As a result, dentists introduced tighter guidelines for infection control procedures. Guidelines were revised using the idea that anyone could be carrying a transmittable disease. Today, dental offices operate under a complete system of rules. These direct the handling of equipment, materials and treatment methods.
The process to guard your safety starts in the reception area. A posted sign may advise you to inform the receptionist if you are experiencing flu symptoms. You may also be asked how you are feeling when you register. If you have symptoms, you might wait in an isolated area or rebook once you are better.
You will always be asked to complete a medical history information sheet. This provides insight into your health background. The rule is ‘never treat a stranger.’
Once seated in the dental chair, you should notice a few safety precautions. The surfaces of the chair, trays and handles may be wrapped in disposable plastic, paper or aluminum foil coverings. These disposable items are changed between patients. Alternately, the surfaces may be wiped with a disinfectant before your arrival.
Your dentist will follow a routine before beginning an exam. A mask will be used. Hands are washed and then dried with disposable towels. An alcohol-based hand rub may be used instead of soap and water. This is acceptable, as long as the hands are clean. The hands should not have an elaborate display of jewellery. Finally, gloves are put on. If a dental procedure is being done, you should be provided with safety glasses to protect your eyes.
Any manipulation in your mouth should be done with ‘single-use’ disposable items or with sterilized instruments. Sterilization is different from disinfection. Disinfection reduces the number of microbes, with varying degrees of effectiveness. Sterilization means that all microbes are killed – nothing survives. To achieve this high standard, every dental health care office including dental clinics, dental hygiene clinics and denturist clinics, must have a sterilizer. This eliminates any chance that a contaminant from a previous patient or office staff can be introduced into your mouth.
You may wonder about whether the sterilizers are working properly and if the instruments inserted into your mouth are actually sterile.
The clinic should use at least three different checks. The first is mechanical monitoring. When the sterilizer runs through a cycle, gauges show that necessary pressure and temperature have been reached. The second is chemical monitoring. Chemical strips are placed into the sterilizer with the load to be sterilized. The strips change colour when sterilization conditions are achieved. These two checks are done every time the sterilizer is used.
The third check, biologic monitoring, is the ‘gold standard’ of proof of sterilization. A test sample containing highly resistant microorganisms is placed in the sterilizer. After the sterilizer completes the cycle, the test sample is cultured (grown). If the sterilizer has worked properly, no microbes will grow. This proves that sterilization was successful. Biologic monitoring should be done on a regular basis. However, in dental clinics, it is not done with every sterilization load. It is a quality control audit that confirms the results of the first two tests.
Discussion continues about how often biologic monitoring should be done in general dental practice clinics. The Centre for Disease Control has recommended it be done weekly in these settings. In Alberta, a higher standard is being proposed requiring daily checks. Currently, Alberta is the only place in the world requesting this mandatory policy in general dental practice clinics.
OSAP (Organization for Safety, Asepsis and Prevention): www.osap.org – see the General Public section.
Don’t hesitate to discuss infection control procedures with your dental health care worker. It’s your health, so be observant. You might ask for more information about your clinic. Does it have formal documented policies? What about sterilizer monitoring? Are gloves, masks and glasses used routinely? Do staff follow common sense behaviours? For instance, while your hygienist’s detailed diamond ring may be beautiful, it makes it difficult to clean hands thoroughly. And remember, it is the hands that should be washed, not the gloves. Also, once hands are gloved, care providers should not handle the phone, adjust the chair or handle charts. Such actions could contaminate the clinic. Gloves should be removed before other objects are touched.
So, how safe are dental practices? Since the introduction of improved infection control rules in 1990, evidence suggests that they are very safe environments. Given the millions of dental visits every year, there is a remarkable scarcity of reports indicating infection transmission to dental patients. Still, there is no room to relax standards. Procedures are only useful if they are followed carefully and exactly.