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

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You feel the water lever rising in your mouth while you are having a treatment done at the dentist. Your natural instinct raises an alarm in you mind.

I’m going to drown…

I’m choking…

Your eyes open wide and you raise your both hands to make a gesture that you want to get up to empty your mouth. The nurse quickly takes the suction to remove the water but there’s always some left, isn’t there? Your hands are still reaching the spittoon next to the dental chair but the nurse lays a hand on your shoulder and says gently

It’s ok to swallow, it’s only water.

Well is it?

Dental Unit (= the Chair) Waterlines Causing Infections?

The water in dental unit waterlines should match the same standards as safe drinking water. In short this means that the bacterial count (colony forming units, CFU) in the water should not exceed certain safe level (if interested to find out more in depth, please visit here). The standards vary in different countries. The countries I have worked the CFU/ml regulations vary from 100-500. Now here comes the nauseating fact:

In practice the CFU/ml levels can be as high as hundreds of thousands of all sorts of nasty bacteria, including the ones of human origin. Needless to say that it is enough to cause problems.

The problem with the dental units is that many of them are old and do not have the latest technology for waterline cleaning. Renewing the dental units is slow as they are expensive and practices want to use the existing ones as long as possible.

Dental units without waterline cleaning system have a slow flow in the waterlines, the water is warm and the water stands still during off-surgery hours (nights and weekends). Sounds like a very bad combination, eh? The old dental units do not have preventive valves in the waterlines to stop suck back of the patient’s saliva into the lines.

So as a result the waterlines in the dental units are lined with biofilm (a mass or layer of live micro-organisms attached to a surface) that should be removed regularly.

Who Is at Risk?

The healthy patients should not worry much. But to be honest, I do not like to swallow the water myself. It’s gross.

The patients whose immune system is impaired are most at risk. The elderly, the young children, medically compromised people and everyone with immunodeficiency. In worst case scenario the visit at the dentist can be lethal.

Of course us professionals are at risk as well. There are lots of aerosols in the air during the use of the dental unit. A bacterium to raise the biggest concern is the Legionella that causes Legionnaires’ disease. So do take care of the unit waterlines.

Advise for Professional to Improve the Water Quality

Use water source that meets the standards for drinking water.

Run the water from the unit waterlines (handpieces, ultrasonic scalers, air/water syringes):

10 minutes after the weekend
3 minutes in the morning
30 seconds after every patient

Use an efficient waterline treatment product recommended by the unit manufacturer. Use it regularly. Running the water as I advised will get rid of the free flowing bacteria but not the biofilm, it needs an effective disinfectant. The most effective product for getting rid of the biofilm are the ones containing:

hydrogen peroxide
hypochlorite
superoxidized water

Invest in new dental unit (do not go to the cheapest option – you only go from bad to worse) with the latest technology. It’s only humane thing to do.

Conclusion and Cause for Worry

In my experience the dental unit waterlines are not looked after as they should to maintain the good quality of the water.

I have seen that instead of cleaning the waterlines the dental professionals have stopped using the water e.g. when using the slow handpiece (the drill that feels like a street drill). Now I must mention that this happened only in the other country I worked at. I never found out why they actually do this (please enlighten me on comment box below!) but perhaps it was because of the water quality problem? When I used a slow handpiece there, I was naturally worried about overheating of the tooth and tried to get water flowing but it was made impossible.

I have seen a dentist performing implant surgery using a water from air/water syringe (it wasn’t the only thing that was wrong with that treatment – imagine dentist’s tie hanging loose and contaminating everything it touches. Sterile surgical coat was nowhere to be seen). Implant surgery if anything needs an absolute clean environment and wearing your personal clothes and using unit’s water supply simply is not up to the standards.

I know for a fact that many dental nurse neglect running the water as described above. It is appalling thing to do. Honestly.

What does this tell about us professionals? We should be the ones that are looking after the patient’s best interest and health. Doing all the fancy and immaculate maneuvers inside the mouth is not enough to fulfil our purpose.

Are we too busy making money and forgetting the basics?

Advise for the Patients

Seek out a modern dental practice with modern equipment. If you are unsure what modern dental unit looks like, here‘s one example (unfortunately I don’t get paid for advertising this site).

It is ok to ask the nurse or the dentist if the waterlines are regularly disinfected and if the nurse runs the water after each patient.


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Soap Opera of the Dental Practice

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Sometimes colleagues act like kids in a sandbox. On a frosty day.

The next time you lay back on dentist chair to have either check-up or treatment done, instead of concentrating on squeezing the handles in a fear of the pain and unknown, pay a close attention to the chemistry between the dentist and the nurse. If you are lucky, it can be very entertaining to watch and listen, and you forget the whole business of being nervous.

Ideal Dentist-Nurse Relationship

An ideal relationship between a dentist and a nurse is such where mutual respect prevails. They are two human beings, professionals working together for the patient’s health and earning their living. Both of them understand that one could not work without the other (at least without seriously compromising the safety of the patient) and especially that they could not work without the patient. They may be good friends that go beyond the working day.

Dentist-Nurse Relationship from Hell

It can be a sign of a non-working relationship if it is the nurse that calls your name at the waiting room of the dental practice. Not always, but often it is so.

Why? Because normally it is the nurse who has more to do after the previous patient than the dentist. The nurse spends long time wiping surfaces (should do), equipment, patient chair with a disinfectant, sterilizing instruments and preparing the room for the next patient.

Meanwhile the dentist chats with the previous patient, records the visit (takes couple of minutes, sometimes even less if the dentist is not bothered to write anything else than check-up and adding a sign that tells us professionals that nothing special was found) and checks the next patient’s treatment plan, which she should have done already in the morning. All this often takes less than what the nurse needs to do.

A revelation:

Some dentists feel that they are too highly educated to walk the aisle of the surgery to call the patient in. It is the nurse’s duty even if it meant that the dentist has nothing to do while the nurse is finishing with disinfection business (well, dentist can always have a cuppa while waiting).

Here is an example of this. I have witnessed a very highly educated specialist taking a seat in the front of the computer every time the nurse walks out to call the patient in. And when the nurse returns with the patient, the specialist is looking intensely at the computer screen looking all important and wise for few seconds and then almost like apologetically getting up (for not noticing that the patient arrived) and rushing to shake hands. This happened with e-v-e-r-y patient. Honestly.

But.

There are nurses that prefer to call the patient in from their own will. In this case any of the following won’t happen in the surgery. So keep reading!

Once you have taken a seat in the dental chair, the nurse gives you the safety glasses and a bib to cover you shirt and tilts the seat down. Here comes the next battle of the non-working relationship between the dentist and the nurse.

The ergonomics are very important in dental profession. It means early retirement or occupation change if you work in wrong positions for many years. In a good healthy working environment the dentist and the nurse have tried and tested the positions of the patient chair that is good for both of them (there will be exceptions e.g. when very large patient or heavily pregnant patient comes in).

So the nurse places the seat down and sits beside you. The dentist washes her hands (hopefully) and puts on the face mask and gloves. She moves her chair beside you and starts adjusting the patient chair’s hight and tilting-angle. If you see the nurse moving hastily further away from you or standing up, you know they do not work well together. The dentist has just adjusted the seat so that the nurse is not able to find an ergonomic position.

If they have worked together like this for years, there is lots of anger and resentment from the nurse’s side. You might be collateral damage in this war, I’m afraid. If you feel like your mouth is filling up with water, you need to swallow it a lot (by the way, you can swallow it, it’s just a tap water, is a lie and I will write about it later on this blog) or it pours out from the side of your mouth on to the dentist’s lap, it might be a silent demonstration against the dentist’s tyranny over the position of the patient chair and the patient’s head.

Twisted, but that’s how it goes.

Other Signs of Non-Working Dentist-Nurse Relationship

  • they don’t chat while treating you
  • they don’t make jokes to try to ease you fear
  • you hear lots of clatter from the instruments (they are thrown in the tray)
  • they reply cynically to one another (normally nurse to the dentist and in non-funny way e.g. as soon as I have time)
  • they argue about treatment, equipment and materials. How they should be used or should they be used at all – the dentist wins these arguments as they are the higher educated ones and cannot be wrong. Especially not in the presence of the patient
  • the nurse sits like a statue after the dentist has requested for an instrument. Just before the dentist is about to renew his request the nurse rolls her eyes and slowly reaches for the instrument

Definite Sign of Non-Working Dentist-Nurse Relationship

The nurse walks out of the surgery.

Conclusion

Just imagine what it is like to work as a pair and the chemistry does not work. It is simply and utterly torture for all including the patient. And it is very common in dentistry.

If you, a dental professional recognised yourself from the above, please start working towards a better relationship. It starts from the respect.


You might also like:

Part I: Is It a Skyskraper? No, It’s Your Ego

Part II: Just Another Day at the Office

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