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.

 

 

Healing hand

hand

 

In the UK, dentists cannot refuse to treat patients who admit to having serious illnesses such as AIDS (HIV). Dentists are supposed to have taken precautions to protect their patients, their nursing staff, and themselves against the risks of spreading disease by cross-infection. However, human nature being as it is, some dentists fear catching diseaes from their patients despite adhering to the appropriate requisites to prevent cross-infection. Irrationally, they try to ‘palm off ‘ patients whose medical conditions they fear by referring them to dental hospitals and specialist clinics. This is unfair to the patients who are forced to wait for long periods to be seen at these referral places for ‘specialist’ treatment that they do not actually need. I was not one of these over cautious fear-filled dentists. I treated everyone whatever their medical status.

I have treated many patients who have been infected with AIDS and other worrying illnesses such as Hepatitis B and C. I followed cross-infection guidelines and treated them no differently than I did for other patients. 

Many, but by no means all, of my patients were grateful for whatever I had done to deal with thier dental problems. Some of them, but not all of them, used to shake my hand and the end of an appointment or of a course of treatment. I appreciated that. What I noticed over the years was that the patients most likely to shake my hand were those who had been diagnosed with AIDS. I had the feeling that they were really grateful that I was prepared to touch their mouths without making a fuss about, or showing any fear of about their undoubtedly serious medical condition. The AIDS patients seemed to appreciate that I did not treat them as pariahs.