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How safe is your dentist?


Dental disease is rarely regardedas life threatening, but unless your dentist takes appropriate precautions, you and your family can be exposed to serious, and often deadly, illnesses while visiting the dental office. A recent government publication estimates that in a typical dental practice of 20 patients a day, an average of 2 patients with oral herpes, 1 carrier of hepatitis B, and an unknown number of patients infected with the AIDS virus will be treated during seven working days. Because dentists' and dental auxiliaries' work brings them into frequent contact with blood and saliva, these professionals are at great risk for contracting and transmitting these and other infectious diseases, including tuberculosis, gonorrhea, syphilis, influenza, measles, and mentally debilitating neurologic viral diseases, as well as infectious and CMV mononucleosis.

Although AIDS is the most notoriousof the infectious diseases, potentially fatal hepatitis is far more common in the general population, and the risk factor associated with hepatitis is five to ten times greater for dental personnel than for the ordinary citizen. No cases have yet been reported involving a dentist's transmitting AIDS to a patient (or vice versa); however, in 1985 an Indiana dentist was ultimately identified as the source of a 1984 hepatitis outbreak that resulted in two deaths.

The risks for infection arise fromthe nature of dental practice. The very sharp instruments used in dental treatment can easily puncture the oral tissues of patients' mouths and the hands of dental personnel. If a sterile instrument comes in contact only with an infectious patient, there's no problem, but if the instrument breaks the dentist's skin as well, there is a chance for cross-contamination.

Instruments aren't the only problem. High-speeddental drills usually spray blood and saliva that circulate freely in the air and often spatter the eyes, nose, face, mouth, and clothing of patients and providers alike. The drills are often water-cooled, and even with check valves installed, minute quantities of fluid from the mouth can be drawn back up into the handpiece when the drill is turned off. Unless the handpiece is flushed and disinfected property, those fluids will be expelled into the mouth of the next patient. It's easy to see that viruses and other microbial agents can have a field day in the dental office unless appropriate precautions are taken.

What are dentists doing controlthe spread of infectious disease? Says Dr. Anthony Di Angelis, the chief of staff of the Department of Dentistry at the Hennepin County Medical Center in Minneapolis: "The dental profession is alarmed over recent increases in infectious diseases. Dental organizations encourage their members to be vaccinated against the hepatitis virus and to follow strictly the guidelines set forth by the American Dental Association and the U.S. government's Centers for Disease Control. Virtually every dental school in the country has stepped up training in infectious-disease control, and countless continuing-education courses are available."

A recent study by Dr. Di Angelisrevealed that more than half the dentists surveyed had taken course work on infectious-disease control in the previous year and that more than half have made significant changes in infection control measures in their offices as well. Although Dr. Di Angelis is proud of the profession's responsiveness, he notes with some regret: "Dentists are like everyone else; their habits are hard to change. Most are very careful, but some dentists are admittedly lax in meeting the standards for proper control of infectious disease."

In one state, a study revealed, barelyhalf the dentists surveyed had been vaccinated against hepatitis B, and less than one-third routinely use rubber gloves and masks. Elsewhere, a study found that about one-third of the dentists were not taking patient histories that would indicate possible exposure to AIDS. This latter study showed that 70 percent of the dentists wore masks during examination and treatment but only 57 percent used rubber gloves safely. Although some fairly effective sterilization and disinfection procedures were used by most dentists, many did not use all the infection control measures considered essential by the Centers for Disease Control.

The likelihood of transmitting diseasefrom patient to dentist is greater than that of passing it from dentist to patient, although everyone is at risk. But remember: you have the right to be treated by health-care providers who are taking the appropriate precautions.

How can you tell if your dentist isfollowing proper infection control measures? Watch for the following:

Is a medical history taken? Yourdentist should ask about medicationsf current and recent illnesses; hepatitis; weight lossf damage (cuts, scrapes, etc.) to your cheeks, tongue, and gums; and other infections you might have. Remember, your dentist probably isn't asking his other patients any questions he doesn't ask you. Watch, too, to see if your dentist examines your head and neck. The lymph nodes are often involved in infectious diseases; an observant dentist will check these and other areas for signs of infection.

Do the dentist, dental hygienist,and dental assistant all wear rubber gloves? Equally important, does the dentist discard the gloves after each patient and scrub his or her hands? Repeated use of the same pair of gloves, even if they are washed, provides poor protection to the wearer and even less to the patient.

Do the dentist, dental hygienist,and dental assistant all wear surgical masks and protective eye wear? Such devices help protect dental personnel and thereby reduce the likelihood they themselves are infected.

Does the dentists use a rubber dam? Therubber dam is a thin sheet of rubber-like material inserted in the oral cavity during many dental procedures. Spreading as it does like an apron acros the back of the mouth, the rubber dam greatly reduces the risk of infection from droplets, spatters, and aerosols. Rubber dams are uncomfortable, but the increased protection they provide is significant.

Do the dentist, dental hygienist,and dental assistant all wear clean gowns or smocks? Ideally, disposable garments will be worn and discarded after each patient. Any garment visibly soiled with blood should be laundered, and reusable gowns should be laundered daily.

Are dental-lamp handles, instrumenttrays, and X-ray unit heads covered with disposable coverings changed between patients? If not, viruses and other microbial agents can easily contaminate such surfaces.

Are disposable needles discardedafter use? Some health-care providers pinch pennies by cleaning and reusing these inexpensive items. Such practices are patently unsafe.

Do the dentist, dental hygienist,and dental assistant wash their hands thoroughly between patients or after handling extraneous materials (dental charts, money, doorknobs, etc.)? Even when gloves are worn, the personnel should wash their hands, because the glove surfaces become worn and often experience minor punctures.

What sterilization and disinfectionprocedures are followed? Recommended sterilization techniques used in dental offices include steam pressure (autoclaving), dry heat, and chemical vapor sterilization. Other techniques effective if used properly include boilg water and a cold bath in approved chemical solutions. The latter process may require as long as ten hours to be effective. Sterilized instruments should be tightly wrapped in sterile packs until needed. You probably won't see your dentist's staff sterilize instruments or disinfect working surfaces, but you have every right to ask what procedures are being followed.

Patients, too, have responsibilitiesin the health-care setting. Unfortunately, you may be carrying certain diseases and not know it. The AIDS virus, for example, has an incubation of 18 months to five or more years. Many people carry, and can transmit, the hepatitis-B virus for an entire lifetime without ever contracting the disease themselves.

If you have ever had contactwith persons known to have had these diseases, you should contact a physician or public health clinic for appropriate screening tests. If you know you are carrying an infectious disease, tell your dentist. Chances are he or she can take appropriate measures to treat you in the dental office. If not, arrangements can be made to provide dental treatment through a hospital or a dental-school clinic fully equipped to provide proper infectious-disease-control measures.

Dentists today are better trainedthan ever before; they have new procedures, improved dental materials, and better equipment than have previously been available. Unfortunately, we live in an era in which infectious diseases represent a very real and present danger to us all. Dentists have a moral and professional obligation to employ every safeguard to protect themselves and their patients. And patients have a responsibility to monitor their own health and to provide critical information to their dentists. Vigilance on the part of consumers and providers alike is our best assurance for healthy dental care.
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Title Annotation:transmission of infectious diseases
Author:Born, David O.
Publication:Saturday Evening Post
Date:Jul 1, 1987
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