Is it safe to Go to the Dental Office?

Yes, This section describes the many measures, the behind-the scenes activities, that we, at Agoka Dental, undertake to ensure that you are not exposed to disease-causing microbes (germs) in our dental office. These measures have been developed over the years in response to concerns about the possibility of transmitting or contracting diseases, particularly hepatitis and HIV, in various health-care settings. The measures are many, and vary from the simple - such as hand washing or the disinfection of a countertop - to the elaborate, such as the sterilization of instruments with high-pressure steam.

Be assured that your dental office has never been more safer.

		Dentistry's Leadership in Infection Control

In health care, dentistry has been at the forefront of the development of new products and procedures that reduce the potential for disease transmission in the office setting. Recently, new dental sterilizer that process instruments faster and more effectively have been introduced. Likewise, protective equipment routinely used by dentists, such as certain types of masks and face shields, is now being used by those in other medical specialities.

Studies have shown that dentists are in fact more willing and accommodating in practicing infection-control techniques than other health-care providers.

		How Are Infectious Diseases Transmitted?

Infectious diseases can be transmitted in several ways, including direct contact with contaminated fluids (such as blood or saliva); indirect contact with contaminated dental instruments or other dental equipment; and contact with air-borne pathogens. However, infection needs four conditions to occur:

1.	The person exposed to the infectious microbes must be susceptible. A variety of factors influence susceptibility, including general state of health, and previous infections or immunizations, which sometimes results in the creation of protective antibodies. For instance, individuals successfully immunized against the hepatitis B virus are no longer susceptible to infection by this virus.	When germs become too numerous, they overwhelm the body's defenses, like water breaking through a dam
2.	A specific number of infectious pathogens must be present. The body's immune system can usually resist a limited number of microbes, but if the microbes become too numerous, they overwhelm the body's defenses and cause an infection.
3.	The microbes must be highly infectious. Weakened viruses can actually be put to use; many vaccines consist of weakened viruses that do not cause disease but instead enable the body to form protective proteins - antibodies - that make individuals immune to disease.
4.	Pathogens must enter the body in an appropriate manner. Depending on the microbe and where it enters the body, infection may or may or occur. For instance, if HIV enters the mouth, infection will most probably not occur. But if it enter the blood stream directly, an infection will probably occur.

Infection-control procedures are designed to disrupt these four conditions, reducing the possibility of disease transmission dramatically.

		What Exactly Is Infection Control?

Infection control is a way to minimize the transmission of microbes in the dental office. Potentially, diseases could be transmitted in a dental setting in three ways-from patient to dental-care provider, from patient to patient, and from dental-care provider to patient.

Infection-control procedures arrest disease transmission by using different methods-such as physical barriers, chemical agent, and heat.

		Universal Precautions

Because the dental team cannot identify all patients who harbor disease-causing microbes, a system called universal precaution is used. Universal precautions simply means that all patients are treated with the same type of precautions. It assures that even if a patient does not know that he or she is infectious, protection for the dental team and other patients is assured. Universal precautions dramatically reduces the spread of potential harmful diseases in the dental setting.

		Everyone Benefits from Infection Control

Many people don't know that the dental-care providers are at higher risk of contracting infectious disease from their patients than are patients from dental-care providers. However, since the introduction of universal precaution and recommendation for vaccination against pathogens such as the hepatitisB virus, the rate of infectious diseases acquired by health-care provider has decreased dramatically.

Federal and state government have laws and regulations that require employers to provide safe workplace conditions for every employee. These laws and regulations require employers to provide employees with appropriate protection against infection. These infection-control procedures benefit both you and members of the dental team.

		Who Sets Infection Control Guidelines?

Numerous federal regulation from the Centers for Disease Control and Prevention (CDC) and Occupational Safety and Health Administration (OSHA) advise health-care professionals, like dentists, how to implement appropriate infection control measures. State and local guideline are also usually based on the recommendation of CDC and OSHA. Failure to follow these guidelines can result in legal action against the dental office.

Professional organizations, such as the American Dental Association (ADA), issue infection-control guideline for dentists. These recommendations are revised and updated continually by world leaders in the field of infection control.

How Is Infection Control Implemented? Approaches to infection control may vary among dental offices, but the same basic principles underlie them. All dental team members are offered regular training programs, free hepatitis B virus vaccinations, and frequent updates on the latest techniques and principles in infection control. Governing the day-to-day implementation of infection control is the use of universal precautions-treating every patient as if he or she were a carrier of an infectious disease. It is achieved in several ways:

A dentist prepares the treatment area for a patient

The dentist conducts a review of your medical forms and performs an oral examination. You can help by filling out your medical history form as honestly and completely as possible. The dentist, or another member of dental team, can help those who have problems understanding or filling out the form. All information on the form is confidential, and no one in the dental office can disclose information without your consent.

Because many people see their dentist more frequently than their physician, dentists are in a good position (and even feel obligated) to identify possible medical conditions. Helping you identify any such conditions is the first step toward ensuring that you are getting the care you need.

		What Are the Infection-Control Procedures?

The prevention of contamination or transmission can be described by two simple concepts: barrier to micro-organisms and eliminators of micro-organisms.

Asepsis

Asepsis is the first way to prevent contamination. In asepsis, microbes are not necessarily destroyed, but their ability to infect is interrupted. In dentistry, asepsis is achieved in two ways.

		What Does the Dental Team wear...?

You may notice the dental staff wearing masks, gloves, gowns and protective eye wear. These barrier methods of infection control do not destroy disease causing microbes but prevent contamination sources from infecting the dental staff and patients. These protective grabs may be changed and /or discarded, or disinfected, between patients.

Gloves

Gloves are worn to prevent exposing the dental-care provider's skin to the microbes in blood, saliva, or mucous membranes. Gloves are changed between patients, and dental team members wash their hands, both before putting on their gloves and after removing them. Some prefer to wear sterile gloves or surgical gloves for certain procedures, as well as regular vinyl  gloves. Latex gloves, known as examination gloves, are appropriate for all general dental procedures and are most commonly used.

Infection control guidelines even address the way gloves are put on, take off, and disposed of.

Masks

Properly fitting masks are worn to protect the dental team member's face from exposure to blood or saliva that may splatter from the patient's mouth during the course of a normal dental visit. Dental aerosol is generated during drilling of teeth and during cleaning of teeth  with a cavitron. The highest concentration of micro-organisms from dental aerosol is found within a two-foot radius of the patient. Any team member within this radius should wear a mask.

Masks also protect the patient from exposure to upper respiratory-tract pathogens that a member of the dental team may be harboring.

Glasses

Protective eye wear, in the form glasses with side shields, or a face shield, is used to protect the eyes from blood, saliva splatters, and dental aerosol. In some dental offices, patients are also asked to wear protective eye wear to minimize the chance of physical injury to their eyes during certain dental procedures.

Gowns

Members of the dental team wear gowns during procedures that generate dental aerosol. These gowns are usually fluid-resistant and act as a physical barrier to prevent exposure from aerosols and other matter to street clothes and bare skin. These gowns can be changed between patients or when visibly soiled. Many dental offices employ outside contractors to clean and prepare  non disposable gowns before they are used with patients.

		What Is Disinfection?

Disinfection is a process whereby most of the organisms that cause disease are killed by chemical agents. Disinfection is distinguished from sterilization, a more complete method of killing microbes. Large objects that can't be sterilized - such as countertops and dental chairs-are disinfected between patients, as are certain plastic or rubber instruments that would be destroyed under the conditions required for sterilization.

Many types of disinfectants are available, but we, at Agoka Dental, usually choose products registered with the Environmental Protection Agency (EPA) and approved by the American Dental Association (ADA). All disinfectants used in our dental office are designed to destroy even very resistant bacteria, such as M. tuberculosis. Premixed disinfection solutions are changed on a regular basis, as determined by their expiration date, to assure maximum effectiveness.

		What Is Sterilization?

Sterilization is the ultimate process to destroy all living micro-organisms, including spores (reproductive bodies) of the hardiest bacteria and fungi. This process is facilitated by initial removal of material by cleaning and the use of an ultrasonic device.

An item can be sterilized in a number of ways. Commonly, instruments are treated with high-pressure steam for an extended period of time. This process is known as autoclaving.

Autoclaving process

In autoclaving, instruments (which are first cleaned, dried, and placed in a special steam-penetrable wrap), are subjected to pressurized steam for 15 to 20 minutes. The machine that performs this process is called an autoclave. After autoclaving, the instruments are left in their protective packaging until they are ready to be used in the treatment of a patient.

Cold Sterilization

For items that would be damaged by the high heat involved in other sterilization processes, a nonheated liquid sterilization procedure is used. This involves soaking the contaminated object in a chemical solution, such as glutaraldehyde, for about 10 hours.

		Do All Dental Instruments Need to be Sterilized?

Only some of the instruments used during the dental visit need to be sterilized. For instance, the dental burs (the actual parts that contact teeth in drilling and polishing) are either sterilized or discarded between patients. All dental offices have extra sets of instruments to allow for proper sterilization time. To ensure that the instruments are appropriately sterilized, they are first soaked in a chemical cleaning solution and then either hand scrubbed or cleaned with an ultrasonic device, which removes debris by means of vibration.

Generally, instruments that do not penetrate oral tissue or bone need only be disinfected, not sterilized. This includes plastic film holders used to take radiographs (x-rays) and metal or plastic impression trays.

		Is There a Way to Be Sure That Sterilization Has Worked?

Because sterilization is so important to infection control, our dental team regularly monitors or tests all sterilization equipment.

Chemical monitoring is accomplished with the use of a special ink. A strip of heat-sensitive ink is included in the package with the instruments during the sterilization process. The ink changes color when the required temperature has been reached. This ink change then signals to the dental team that packaged instruments have been exposed to the proper temperature.

Biological spore testing is done by testing the sterilization process on harmless live bacteria, which are contained in sealed vials. Biological spore monitoring is considered a more reliable method of measuring the effectiveness of sterilization. It is accomplished by exposing difficult-to-destroy bacteria to the normal sterilization process and verifying that these bacteria have in fact been destroyed. If sterilization was not successful, the instruments are not used on patients and the sterilizer is repaired or replaced.

		Where Does the Infectious Waste Go?

Disposal of all infectious waste generated in dental offices is governed by federal, state, and local laws and regulations. Special containers, called biohazard containers, are used to store the waste before licensed haulers remove it from the dental office. Such waste is delivered to government-approved processing sites, were it is decontaminated and destroyed. These processing sites are strictly regulated by the federal government and the Enviornmental Protection Agency.

Burs and other sharp disposable materials that may be used in the course of dental procedures have special containers for disposal. These "sharps" are placed in designated containers that are puncture resistant, leakproof, and specially labeled. Like other infectious waste, their disposal is governed by various regulations.

		What About AIDS ?

Transmission of HIV occurs through contact with blood, intimate sexual contact, and from HIV-infected mothers to their newborns. Casual contact has never been known to transmit HIV. HIV cannot be transmitted by tears, urine, sweat, dental aerosol, or insect bites. Furthermore, HIV is a very fragile virus-it is easily killed by disinfectants regularly used in dental offices.

Recent studies have suggested that saliva contains components that render HIV harmless. In fact, these factors that inhibit HIV are being widely studied and one day may be used to treat HIV disease.

HIV has not been shown to be transmitted even when blood is present in saliva. Thus, being a patient in a dental office that treats HIV-infected patients does not pose any risk. However, even if there were a chance that HIV could be transmitted in a dental office, adherence to "universal precaution" would virtually eliminate such an occurrence. Furthermore, it is probably safe to presume that dental offices that knowingly treat HIV-infected patients will have the best infection control available!

		The Controversy

Since the initial reports of HIV- infected patient in the early 1980s, the possible transmission of HIV in health-care setting has been debated both among health-care providers and in the lay press. Concern heightened in 1990, when CDC, the federal watchdog agency for public health policy, reported a possible transmission of HIV from a dentist with AIDS to one of his patients. Since that time, five additional patients have come forward claiming to have been infected by the same dentist.

Numerous investigations have tried to explain if and how such a transmission might have occurred, but none have succeeded in doing so. Furthermore, even today, this case remains a puzzle, as no mode of transmission has been detected and no other cases have been found where HIV-infected health-care providers have been implicated in the transmission of HIV to patients. In fact, the opposite seems to be true. Studies of over 22,000 patients treated by 51 HIV-infected health-care providers, 29 of them dentists and dental students, could not document a single case of HIV transmission from an infected health-care provider to a patient.

Because HIV is so fragile, and because all equipment and surfaces that may have been contaminated are cleaned and disinfected between each and every patient, it's not surprising that HIV transmission between patients has never been documented in a dental office.

		YES, IT IS SAFE to go to Dental Office

Yes! You now know that all dental equipment is replaced, disinfected, or sterilized between patients. In some cases, additional protective barriers are used to facilitate cleaning. You may notice plastic or latex wraps or aluminum foil on the light handles or covering the chair controls in the dental office. All of these measures are ways of ensuring your safety in the dental setting.

Dental offices that use appropriate infection-control techniques and routinely practice "universal precaution" for all dental procedures are safe. The members of the dental team care very much about your safety and follow every known recommendation to prevent the transmission of disease in the dental setting.

Because of the increasing sophistication of infection-control measures, your dental office has never been more safer.