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.