Dental Clinic Hygiene: Questions to Ask Before You Book

Dental clinic hygiene is something you can check before you ever sit in the chair. A clinic should be happy to explain how it cleans instruments, which items it throws away after one patient, and how its staff wash their hands. Ask these questions when you call, and note how clearly the answers come.

This is general information, not medical advice. Ask your dentist about anything that applies to your own health.

Ask how instruments are sterilized

Instruments that cut or pierce the gums or bone should be sterilized by heat. That is the advice in the 2003 Guidelines for Infection Control in Dental Health-Care Settings from the US Centers for Disease Control and Prevention (CDC). The usual tool is an autoclave, a machine that uses hot steam under pressure.

Instruments should be cleaned before they go into the machine. Dirt left on a tool can get in the way of sterilization. The CDC also says each package should hold an internal chemical indicator, a small strip that changes color when the package has been exposed to the right conditions.

Good questions to ask: Do you use an autoclave? Are instruments wrapped or pouched before sterilizing? Can you show me a sealed pouch being opened at my visit?

Sources: CDC, Guidelines for Infection Control in Dental Health-Care Settings, 2003 (MMWR, December 19, 2003).

Ask how the clinic checks that the machine works

A sterilizer can fail without any sign you can see. For that reason the CDC recommends testing each sterilizer with biological indicators at least once a week. These are test strips that carry heat-resistant spores. If the spores do not survive a cycle, the machine is doing its job.

Loads that include implants should be tested every time. The CDC adds that mail-in testing services are acceptable. A clinic does not need its own laboratory to do this well.

Good questions to ask: How often do you test your sterilizer? Do you keep a written log of the results? Who is in charge of it?

Sources: CDC, Guidelines for Infection Control in Dental Health-Care Settings, 2003.

Ask which items are used only once

Some dental items are hard to clean or cannot take heat. The CDC lists syringe needles, polishing cups and brushes, and plastic orthodontic brackets as usually single use. Single-use disposable instruments are an acceptable choice if they are used once and then thrown away properly.

Gloves are also for one patient only. The CDC says gloves should be changed between patients and whenever they tear or get a hole. Washing gloves for reuse is not recommended.

Good questions to ask: Are needles opened in front of me? Are gloves changed for every patient? Which tools are thrown away after my visit?

Sources: CDC, Guidelines for Infection Control in Dental Health-Care Settings, 2003.

Watch the hand hygiene

The CDC calls hand hygiene the single most critical measure for reducing the spread of germs in dental care. For routine visits, staff can wash with soap and water. If hands are not visibly dirty, an alcohol-based hand rub is also acceptable. Hands should be clean before gloves go on and again after they come off.

The World Health Organization (WHO) published its own guidelines on hand hygiene in health care in 2009. They aim to cut the spread of germs to patients and to health workers in any place where care is given, and a dental clinic is one of those places.

You can simply watch. Does the dentist or assistant clean their hands and put on fresh gloves while you are looking? A clinic with good habits does not mind being seen.

Sources: CDC, Guidelines for Infection Control in Dental Health-Care Settings, 2003. WHO, WHO Guidelines on Hand Hygiene in Health Care, 2009.

Ask about the water and the room

Water lines inside a dental chair can collect a film of bacteria over time. The CDC advises running water and air through handpieces and the air and water syringe for 20 to 30 seconds after each patient. It also says dental treatment water should stay under 500 colony-forming units of bacteria per milliliter, which is the same limit used for drinking water in the United States.

Since the manufacturer knows its chair best, the CDC suggests asking the chair maker how to keep the water clean and how often to test it.

Good questions to ask: How do you keep the chair water lines clean? Do you flush them between patients?

Sources: CDC, Guidelines for Infection Control in Dental Health-Care Settings, 2003.

A short checklist for your call

• Do you sterilize instruments with an autoclave, and are they pouched?
• How often is the sterilizer tested, and is there a log?
• Which items are single use, and are they opened in front of me?
• Are gloves changed and hands cleaned for each patient?
• How are the chair water lines kept clean?

A clear, calm answer to each one is a good sign. Vague answers or irritation at the questions are worth noting. You can always book elsewhere.

Sources: CDC, Guidelines for Infection Control in Dental Health-Care Settings, 2003. WHO, WHO Guidelines on Hand Hygiene in Health Care, 2009.

Sources

• Centers for Disease Control and Prevention, Guidelines for Infection Control in Dental Health-Care Settings, 2003: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm
• World Health Organization, WHO Guidelines on Hand Hygiene in Health Care, 2009: http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf