NATIONAL CENTERFOR CASE STUDY TEACHING IN SOENCE NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE Applying High-Throughput Analysis to Biofilms Questions 1. Using the information provided, complete the Treatment column in the following table and consider what the procedures have in common. Table 1: Treatment received by patient and presence of bacterial infection. by Michael L. Homesley, Jr. Department of Physiology North Carolina State University, Raleigh, NC Patient Treatment l- for Mycobacterium abscessus Mark Stephen Carla Part I- Dentistry Mystery Dr. S was a general dentist practicing in the western mountains of North Carolina, wekcoming patients with a wide variety of needs into his office. The week of March 13* had been much like any other at DDS Family Dentistry, with the seats of the lobby filled daily with people anxiously waiting to receive care. However, the following week the office received a call that all practitioners dread-the health inspector was en route to assess the condition of the workplace. What was the reason for the unexpected inspection? Scott Albert Samuel Olivia Jaylen Let's backtrack to review some of the care that was administered during the week in question in order to establish the cause for the inspector's visit. The following patients were seen on Thursday. March • Mark had been a smokeless tobacco user for nearly 25 years. His lower right molars had become so severely decayed that he was in excruciating pain. Dr. S offered the option to extract the teeth, and Mark decided to have the procedure performed immediately. • Fourteen-year old Stephen had a biking accident. His front tooth hit the handlebars and knocked the bracket loose and bent the wire in his braces. Dr. S determined that no additional damage was done besides the one loose bracket and was able to complete the repair of the braces. • Carla, Scott, Albert, and Samuel all came in for their bi-annual checkup. An oral examination revealed no discase, so all of these patients received routine teeth cleaning • Olivia had prom in two months and was not happy with her smile. She came in a week prior for impressions to be taken so that trays could be fabricated to deliver whitening product. Her trays were delivered on Monday, so she had come in to pick them up and receive instruction for use. • Jaylen had been dealing with what he thought was an ulcer, but after using multiple over-the-counter (OTC) rinses for several wecks and secing no improvement, he decided to make an appointment with Dr. S. After an oral examination, it was determined that a segment of metal had frayed on his bridge appliance. The stray end was clipped off using a pair of sterilized pliers, and Jaylen's pain was alleviated. Doris was scheduled for her annual checkup for her dentures. Dr. S observed signs of a malocclusion (in this case, crossbite) and made a minor adjustment by removing a small portion of several denture teeth using the high-speed handpiece. After rinsing off the appliance using water from the dental unit, the denture was placed back in the patient's mouth. A few bites on the articulating paper to check the contacts berween the teeth made it clear that the problem had been solved. Brian had his braces removed last month and had already managed to lose his retainers. He came into the office Doris Brian 2. According to Table 1, what do you think could be the source of contamination leading to the infection? Use the following information about the various procedures the patients underwent to help you. • Teth extraction: teeth extracted using sanitized instruments, area rinsed with water from dental unit waterline (DUWL), and gauze secured. • Repair of broken braces bracket: tooth lightly air-dried, bracket bonded into place, adhesive cured. • Bi-annnal checkup: scaling, polishing, flossing, and rinsing of teeth from DUWL, along with complete oral examination with sterilized tools. • Whitening tmay pickup: patient received whitening trays and supplied with whitening gel. • Bridge repair: anchor adjusted using sterilized instruments. • Denture checkup: appliance removed and adjusted, rinsed with water from DUWL, and re-inserted for patient. • Fitting for retainer: impressions taken of teeth and mouth rinsed with water from DUWL 3. Based on your answer above, is this source an ideal environment for the formation of microbial biofilms? in order to have new retainers made. It was now a week later, and further discussion with the health inspector revealed that multiple patients had been admitted to the hospital with the same AMycobacterium abceuw bacterial infection. The factor they shared in common was a recent visit to DDS Family Dentistry. A thorough investigation of the facility was deemed necessary and patients treated within the same timeframe were notified about the apparent contamination and encouraged to visit their primary physician in order to be tested for the presence of this bacterial organism. Mycobacterium abcessus has been linked to the development of a "wide spectrum of skin and soft tissue diseases" (Lee et al. 2015).