The recent news in Tulsa, Oklahoma, brings to light an issue that is rare, but nonetheless important — cross infection in the dental office, or the transfer of infection from one patient to another in a health care environment.
The unfortunate reality is that you, as the consumer, have very little chance of knowing what’s going on — it’s a huge trust relationship. Cross contamination is literally invisible because it’s caused by microbes invisible to the human eye, so only the professionals can guarantee that it doesn’t happen.
That doesn’t mean it’s out of your control. Use this checklist to find out how seriously your dentist takes the issue of infection control procedures.
1. Watch the gloves
You would never use a cutting board used for raw chicken to chop up some broccoli unless you washed it first — and preventing cross infection in the dental office is no different.
Ask yourself:
* How does my dentist put on gloves? Gloves put on by your dentist should come out of the glove dispenser, not off an unsterilized countertop.
* What does my dentist touch with the gloves? Your dentist should only touch the sterile instruments or your mouth * if anything else gets touched or if the dentist leaves the room, it’s time for a new pair of gloves.
* How many soap containers do I see in the office? Soap containers should be visible and everywhere and dentist and staff should be making use of them in front of you, in addition to using gloves.
Ask your dentist:
* Do you change your gloves for every patient? Gloves should absolutely be changed in between patients.
2. Check out the office
A clean, uncluttered office can be an indication of how serious your dentist is about sterilization. If the office is cluttered, it’s harder to clean.
Ask yourself:
* How clean is the office? Is it tidy and uncluttered? If there’s lots of junk on the countertops, that can make for surfaces that aren’t easily sterilized.
* Are there carpets? Carpets can’t be sterilized, but hospital-grade linoleum floors can. These can all be indications of how serious a dentist is about cleanliness.
* Are there special containers for disposal of needles and sharp items? If you can’t see them, ask where they’re kept. Devices have to either be sterilized or thrown away. A dentist should be using these containers to dispose of used devices and using new ones on the next patient.
Ask your dentist:
* Are operatory rooms (the room where the dental chair is) cleaned between patients? The staff should be disinfecting the surfaces in the operatory between every patient.
* Where do you disinfect instruments? There should be a single room or space in the dental office that is completely dedicated to the disinfection of instruments. Ask your dentist to tell you about this space and what the procedures are.
* How do you sterilize your instruments? Instruments should be sterilized in between each patient, including the dental drill.
* How do you know that the sterilizer is working properly? This brings me to my next point.
3. Ask for autoclave validation
In my office, this is a form that we keep on our bulletin board. It’s a certificate from a third party company that sends the dentist a package full of envelopes of bacteria that are difficult to kill.
The dentist or staff will put these bacteria into the sterilization machine — or autoclave, in dental terms — weekly or monthly, put the package into the mail, and the company analyzes the package and sends a report to the dentist on how well the sterilization machine is functioning. Another word for this is biological monitoring.
Ask your dentist:
* May I see a copy of your autoclave validation? If your dentist is willing and able to show you this report, this demonstrates a commitment and dedication to protecting your health. If your dentist doesn’t want to show you or gets defensive, this could be a red flag.
4. Check the instruments
Your dentist should be unwrapping a sealed bag of instruments in front of you. A sealed bag indicates that the instruments have been sterilized — or in dental terms, autoclaved — by a machine. If bag is already open, then it’s possible that those are used instruments that contain another person’s germs.
Ask yourself:
* Where did the instrument come from? Once instruments are out of the sterilized bag, your dentist should leave them on a sterile tray, not a dirty countertop.
Ask your dentist:
* Do you use the bags that change color when they’re autoclaved? Many autoclave bags have a color indicator on them to indicate that the instruments inside were properly sterilized. Not all bags have this, but it can start a good conversation with your dentist about sterilization procedures used in the office.
5. Speak up
Never be afraid to ask questions. A good dentist will be proud to tell you of the measures the office takes to ensure your safety, protection and well-being.
Ask your dentist:
* “In your office, how do you guarantee that you do not cross infect patients?” The dentist’s reaction to this alone is telling. The dentist and staff should be dedicated to answering your questions and making you feel comfortable.
And do your research. The more you know about this topic, the better able you will be to engage in a conversation with your dentist. Do a background check. Usually, there’s a governing body that oversees dentists in your state. They keep a record of infractions — call to find out if your dentist is on that list.
Educate yourself about dental infection control standards. The Occupational Safety and Health Administration, the Centers for Disease Control and the American Dental Association can help.
If you ever see something that makes you believe that your dentist and the staff are not perfectionists when it comes to cleanliness, trust your instincts and go somewhere else, or at least speak up.
Cross infection, in general, is exceedingly rare because dentists follow strict state and federal guidelines.
The risk of your health being affected by not seeing the dentist is far greater than the risk of cross infection.
Mark Burhenne is a practicing family and cosmetic dentist of 25 years and founder of AsktheDentist.com. He is dedicated to empowering people to take control of their dental health, stop managing symptoms and prevent chronic illnesses in the mouth.
Dr. Mark Burhenne | Special to CNN
