A patient came in for a long appointment to have a bridge done. This appointment was to include filing down the teeth to abutments which meant that the high speed drill was to be used. A lot.
High speed drills have water cooling system and this means there are aerosols in the air when the drill is used. And the aerosols carry pathogens from the patients mouth as far as two metres (about 6,6 feet) from it’s origin.
The nurse noticed that the patient had a large cold sore on a lip. Dentist appeared as if he had not noticed it and asked the patient to sit down in the patient chair. Chair was tilted back and when the dentist put his fingers inside the patient’s mouth the nurse discreetly pointed out the cold sore. The dentist carried on with the treatment and said nothing about the cold sore.
The nurse was worried. Very worried. And she had all the right to be. She knew the cold sore virus – herpes simplex – can easily spread to her eyes and hands, dentist’s eyes and hands, patient’s eyes and mouth via the aerosols produced by the high speed drill.
Herpes simplex virus in the eye can result in blindness. Herpes infection on hands (herpetic whitlow) of a dentist/hygienist/nurse might force a career change as one cannot do any treatment on patients when the herpetic whitlow is active.
But the nurse didn’t have any other option but to continue with the treatment as the dentist is considered to be the one who is more educated in the matters of health and carries the responsibility of the treatment. This means the dentist makes the decisions behalf of the nurse and the patient whether to continue with the treatment or not.
Now it might be a good idea to read one of my previous post about integrity of dentists so you understand the motives behind the dentist’s decision in this story.
So on they went with the high speed drill. For an hour and a half.
Less than a week later the nurse developed a bad head ache and the next day she had sores in the mouth. Two days later she had temperature of 40 degrees and the mouth, gums and lips were full of painful sores. The GP diagnosed a primary herpes and prescribed anti-viral medicine. She was off work for a week.
When the patient with the cold sore was seen the next time in the surgery he had small blisters near the operated site.
Before the anti-viral medication was developed the primary herpes used to be an infection that was often lethal. The doctors treating the patients with primary herpes could only cross their fingers and hope the patient will make through it. Many didn’t.
It can still be lethal but we have medication to treat it.
Most of the people get the primary herpes as a child and it often is asymptomatic. If contracted as an adult the primary herpes can have more difficult symptoms.
The primary herpes can be followed by secondary herpes (recurrent infection) – most commonly as a cold sore on a lip. The most frightening one of the recurrent infection of herpes simplex virus is encephalitis.
Guidelines for Treating Patient’s with Cold Sore
I used my friend Google and she quickly found me several sites that were unanimous about what us dental professionals should do if we see a patient with a cold sore.
Do not do any treatment that can be postponed!
To convince you I copy-pasted guidelines from couple of sites.
Elective dental treatment should be deferred for patients with active lesions as aerosolization of the virus may occur during dental procedures, placing both the patient and oral health care provider at risk for possible infection or re-infection.
Elective treatment should be postponed until the lesion has healed completely. Though the patient may be comfortable after you have applied a topical medication, there is still the risk of spreading the disease to the health-care provider.
Because herpes is transmittable to patients from dental health-care professionals who have active lesions, there is a risk of spreading this disease. The guidelines from the CDC are clear. Each of us has to keep patient safety and staff safety a priority.
The guidelines are clear. The medical facts are clear. Why do dentists still treat patients with cold sores and risk the health of the nurse and the patient, let alone their own health? They if anyone should know how serious risk it is to treat a patient with a cold sore.
I’m afraid you might know what’s coming (especially if you read my post Morals in Dentistry). Yes, the only reason for this kind of selfish and negligent behaviour from a dentist is GREED. And perhaps small amount of twisted enjoyment of having power – being almighty in this little world that has two people the dentist can make decisions for.
When the patient walks in the surgery with a cold sore it is simply just not acceptable to reschedule the appointment even though everyone’s health is at risk. No,no. Profit overrules the reason. Shame you who just recognised yourself.
I know there are also hygienists who see the patients with a cold sore. But this is because they don’t either know better or because they are not practice owners. Refusing to see a patient with a cold sore is not considered to be in the best interest of the practice. Plus what can you do if the patient with a cold sore just saw a dentist for a filling and is scheduled to see you for a scaling. How can you say no when the dentist said yes?
It requires lot of self confidence and experience to be able to stand up for you right to decide for your own health. Something the nurses do not have a chance to do. It proves once again how the dentist-nurse relationship is nowhere near about equality as co-workers. Not even in the matters of personal health.
I reschedule the appointment if the patient has a cold sore. And the next appointment won’t be sooner than a fortnight. I also use the opportunity to inform patient about the herpes simplex and ask patient to cancel the appointment next time when he gets a cold sore before the dental appointment.
And seriously (for all the dental professionals):
Applying Zovirax and placing a plaster on top of the cold sore before doing the treatment is just simply bonkers.
Here’s some further reading about the guidelines of seeing a patient with a cold sore.