Are Your Dentist’s Tools Clean?

20161208_093300-1

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 4 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 that were taken straight from the package. This of course meant that the pouch was non-sterile as it had not gone through the cycle in the autoclave. Non-sterile pouch equals non-sterile instrument – no matter if the instrument has gone through the cycle.

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.

20161207_234528

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.


If you liked this post, you might also like:

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

Advertisements

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


Sandbox-4950

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).


You might also like:

Told You So

Told You So, Part II

 

Told You So, Part II

The Telegraph: Going to the dentist every six months is unnecessary, says UK’s top dentist

Ha! So it is and I was very pleased that somebody more influential than I was able to get the topic in the broadsheet paper. In case you haven’t read my blog post about the same subject, please click here.


You might also like:

Told You So

Told You So, Part III

Yet Another Anti-Patient

Dental Revelations Blog-24982

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 my post Cold Sore Is Herpes – Cancel Your Dental Appointment Because Your Dentist Won’t!

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?

 

Blast from the Past

Do you know how it was like to work at dental practice in the 70’s?

Once upon time there was a young nurse Jane. She was hard working and liked by the dentists. One day Jane moved to another town and applied for two dental nurse’s posts. She was offered a job from both of them but she chose a dental practice of four dentists. She was allocated to work with a 30 year old dentist Anna.
Anna was pleasant in behaviour towards Jane. Using kind words and voice when talking to her. Jane was very happy to have found such a good workplace.

But then – and not very long after Jane had started working there – became a day when everything changed. Jane had done something to upset Anna. It was something that Anna found completely incomprehensible.

“You are not a very good nurse, are you?! Not half as good as your predecessor! She at least cleaned my windows!” Anna said with a raised voice.

Jane wasn’t sure how to react. She was in shock about this sudden change in Anna’s behaviour. What windows did she possibly mean?

“I don’t understand what you mean?” Jane said cautiously.

“You… What… You… Don’t understand?!” Anna gasped.

“MY windows of course. My windows at home!” She added and stormed out of the room.

Jane was standing still for a while holding the instruments she was organising. She didn’t know she was supposed to clean dentist’s private windows as well. And probably on her own time as working hours she spent in the practice. That’s not what she signed for.

From this day onwards Anna treated Jane like garbage. Shouting and swearing at her even in front of the patients. Jane felt humiliated and insecure. Should she leave? She didn’t want to as nurse’s jobs were hard to find. So she stayed and the thing that made it easier to put up with Anna’s bullying was the practice’s other dentists’ support to her. They told Anna off many times but it made no difference whatsoever.

One morning Jane came to work and was walking practice’s long corridor to her surgery. Just when she was reaching to open the door Anna came out. She was sitting on her chair and rolling it forwards with her feet.

“Odd.” thought Jane, “What a peculiar thing to do…”

She watched Anna and her transporter chair rolling to the other end of the corridor where the toilet was. In she went and so did the chair without Anna getting up. Her long white saggy uniform got stuck between the door and it went up and down as Anna tried to pull it in without opening the door. Jane was amused and was wondering if Anna has completely lost it. Probably has.

The bullying – and the chair rolling – carried on for the next 4 months but Jane put up with it and did her job as well as she could. But she did not clean Anna’s windows. Nor her home. That’s where she drew the line. She was a dental nurse, not a servant!

Jane had been working for Anna for almost six months when Anna one day – at the end of the day – said to Jane

“Your employment will be discontinued in a fortnight.”

Jane was caught by surprise and wasn’t able to say anything sensible to Anna. But perhaps the question mark over her head was so obvious that Anna continued with a blunt voice

“I am pregnant and my due date is in a month.”

Now Jane was even more surprised but suddenly it all made sense. The saggy uniform, rolling with the chair, mood swings… It wasn’t because Anna was a loony. She was pregnant which now was obvious!

Jane felt angry and helpless. There was nothing she could do but to find a new job. Should she have known it was a temporary post she would have chosen the other job she was offered.

The working relationship between these two ladies came to an end. Whenever Jane saw Anna in town with her baby and husband she never greeted Jane or made any gesture she knew her.

Today is the day of the retirement for Jane but she remembers Anna and her bullying like it was yesterday. Even 40 years was not enough to forget or forgive and she secretly feels satisfaction over the fact that Anna is in a care home suffering from the Alzheimer’s.

“Karma” She thought when she closed the door of her work place for the last time.

Part III: I’m Sorry but I Did Not Get Qualified So That I Can Make Coffee for You

Dental Revelations Blog-

It is (finally!) time for the final part of the series of posts. This time it is of course the nurse’s role in the dental practice which probably is the most difficult one. Here’s why.

Experience Brings Wisdom

The dentist may know dentistry but he does not necessarily have any people skills. Or respect for others. Or ability to feel empathy. This kind of dentist is not fun to work with. Not even close to pleasant.

The nurse needs to put up with the dentist’s whimsy ways and misuse of power. Some nurses might tolerate this for a long time but some do find another job quite quickly. Especially those who are experienced ones.

But having said that, sometimes experienced nurses are allocated purposely to assist difficult dentists. To kind of bring them in the line. And oh boy if the dentist resists the change. He will have miserable time as the nurse tells him off about everything. The dentist’s whining is quickly silenced by the quick-witted nurse who do not tolerate any nonsense.

So the wisest dentists will comply very quickly as it is crucial for the congenial atmosphere of the work place. Plus the wisest dentists understand that the experienced nurses are worth their weight in gold no matter how they seem to disrespect the outdated hierarchical structure of dental practice.

Experience Brings Knowledge

In the Part I of this series of posts I wrote that sometimes the hygienists can have better knowledge on how to treat the gum disease. It is the same with the nurses – especially the nurses with 20+ years of experience. They have stared at people’s mouths for such a long time that they know a cavity when they see one. They can tell if the soft tissues look suspicious or if the filling has sharp edges that would bother the patient’s tongue.

If the dentist is lucky to have this kind of nurse assisting him he should be grateful to have extra pair of eyes looking out for problems in the patient’s mouth. But too many let their ego come in the way of team work (please read Part II for more on this subject). They ignore the fact that the nurse is looking at the mouth from another angle and can see things that are on dentist’s blind side.

Nurse Aka the Barista

One thing I have never understood is that why is it the nurse’s duty to make a cup of coffee/tea for the dentist? Please tell me one good reason why the person behind the title nurse should be considered as a servant? If anything, it should be the dentist making the coffee for the nurses as once they are finished with the patient they can enjoy their lunch in peace whilst the nurse disinfects the surgery’s surfaces and deals with the sterilisation of the instruments.

Another thing I have never understood – which I have already written about on my second post – is the fact that the patients bring gifts to the dentists but not to the nurse. Wine, chocolate, sweets, books you name it. I guess they don’t realise that dentist would not be able to do any treatment without the nurse (well without compromising good quality of treatment).

About Qualification Requirements

You may not need any qualifications to start as a trainee dental nurse.

This is a quote from National Careers Service’s website. It amazes me that in the UK you are still able to begin working as a dental nurse trainee without any qualifications and train yourself on the job. When I began working in the UK over a decade ago the dental nurse did not need to be qualified. Anyone could work as a dental nurse. Any random gal from the street. Seriously.

Somebody who has no clue about cross infection control or how to use all the equipment and materials safely would seriously compromise the patient’s, the dentist’s and the nurse’s own health.

In my current country that I work in the trainee nurses need to have certain modules accomplished before they can work as a trainee nurse. In my opinion this is far better system.

Hard Work Does Not Pay Off

The amount of work the nurses do does not show in the salary. They are very poorly paid and are expected to work on their lunch breaks if the dentist runs late and they are even expected to open the surgery in the morning on their own time.

I will tell you about one of my workplaces I used to work at. In this rather big company the nurses working hours were from 9am to 5pm. This was the time they got paid for. The problem with these working hours were that the patient came in at 9am and the surgery needed to be opened prior to that. All the nurses and the dental hygienists know that if you open your surgery properly it will take at least 30 minutes. Who would want to work 30 minutes for free? No-one apart from the charity volunteers but dentistry is no charity.

This meant that the nurses came in around 8.45am to open the surgery and they cut corners where ever they could. The same happened in the afternoon when the last patient had left. Closing the surgery also should take around 30 minutes but it was often done in less than 15 minutes. Needless to say that something important is left undone.

Pay Enough to the One You Want to Keep

Now on this final chapter I will give an advice to all the dentists who have nurses as employees. It is an advice that will make your practice a success story.

If you think your nurse is doing magnificent job

  • pay her enough money for that. Even more than what would be current going rate of the nurse
  • be flexible and take her personal life into consideration. Show that you care if she struggles with the demands of bringing family life and work life together
  • give her gifts every once in a while. Perfume, chocolate, her favourite music… anything
  • make sure you apologise if you run late before the lunch break. Let her go for an extra break later to compensate the lost time
  • buy her a lunch every now and then – after all you make gazillion times more money
  • make sure you both work in an ergonomic position
  • respect her

These are the only ways to stop your nurse looking for another job. You see every nurse know eventually that there are dentist’s who do value them more. Believe me, I know many nurses who have been rewarded generously by their employer – they have been paid more than an average nurse, they have been taken on board to a course trip overseas (even to Mauritius!), they get extra time off…

You see the dental practice who’s supportive staff keeps on changing all the time is not giving a very good impression to the patients. And that alone can be a reason for them to change dentist.


You might also like these posts:
Part I: Is It a Skyskraper? No, It’s Your Ego
Part II: Just Another Day at the Office

About Me, Myself and I

Dental Revelations Blog-1389

Before I will release the Part III of the series of posts I will tell you something about myself.

I have not written a lot about myself in this blog but this post will be an exception. And the reason for doing this is that you – my dear reader – would understand why I haven’t been and won’t be writing new posts as often as before.

Let me first tell you about the time when I decided to start writing this blog. This was in March this year. I had finished writing a novel in December last year which left a void in my life. More time in my hands. Thoughts that I wanted to put on paper (so to speak). Endless ideas for books.

But.

I have a family. Small children who need my time. I have a spouse who needs my time. I couldn’t begin another massive project of writing a novel. So I decided to put all my creative energy on this blog. But little did I know how time-consuming it would be. All the researching, writing, editing and advertising. It consumes as much time as writing a novel.

But I am not a person who gives up something that I have started. I will see things through until the (bitter?) end. So I made time for blogging and it went well up until now. You see my littlest one is about to begin nursery and I am about to return to practice my dental profession. And to be honest I am not looking forward to it. If you have read my posts you might have a pretty good idea why I feel this way.

As if all those things I have written about in my blog weren’t enough to make me wish I didn’t have to go back to my profession. On top of all those things I also work in a dental practice that have been dysfunctional for decades and even though people have come (including me) and gone it has made a very little difference to the atmosphere. But as a thoughtful and problem solving person that I am I have started to see this fast approaching and unwelcome life change as an opportunity. You see I won’t be out of post topics whilst working in there. Nope, it will be a horn of plenty!

So bear with me whilst I go through this hectic time in my life. Keep reading, sharing and commenting my posts. I have reached readers in every continent which I believe proves that people in dentistry go through the same problems all over the world. Let’s keep on changing the problems by discussing about them.