skin.
NANOSILVER PRODUCTS CONTAIN NO CHEMICAL PRESERVATIVES
There are literally dozens and dozens of Hand Sanitizers on the market which contain Organic ingredients in order to combat the drying effect of the Ethyl or Isopropyl Alcohol – however, once these organic ingredients (many of which are Oils) have been made soluble in water a broad spectrum Preservative need to be added, in order to kill microorganisms and water-borne bacteria, and to prevent contamination from bacteria, mold and yeast which can cause degradation of the product.
Such chemical Preservatives play a very important function in skin care products containing water but, they are themselves – potential irritants and toxins. These chemicals also generate an inflammatory response in the skin which triggers the production of free radicals which in turn starts a destructive chain of events in the skin called an inflammation cascade. Immediate effects of inflammation on the skin causes roughness, tightness, redness and spots (hyper-pigmentation). Examples of such chemicals include preservatives such as Parabens (Methylparaben), Formaldehyde Releasing Agents (Hydantoin), Phenoxyethanol (Optiphen), Isothiazolinones (Kathon) and Organic Acids such as Sodium Benzoate.
VeraSIL Antiseptic Skin Cleanser contains NanoSilver which meets the USFDA guidelines / standard as an Anti-microbial and Anti-fungal preservative under USP 51, 21 CFR Part 58 and DO NOT CONTAIN any of the aforementioned potential irritants and chemical toxins so they are safer and healthier for use on the skin.
To summarize, there is huge advantage to having a Hand Sanitizer which has the built in Antibacterial and Antimicrobial preservative properties of NanoSilver. The addition of Hydrogen Peroxide and the IPA to the NanoSilver serves to provide even more potent antibacterial benefits while the addition of Vitamin E at the same time helps prevent premature skin drying, peeling and cracking.
For more detailed market analysis, please refer to the “Competitive Market Analysis” section on the QR Product Page of the websites listed below.
There is only one Disinfectant solution that is capable of disinfecting a broad spectrum of pathogenic bacteria and viruses without harming the oral tissues while acting as a wound healing agent and that is a Silver technology called NanoMetallic Silver Tetrahedral Tetraoxide or “NMSTTO”. NMSTTO is a new product category with near ubiquitous applications in the Dental industry which was recently launched at the Vancouver PDC March 5-7, 2020 under the OraSIL, VeraSIL and CuraSIL brand names.
As an example of this technologies diversity, DDSource has launched a online portal named VeraSIL.com where Dental staff can access a hi-quality Skin Antiseptic called VeraSIL Antiseptic Skin Cleanser. This is the only IPA based Skin Antiseptic (cleared in Canada) which contains NanoSilver with proven anti-fungal and anti-bacterial preservative capabilities. The VeraSIL Hand Sanitizer product meets the Canadian Monograph for 70% Isopropyl Alcohol and and is proven alternative to hand washing with antibacterial soaps and water and can be used at home and at work to help protect your staff, your patients and your family. VeraSIL Antiseptic Skin Cleanser contains no harmful chemical preservatives.
Heres a PRAGMATIC SOLUTION for Dentists regarding the use of Face Masks…. If you don’t have an N95 Mask, You can Spray the inside of the Level 2 or 3 ASTM Mask with the VeraSIL Skin Antiseptic which is skin friendly and not a schedule 1 drug. As per my earlier post, the difference in the level of Protection between an N95 Mask and an ASTM F2100-2011 Level 2 or 3 Mask is negligible.
Spraying the Level 2 or 3 Face Mask allows you to improve the overall Antimicrobial efficacy and performance of these Masks for both you or your staff. In fact, you are providing an additional level of protection using a skin friendly, NanoSilver based broad spectrum Antimicrobial agent (proven to kill MRSA, VRE, Tuberculosis smegmatis as well as a long list of oral pathogens.)
You cannot use Lysol spray or a general purpose disinfectant as a Mask Spray anymore than you can spray dilute NaOCL onto the Face Mask (unless you want to burn your lips or your eyes). You cannot use Isopropyl alcohol in this same manner because it evaporates and is not safe for oral ingestion/absorption. You can’t use a hospital grade disinfectant like Metricide, Cavicide, Glutaraldehyde or Accelerated Hydrogen Peroxidase because these are all chemotoxic to the skin and require the donning of PPE before use. VeraSIL Protective Spray is NOT Cytotoxic to humans but, is deadly to wide variety of pathogenic micro-organsisms. MY POINT: There are specific additional steps you can take to help protect yourself that won’t harm your lips, mouth, nose or eyes!
The bottom line is that some of our regulatory bodies are unaware of all the working solutions we Dentists have at our fingertips. They also know very little about the myriad of dental applications of Nanotechnology that are now commercially available. CASE & POINT: the VeraSIL Antiseptic Skin Cleanser and Protective Mask Spray which could dramatically improve the level of personal barrier protection when HCWs are forced to re-use an N95 Mask or use an ASTM Level 2 or 3 Mask.
Essentially, our BC Ministry of Health is making decisions for Dental Healthcare Professionals without ALL the material facts / solutions. This is severely impacting our ability to earn an income (for Dentists and Staff).
I am asking for my dental peers help, to spread the word about this science based Nanotechnology solution so that we can all get back to work and help our patients and our staff!
Don’t forget to check out the science… http://ddsource.com and http://verasil.com
Normal maintenance and operation of our DUWLs dictate that we utilize daily cleaner/flushing solutions in our DUWL bottles in order to help reduce the total CFU count and biofilm that exits from the dental tubing connected to our Handpieces, Tri-syringes and Cavitrons / EMS units. Unfortunately, NONE of these solutions offer any sort of true Disinfectant or Antimicrobial capability – NONE. At best they provide bacteriostatic benefit. These solutions are either all surfactant based or enzyme based solutions with tiny amounts of added hydrogen peroxide which (by itself) is woefully inadequate at killing pathogenic bacteria, viruses and polymicrobial biofilms. Besides, you cannot blend Disinfectant class chemicals with enzymes, for inanimate surface disinfection, because these disinfectant chemicals will denature the enzymes! I have heard through some blogs that Dentists are suggesting that we simply add Chlorhexidine Di Gluconate (“CHG”) to the water bottle (because we are taught that CHG is a general purpose disinfectant which is safe for internal / oral use). There are several serious shortcomings with this approach including;
CHG is now classified here in BC as a schedule 1 drug – so unless Dentists are prepared to have detailed conversations with our patients (before you even pick up the handpiece or the ultrasonic scaler) about All Reasonable Tx Options / All Costs / Risks /Benefits and Choice of Materials and give the patient the Option for No Tx and then verbally prescribe the use of CHG to the Hygienist for each patient and then review in detail an informed consent and then make detailed patient notes in their chart – you cannot use CHG in any capacity – least of all as a chemotoxic antimicrobial (drug) additive to the DUWLs.
See below information circular from CDSBC:
Interpretive Guidance for Dentist-prescribing of Schedule I Drugs (including epinephrine and chlorhexidine) for Administration by a Dental HygienistThe following interpretive guidance from the College of Dental Hygienists of BC and the College of Dental Surgeons of BC is applicable to both the dental office setting – whether or not the dentist is on site – and to private dental hygiene practice.On February 24, 2020, the Ministry of Health announced amendments to the regulations (scope of practice statements) for dental hygienists, dental technicians, denturists and dentists. Two of the changes that affect the provision of dental hygiene services are:Dental hygienists with the proper certification can now administer local anaesthetic without a dentist on site. The College of Dental Hygienists of BC indicates this certification with the letter “C” on a dental hygienist’s registration.Dental hygienists wishing to administer a Schedule I drug (e.g. local anaesthetic containing epinephrine or chlorhexidine), must ensure the patient has a prescription from a dentist, authorizing the dispensing of the Schedule I drug.Local anaesthetics without epinephrine are not Schedule I drugs and do not require a prescription.In response to the amended regulations, CDSBC is continuing to work with the other oral health colleges to develop guidance for registrants. CDSBC will be updating the professional standard document Prescribing and Dispensing Drugs in the near future. It is expected the decision to administer a Schedule I drug will be based on collaborative discussion and decision-making amongst the patient, dental hygienist and dentist and include thorough documentation of those discussions and decisions, including the authorization by the dentist to dispense the drug. In order for a patient to provide informed consent for the administration of a Schedule I drug, it is expected that patient will be made aware of all of the risks, benefits, associated costs and options (including not administering the drug). In the case of anaesthetic containing a vasoconstrictor, this would include a discussion that while this formulation increases the depth and duration of anaesthesia, it may impact cardiac function. The dental hygienist and dentist must be satisfied that, following a thorough clinical assessment and review of the medical history, there are no contraindications to the administration of the Schedule I drug. A prescription can be defined as an authorization for the dispensing of a drug to a patient and may be written or verbal. Within the traditional model of a dental hygienist and dentist working collaboratively within the same office, the specific requirement in the amended regulations of a prescription prior to administration of a Schedule I drug by a dental hygienist is not expected to change existing protocols. Rather, it will serve to focus the entire dental team on the existing standards of collaborative care, including a complete pre-treatment assessment of the patient, reviewing and updating of the patient’s medical history and a determination through discussion between the dental hygienist and dentist of the need for the administration of the drug for the patient. Once a need is determined, the dentist can provide a verbal authorization for the drug to be dispensed to the patient and the dental hygienist can proceed with the administration, regardless of whether the dentist is on site or not. In the case of a private dental hygiene practice, the authorization can be provided by a written prescription from the dentist for the patient or over the phone following the expected standards of collaborative care including assessment, review, and thorough discussion between the dental hygienist and the dentist. A dentist may choose to make a standing order prescription for a given patient to cover a specific time frame (e.g. three to six months). If this is the case, it is expected the hygienist will review, update and document the patient’s medical status as well as revisit and determine the ongoing need for the drug before each subsequent administration, engaging the prescribing dentist in discussion should any changes be noted. It is expected the patient record will include:The name and concentration (dosage) of the Schedule I drug being prescribed and administered.The reason and/or rationale for the need to prescribe and administer the drug.Documentation in the chart of the verbal prescription, along with the prescribing dentist’s signature. If the dentist provides a prescription by phone, the dental hygienist must document this in the patient record and sign it. If the dentist has provided a written prescription for the patient, a copy must be included in the patient’s record.Documentation as to the patient’s provision of informed consent for the administration of the Schedule I drug.
b) The latest peer reviewed literature shows that the use of CHG actually negatively impacts interfacial bond strengths to dentine – rather than improving them by eliminating Metallo Matrix Proteinases (“MMPs”). There are literally dozens of Antibiotics that can also remove MMPs – this is not something that is exclusive only to CHG.
c) CHG is a non-specific chemotoxic drug which attacks both Pathogenic AND Probiotic bacteria upsetting the oral microbiome which can lead to oral candidiasis. It is also irritating to the tissue and stains the teeth.
d). CHG has very limited efficacy against certain anaerobic gram negative cocci such as Viellionella commonly found in the oral cavity.
e) Antibiotic Resistance to CHG usually arises through the expression of drug efflux proteins that can pump out CHG such as QacA/QacB from S. aureus and the MexAB-OprM system from P. aeruginosa[Kampf G et al 2016, J.Hosp. Infect.94,213-227] This also poses the question as to the possible relationship between CHG tolerance and Antibiotic Resistance. Very recently, links between the use of CHG and resistance to both vancomycin and the last line antibiotic, Colistin, have been established. [Wand ME,Bock L et al 2016, Mechanisms of increased resistance to CHG and cross resistance to Colistin. Antimicrob. Agents Chemother. 60, e01162-e01216,101] These worrying observations clearly indicate that in addition to antibiotic stewardship we also need stewardship of our biocides especially the critically useful ones such as CHG.
The use of other Hospital Grade Disinfectant solutions in the DUWL is NOT POSSIBLE because of the known cytotoxic effects associated with chemicals such as Accelerated Hydrogen Peroxide, Glutaraldehydes, Tri-chlorinated Phenolics, Sodium Didecyl Methyl Amonnium Chlorides / Sulfates – ALL of which require the use of PPE before handling.
So, to help reduce the bacterial and viral bio-burden from patients saliva and mucous secretions (that are potenitally infected with Covid 19) which are going to mix with the contents of the Waterline in the mouth and result in aerosolized particles, WHY NOT utilize a proven Antimcrobial, Wound Healing agent as a DUWL Cleaner? – The OraSIL product has proven broad spectrum efficacy against many pathogenic microorganisms including, Hep, B, MRSA, VRE, CRE, SARS, Bacillus anthracis, Candida as well as pathogenic bacteria including all 8 aggressive strains of MDR Acinetobacter baumannii and Leishmania Promastigotes – (flesh eating bacteria).
This would help to effectively kill any pathogenic microorganisms in the aerosolized liquids without harming the probiotic bacteria. Unless someone else can suggest an alternative, pragmatic solution to this problem – one that already has Cdn NPN approval for use in surgical applications as an “Antimicrobial Wound Wash Irrigant” and could easily be used by Dentists today (in an off label application) as a DUWL Cleaner? NOTE: that Better than 75% of ALL Healthcare Professionals use medical products for off label uses – as a HCP you have that right so long as you can justify the products intended use and substantiate its safety, efficacy and performance. There is enough peer reviewed science, clinical documentation, regulatory clearances and Patents surrounding this technology to easily meet that minimum threshold.
I am asking for my dental peers help to spread the word about this science based Nanotechnology solution so that we can all get back to work and help our patients and our staff!
There is only one commercially available alternative to Saline available in Canada as an antimicrobial surgical wound wash that is also capable of disinfecting a broad spectrum of pathogenic bacteria and viruses without harming the oral tissues while still acting as a wound healing agent. That product is called OraSIL Wound Wash Irrigant and the technology behind it is referred to as NanoMetallic Silver Tetrahedral Tetraoxide or “NMSTTO”. NMSTTO is a new product category with near ubiquitous applications in the Dental industry which was recently launched at the Vancouver PDC March 5-7, 2020 under the OraSIL, VeraSIL and CuraSIL brand names.
Efficacy and Performance: In 2017, the worlds largest Peer Reviewed Meta-Analysis on Silver Nanotechnology was published in Dental Materials magazine entitled:
“Silver NanoParticles in Dentistry – A review of 155 peer reviewed articles, Dental Materials, Volume 33, Issue 10, October 2017, Pages 1110-1126.”
In this Meta Analysis, Silver nanoparticles (AgNPs) were extensively studied for their antimicrobial properties, which provide an extensive applicability in dentistry. Because of this increasing interest in AgNPs, the objective of this paper was to review their use in nano-composites; implant coatings; pre-formulation with antimicrobial activity against cariogenic pathogens, periodontal biofilm, fungal pathogens and endodontic bacteria; and other applications such as treatment of oral cancer and local anesthesia. Recent achievements in the study of the mechanism of action and the most important toxicological aspects were also presented.
Meta Analysis Results.A total of 155 peer-reviewed articles were reviewed. Most of them were published in the period of 2012–2017, demonstrating that this topic currently represents an important trend in dentistry research. In vitro studies reveal the excellent antimicrobial activity of AgNPs when associated with dental materials such as nanocomposites, acrylic resins, resin co-monomers, adhesives, intracanal medication, and implant coatings. Moreover, AgNPs were demonstrated to be interesting tools in the treatment of oral cancers due to their antitumor properties.
Significance.The literature indicates that AgNPs are a promising system with important features such as antimicrobial, anti-inflammatory and anti-tumor activity, and a potential carrier in sustained drug delivery. Additionally, when NanoSilver is combined with the use of Oral Antibiotics the literature demonstrates improved bacterial clearance rates which means a lower risk of Antibiotic Resistance!
Safety: In the Bibleography of this Meta Analysis, there is a reference to the worlds largest human ingestion, absorption and inhalation study on Silver Nanoparticles which concluded that the Silver Nanoparticles were safe for human ingestion. These findings were also published in online in a 3 part PubMed report where blood, saliva, urine and the P450 Cytochrome A enzyme cascade were evaluated on human test subjects after oral ingestion of NanoSilver using MRI and CT imaging – all showing no negative side effects.
The bottom line is that some of our regulatory bodies are unaware of all the working antimicrobial solutions we Dentists have at our fingertips. They also know very little about the myriad of dental applications of Nanotechnology that are now commercially available. Case and Point: the VeraSIL Antiseptic Skin Cleanser and Protective Mask Spray which could dramatically improve the level of personal barrier protection when HCWs are forced to re-use an N95 Mask or a Level 2/3 Mask. Essentially, our BC Ministry of Health are making decisions for Dental Healthcare Professionals without ALL the material facts/solutions. This is severely impacting our ability to earn an income (for Dentists and Staff).
And IF ANYONE has an alternative solution that is; i) regulatory approved ii) commercially viable and iii) an effective science based solution (other than a) taking an forced ‘vacation’ for the next 2 or possibly 3 months or b) continuing to use mildly bacteriostatic enzymatic solutions in your DUWLs or c) utilizing an array of chemotoxic disinfectants that are unsafe for human ingestion and proven to contribute to Antibiotic Resistance, I would be very interested in hearing from you……
Two weeks ago, the experts (here in North America) were saying that there was NO NEED for the general public to be wearing Face Masks because they were ineffective at preventing the spread of disease and because they were contributing to a dwindling supply for front line healthcare workers. In South Korea, which had its first confirmed case of CoVID-19 on the same day as the United States, a different approach to the general use of Face Masks was taken, with startling differences in the trajectory of the disease. South Koreans are all being told to wear Face Masks to help reduce the transmissibility of the disease (via droplet transmission) and it appears to be working as the curve of infected people has been substantially flattened in South Korea, whereas in the USA it continues to display exponential growth with over the 305,820 infected patients and 8,291 dead (as of April 4,2020). It appears that the use of Facial Masks by the general population is having a much more dramatic effect in South Korea than the alternative strategies being currently recommended here in Canada and the USA. On Sunday, April 5, 2020 the US Centers for Disease Control (“CDC”) started recommending that the general pubic wear non-medical face coverings because of a shortage of medical face masks but that recommendation continues to rapidly evolve….. Today, in fact, individual states like Florida and Louisiana are now mandating that if you leave your home you must wear a Face Mask…..
Many Doctors are also being told to re-use their Face Masks and are attempting to disinfect them with Alcohol.
To conserve Face Masks during this crisis, Mount Sinai Hospital in Toronto, Canada put out a press release on March 23, 2020 to their HCWs detailing how their medical staff will be issued one mask per day which means they are being asked to re-use their Mask on multiple patients.
The need for a Procedural Mask Disinfection Protocol (for ALL Masks) has just become of utmost importance.
Toronto, CANADA: Mount Sinai Hospital information circulars to HCWs about how a “SINGLE PROCEDURAL MASK WILL BE ISSUED PER DAY” and how the “MASK WILL NOT BE CHANGED IN-BETWEEN PATIENTS“
There is also significant confusion over the similarities and differences between a Level 2 or Level 3 ASTM 2100-2011 rated Procedural Mask and an N95 Respirator. These Masks ALL have the exact same “Delta P” specifications – The Level 3 ASTM Mask also has the identical Fluid Resistance Level (160mm Hg) as the N95 Mask and both Level 2 and level 3 ASTM Masks have the same Class 1 Flame spread as an N95 Respirator. The Bacterial Filtration Efficiency (“BFE”) of the N95 Mask is 99.9% only marginally better than the the Level 2 and Level 3 Mask which is 99% at 3 microns. However, IF that N95 mask is not fitted properly or does not have a proper seal that minute difference in Filtration Efficiency is lost. Particulate Filtration Rates for all 3 Masks are identical – greater than 99% at .1 microns. So the question that begs asking is: why can’t Dentist’s and other Health Care Workers be allowed to use a Level 2 or Level 3 ASTM Mask to work on potentially infectious patients when studies have shown that there is no appreciable difference between the N95 and the Level 2/3 ASTM Procedural Mask:
Here is a PRAGMATIC SOLUTION for Dentists regarding the use of Face Mask….If you Spray the inside and the outside of the Level 2 or Level 3 ASTM Mask with a proven broad spectrum Disinfectant like VeraSIL Protective Spray (which is skin friendly and not a schedule 1 drug) you can readily improve the overall Antimicrobial efficacy and performance of these Masks without putting you or your staff at additional risk. In fact you are providing an additional level of protection using a skin friendly, NanoSilver based broad spectrum Antimicrobial agent (proven to kill MRSA,VRE,CRE,Candida, Hep B and a long list of other oral pathogens). You cannot use Lysol spray or a general purpose disinfectant in this same manner because they are chemotoxic to humans. You cannot use Isopropyl alcohol in this manner because it evaporates and is not safe for oral ingestion. You can’t use a hospital grade surface disinfectant like Metricide, Cavicide, Glutaraldehyde or Accelerated Hydrogen Peroxide because these are highly chemotoxic to the skin and actually require the use of PPE before use. VeraSIL Protective Spray is NOT cytotoxic to humans but it is deadly to a wide variety of pathogenic microorganisms.
Here is Dr. Willoughby’s latest project where he was invited by PBS TV and thedoctorshow.com through their Innovations in Medicine program to talk about Dental Implants”. In this video he discusses the techniques he uses to complete a complex full mouth reconstruction (28 porcelain crowns) for a patients badly broken down dentition using a combination of dental implants and natural teeth.
Please be sure to check out my Ask the Dentist Article on “Root Retained Over-Dentures” as this is a terrific cost effective solution / alternative to extractions and dental implant placement for patients who wish to preserve some of their remaining teeth/bite.
