An Investigation of the Presence, Types and
Sensitivity to Different Antimicrobial
Medications of the Communal Bacteria
in the Children Dental Clinic Service
Fowziya M Ali1* and Miftah S M Najm1, Noor Alhooda Milood Alawaklli2 and Ahmed Abouserwel3
1 Oral Science Department, University of Benghazi, Libya
2 Ministry of Health, Libya
3 Birmingham Community Health Foundation Trust, UK
Submission: July 30, 2019; Published: August 13, 2019
*Corresponding author:Fowziya M Ali, BDS, M Dent Sc., PhD, Paediatric Dentistry Department, Faculty of Dentistry, University of Benghazi, Libya
How to cite this article:Fowziya M Ali, Miftah S M Najm. An Investigation of the Presence, Types and Sensitivity to Different Antimicrobial Medications
of the Communal Bacteria in the Children Dental Clinic Service. Adv Dent & Oral Health. 2019; 11(1): 555805. DOI: 10.19080/ADOH.2019.11.555805
a) To investigate the presence of airborne and splatter microbial contamination in a children dental clinic practice inside the children dental clinic service after standard procedure of infection control and safety practice in controlling cross-contamination before the start of the dental clinical work.
b) To identify the type of microbial contamination and its sensitivity to mostly used antimicrobial medications in dentistry.
c) To explore the presence of resistant bacteria in different selected place and surfaces in the dental clinical practice.
d) To verify the effectiveness of the cross-contamination control in the area.
The mouth contains tremendous diversity of microorganisms which constitutes the normal oral flora. The dental clinical practice room is predominantly the source of largely multiple dental procedures that exhibit occupational exposure to blood and saliva borne contamination and other potentially infectious dental materials, (such as the periodontal crevice and pockets, tongue dorsum and other mucosal surfaces) . Therefore, requires a high standard of infection control and safety practice in controlling cross-contamination and occupational exposures to blood- and saliva-borne diseases. The microbial flora of the oral cavity is rich and extremely diverse and has an important role in initiation of oral disease . Temperature and availability of multiple surfaces on which microbial inhabitants can develop. Most of these organisms carry no significant risk to dental professionals; however, several them cause infections that may be difficult to cure [3,4].
It was revealed that there are in excess of 700 bacterial species inhabiting the mouth. Moreover, the latest developing based methods have further exceeded the extent of bacterial diversity in oral niches . Dental health care workers may prone to the risk
of infection from blood or saliva borne pathogens as result of their work .
Ten swabs were taken from different selected apparatus and surfaces inside the dental clinic room and culture-based identification was considered for the detection of most bacterial presence, type and bacterial sensitivity and resistance. Every tube swab was filled with 5ml of 10% dextrous solution. Then each tube was identified by number, date of examination and name of the selected surface to be examined.
The 10 selected apparatus and surfaces were:
1. the wall of the dental room,
2. hand wash basin,
3. the handle of the autoclave,
4. sterilised handpiece by an autoclave method,
5. the surface dental chair,
6. The sides of the dental chair,
7. The dentist’s setting tool,
8. the working table surface of the dental chair,
9. The roof of the dental room,
10. the suction tubes.
All tube swabs were taken immediately to Alakeed medical
laboratory for culture- based identification.
Positive bacterial culture results were found in three places
a) The surface and sides of the dental chair and the
working surface table of the dental chair. Contamination
with staphylococcus aureus identified on the surface of the
dental chair while micrococcus gram positive bacteria species
found on the sides and the working surface table of the dental
chair. Whereas, the other investigated locations and dental
apparatus showed negative bacterial culture results (Table 1).
b) The susceptibility sensitive results of staphylococcus
aureus (SA) isolated from the surface of the dental chair to
the various most common antimicrobial medications show
resistance to six most commonly used antimicrobials such as
Cefotaxime, Azithromycin, Cefazidim, Oxacillin, Ceftriaxone
and Augmentin (Table 2).
* Resistant antimicrobial medications.
c) The susceptibility test results of micrococcus gram
positive which isolated from the sides of the dental chair to
the various most common antimicrobial medications show
resistance to six most commonly used antimicrobials such
as Cefixime (CFM), Cefuroxime NA, Cefazidime, Oxacillin,
Ceftriaxone and Augmentin (Table 3).
In Table 4, the results show six antimicrobials resist
micrococcus gram positive bacteria which taken from the working
surface table of the dental chair. The resistant antimicrobials
are as Cefixime (CFM), Cefazidime, Oxacillin, Azithromycin and
This is the first study in our dental faculty to investigate
microbial contamination in the dental clinical room and little is
known about the presence of bacterial resistance to commonly
used antimicrobial medications. The study was conducted before
the beginning of dental procedure activity on the morning time
after conventional infection control. There was no air-conditioning
or central ventilation system, so ventilation was achieved by
opening windows. The cleaning procedure for the surfaces
implicates using 70% Ethanol and autoclave sterilisation for the
handpiece instrument. Furthermore, to explore the Susceptibility
test of the isolated bacteria species to different commonly used
antimicrobial medications in dentistry. In this study, we detect
the most bacterial contamination was with staphylococcus
aureus and micrococcus gram positive by culture methods and
determining the antimicrobial sensitivity and the resistant
strains. These bacterial species were considered normal bacterial
flora in the mouth. Staphylococcus and Micrococcus species were
found on some areas of human skin . Staphylococcus aureus
and micrococcus species were also detected in orthopaedic
health worker surgical scrubs room It has also been shown that
the bacterial burden of scrubs in the operating room that may
influence the contamination of wounds intraoperatively and the
risk for postoperative infection of those wound Krueger et al. .
Micrococcus leutus and staphylococcus species were also
isolated from dental clinic Decraene et al.  Aerosols or airborne
bacteria mostly gram positive cocci such as staphylococci and
streptococcus viridians spread during dental treatment was found
when using modern high-speed rotating instruments Rautemaa et
Our findings revealed that the dental chair and its working
surfaces table are the most common areas for bacterial reservoir.
Negative culture results were obtained from other selected areas
for microbial investigations.
The normal microbiota of the oral cavity consists mainly
of bacteria. Therefore, saliva must be treated as potentially
infectious as blood or other body fluids with respect to HIV
and other blood-borne diseases. Resistant form of methicillin
resistant-strain staphylococci aureus bacteria can survive in the
hospital environment despite use of infection control protocols,
Duckworth et al. . It was suggested to be responsible for
staphylococcal infection in hospitals and patients Beachey ,
Streptococci constitute 60 to 90% of the bacteria that colonize
the teeth in the oral cavity . Micrococcus leutus bacteria was
isolated from the tongue, and supra- and subgingival plaque in the
mouths of volunteers and patients with periodontitis Anesti et al.
Caries-associated bacteria were detected in samples of
dental plaque and bacterial profiles change with caries lesion
progression and differ between primary and secondary dentition
Aas et al. . It was believed that a gram of dental plaque (about
one quarter of a teaspoonful contains about 200 billion bacteria,
and saliva contains 10 to 100 million bacteria per millilitre .
Culture-based microorganism’s identification has been
considered the ‘gold standard’ for the detection of most bacterial
and fungal infections . Another novel metagenomic approach
has increased numbers of bacterial species Parahitiyawa et al. .
Various bloods borne bacteria, airborne bacteria saliva borne
bacteria and aerosol streptococcal produced by dental turbines
remains in air up to 24 hours. Samples of bacteria isolate from
environmental hospital Formica blocks found to be survived up to
24 hours Duckworth et al. .
The importance of determination of antimicrobial sensitivity
highlights the detection of the resistant species of bacteria to
the commonly prescribed antibiotic in dentistry. This is the first
study presented antibiotic susceptibility testing against different
commonly used antimicrobial in dentistry against staphylococcus
aureus and micrococcus leutus. Our finding showed both
staphylococcus and micrococcus positive cocci found to have
resistance to Augmentin and oxacillin and those commonly
prescribed among dental practitioners.
Staphylococcus aureus isolated from the surface of the dental
chair showed resistance to six most commonly used antimicrobials
such as Cefotaxime, Azithromycin, Cefazidim, Oxacillin, Ceftriaxone
and Augmentin. While, micrococcus gram positive which isolated
from the sides of the dental chair to the various most common
antimicrobial medications show resistance to six most commonly
used antimicrobials such as Cefixime (CFM), Cefuroxime NA,
Cefazidime, Oxacillin, Ceftriaxone and Augmentin. Micrococcus
gram positive that isolated from the working surface table of the
dental chair demonstrated resistant to 7 antimicrobials Cefixime
(CFM), Cefazidime, Oxacillin, Azithromycin and Augmentin
Cefuroxime, Cefotaxime resistance.
Thus, most dental infections can be treated local operative
procedures without antibiotic prescriptions and dentists still
prescribing antibiotic unnecessarily Oberoi et al. .
a) Dental chair and its apparatus were more contaminated
than other investigated areas and harbouring resistant
staphylococcus and micrococcus bacteria even after
conventional disinfection procedures.
b) Negative culture results were obtained from the wall and
the roof of the dental clinical room, dentist mobile setting tool.
c) No bacterial growths were found from the hand washing
sink inside the dental room and the handle of the door of the
commonly used autoclave for sterilisation.
d) No bacterial growth was found from the sterilised
handpiece drilling instrument that indicates the autoclaving
system is effective.
e) No bacterial growth from the suction tube line apparatus
that attached to the dental chair.
f) Emerging of resistant species of staphylococcus and
micrococcus leutus to most commonly used antimicrobials.
g) Augmentin and oxacillin which are commonly used
antibiotic showed ineffectiveness in gram positive cocci.
h) Vancomycin, gentamycin and doxycycline are more
sensitive to staphylococcus and micrococcus leutus.
i) Chloramphenicol, septrine, Ertapenem (ETP), and
Meropenem are less prescribed among dental practitioners,
for that reason proved to be sensitive to staphylococcus and