Understanding what really protects those in dentistry


Understanding what really protects those in dentistry

Incisive Bite

by Dr Sharon Robinson

Sunday, May 10, 2020

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THE prevention of the spread of diseases from staff to patients and vice versa, as well as from patient to patient or staff member to staff member, is why every infection prevention protocol, procedure and intervention is important and must be carried out, in detail, without any shortcuts to the steps that break the chain of infection.

Our personal protective equipment (PPE) is not the only thing to protect us in dentistry. There are many other defences and precautions that keep us safe and limit the spread of infection.

The COVID-19 pandemic has brought to light multiple perspectives on the use of PPEs in dentistry. Some practitioners believe that we have good enough PPEs in dentistry and should be allowed to continue working throughout the pandemic, while others are afraid to return to their workplaces because they fear for their own and their patients' health.

PPE is the last measure of control we can utilise to protect ourselves against infectious diseases, but rather than relying on the false sense of security it provides, we should constantly be taking precautions and following protocols that promote a safe environment in our dental practices.

The last defence

The term PPE refers to protective clothing including gloves, face shields, eyewear, face masks and/or other equipment designed to protect the wearer from injury or the spread of infection.

Most commonly used in health care settings, PPE components act as barriers between infectious materials and your skin, mouth, nose, or eyes. It is essential, however, that PPE be used with other infection control practices, such as hand-washing, using alcohol-based hand sanitisers, and the consistent enforcement of infection prevention practices.

The first defence

The fight against infection begins with the implementation of the hierarchy of controls, as follows:

1. Eliminate workplace conditions that, or contagious individuals who negatively impact well-being.

2. Replace or substitute unsafe/unhealthy working practices with policies that improve the culture of safety and health in the workplace.

3. Redesign or rearrange the workplace to promote safer practices.

4. Provide safety and health resources for employees.

5. Encourage personal change so that individuals will do their part to keep the office safe.

Following these control guidelines is the first step to bolstering your practice's defences against the spread of viral infections. The second step is to recognise and understand the unique dangers present in a dental office.

The face-to-face nature of dentistry, in combination with the exposure to saliva, blood and other bodily fluids, makes it very easy to transmit infections. As a result, dental professionals must adopt infection control measures to limit airborne spread (often through aerosols), contact spread, and the contamination of surfaces.

Some protocols to protect against these transmissions of infection include the following:

Screening patients prior to their appointments

The best way to break the chain of infection is to prevent the introduction of the pathogens in the first place. Sick patients and employees should not enter the building.

Screening patients, by asking basic triage questions before their appointments, is the best way to determine if they are healthy enough to continue with their scheduled procedures. This does not mean only during a pandemic, but rather at all times.

Staying home if you are sick

Any employee who does not feel well should stay home. If you are ill, you are a potential hazard in the workplace and would better serve everyone by isolating yourself and getting better.


Oral health care professionals should properly wash or disinfect their hands before the patient examination, before starting any procedures, after touching the patient, and after touching any of the surrounding medical equipment.

Opting for procedures that create fewer aerosols, if possible

The aerosols and spatter created in many dental procedures can stay airborne for long periods, thereby creating a risk for the transmission of infection via the respiratory passages.

Certain procedures, such as those that use ultrasonic scalers, air polishing, air abrasion, and air-water syringes, create more aerosols than others. During a pandemic or outbreak it is wise to opt for methods that will create fewer airborne droplets. When this is not possible, devices such as a high-volume evacuator are imperative to limit the spread of these contaminated droplets.

Implementing preoperational mouth rinses before procedures

A preoperational antimicrobial mouth rinse may reduce the number of oral microbes present in the patient's mouth. In procedures known to create more aerosols, a mouth rinse can limit exposure to pathogens.

Utilising rubber dams

A rubber dam is a thin, six-inch square sheet of latex used to isolate one or more teeth from the rest of the mouth during dental procedures. This isolation can reduce the likelihood of spreading bacteria and saliva from the patient's mouth.

Disinfecting in strict adherence to safety measures

Regular cleaning of your office is always important and should follow the directions present on the cleaning and disinfectant supplies. When applicable, implement extra measures such as air cleaning systems to reduce the size of any bioaerosols that might be present in the air.

Dr Sharon Robinson, DDS has offices at Dental Place Cosmetix Spa, located at shop #5, Winchester Business Centre, 15 Hope Road, Kingston 10. Dr Robinson is an adjunct lecturer at the University of Technology, Jamaica, School of Oral Health Sciences. She may be contacted at 630-4710. Like their Facebook page, Dental Place Cosmetix Spa.

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