No sterile field?

[Fuji]

After shadowing several dentists, an oral surgeon, and an orthodontist, I have noticed a similar trend: each doctor had very little regard for sterility. I saw handpieces and crowns dropped on the floor, they never changed lab coats or scrub tops (even if they went out to lunch in them), and there was never any mention about the cleanliness of the patient's face or clothes. To their credit, all of the doctors changed their gloves regularly (some changed their masks), and they all wiped down the operatories after each patient (at least their assistant did), but other than that it seemed pretty lax.

Is this common? Is the risk of infection so low for the oral cavity that it doesn't really matter? Why aren't oral surgeries treated like other surgeries, with sterile drapes and the like?

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[wizziefiend]

After shadowing several dentists, an oral surgeon, and an orthodontist, I have noticed a similar trend: each doctor had very little regard for sterility. I saw handpieces and crowns dropped on the floor, they never changed lab coats or scrub tops (even if they went out to lunch in them), and there was never any mention about the cleanliness of the patient's face or clothes. To their credit, all of the doctors changed their gloves regularly (some changed their masks), and they all wiped down the operatories after each patient (at least their assistant did), but other than that it seemed pretty lax.

Is this common? Is the risk of infection so low for the oral cavity that it doesn't really matter? Why aren't oral surgeries treated like other surgeries, with sterile drapes and the like?

Certain patients get the starile drape for implants but other than that...no draping or surgery site prep.

Perhaps the mouth is such a dirty place anyway that basic precautions are good enough.

 

[OceanDMD]

Sterile = Free of live bacteria or other microorganisms. This is not possible in either a dental setting, or hospital setting(you disinfect the operatory via disinfectant usually sprayed, wiped, and then misted). Most of the surgeons I have worked with/mirrored change their smock between each of the patients they see. This is a standard. Obviously gloves and masks are changed/patient. I can't imagine you saw a surgeon go from one patient/surgery to the next without changing gowns.

 

[dentwannabe]

The oral surgeons I worked with were very careful.

Every instrument was always sterilized before use and if something was dropped on the floor it was NOT used again. They wore white coats and they didn't change those -- you really don't need to unless it got messy which it usually didn't.

 

[armorshell]

I find it hard to believe that someone would use non-sterile instruments/instruments dropped on the floor.

The dentists I worked with (at a mill type practice) would have me get them a new instrument if they so much as brushed them across their sleeve.

 

[Fuji]

I find it hard to believe that someone would use non-sterile instruments/instruments dropped on the floor.

The worst was the crown. He was polishing it and it flew out of his hand, so he picked it up, sprayed it with water and air, and then kept polishing.

 

[NavyDDS]

Just think, in the 70's they didn't even wear gloves... and some dentists and patients even smoked in the opatory! Hey Doc.... you just ashed in my grill!

 

[north2southOMFS]

I can't imagine you saw a surgeon go from one patient/surgery to the next without changing gowns.

You wear a gown taking out teeth? And then you change it between patients? I wear a scrub top and try not to get it dirty cause if i do then i gotta wear that funk on me for the rest of the day.

 

[OceanDMD]

You wear a gown taking out teeth? And then you change it between patients? I wear a scrub top and try not to get it dirty cause if i do then i gotta wear that funk on me for the rest of the day.

Hence the gown.

 

[setdoc7]

The hospital where I work adheres to strict rules regarding clean technique. Gowns, masks, and gloves changed between each patient. Hands washed between each patient (a rule for everyone, and a good one). Operatory wiped down and new plastic covers and barrier shields placed. All instruments sterile. I have and issue with residents wearing the same covering between patients, as it is a way to spread infection, as well as a method for the staff to get ill. The time it takes to change gowns is well worth it.

 

[OceanDMD]

Read up on the OSHA guidelines for protective clothing, etc.. I can tell you that if you are doing a dental exam on a patient in a scrub top only, its likely your breaking a rule. I know, I know, everybody does it. Especially GPs. But as a surgeon, there is quite a bit at risk usually with the daily procedures they do. Gowns, hell even hairnets are probably indicated

 

[I'mFillingFine]

A few questions from a first year:

--Most dentists don't change their white coats during an office day. Is it a good idea to always wear disposable gowns over the white coat? It may seem like overkill...but then why wear the white coat at all? There's just as much risk for infection as with a specialist (perhaps less blood of the GP doesn't do a lot of surgery), but I never really understood this. I can see how a dentist wouldn't pay to have a coat for each patient, obviously....but this always did strike me as less than sanitary. Why do GPs often not wear the paper gowns for each pt?

--If you DO drop a crown or anything fitted for the patient, there obviously isn't another sterile one sitting in a bag that the assistant can replace. What do you do? Cavicide and rinse?

--From my observations at dentists and in the clinic, the big time where most practitioners don't practice hygienic handling of stuff is when getting disposable things or more burs. Is it rediculous to suggest that each instrument tray (perhaps in my own future practice) include a sterile pair of tweezers so that my assistant and I can grab cotton rolls, burs, wedges, etc.? That way, you can pick up the tweezer and grab anything (including the lid off of things), drop them on the tray, and use them as needed. I've seen SOOOO many dentists and assistants handle primer bottles, lids of cotton ball containers, and drawer handles with gloved hands. Good idea??? I imagine tweezers are cheap.

 

[12YearOldKid]

You guys are really making a big deal out of nothing. You have to use a little common sense.

Do we need to show some care when performing semi-invasive procedures like surgery or endo? Of course. But for many procedures our instruments are used no more invasively than a common fork.

Do you think restaurants should be forced to bring your utensils in little autoclave bags? That the dishwashing people should be gloved and gowned before touching your saliva-ridden dinnerware?

As for the crown on the floor, I don't care how many times you sterilize it, you are never going to get a crown cemented without bacteria all over that thing. I think I would be more thorough with a dropped crown than just rinsing with the air water syringe - but that is just for the sake of keeping up appearances in front of the patient. Is it honestly going to harm the patient to seat a crown that fell on the floor. Definitely no more harmful than picking up a dropped grape, rinsing it and eating it. What about potatoes and carrots that actually grow in the DIRT, we just wash them and eat them. Nobody develops bizarre septic infections. Do you know where they grow mushrooms? In piles of straw and MANURE. I love mushrooms. I wipe the black stuff off and pile 'em on my salad.

I'm a clean person, but you guys are bordering on phobia/OCD here. Actually, you should probably look into perio. Then you can wrap the whole room in saran wrap and tin foil. Drape the patient. Put on your surgical gowns, bonnets and booties and perform that highly invasive open flap debridement around #20 and 21.

 

[HermeytheElf]

The worst was the crown. He was polishing it and it flew out of his hand, so he picked it up, sprayed it with water and air, and then kept polishing.

What makes you think the floor is any dirtier than the lab tech's hands?

 

[dudewhensmydat]

The dentist I worked for was very strict and vigilant about sterility and the cleanliness of the operatories...I hope to be just as good about it.

 

[I'mFillingFine]

You guys are really making a big deal out of nothing. You have to use a little common sense.

Do we need to show some care when performing semi-invasive procedures like surgery or endo? Of course. But for many procedures our instruments are used no more invasively than a common fork.

Do you think restaurants should be forced to bring your utensils in little autoclave bags? That the dishwashing people should be gloved and gowned before touching your saliva-ridden dinnerware?

As for the crown on the floor, I don't care how many times you sterilize it, you are never going to get a crown cemented without bacteria all over that thing. I think I would be more thorough with a dropped crown than just rinsing with the air water syringe - but that is just for the sake of keeping up appearances in front of the patient. Is it honestly going to harm the patient to seat a crown that fell on the floor. Definitely no more harmful than picking up a dropped grape, rinsing it and eating it. What about potatoes and carrots that actually grow in the DIRT, we just wash them and eat them. Nobody develops bizarre septic infections. Do you know where they grow mushrooms? In piles of straw and MANURE. I love mushrooms. I wipe the black stuff off and pile 'em on my salad.

I'm a clean person, but you guys are bordering on phobia/OCD here. Actually, you should probably look into perio. Then you can wrap the whole room in saran wrap and tin foil. Drape the patient. Put on your surgical gowns, bonnets and booties and perform that highly invasive open flap debridement around #20 and 21.

Sure, there are levels. But I'm talking about reaching into a jar full of cotton rolls still gloved in the middle of any procedure at all. Simple restorative can generate all kinds of goodies (more than endo, some of the time), and I see this happen all over the place. Or opening drawers. I don't see how that's overreacting...

 

[TucsonDDS]

You obviously haven't had Dr Neiders give you the talk on how many times you need to wash just to perform a comprehensive oral on someone. Goes something like this:

Wash, take vitals, wash, glove, extra oral, deglove, wash, mask, wash, glove, intraoral exam. Good thing we only see a couple of patients a day otherwise we won't have any skin left on our hands. Oh, and the wash, mask, wash, glove goes for everytime you see step away from your patient. Wait until next year.

 

[1992Corolla]

if it falls on the floor I usually just lick it off, saliva is sterile anyway right?

 

[Fuji]

Alright, now I'm more confused. It seems like some people think sterility is over-rated, while others need to be treated for OCD.

 

[1992Corolla]

The dentist I shadowed was sterile. If you drop a crown n the floor it is cleaned before it goes in the mouth. If you drop an instrument another one is retrieved. I worked for a dentist who got a coupe of infection patients back within a week (more than usual) and we all sat down and re-evaluated the sterile techniques we were using both in operatory and sterilization.

I am not saying to throw down the blue sheets and batadine for a gingival flap, but you do have to have a certain amount of cleanliness.