What? No gloves!

DENTISTS ARE FRONT-LINE workers, risking their lives for you. We put our fingers in people’s mouths and risk inhaling their expired breath and droplets of saliva and infected material. This has been the case ever since the start of human endeavours to resolve problems related to dental and oral pathology. I began hands-on dentistry in 1977 during the second year of my course in dental surgery undertaken at University College Hospital Dental School (‘UCHDS’). I qualified in early 1982 and worked in general practice until September 2017.

BLOG GLOVE Silvi_1024

At UCHDS we never wore gloves or masks while treating patients. The exception was for extractions that required minor oral surgery (cutting the gum etc.) when we were required to wear disposable latex gloves. For extraction that only needed forceps (‘dental pliers’) and elevators (wedge-like instruments), gloves were not required, but we did wash our hands between patients. When using the dental drill, we were required to wear safety googles over our eyes. What I have just described was what was considered correct practice at one of Britain’s leading dental schools. In those days, as in the future, any patient we treated was capable of harbouring nasty pathogens that could cause diseases such as tuberculosis, herpes, hepatitis B (and other forms of this virus), mycobacteria, fungi, and rarer diseases, all of which could have proved very detrimental to the clinician or his or her assistant.

The first practice I worked in was rightly considered to be one of the most ethical in the area. Once again, gloves and masks were not worn. Patients rinsed from a proper glass that was washed between appointments before being re-used. Instruments that had been used on a patient were placed in a bath of Savlon disinfectant for a while until they were needed again. All needles and local anaesthetic cartridges were single use only. At lunchtime and at the end of the day, all our metal instruments were sterilised in a hot air steriliser. It was not every practice that bothered to do this.  Horrified? Well, you might well be if you are old enough to have had dental treatment in the UK before the second half of the 1980s.

After I qualified, I subscribed to the New England Journal of Medicine with a vague idea of keeping up to date with medical science. Most of the articles were beyond my comprehension. However, in the mid-1980s, I began noticing many articles were being published about t-cells (a kind of white blood cell). What I only realised later was that these were being published because of the arrival and proliferation of a new threat to health: HIV (‘AIDS’). This epidemic prompted a dramatic change in how dentists operated. Almost overnight, we were required to wear gloves; advised to wear masks; commanded to sterilise instruments before re-using them; giving disposable single-use paper or plastic mugs for patients to use for rinsing.

What amazes me is that during the 35 years that I worked as a dentist, I never heard of or read about more than a handful of patients who were infected following dental procedures. There have been some newspaper reports of patients contracting HIV after seeing a dentist, but in some of these cases the mode of transmission was other than from clinical procedure. Over the years, I attended several lectures on the latest developments in cross-infection control. After each of these, I always asked the lecturer whether there was any scientific evidence that showed whether cross-infection controls in dentistry significantly affected patient mortality. Not one of these academic clinicians could provide an answer. One of them said to me:

“That would make a very good topic for a PhD.”

Whether they make a difference or not, modern cross-infection protocols make both the patient and the clinical team feel safer. I hope that everyone will feel sufficiently safe to be treated now that the atmosphere is infiltrated with particles of the Covid-19 virus. The nature of this highly contagious airborne pathogen justifies the many advances in cross-infection control that the profession has made since HIV appeared on the scene and will require further refinements especially in the field of air purification.

When I think back to my days of providing dental treatment with my bare hands and uncovered face, I am amazed that I and most of my colleagues never succumbed to anything much worse than fatigue and frustration caused by awkward patients.

 

 

Flying rats

pigeons

 

My late mother was awfully concerned about avoiding germs. For example, every can of food had to be washed before opening it just in case rats or mice had scampered across it in a warehouse.  Also, when we visited toilets in public places in the 1960s, we were told to put toilet paper on the seats so that we would not pick up germs that other users had left behind. Interestingly, in many public toilets nowadays, notably on aeroplanes, disposable toilet seat covers are provided. Mum would have approved of this development.

Recently while rummaging through some old photographs, I came across one of me, aged about 10, in Siena, Italy. I was kneeling on the floor feeding pigeons that had flown on to my hand. As a child, I loved doing this. My parents would buy me a paper cone filled with corn seeds. I would fill my palm with some of these, and then pigeons used to perch on my finger tips and pick up bits of corn with their beaks. I remember that the pigeon’s ‘feet’ felt quite soft. Feeding these creatures was a real treat.

Well, I was not unusual. Many people enjoy feeding birds from their hands. Today, in London’s Kensington Gardens there are flocks of green parakeets that happily feed from visitors’ hands.

The surprising thing was that my germ conscious mother permitted my sister and me to feed pigeons as described already. In New York, pigeons are known as ‘flying rats’. Pigeons are are actually less hygienic than rats and they carry mites, which irritate human skin. I cannot believe that pigeons in Italian cities in the 1960s were any cleaner than those flying about today. Had my mother been aware of the pigeons’ unsavoury lack of hygiene, feeding these creatures would have been totally forbidden to my sister and I. I am pleased that she did not realise that the dear flying rats are so filthy!