I don’t often read the news but lately I have been following, and with considerable interest, the Guelph Mercury-Tribune. It reads along the lines of “thousands of patients at a Guelph dental clinic were advised to get tested for HIV, hepatitis B virus, and hepatitis C virus, due to concerns that sterilization of dental instruments was not done properly”1. What? “Public health inspectors discovered the issue after receiving a complaint from a member of the public about the clinic… following the inspection, they closed the dental practice.”
Wow. This was a complete shock to me, and no doubt, a bigger shock for the patients of that clinic. Can you imagine, potentially getting a serious infection from a quick visit to the dentist? I am getting a toothache just thinking of it. “While experts say that there is a low risk for being infected, patients are still encouraged to get tested.” By all means, please do get tested, but I’m also curious… what exactly is low risk? Let’s take a closer look.
HIV, while sounds scary, is actually a very weak virus that needs to be in a controlled environment in order to survive. According to the Centers for Disease Control and Prevention, “HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce outside a human host”2. Thus, the chances that you got HIV from a not properly cleaned dental instrument, is highly unlikely.
Hepatitis B virus on the other hand, is a bit more stubborn – it can survive outside the body for at least 7 days. And Hepatitis C virus, up to 3 weeks. During that time, the viruses can still cause infection if it enters the body of a person who is not infected. While concerning, so far there has been no evidence that any disease transmission from the dental office to a patient has occurred.
So how did this happen? Isn’t Public Health supposed to prevent these issues?
Public Health is mandated to routinely inspect restaurants and personal service settings like spas and nail salons to ensure they are maintaining proper food safety and infection control practices3. The same, however, does not apply to offices or clinics run by regulated health professionals, including dentists and doctors. Public Health is not authorized to inspect these premises unless a complaint is made.
In these settings, the College of the health professional regulates and sets the guidelines that are to be followed. However… “Guidelines are just that – guidelines. They are not attached to any by-law or professional misconduct regulation or standards,” states College Registrar Irwin Fefergrad4. Adding further, “Professional judgement by individual dentists will always inform how each of the best practices outlined in the Guidelines should be used.”
It Is important to note that Public Health units only gained responsibility for investigating regulated health professional premises as of October 2015, and that this case was not the first investigation. Since the beginning of 2017, there have been five complaints and orders issued to address health hazards at dental clinics5. Prior to Public Health gaining mandate to co-investigate complaints, the Royal College of Dental Surgeons of Ontario would investigate complaints. Looking at complaints history over the last 10 years, allegations were mainly due to “failure to maintain the standards of practice of the profession”, or “unprofessional or unethical conduct”6.
So what can be learned?
It is possible that the focus of complaint investigations had differed between Public Health and the College. Perhaps now, there is more of a balance between concerns of sanitation and concerns of standards of practice of the profession. Public health issues tend to be more prominent in the media, and rightfully so.
While the risk of infections from improperly cleaned dental instruments is low, is it possible that the risk is underestimated? There is not a lot of research in literature. Furthermore, it appears that there is no system to monitor dental clinics or dental-associated infections. Whether, a system should be put place, should now be revisited.
What are your thoughts? Should we be concerned with current infection prevention and control protocols among dental clinics? I would love you hear your thoughts in the comments section.
*PS it is also World Hepatitis Day this upcoming Friday! An important reminder to raise awareness of Hep in your community.
- Guelph Mercury Tribune. 2017. Patients of Guelph dental clinic told to get tested for hepatitis and HIV. https://www.guelphmercury.com/news-story/7400863-patients-of-guelph-dental-clinic-told-to-get-tested-for-hepatitis-and-hiv/
- 2017. HIV Transmission. https://www.cdc.gov/hiv/basics/transmission.html
- Ministry of Health and Long-Term Care. 2015. Infection Prevention and Control Practices Complaint Protocol. http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/infection_prevention_complaint.pdf
- Royal College of Dental Surgeons of Ontario. 2010. New Guidelines on Infection Prevention and Control in the Dental Office. http://www.rcdso.org/KnowledgeCentre/DispatchMagazine/OnlineDispatchArchive/NewGuidelinesonInfectionPreventionandControlintheDentalOffice
- Wellington-Dufferin-Guelph Public Health. 2017. Inspection & Infection Control Complaints. https://www.wdgpublichealth.ca/tickets-orders-and-closures
- Royal College of Dental Surgeons of Ontario. How to file a complaint. http://www.rcdso.org/publicprotection/howtofileacomplaint