Infection Control in Dentistry
James F. Galbally, Jr.
This presentation gives an overview of the problem of infection control in dentistry and considers its economic impact on the profession. The talk also describes the implementation of infection control policies in a dental school clinic, and ends with a brief look at recent new guidelines concerning infection control.
Historically, the groundwork for recognizing the potential link between dental treatment and disease transmission was laid by the discovery in 1685 of microorganisms in the mouth. In the 19th and early 20th centuries, a number of reports established two fundamental truths: (1) that infectious diseases could be spread through the oral cavity, and (2) that instruments used in the practice of dentistry contributed significantly to bacterial contamination of the dental operatory. Nevertheless, the potential for the transmission of infectious discase in dental offices was not widely recognized until the early 1970s.
The 1980s saw the introduction of a number of regulatory initiatives aimed at reducing the risk of occupational exposure to infectious disease, along with guidelines from the American Dental Association on infection control. General acceptance of the need for such measures has, however, been low, a chief obstacle being the resistance of experienced practitioners who have, until recently, found such measures to be unnecessary. Changes in the social context in which dentistry is practiced are, however, forcing even reluctant professionals to reevaluate their attitude regarding the need to adopt infection control practices. The bottom line is that the increase in serious infectious diseases is a true percentage growth, and not just an increase caused by the growth of world's population.
Assuming that reluctance regarding the need for adopting infection control measures is overcome, however, the dental profession is still left with the issue of cost. The cost of infection control has been the subject of a number of studies. It has been estimated that the total cost of infection control could run as much as $5.4 billion annually. Although the bill for infection control is high, the case is now clear that, for the practitioner, it must be considered part of the cost of doing business.
With the increased need for infection control over the decades, various methods to control the spread of diseases have been devised. The experience of the University Pennsylvania School of Dental Medicine serves as a case study in the implementation of infection control policies that address sterilization, the use of disposal supplies, and other measures.
The challenges for infection control in the context of dental treatment will continue. New guidelines are being developed to address the problem of transmission of HIV;the lack of guidelines for the prevention of transmission of tuberculosis is another ongoing issue. Implementing effective infection control in the future will depend on our ability to exploit advances in molecular microbiology. Investigators must continue to address the pathogenesis of infectious diseases, and infection control strategies must continue to be devised, based on an improved understanding of the mechanisms of disease transmission.