Tag: should i cancel appointment

Google for a Day – Comprehensive Answers about Cold Sore and Dentist

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To treat or not to treat? The answer should be easy one to answer. Why isn’t it?

My most popular post by far has been Cold Sore Is Herpes – Cancel Your Dental Appointment Because Your Dentist Won’t!. It proves that people certainly know that herpes simplex virus is not something that you could compare to common cold for example. They are unsure what to do when you have a cold sore and you have booked a dental appointment. And like with many other matters that you are not sure about, people turn to their all-knowing friend Google.

But it’s not only the patients who are unsure. Also the dental professionals seem to be confused and represent their questions to Google. How do I know this? Well, WordPress has very useful statistics that include also the search terms people have used when they end up to my blog. I have kept an eye on the search terms and I got this idea to write a post about them and act as a search engine for you. So here it is. The search terms (ST) and my answers.

ST: Can you go to the dentist with a cold sore?

Preferably not. Any treatment that can be postponed should be postponed.

ST: Can they take out a wisdom tooth with a cold sore?

Only the ones that cannot be postponed. If the wisdom tooth is risking your life due to an acute infection and signs of the infection are spreading to your bloodstream then it should be removed even if you have a cold sore.

ST: Why won’t the dentist see me when I have a blister in my mouth?

Because your dentist knows his business. Any responsible dentist would postpone the treatment if there are signs of herpes infection inside your mouth, lips or nose. But your dentist could explain a bit more why he didn’t see you so you wouldn’t have to google it. Here’s further reading about cold sore as an occupational hazard.

ST: Can dental treatment cause cold sores?

In theory, yes. If the practice’s cross infection control protocol is not up to the standards and they treat people with cold sores, the virus can be passed on to the next patient. The virus can stay infectious as long as 2 hours in the surfaces of the surgery and the instruments. If the next patient has never had any type of herpes infection, she’ll get primary herpes first. That’s nasty thing to have if you are an adult. Cold sore can follow as a secondary herpes after a while.

ST: Cold sore, herpes simplex, dental appointment.

I hope these things never meet in real world. Unless absolutely necessary.

ST: Does an orthodontist still take you if you have a cold sore?

If the treatment can be postponed, it should be postponed. But having said that, if the orthodontist treatment is such that no rotating, high-speed drills are to be used then it might be ok to do the treatment if the cross infection control is up to the standards.

ST: Can I have dentist with a cold sore?

Are you sure you want one? Wait until it clears and you’ll find that he is exactly the same person without cold sore. Just less infectious.

ST: Can I have a dental treatment with a cold saw?

Well, you actually could. We have instruments that look like a saw.

ST: Can you get oral herpes from the dentist.

Yes if your dentist’s cross infection control is not up to the standards and they treat patient’s with cold sore. Herpes virus can survive 2 hours in the surfaces that have not been adequately disinfected.

ST: How dental professionals can prevent from getting herpes?

Do not treat patients with cold sore. If you must (patient’s life is at risk), protect yourself with visor mask, take care of your skin as healthy skin on hands works as barrier to pathogens, use gloves, try to avoid using high-speed instruments and sonic scaler as they produce aerosols that carry pathogens, do only what is necessary until the time when the cold sore has healed. There’s no point in covering the cold sore with plaster or similar as the herpes simplex virus is also in the saliva. You should also read this article.

ST: Should a dental hygienist treat a patient with a cold sore?

Treatments the hygienists perform are rarely such that cannot be postponed. So do not take a risk. If you still act against my advise, protect yourself as advised above and do not use sonic scaler. And cross your fingers. You should also read this (scroll down to Case histories).

ST: Dentist refused to treat due to herpes.

Hooray! We have hope! Hold on to your dentist, he clearly knows his business!

ST: Dentist won’t treat me bc herpes.

Another good and responsible dentist somewhere out there! Be happy!

ST: Can I still have a filling with a cold sore?

No dentist should make you a filling when you have a cold sore. Making a filling requires high-speed rotating instruments that have water cooling system. They produce aerosol when used and the aerosols carry pathogens far and wide – possibly in the eyes of the dentist, nurse and yourself! Even if you wear protective eye-ware.

ST: What to do if patient has herpes simplex dental nurse.

I’m afraid there is not much you can do as the dentist is considered to be the one who is responsible for the treatment. The dentist decides if the treatment can be carried out. He shouldn’t of course treat patients with cold sore unless patient’s life is at risk but as you probably know the reality is very different. When you begin working with a new dentist, ask him how he deals with patients who have cold sore. If he is all about money, money, money, change jobs. Protect your health and your future as dental nurse. You can always show the dentist my article about cold sore or this article. Maybe that’ll convince him.

ST: Do dentist still remove teeth if you have a coleslaw.

We do find many things from people’s mouths. Sometimes even coleslaw between the teeth. I don’t think the dentist minds. He just wants to get your tooth out.

(It’s an obvious spelling mistake or an auto-correct error but I couldn’t resist making fun of it.)

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

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Zovirax can be used to make the cold sore heal quicker.

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 ignored 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 her 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.

Cold Sore Aka Herpes Simplex 

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 asked 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.

Conclusion

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.

So why?

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 from the dentist’s perspective to reschedule the appointment even though everyone’s health is at risk. No, no. Profit overrides 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.

Remember to share this post if you think there was important information that everyone should know.

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

Google for a Day – Comprehensive Answers about Cold Sore and Dentist
Are Your Dentist’s Tools Clean?