by Diana Aziz
SDN Staff Writer
For most people, going to the dentist is a nightmare. Whether it is the sound of the drill,
the fear of the needle, or just the anxiety of being in the office, they walk in scared and very apprehensive. Most people do not realize that the entire time they are worried about the shriek of the drill or prick of the needle, the dentist carries that same fear but in a different way. Each dentist can only hope that the patients he encounters have been truthful about their entire medical history.
While it is important that the patient choose a clean and reliable dental office, it is twice as important for the dentist to treat every patient as if he has a hazardous disease. This is not meant for the dentist to work in fear, but instead for him to take all the precautions necessary to keep the dental office a safe and clean work environment. Having a dentist that is unaware of the potential hazards in his work environment makes his entire staff, including himself, and his patients more vulnerable to injury.
Dental offices are prime locations for diseases to be transmitted. Many of the procedures involve the use of needles, drills, and other objects that can cause bleeding. A simple extraction leaves much of the office covered in blood, and sometimes even when the blood has dried it still carries different diseases. The remaining, less invasive procedures all require contact with saliva, which also carries many transmittable microbes.
The name of the game in safety is to prevent transmission of saliva-borne and blood-borne pathogens. Whether it is from dentist-to-patient, patient-to-dentist, patient-to-staff, or patient-to-patient, it is crucial that all parties are made aware of the hazards they face. Let this be a guide of the most common pathogens that can be contracted in a dental office. While ignorance is bliss, knowledge is indeed priceless.
Saliva-Borne Pathogens
Although people tend to worry less about things transmitted through saliva, it does not make them any more desirable. Unlike blood-borne pathogens, some people view saliva as only a minor threat, when in reality the little things sometimes add up to the bigger picture. The reality is that most people do not realize how often they encounter someone else’s saliva. People constantly have their fingers in their mouths biting their nails or licking their fingers. Then they touch objects all around them.
Saliva can carry many illnesses, including the common cold, infectious mononucleosis, and cytomegalovirus. There are also other viruses, like herpes, that can also be transmitted through saliva. Many cold sores are the result of the herpes virus. Herpes results in blisters that can form on the mouth, lips or genitals. These blisters may also recur periodically in place of ones that disappear. Herpes can also leave unwanted scarring and can be quite painful.
Other things like Methicillin-Resistant Staphylococcus Aureus (MRSA) can be transmitted. It may not be a huge threat for those that have a healthy immune system, but those that have an immune deficiency are at great risk. Symptoms of MRSA include skin infections that resemble a boil or an abscess. The area is often red, swollen, painful and filled with pus. MRSA can also present other symptoms since it can affect the urinary tract and the bloodstream. If Staph. affects the lungs and causes pneumonia, you can also have other symptoms such as shortness of breath, fever, and chills.
Blood-Borne Pathogens
In comparison to saliva-borne pathogens, blood-borne pathogens are more serious. Blood-borne pathogens may seem difficult to contract, but in actuality the hazards are everywhere. They can be transmitted through accidental punctures from contaminated needles, broken glass, or other sharp objects around the office. Contact between broken or damaged skin and infected body fluids will also transmit any blood-borne pathogen. This is a list of the most common pathogens and some of the risks they carry.
Hepatitis B (HBV) is primarily transmitted through “blood to blood” contact. HBV initially causes inflammation of the liver, but with time can also lead to more serious conditions such as liver cancer and cirrhosis. HBV cannot be cured, but can be treated to help people build antibodies to fight an infection and keep it from returning. There are vaccines that can be administered to prevent contraction of HBV. HBV is very durable and can survive in dried blood for up to seven days, so any blood around an office should be handled with extreme care. Symptoms of HBV include nausea, fatigue, possible stomach pain, loss of appetite, jaundice and darkened urine. Those infected may not show signs for up to nine months.
Hepatitis C (HCV), similar to HBV, also affects the liver. Hepatitis C damages the liver and can be very tricky because it does not always show immediate symptoms. Around 80% of people diagnosed with hepatitis C see no symptoms. If symptoms do emerge, it usually takes 10-20 years, sometimes even longer. This asymptomatic latency can cause serious damage. Hepatitis C is also transmitted in a similar manner as HBV, from blood-to-blood contact. Symptoms of hepatitis C are very similar to those of HBV, and it also has no cure. Considering hepatitis C targets the liver, the body is at a greater risk of infection, prolonged bleeding, and inability to break down toxins.
Human Immunodeficiency Virus (HIV) attacks the body’s immune system and weakens its ability to fight diseases. HIV can develop into Acquired Immune Deficiency Syndrome (AIDS) over time. HIV, which has no cure, can be fatal. Even though it is said that there is a 0.4% risk of contracting HIV in the workplace, this disease is deadly and every precaution should be taken. Symptoms of HIV include weakness, sore throat, fever, headaches, diarrhea, nausea, weight loss, a white coating on the tongue, and swollen lymph glands.
This information is not meant to frighten, but instead to prepare healthcare providers. When entering a healthcare profession, we are made aware of the risks, but it’s easy to forget them. You can never get too comfortable or be too careful. Life is precious and as healthcare providers, we should be the ones to set the example and inform those that may not carry the same knowledge.
References:
EHS Safety Training Bloodborne Pathogens. http://www.pp.okstate.edu/ehs/modules/bbp/index.htm
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Maybe a dumb question, but isn’t Microbiology a prerequisite to get into dental programs?
Microbiology is a pre-req in some schools, not all. This article is more of a reminder of the different hazards, not so much a new lesson. It’s also for patients to read and understand what they need to watch out for when picking a new dental office and the cleanliness of it.
nope. its required to pass the boards, but not to get in to school.
This is an important article for all future health professionals because we should constantly be reminded that we need to take proper precautions to ensure our safety. As a future dentist, I am well aware that dentistry is an invasive profession where dentists are regularly exposed to saliva and blood. But, with the wearing of masks and gloves and adherence to OSHA guidelines, I believe that dentistry can be a very safe profession.
I’ve been accepted to dental school and it’s crazy that I saw this article. I’ve been thinking a lot about the potential for needlesticks and sharps incidents and to be honest, I’m feeling uneasy about it. I am wondering if I’ll feel comfortable after classes and clinicals…or if I’ll always have an uneasy feeling throughout my career? Any thoughts? Anybody feel the same way?
I can say from the prospective of a phlebotomist, drawing other people’s blood all day, that you are much more worried about needlesticks when you first start. It should always be in the back of your mind to be careful, but the apprehension fades with time.
Fortunately for you guys in dentistry the risk of transmission is lower than for other specialties because you don’t tend to draw blood or cannulate vessels. The greatest risk is from a stick with a large hollow bore needle, filled with blood, stuck into muscle (such as thenar muscle in the hand). That’s why nurses have the most risk from sticks. Getting stuck with a needle used to infiltrate local anesthetic is less risky and getting stuck with a solid object like a scalpel is even less. Gloves lower the risk because they wipe blood off the instrument as it penetrates.
“A simple extraction leaves much of the office covered in blood…”
Excuse me!??!?!? Obviously, the author has not observed a simple extraction before…
I have indeed witnessed extractions, and you’re right not all of them leave the office bloody, in fact some of them are rather clean. I have witnessed some though that have left quite a mess, especially when it’s multiple extractions and the teeth go flying out of the mouth and start bouncing off of things in the office. I’m sorry for the poor wording in that sentence.
When I go to the dental office I notice that everyone seems more concern with protecting themselves then the patients. The x-ray techs are touching the machines and switch with the same glove that goes into your mouth. The Dentist also touch the machine and drawers with the same glove that goes into your mouth. I am always afraid every time I have to step foot in a dental office!
Good Point! I have seen dentists reaching for the light, and messing with their chair while they work on me. That would be a problem, especially if they are pulling teeth.
Proper procedure is for the dental assistants to wipe down all the areas of the room that are usually touched (lamps, switches, handles etc.) after every patient. Everything should be sterile and clean before the patient enters the room.
I am a dental assistant right now for a pediatric and orthodontic practice and you don’t need to worry about the dentist or assistants touching other things in the office if you go to a responsible practice. It is part of our jobs as assistants to take note of everything that has been touched during a procedure (be it the light, chair, x-ray machine, drawer, etc) and to throughly wipe down anything that has been touched with a sterile wipe. Also if we need to get something out of a drawer, we keep a sterile pair of cotton pliers next to us so we can get what we want without contaminating the other materials. Also, the room gets a general wipe down after every procedure, including the chair handsets, the counter, the chair, and the light, even if we never saw them get touched… just to be on the safe side.
speaking of dental hazards, why are the people in the picture connected to the article not wearing any eye protection…ahem…OSHA!!
Very nice article. Safety first!
This article is terrible. When is the last time an extraction covered the walls. Usually it barely covers the gloved hands.
And for MOST people, the dental visit is not a nightmare.
Is the author a dentist or a dental student? Bad writing SDN!
I’m sorry you disagree with the article. I’m a dental assistant, and the majority of patient’s that come in are quite terrified of being in the chair. I myself have left an extraction with blood on my scrubs, and actually on my face a few times. Not because the patient had blood squirting out, but because the tooth would come flying out of the patients mouth. Once again, I apologize for giving the impression that blood would cover the walls.
The most recent criticism centers on the use of hyperbole as a writing tool. Since neither of the exaggerated items were things that any reasonable person would be misled by, it seems to be a matter of personal taste more than anything else.
You left out the part where the dentist climbs up on the chair and put their knee in the patient’s chest to get the tooth out…..
I’d be scared to go to an office that was covered in blood from pulling a tooth. Does the dentist really stand on someone’s chest?
“Does the dentist really stand on someone’s chest?”
no
Thank you for an informative article. However I would like to make some comments regarding the content. I believe that in our modern time, gone were the days when people only come to the dentists with bandages wrapped around their heads followed with some sadistic and comical tooth extractions. With today’s advances in restorative materials and techniques, dentistry is becoming more cosmetic orientated rather than just relieving pain and suffering. In my practice, our patients look forward to their visits and more often than not, they fall asleep in the chair! True, there are some who are terrified of dentists but in the majority of the cases, it is not “a nightmare” but rather a very pleasant experience. Perhaps the nightmare at the dentist was the real thing 150 years ago but I assure you it is not the case now.
Every responsible dental practitioner takes care to ensure there is no cross contamination between patients and providers. You should not be concerned about the doctor touching the light handle then working in your mouth. This is because these light fixtures are first disinfected between patients then a clear protective wrap is placed. Then after completion of the procedure, the plastic wrap is removed then the fixture is disinfected again. With OSHA strict regulations of infection control in dental practices, you can be assured your dentist carry out all necessary steps to ensure YOU a safe and pleasant dental visit.
Extractions of a single tooth and or a full mouth can be bloody but it should be limited only on surgical gauze. If a patient and providers got splattered with blood, perhaps better surgical technique should be investigated. Even under the most inexperienced hands of the provider, I still can’t imagine any surgical procedure that can end up “leaving much of the office in blood”.
With our increasing understanding of blood born pathogens and pathways, strives in infection control regulations have been made to ensure both the patient and doctor’s well beings. And as a conscientious consumer you should be able to determine if your provider is following proper infection control techniques. Don’t be hesitant to mention to your doctor or auxiliary personnel if you feel they are not doing the right thing. You could potentially save your life and theirs.
Dai C. Phan DDS, MS
I worked for an oral surgeon who has managed to fling blood for some distance. Never to the walls, but far enough to hit me and the floor several times. This usually happens when speed and finesse find a stubborn tooth.
We always wiped it up though, so as to never leave a room a bloody mess for another patient.
Hi, there:
Here is one question I concerned a lot recently :
If an office received a lot of patients with HIV or AID, is it fair for patients without this disease to come to the office and do not know this situation?
“Having a dentist that is unaware of the potential hazards in his work environment….”
I am a dentist, and I find this comment to be patently insulting to my profession.
Perhaps Ms. Aziz thinks that dental students are introduced to the drill on their first day in school and bypass the countless medical sciences taught to other health professionals.
A dentist who is unaware of the hazards in his work environment (like communicable diseases) is like a neurosurgeon who doesn’t know where the cerebellum is–he doesn’t exist.
Before Ms. Aziz churns out her next attempt at an informative article, perhaps she should take the appropriate steps to inform herself.
i’d love to tell all my patients that i just saw an HIV patient…correct that, i saw a patient that admitted he/she had HIV, let alone the 2 dozen from earlier who thought it was none of my business that they had HIV,
universal precautions, learn it, use it, every drop of saliva and blood, has potiential to be infectious doesn’t matter if the patient comes clean about their health history or not.
another comment…my office wipes down everything we touch…and the things that we don’t remember touching…just cause we didn’t use the high vac suction in that proceedure…doesn’t mean it doesn’t get wiped down.
somewhere along the way if dental school doesn’t teach infection control, common sense should kick in, so just cause you see us touch the light, the switch the drawer handle, it does not mean someone elses saliva is on it…its clean
my office simple rule, pretend you or someone you love is the next person that’s sitting in the chair when you go to clean it up and when you clean the instruments