The Case of the Dirty Dentist

English: Putting toothpaste on a toothbrush. T...

English: Putting toothpaste on a toothbrush. The toothpaste is Crest Pro-Health Clean Cinnamon, 0.454% stannous fluoride, 0.16% w/v fluoride ion. Deutsch: Zahnpasta auf eine Zahnbürste auftragen. Русский: Выдавливание зубной пасты из тюбика на зубную щётку (Photo credit: Wikipedia)

Most of us wouldn’t think twice before checking that our silverware is clean at a restaurant.  But, when we sit in the dentist’s chair nervously eying the tray of gleaming stainless-steel instruments laid out beside us, we don’t pick them up and make sure they’re clean. We rely on our dental professionals to sterilize anything going into our mouth. That reliance may be a mistake.

Last week the Board of Dentistry performed a surprise inspection of oral surgeon Dr. Scott Harrington‘s Oklahoma office and found numerous problems with sterilization of instruments. The good doctor’s response when questioned?

“Dr. Harrington referred to his staff regarding all sterilization and drug procedures in his office,” the complaint read. “He advised, ‘They take care of that. I don’t.'” His attitude seems to be that not infecting his patients with blood-borne diseases is someone else’s job.

Other issues that came to light during the inspection included the doctors reuse of needles, disregard of expiration dates (one bottle of morphine expired in 1993) and his use of unlicensed assistants to perform tasks only a licensed dentist should perform, such as giving IV sedation.

Now over 7000 patients will undergo  testing to see if they contracted hepatitis or HIV due to the oral surgeon’s noncompliance with basic infection control practices.  In the meantime, don’t be fooled into thinking this is an isolated problem caused by one errant doctor.  On March 22, 2013 the Rhode Island Board of Dentistry temporarily shut a practice down after finding debris on multiple instruments in ‘sterile’ packages in exam rooms. No word on whether that dentist took responsibility for his office practice.

But, speaking of responsibility, how much responsibility do patients have to protect themselves from healthcare acquired infections? People have been trained not to touch someone else’s blood unless they wear gloves. People are encouraged to use barrier devices, such as condoms, during sex to prevent STD’s. Should our public health officials start a campaign to encourage patients to protect themselves during invasive procedures such as dental procedures, colonoscopies, and injections? If so, how can that be accomplished?

Recent articles have suggested patients ask dentists to prove they’re following guidelines in the care and maintenance of sterilization machines.  They’ve also advised patients to request to inspect the instruments prior to being removed from their sterile packages.  Other tips are to watch the dentist’s glove use, look at the overall office cleanliness, and quiz the dentist and staff as to how they handle reusable instruments. All excellent points, but it also requires a level of doctor-patient transparency and discussion that’s not usually seen. More importantly, how is your dentist going to react to his judgement and cleanliness being questioned?

In my work in the healthcare field, even the idea of a patient (or another healthcare team member) questioning whether someone has washed their hands before patient contact is a source of controversy. In a Swiss study, 76% of patients felt uncomfortable asking a nurse if she’d washed her hands and 77% felt uncomfortable asking a physician the same question. If patients don’t feel comfortable asking a simple question like that, do we really expect them to ask complicated, technical questions about sterilization procedures? Asking for clean instruments should be as easy as asking for a new knife or fork at a restaurant when the one on the table is dirty, but it isn’t.

English: South China Sea (May 16, 2006) - Hosp...

English: South China Sea (May 16, 2006) – Hospital Corpsman Steffon Corna sets up dental tools for a tooth extraction in the Dental Department aboard the Nimitz-class aircraft carrier USS Abraham Lincoln (CVN 72). Lincoln and embarked Carrier Air Wing Two (CVW-2) are currently underway in the Western Pacific operating area. U.S. Navy photo by Photographer’s Mate Airman Apprentice Brandon C. Wilson (RELEASED) (Photo credit: Wikipedia)

Will I stop going to my dentist? No. Will I ask to inspect the instruments for debris before my next procedure or cleaning. Yes. Hopefully he’ll understand, but if he doesn’t, I’ll tell him I’m holding him to the same standards I’d hold a restaurant to. I’m sure he doesn’t like eating off dirty forks any more than I do.

 

 

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