The goal of our website to is to raise awareness to dentists, orthodontists, hygienists, and the public about rising health concerns that are occurring in dental offices. For the most part, people understand that you can get sick in a hospital. But what patients don’t realize is that when they go to a dental office, they too can become sick or infected. The primary role of a dentist and their staff is to ensure their office is safe and sterile. Infection control protocols are the most important aspect of the day-to-day activities in a dental office.
Unfortunately, infection control protocols are not always followed. Sometimes an office gets busy and steps are skipped during the rush. Sometimes it’s a money factor. Cutting costs here and there to save on the bottom line. Beyond these situations, sometimes the protocols being followed do not align with current CDC, FDA, ADA, and OSAP recommendations. We are not saying this happens in all offices. The majority of dental offices are safe and the staff do a great job, but there are still areas of concern we would like to discuss.
OSHA vs. Compliance Safety
Knowing the difference between OSHA and compliance safety is something that needs to be discussed. With the Occupational Safety and Health Act of 1970, Congress created the Occupational Safety and Health Administration (OSHA) to ensure safe and healthful working conditions for workers by setting and enforcing standards and by providing training, outreach, education and assistance. OSHA was created to help ensure EMPLOYERS provide safe working conditions for their employees. OSHA protects employees from workplace hazards. It does not create standards for procedural infection control protocols.
OSHA currently has no specific standards for dentistry. On the other hand, compliance safety is centered on device sterilization protocols and ensuring each patient is provided with a safe treatment. The focus being on ensuring patients are treated with sterile equipment and that patient safety is at the forefront of every procedure. To simplify the differences, OSHA protects employees and compliance safety protects patients. Unfortunately, some dental offices think that passing OSHA audits mean they are doing everything correct in their office. But this is not true. That simply means they are providing a safe work environment for their employees, not their patients. This confusion is a major cause for concern. It leads dental offices to the idea they are doing everything right for their patients, which just isn’t true.
OSHA doesn’t check if a dental office sterilizes their equipment. OSHA doesn’t check if dental offices use single-use items when required. This false sense of safety, can endanger patients. The CDC provides compliance safety standards, not OSHA. The CDC is what you want your dentist to follow for patient safety. CDC recommendations are then passed to other agencies like the FDA, ADA, and OSAP.
Air Water Syringe
The dental air water syringe is the most used device in a dental office. No matter if you are getting a root canal or a simple cleaning, the air water syringe is always present for the procedure. Unfortunately, the air water syringe is one of the dental devices we are most concerned about. Shockingly, the air/water syringe is the only device that is not removed from the delivery system to be heat-sterilized. Every other item is removed and heat-sterilized between patients, so why not the air/water syringe?
In the USA, the majority of dental offices buy delivery systems that come with an air/water syringe that once installed, cannot be removed. This means years and sometimes a decade of this device being used on patients and never getting sterilized. The current standard for air/water syringe cleaning is to wipe down the air/water syringe with a high-level disinfectant and cover with a barrier sheath. Unfortunately, this does not sterilize the air/water syringe. It is impossible in a mere couple seconds to disinfect all the crevices and internal parts of the air/water syringe. Does that sound sanitary to you? This technology is not new, but in the USA, it is not a standard. We need to help raise awareness about the lack of air/water syringe regulations. If there is a safer alternative to current products, why hasn’t the dental community made the switch?
Air Water Syringe Compliance
The CDC, FDA, ADA, and OSAP all recommend that if a dental device is attached to the air and water lines, that it should be removed and heat-sterilized between patients. The CDC also states, “Because the majority of semi critical items in dentistry are heat-tolerant, they should be sterilized using heat. If a semi critical item is heat-sensitive, the DHCP should replace it with a heat-tolerant or disposable alternative.” Unfortunately, for the majority of dental offices in the USA, these recommendations are not being followed. This means that the majority of dental offices our non-compliant with leading health authorities’ recommendations.
Air Water Syringe Infection Control
Would you feel comfortable knowing the air/water syringe that will be used on you was simply wiped down in seconds before treating you? We would assume not. Infection control for the air water syringe definitely needs to improve.There are new solutions available to dentists that allow the air/water syringe to be removed and heat-sterilized between patients. But like a lot of things in dentistry, change is slow. Next time you go to your dentist, ask them when the last time they heat-sterilized their air/water syringe. Actually removed the air/water syringe and put in their autoclave. You will be shocked by the response.
Air Water Syringe Tips
When a dentist, orthodontist, or hygienist use an air water syringe, that means they too must use an air water syringe tip. The majority of dentists in the USA still use autoclavable air water syringe tips, meaning, they reuse the tips. The problem with this is that science has proven over and over that there is no effective way to sterilize these air water tips. The small channels within the autoclavable tip make it near impossible for steam to penetrate all the way through. If you ask any dentist, orthodontist, or hygienist, they will tell you these tips get clogged and spray patterns dramatically change from first use. Why does this happen? The autoclavable (metal) tip has air channels with a diameter smaller than that of a hypodermic needle. These channels are known as micro-lumens.
Air Water Syringe Tips In The Dental Office
During a dental procedure, debris (blood, saliva, tissue) gets aerosolized and sucked back into the metal tip. The tip, filled with this debris, is then placed into an ultrasonic bath, which is not cleaned as often as it should be. This bath then fills the tip with more potential contaminants. The final step is placing the metal tip into the autoclave, which then bakes the debris into the tip. Over time the metal tip becomes clogged with this debris, make it impossible for steam to penetrate all the way through the tip. When this happens, there is no way for the sterilization protocols to be effective. There are many alternatives to autoclavable (metal) tips, but the majority of dental offices still use these tips.
So why do dentists continue to use autoclavable tips? A main factor is cost. Single-use alternative tips, are used on one patient and thrown away. This adds an additional cost of $0.10 – $0.25 per treatment. If you were asked to pay, at the most, an additional 25 cents to receive a treatment with a single-use tip, would you pay it? The majority of people, armed with the facts, would gladly pay even an extra dollar to ensure they are not treated with an autoclavable air/water syringe tip. From an infection control standpoint, autoclavable air water syringe tips should not be used.
Raise Awareness in the Dental Office
The air/water syringe, autoclavable tips, and a false sense of compliance are a major cause for concern in the dental office. Universal precautions state that every patient should be treated as if they are infected. Current air/water syringe systems and autoclavable air/water tips do no meet CDC, FDA, ADA, OSAP, or universal precaution recommendations. Armed with the information from this website, we hope this helps you and your family identify things to be cautious of and discuss with your preferred dental office.