Terminology, technology, and troubleshooting: Q & A.

I cannot believe how time gets away from us so quickly. Here it is, almost the end of the year ... a very busy time for everyone in the dental office. This is also the time of year that the ADAA Journal focuses on infection control. Due to full, busy, clinical schedules, time is a factor when tearing down and setting up the operatory. Dental assistants and hygienists alike are continually faced with efficiently and effectively preparing the room for the next patient who is waiting to be seen.

This article includes some questions that have been e-mailed to me from dental assistants across the country. Thank you for contacting me. I will do my best to answer your questions. I would also like to take this opportunity to talk about something very important to all of us, that for some reason has been put on the back burner for some years now, actually since 1994. That issue being DUWL (dental unit water line) decontamination.

First let's address some of the readers' questions.

Mary from Idaho would like to know: If using a surface disinfectant to wipe down the operatory, including the patient chair, do I still need to cover items, such as the chair, with a plastic barrier?

Great question, Mary. We as dental professionals are required to treat every patient as if they have an infectious disease. Standard precautions are of utmost importance in our field. Water spray from the handpieces, air/water syringe and ultrasonic scaling unit goes everywhere. We've all seen "If Saliva was Red" ... and if you haven't, you should.

The surface disinfectants are very strong solutions used to kill everything from TB to HIV. If time allows you to be able to spray, wipe, spray the chair along with all the other surfaces, that is great. However, it is such a time-saver to have the patient chair covered with plastic, and to just be able to pull it off. Also, the harsh solutions we use can be damaging to leather or plastic over time. Discoloration of the surface will occur, especially if the solution is left on for the instructed amount of time. If you choose not to cover the chair with a plastic barrier, please make sure to use at least a 4x4, or preferably something larger. I am a lover of Cavi-Wipes. (See photo #1 Dentsply.) They are fast, effective and cover a much larger surface with each wipe. Believe it or not, there are still some chairs out there that have some type of fabric on them. If this is the case in your office, it is only prudent and ethical for the surface to be covered in plastic.

It is better to be safe than sorry and protect yourself as well as the patient. Covering with plastic also saves you time, which always seems to be an issue. (See photo #2--dental chair protected with plastic barrier.)

Anne from Texas writes: I work for a general dentist who does a lot of endo. All of the assistants in the office fight over who cleans, sterilizes and puts away the reamers and files. Do you have any suggestions for making this "task" easier?

Oh yes, the dreaded sterilization pouch full of endodontic reamers and files. I remember those days ... they seemed to sit there forever. It is a tedious, but necessary responsibility, isn't it?

The first thing I can suggest would be to take your time when running them through the ultrasonic. You need to be slow and careful when placing them in and taking them out of whatever type of holder you utilize to run them through the ultrasonic cleaner. It is best, of course, to be wearing a pair of heavy utility gloves when doing so. Don't forget the eye protection too! This is recommended for handling all contaminated instruments. If your office does not have a sterilization assistant, then each person should be responsible for the endo files that they have used. Label the sterilization pouch with the assistants name ... if your name is on it, then you should put it away.

One other way to avoid this "task" involves the doctor. There is an endodontic treatment system on the market called A.E.T. (Anatomic Endodontic Technology) from UItradent Products, Inc. When I first saw this system I absolutely went crazy for it, because each patient has his or her own kit of cleaning and shaping files! No more cleaning of reamers and files. Better yet, no more putting them away!

The patient kits are affordably priced and are recommended for one-time use. The doctor needs to be involved in this because it is a complete system. It is a fast and easy way to perform root canals. This system can also be marketed to the patients. With the patient kit, you can let the patient know that this kit is sealed and sterilized, and for his or her mouth only. Patients love the security of knowing those little reamers and files have never been in anyone else's mouth. (See photo #3--patient kits AET system.)

Thanks, Anne. To get more info on the AET system you can call 800-552-5512.

Trudy, who is fairly new to dental assisting, is concerned about cross-contamination when grabbing items kept in tackle boxes during a procedure. Trudy is from Florida.

I'm glad you asked. There is a simple, straightforward answer to this. First of all, I personally think keeping items in a tackle box is a great idea. Not only does it keep items organized per procedure, but protected from airborne organisms.

Keep two cotton pliers on each tray setup, for all procedures. One can be marked with a red band to let you know that one is used only for grabbing items, and not to be used in the oral cavity. Pretty simple, and easy to address. I also recommend you always keep a basic setup or two in a drawer that is handy ... just in case one may fall to the floor. Hygienists should also have duplicate cotton pliers in their setup as well.

Thanks for the question, Trudy, hope that helps. Best of luck to you and your dental assisting career. It is very rewarding and fun.

I would like to touch on a few other items before I help to educate you on water line biofilms.

I give a six-hour seminar called "Searching for the Perfect Practice." This seminar covers a lot of everyday dental practice issues and solutions. I also discuss product and procedure troubleshooting. One question I ask is, "Do you provide eye protection for your patients?" It amazes me the number of offices that do not. I preach to the attendees at least four times throughout the day. Please, please, please provide and insist that all your patients are equipped with protective eyewear. Thank you.

The last item on the list today is education about DUWL (dental unit water line) contamination and eliminating the biofilm. A biofilm is a community of microorganisms attached to a solid surface. (See picture #4, biofilm.)

This is a problem nationally and internationally. The ADA, along with the CDC, issued concerns with levels of CFUs (colony forming units) in our water sources more than ten years ago. No specific rules or laws are in place at this time, only recommendations that water sources be checked and maintained at levels lower than 500 CFUs / ppm. Believe it or not, some dental offices tested at levels of >100,000 CFUs.

What to do? Read, research and commit to taking care of the problem if one exists in your office. There are numerous products available to address the issue.

First, have a test done of the water coming out of your hand-pieces, air/water syringe, ultrasonic scalers. This includes anything that has a tube, or water line coming in from a main water source. A simple dip test or agar plate test will do. The number of CFUs will be determined. More times than not, they will need to be lowered.

Before using any product as a maintenance solution, the biofilm must be eliminated or eradicated. This can be accomplished by a purge of the lines. If a purge is not completed first, and biofilm eliminated, the use of a water line disinfectant is ineffective.

For more information on this subject you can go to: www.osap.org/water/pp-duwl.htm

Happy Holidays and Happy and Healthy Living. Victoria

Victoria L. Wallace, CDA, RDA, has a varied dental assisting career that includes general dentistry, cosmetic/esthetic dentistry, lecturing and consulting. Currently she is Western U.S. University Relations Manager for Ultradent Products, Inc., and an independent practice organizer for dentists starting their own practices. Ms. Wallace is President of the Nevada Dental Assistants Association and a director of the ADAA Foundation.