Are Your Dentist’s Tools Clean?

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It is extremely unlikely that you get HIV from a dentist appointment.

Fox6Now.com: Tomah VA dentist accused of using improperly cleaned tools resigns

I shouldn’t read news as I always have something to say about them. This news above reminded me about working in the UK and how the instruments were cleaned there.

This Thomas VA dentist is not the only dentist that is underperforming in the instrument cleaning. There are dentists who have read this news and have wiped sweat from their foreheads and thanked their lucky stars it wasn’t their name on the headlines. Honestly!

Let me tell you how things were done in six of the practices I used to work in the UK. I will first go through the correct way of cleaning the instruments.

This I How It Should Be Done

1. Disinfect the contaminated instruments preferably in a washer disinfector like Miele Dental Disinfector

With this washer disinfector the cleaning job is half done. You just put used instruments within 6 hours of using them to the washing cycle and you get disinfected instruments in less than an hour (no need to soak them in anything prior the cycle).

No scrubbing is needed which will minimise the accidents of nurses cutting themselves.

2. Dry the instruments thoroughly. Use pressurised air on all the hard-to-reach areas like matrix retainers, sonic scaler tips, forceps.

3. Place the instruments that  don’t need to be sterile on the metallic tray to be autoclaved. Put the instruments that need to be sterile in pouches and close the pouches.

4. Put all the instruments in an up-to-date vacuum autoclave and run the cycle. Once they are cooked, put them in cupboards or drawers to be picked to the surgeries.

Simple and pathogen-free tools.

This Is How It Should Not Be Done

None of the surgeries I worked at in the UK had washer disinfector. Instead there was a dish brush and Hibiscrub. Yes, you read it correctly. Hibiscrub was used like washing up liquid on dish brush and the instruments were washed over a sink in the surgery. But this was done only up until health and safety regulations stated that using dish brush was a health hazard – there was too big risk of an injury from sharp instruments.

Once the instruments were brushed with Hibiscrub and rinsed with water, the instruments were placed on metallic trays (no drying) and put in the Instaclave, the simplest of the simplest model (non-vacuum). If there were surgical instruments, they were either put on the pouches and put on trays without closing the pouch. The pouch was closed after the cycle in the Instaclave. Sometimes the surgical instruments were put on the trays without pouches and once they had gone through the cycle, the nurse put them in the pouches and closed them.

So needless to say that many things went wrong. And let me clarify that all the above was done in the surgery. Every surgery had their own autoclave – just about five feet away from the patient.

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This was the typical setup in the dental surgery in the UK for cleaning tools used on patient

The Question: Did I Do It Too?

Well, as much as I think that you live by the rules of the country you are in, I did not follow this questionable way of cleaning instruments. I did inventory on surgery’s storage room and found a container with a lid. I asked the practice manager to order me instrument disinfection liquid. I had to do some convincing before the liquid was ordered – understandably of course as no-one else was using one. So why should I?

So all my instruments were brushed with dish brush under running water and then placed into this container which had disinfection liquid in it. The instruments were kept in there for the recommended time, rinsed with water, dried and then put in the Instaclave.

Not perfect, but enough for me to have a clean conscience.

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Welcome to My Surgery – Waterline Cleaning Video

Thank you for visiting my surgery! Please note that I do not get any financial benefit of introducing certain brands (although I am starting to feel I should – this blogging is hard work I don’t get paid for!).

Now it might be time to read two of my posts regarding the waterline cleaning so you understand why I posted this video:

It’s ok to swallow, it’s only water… Or is it?

Told You So, Part III

Told You So, Part III

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CNN: Bacteria in dentist’s water sends 30 kids to hospital

I don’t like being right when innocent kids are involved. But I was. The water quality in dental unit’s waterlines can be harmful to the weakest, like kids. I have written about it in this blog and you can find the post here.

Isn’t it about time to make things right and update your dental unit to the one that has the waterline cleaning system. On top of that the guidelines need to be checked because flushing with water for two minutes once a day simply won’t do the job (like suggested by the state of California).

Yet Another Anti-Patient

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How on earth did I not remember this type of Anti-Patient? I guess it is all coming slowly (but surely) back to me after returning to work.

Before you read any further, it might be good idea to read my post Anti-Patient so you know what I am on about.

Anti-Local Anesthesia

Now, this type of patient is not so uncommon in the dental chair. Let me tell you about the two of the most typical situations I face.

Patient Case I

I am about to start the scaling and root planing and I can tell from the looks of the gum that it is going to be painful. I offer local anesthesia  (LA) but the patient declines by saying:

“I once had such a bad experience with LA that I have not taken any since..”

Or

“Oh, I never take any LA, not even when I have a filling done.”

I explain that it will most likely hurt but the patient does not change his mind. Not even when I explain we could use topical LA (I use Oraqix) which would not require needles.

So I begin the treatment. The sonic scaler goes relatively well but when I begin to scale those deep pockets the patient is jumpy (as if somebody was poking his limbs with a needle), turns his head suddenly (exaggeratingly) and is kinda slowly sliding towards my lap as he’s pushing from the handles of the chair.

After I have nearly injured my own finger and patient’s lips for the third time because of the unpredictable motions and after I have three times asked patient not to move his head, I stop the scaling and tell the patient that I won’t be able to carry on unless he keeps the head absolutely still. Because it’s not safe. I offer the LA again and usually at this point they agree.

Patient Case II

The patient (who also just declined LA) keeps still throughout the treatment (scaling) and says she’s fine when I ask her if she’s ok  (multiple times). So naturally I carry on to finish the treatment.

Once the patient gets up from the chair she does not look happy and says

“It hurt a lot.”

Or

“Oh I hate having this done.”

Or

“It’s never hurt before.”

Soooo annoying! Did I or did I not offer you LA? Of course it hurts if you decline LA when it is recommended. And why would you say you are fine when you are not?

What is the most annoying in all this is that she will go and tell ten of her mates how horrible experience it is to have the teeth cleaned. Simple marketing rule – bad experiences you tell to ten people, good experiences to one. So unfair!

Repost with Forewords: Cold Sore Is Herpes – Cancel Your Dental Appointment Because Your Dentist Won’t!

Dental Revelations Blog

I am reposting one of my blog posts in the light of the news of the 10-year-old Briony who died from herpex simplex virus which the doctors failed to diagnose.

In this blog post I wrote about a dental nurse who contracted the herpes simplex virus whilst the dentist was treating a patient with a cold sore. I wrote that the GP diagnosed a primary herpes (meaning she had never had herpes infection which most people do have as a child). What I did not share with you was the fact that the dental nurse attended the GP’s practice on Friday and the GP sent her home thinking she had gingivitis. The nurse tried to tell the GP that she had seen a periodontist in her practice due to the ulceration in her mouth and it definitely wasn’t gingivitis. Nevertheless the GP advised the use of chlorhexidine mouthwash and sent her home.

Over the weekend she developed high fever (40 degrees) and could not eat anything due to sore mouth. At this point the ulceration was covering every corner of her mouth including the lips. She returned the GP’s practice on Monday morning and was barely able to stand up. Still the GP insisted it was gingivitis. But at that point the nurse realised the GP needed to see more than what he could with her just opening the mouth and him poking with this wooden spatula. So she grinned as wide as she could. The GP jumped back and said “Well that is definitely a herpes infection!” and prescribed the antiviral medication.

So it is not so uncommon that the herpes infection goes undetected by the professionals. This is one more reason to take the virus seriously – even though the deadly side of the virus should be enough of a reason, eh? Please read the post below by clicking the link.

In case you haven’t read the news about Briony, click here.

My heart goes out to Briony’s family who must be devastated. RIP little Briony.


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 …

Source: Cold Sore Is Herpes – Cancel Your Dental Appointment Because Your Dentist Won’t!

Eavesdropping

Today I overheard a conversation between the nurses and the hygienists. They were sipping away their coffee on a lunch break when one of the hygienists said

“Today I punished a patient for missing his previous appointment by playing Justin Bieber. But it didn’t go as planned because he said that it wasn’t really that bad even though he was a fan of classical music.”

The nurses laughed in amusement.

“It is actually unfair how the nurses are forced to listen music the dentist has chosen.” the hygienist continued.

“Yes, I have to listen to the folk songs every freaking day!” said one of the nurses.

“Mine at least listens to the radio but the channel is not something I would choose.” another nurse added.

“I know! And your dentist turns up the volume when there is a good song – in her opinion – and doesn’t turn the volume down when she talks to the patient. So she’s nearly shouting.”

Everyone laughs and nods their head in mutual understanding.

“One of my patients once told me that his previous dentist used to play Rammstein loud when drilling. And he was a nervous patient!” said the hygienist.

Everyone around the lunch table rolled their eyes and were laughing.

Something to Think About

What do you listen when you work?

Do you let the nurse decide or are you the exclusive DJ in the surgery?

Do you play music for the patient or for yourself?