Don't Get Stuck With HIV

Protect yourself from HIV during healthcare and cosmetic services

Patient observed sterile treatment for dental care

POST for dental care
1. Avoid skin-piercing procedures (a) If you are not 100% sure that your dentist sterilizes all instruments, including hand-pieces (that hold and turn drill bits), avoid care as much as you can.

(b) Take care of your teeth to avoid cavities.

(c) Don’t fill baby teeth, which will soon fall out.

2. Use new disposable instruments (a) For injections of local anaesthetic, use a new disposable syringe and needle from a sealed package (see Injection section).

(b) If you take an injection of local anaesthetic, arrange for the dentist to use a single-dose vial, or to open a new multi-dose vial for you (see Injection section).

(c) Whoever puts a hand in your mouth should be wearing new gloves taken from a package in front of you, or you can bring them yourselves.

3. You sterilize the instruments This does not apply to dental care.
4. Ask providers how they sterilize instruments (a) Because many dental procedures reuse tools, you will often need the dentist’s cooperation to ensure safe care. Think ahead. You may want to talk to one or more dentists to find one with which you are most comfortable.

(b) Dentists should have autoclaves. All instruments that might get blood on them, including hand-pieces (that hold and turn drill bits), should be autoclaved or boiled.[i][ii] To be sure that the tools going into your mouth have been autoclaved, you might ask to see it done. You could, for example, arrange to be the first patient in the morning, and come early to watch the instruments come out of the autoclave.

(c) Some dentists inject local anaesthetic with a special reusable syringe and needle designed to inject anaesthetic from single-dose canisters. This removes the risk that comes with multi-dose vials, but leaves you with the risk that the syringe and needle may be reused without sterilization. You need to ask how they are sterilized.

Additional information about dental care

Be especially careful with dental care: In countries with generalized HIV epidemics, you should be on high alert for blood-to-blood contact during dental care. There are several reasons for this.

First, people with AIDS have a lot of problems with teeth and gums, and so get a lot of dental care.

Second, dentists use a lot of tools to scrape, drill, and pull teeth. They may use tubes to suck out saliva. Virtually all of these instruments are contaminated with blood during normal procedures, and all are reused with other patients. Because dentists see many patients in a day, they should have enough sets of tools so they can sterilize used tools while having clean ones for each patient they see. Autoclaving takes time – several hours to wash tools, put them in the autoclave, steam them for the required time, and then cool them before use. To save time and money, some dentists don’t autoclave tools between patients – they may wipe them with bleach or alcohol. This is especially common for hand-pieces (that hold and turn drill bits). Wiping reduces risks, but it is not safe. HIV survives wiping. Vibrating instruments can shake off remaining HIV into bloody sores in the mouth. Such risks are avoidable.

Who gives dental care? Many people do not go to dentists. If they have a tooth that is giving them problems, they may go to a doctor or an to informal expert who pulls teeth with simple instruments or even by hand. Insofar as HIV is concerned, this is safe as long as the provider wears new gloves and uses instruments that have just been boiled.

Risk to get HIV from dental care

Your risks to contract HIV during dental care come from injections of local anaesthetic and from reused instruments and gloves.

If the previous patient had HIV, and the dentist reuses the syringe or needle with no effort to clean, and takes anaesthetic from an opened multi-dose vial, your risk to get HIV from an injection of local anaesthetic may be estimated at 3%-10% (see Table on Estimated risks in Blood-borne Risks section).

If the dentist makes no effort to clean instruments between patients, or to change gloves, the risk to transmit HIV from an infected patient to one or more subsequent patients on tools and gloves may well exceed 10%, considering the multiple cuts and prolonged exposures that may be involved in a dental procedure, such as filling or pulling a tooth. Wiping or otherwise cleaning – but not sterilizing – instruments between patients will reduce but not eliminate risks.

If the dentist uses a new syringe, needle, and gloves, opens a new vial of local anaesthetic for you, and sterilizes all instruments, you have no risk to get HIV from dental care.


[i] CDC. Recommended infection-control practices in dentistry, 1993. MMWR 1993; 42 (RR 8): 1-13.

[ii] Kohn WG, Collins Cleveland JL, Harte JA, et al. Guidelines for Infection Control in Dental Health-Care Settings – 2003. MMWR 2003; 52 (RR 17): 1-61. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm#top (accessed 13 January 2011).

24 responses to “Patient observed sterile treatment for dental care

  1. Pingback: Welcome to the Don’t Get Stuck With HIV blog and website « Don't Get Stuck With HIV

  2. Pingback: Let Us Give Up Our Anti-Gay Prejudice, But Not Just Yet « Don't Get Stuck With HIV

  3. Anonymous October 9, 2012 at 9:57 am

    Dental Procedures, as simple as a cleaning can be bloody . They do wear gloves ,mask , sterilized tools, but than they continuously touch the light handle or press the button to fill the water cup with the now dirty glove, which they touched with many patients, than touch your mouth , tools – even the side that’s going in your mouth . The only thing those gloves are doing is protecting the dentists! I feel dentists should have strict guidelines for infection control .

  4. Simon Collery October 9, 2012 at 2:26 pm

    Absolutely, I was in a dental practice in South London one time and the dentist used the handle of the prodding device to tap the keys of his absolutely filthy keyboard. Sometimes he used the wrong end for the keys and even stuck the handle into my mouth at one stage. Next time I went (to a different dentist), I asked about hygiene and infection control and was given a guided tour and the situation was completely different. The dentist and dental nurse told me the only time someone had asked before the client was neurotic about everything, not just hygiene. So it’s worth asking around and choosing a good dentist. If you see anything terrible, you could even consider reporting the clinic.

    • Jade October 22, 2013 at 7:49 pm

      I agree with you about this. We have seen almost same things in some dental offices. I now even collect some dental tools which we can get rid of tartar from our teeth at home. I have reviewed some documented which told that in the past our ancestors did not need dentists at all. a few of them seem to be clumsy way but if we can regulate we can have safe dental treatment at home. about the general machine to get rid of tartar is around 100 euro ( price in vietnam, hope that we can exchange more info of this problem in dentistry.

  5. jade. May 26, 2013 at 12:01 pm

    i am using pep to avoid hiv when i was once in careless dentist office. and now i have had problems with a few teeth and need treatment so i think i must use pep to avoid hiv, i hope i have not been infected with hiv, hepatitis c or b and sexual transmitted diseases.

  6. Simon Collery May 26, 2013 at 1:13 pm

    Hi Jade, thanks for your comment. You should avoid careless dentists or ones who refuse to answer questions about safety. But you should talk to a doctor if you think you have been infected with something.

  7. Anonymous August 30, 2013 at 10:09 am

    You can’t contract Hiv from a visit to the dentist because HIV becomes inactive and therefore unable to infect you once exposed to air, even if the person before you was Hiv+

    • davidgisselquist August 30, 2013 at 1:08 pm

      Thanks for your interest in this website. What you say is flat wrong.
      Everyone who has looked at the issue (watching and testing HIV outside the body) finds that HIV can live hours to days on dry surfaces, and weeks if wet. Here’s a review of the evidence you can read online: Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006; 6: 130. Available at: http://www.biomedcentral.com/1471-2334/6/130 (accessed 30August 2013).
      If you follow the link, here’s what you find: In the Background section: “The aim of this review is to summarize data on the persistence of different nosocomial pathogens on inanimate surfaces.” Inanimate means not living – such as something metal, plastic, etc. In the Results section: “Blood-borne viruses, such as HBV or HIV, can persist for more than one week.”
      For more information, look at this page in this website: https://dontgetstuck.wordpress.com/what-is-your-risk/ You can also get to this page by clicking on “intro” on the top menu and then clicking “estimated risks to transmit HIV through skin-piercing events”

    • Jade October 31, 2013 at 3:47 pm

      the problem is that some people were infected by HIV in dentist office. This can be from dirty tools, anesthetic which the dentist used to make patients not feel painful. But they did not use for only one patient they wants to save a little money so they use the same small phial of anesthetic for a few patients. In my country some people were infected with HIV because a nurse used the same phial for many patients. So far this case has led 12 people were infected with HIV. Also, in some cases, heroine addicted were not infected HIV from the same needle-stick but were infected from the same phial of heroine liquid. Therefore going to dentist office now is like the kind of risk game. In my country, there is a statistic of HIV cases, around 15-20% hiv infected people did not know the reason/source which make they infected with HIV.

  8. Jade October 22, 2013 at 7:19 pm

    I have used twice of PEP to prevent HIV because I have seen a few risks in the dental office. my boyfriend was in 2 dental offices for treatment,too but he seems to be overconfident. We quarreled about this.Tomorrow he will take hiv test. he is living in Holland now.
    he does not have as much knowledge of hiv as I do therefore he can not imagine how terrible it is.
    if someone is infected with HIV in any country from dental treatment, it is really much more terrible and mournful than they have any fatal and painful disease. Especially, nowadays many government still discriminate hiv infected patients, they are deprived chances of working and studying. So i hope good people ( those who has high awareness of HIV , HBv, HCV, herpes viruses , never have libertine sex lifestyle, never use heroine, cocaine, . . . .) will never be infected with frightful infected diseased from unmoral and dirty health services.
    whenever i have read the news which patients must suffer from hiv from careless health services in anywhere, i always feel very sad and want to do something for them.
    I stopped using PEP not long ago, not up to 3 months so I must still wait for the right time to test again. I hope i can meet friends all over the world who care hiv, hbv, hcv and infected other diseases in health services to do something for our world.
    The information about hiv such as Don’t have unsafe sex, not use heroin or using the same syringe and needles-sticks are too stock. a part of doctors in vietnam don’t care to health of patients they only care more to the money they earn therefore i hope useful information and advices and medicine will come to good people in time.
    Thank you for reading my expression.

  9. davidgisselquist October 24, 2013 at 2:33 am

    Hi Jade,
    Thanks much for your comment. As you say, it is a shame that people are not warned about all risks for HIV and hepatitis. Too many people get HIV from risks they don’t suspect.
    One place to meet people trying to stop HIV and hepatitis transmission through unsafe health care is: SIGNpost. SIGNpost is a weekly email newsletter. You can sign up to get SIGNpost at: sign.moderator@gmail.com.
    The SIGNpost Website is http://SIGNpostOnline.info
    David

  10. julie November 13, 2013 at 8:41 pm

    Hi was just thinking if someone has had the norovirus and then they visit the dentist could it be past on to someone else. I ve been today the lady put new gloves on then touched the light handle before she started work on me could it be past liked this

  11. Simon Collery November 14, 2013 at 4:32 am

    Hi Julie
    Thank you for your question. It is important to ask because it is the kind of thing that many people visiting a clinic might miss. However, as this site is about viruses transmitted through contaminated blood and other bodily fluids, and mainly in developing countries, it would probably be better to raise the question with NHS Complaints:

    http://www.nhs.uk/choiceintheNHS/Rightsandpledges/complaints/Pages/NHScomplaints.aspx

    They should at least be able to explain whether the dentist failed to follow safety procedures and whether this kind of breech could pose a risk to patients.
    Regards
    Simon

  12. Pingback: Happy New Year to All our Visitors | Don't Get Stuck With HIV

  13. Jane October 9, 2014 at 9:54 pm

    Hi. I have a question my dentist always answer the phone during the his fixing my teeth with the gloves on I wonder if he do that with every costumer so the can hold HIV viruses on I don’t know for how long there any chance to catch the HIV from that?

    • Simon Collery October 10, 2014 at 9:25 am

      Hi Jane. It’s very unhygienic and unprofessional. I don’t think it would put patients at risk of HIV but you don’t want bacteria and viruses in your mouth and you may well risk other infections. I don’t know what country this is in but is there a patient’s charter or a standard way of reporting such behavior? It would protect other patients as well.

  14. mike williams November 26, 2015 at 7:16 pm

    Hey thanks for the info, very informative to people who other wise would be ignorant to the sanitary procedures in dental envirnment..even me myself got alot more educated my self by your posting…I just wanted to know how do you go about getting an inspection done by deptment of labor or who ever to if the dental office is sanitary or are following sanitary laws?

  15. Simon Collery November 27, 2015 at 6:37 am

    Thank you Mike, it may depend on which country you are in and whether this falls under the Department of Labor, but you could either try their website, the Department of Health website, your government health ombudsman or your local government health offices.

  16. A.B.D March 25, 2016 at 3:57 pm

    hi simon thank you for this info you spread on this site, i have a question…
    i went to a dentist that worked for an organization to get a tooth filling. so it was crowded with people.
    he had alot of equipment, weared gloves and a mask, and he had a nurse there with him. so it seemed like he ran it very clean.
    but i don’t know if he changed the needle for the anesthesia shot he gave me, and i unfortunately didn’t ask him, the shot was administered to me on the top of the inside of my mouth.
    do dentist that work for organizations follow health protocols? what are my risks of getting hiv or hepatitus from it if he didn’t change it the needle?
    i live in a middle class country with a relatively low hiv prevalence (an estimate of 0.1%) but with a small percentage of unknown causes.
    oh and this all happened 4 months ago and i don’t recall having symptoms after it.
    please help me as im very worried about this…

  17. Simon Collery March 25, 2016 at 6:27 pm

    Hi, if you are worried you can go back there and ask all the questions you have. If you are not convinced you can go to the medical/dental regulating body in your country, and find out from them how you can take the matter further. They should also help you to understand the risk you face. The risk of hepatitis may be higher than the risk of HIV if prevalence is .1%, which is very low, so ‘feeling fine’ after four months doesn’t tell you anything. Would also be a good idea to talk to a general practitioner and ask them to refer you to a specialist if you are still unhappy. Your risk should be extremely low, but if you are not satisfied, I don’t expect an answer on a blog to be enough!

  18. A.B.D March 25, 2016 at 7:10 pm

    from the way i described this dental facility to you what do you think of it?
    oh and sorry the hiv prevalence is .2% in my country according to 2014 studies.
    should i get tested?

    • Simon Collery March 25, 2016 at 7:15 pm

      .2% is still very low, lower than in several wealthy countries. But I can only give you the same answer, talk to a specialist, don’t rely on an assessment from a website. The advice on this website encourages people to check, not assume, but that means consulting a professional, who is licensed to practice, and has an obligation to give advice they can stand by.

Leave a Reply (Please feel free to do so anonymously)

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: