In the majority of instances the use of a 70-90% alcohol-based hand rub is the preferred method of hand hygiene. If hands are visibly unclean, they should be washed with plain or antimicrobial soap and water
All critical and semi-critical instruments used in dentistry, including handpieces, are available in heat-tolerant and/or single-use (disposable) forms. All heat-tolerant critical and semi-critical instruments must be heat-sterilized between uses. All single-use items must be disposed following use.
Dentists check their sterilization procedures using mechanical, chemical and biological indicators.
Mechanical indicators are the gauges or displays on the sterilizer for the cycle time, temperature and pressure.
Chemical indicators use sensitive chemicals to assess physical conditions during the sterilization process. For example, heat-sensitive tape, applied to the outside of a package on instruments, changes colour rapidly when a given temperature is reached. This means the package has undergone a sterilization cycle.
Biological indicators (or spore tests) are the most reliable for monitoring sterilization because they directly assess the procedure’s effectiveness in killing the most resistant micro-organisms.
Clinical contact surfaces (those that are frequently touched in the course of patient care) are cleaned and disinfected between patients and at the end of the workday using an appropriate disinfectant.
Alternatively, surfaces and equipment are protected from contamination using barriers. Barriers are particularly effective for surfaces that are difficult to clean and disinfect due to their shape, surface or material characteristics. Barriers should be removed and discarded between patients. The underlying surfaces should be examined, cleaned and disinfected if they have become inadvertently contaminated and clean barriers should be put up.
Other surfaces, such as floors and walls, usually require only periodic cleaning with dilute detergents. If a surface becomes contaminated with blood, saliva or other bodily fluids, it should be cleaned first and then disinfected with an appropriate low-level disinfectant.
Most dental treatment is routine. Sometimes a health condition can influence the way dental care isprovided. For example:
If planned dental procedures involve bleeding, your dentist wants to know that the blood will clot normally. Many conditions can affect blood clotting, such as liver disease. Medications, including aspirin and even some herbal preparations, can also interfere with normal blood clotting.
Some conditions like diabetes, and some medications like steroids, reduce the effectiveness of the immune system.
Some patients need to take preventive antibiotics before certain dental procedures. For example, patients with an artificial heart valve may need to take an antibiotic to help prevent a serious infection.
Your dentist needs to know about your past and current health conditions. This means that your dentist must take an initial complete medical history and keep it up-to-date by checking with you on a regular basis.
Medical History Recordkeeping Guide and Patient Information Pamphlet
Your dentist may speak with a family physician or medical specialist to obtain additional information about a health condition before initiating care. For example, a patient may have an existing heart and/or blood pressure problem, but be unsure regarding their full nature. Ideally, the dentist will consult with the patient’s physician to determine if there are any risks to delivering dental care and whether any precautions should be taken.
If your dentist needs to consult with your physician or another health- care provider, this will be discussed with you first.
In addition to obtaining a complete medical history, your dentist may take and record vital signs, such as your heart rate and blood pressure. This can happen if you have a health condition, such as high blood pressure or cardiovascular disease, or to establish baseline vital signs before treatment or services, such as the administration of any form of sedation or general anaesthesia.
No. Your dentist must ensure that they obtain all necessary and relevant medical information before starting treatment. You should carefully and thoroughly answer all questions on the medical history questionnaire.
Each question is there for a reason. If you do not understand why a question is being asked, or you are not sure about the answer, ask your dentist. All of the information on your medical history questionnaire is kept strictly privateand is protected by doctor-patient confidentiality. It will not be shared with anyone outside your dentist’s office without your permission.
This information allows your dentist to identify the type and severity of certain underlying medical conditions. Your dentist may also determine possible adverse drug interactions.Your dentist may also identify potential problems from the use of non-prescription drugs, such as an increased bleeding time with the use of Aspirin (acetylsalicylic acid) or some herbal supplements.
This information can help a dentist assess risk of several diseases, both systemic and oral, and may influence the development of the dental treatment plan.
For example, smoking can put you at risk for complications such as cardiovascular disease, lung disease, oral cancer, gum diseaseand impaired healing. With this knowledge your dentist can identify if you will benefit from smoking cessation programs..
Also, drinking alcohol regularly may put you at risk for developing some degree of liver dysfunction, which in turn can cause bleeding problems that could affect the outcome of surgical procedures. If you have some liver dysfunction, your dentist may also need to avoid prescribing certain drugs.
Some recreational drugs such as cocaine or amphetamines, especially if used within 24 hours of treatment, can cause significant cardiac dysrhythmias, which can be made worse by certain ingredients in local anesthetics. The dentist may need to modify your treatment plan.
RCDSO advises dentists to review the Consensus Statement by the Canadian Dental Association, the Canadian Orthopedic Association and the Association of Medical Microbiology and Infectious Disease, on Dental Patients with Total Joint Replacement having Dental Procedures and implement it in their practice.
Patients should not be exposed to the adverse effects of antibiotics when there is no evidence that such prophylaxis is of any benefit.
Routine antibiotic prophylaxis is not indicated for dental patients with total joint replacements, nor for patients with orthopedic pins, plates and screws.
Patients should be in optimal oral health prior to having total joint replacement and should maintain good oral hygiene and oral health following surgery. Orofacial infections in all patients, including those with total joint prostheses, should be treated to eliminate the source of infection and prevent its spread. https://www.cda-adc.ca/en/about/position_statements/jointreplacement/
Although antibiotics are indicated in many circumstances, they are not without risks. These include hypersensitivity reactions, anaphylaxis, drug interactions, damage to the healthy microbiome and opportunistic infections (such as Clostridium difficile). An additional concern is the potential development of antimicrobial resistance to the available antibiotics, which may lead to increasing difficulty in managing even relatively common infections. Patients should not be exposed to the adverse effects of antibiotics when there is no evidence that such prophylaxis is of any benefit.
Treatment decisions should be made in light of all circumstances presented by the patient. Treatment and procedures applicable to the individual patient rely on mutual communication between patient, physician, dentist and other healthcare practitioners who are involved in the patient’s care.
Patients may have a recommendation from the orthopedic surgeon or primary family health care provider that is inconsistent with the consensus statement. This may reflect a lack of familiarity with the consensus statement or special considerations about the patient’s medical condition of which the dentist may not know about.
In such circumstances, dentists are encouraged to discuss the current evidence with the patient and consult with the orthopedic surgeon or primary family health care provider.
Each provider is ultimately responsible for his or her own treatment decisions. Following a consultation, the dentist may or may not decide to follow the recommendation of the orthopedic surgeon or the primary family health care provider. If they don’t, the dentist may suggest that the orthopedic surgeon or primary family health care provider prescribe for the patient as they deem appropriate.
In 2007, the American Heart Association (AHA) published revised guidelines for the prevention of infective endocarditis. This guideline concluded that taking prophylactic antibiotics is reasonable only for patients who have cardiac conditions that put them at highest risk of adverse outcome from infective endocarditis.
Conditions associated with highest risk include:
Prosthetic cardiac valve or prosthetic material used for cardiac valve repair.
Previous infective endocarditis.
Congenital heart disease (CHD)*:
a) Unrepaired cyanotic CHD, including palliative shunts and
b) Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure.
c) Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialisation).
Cardiac transplantation recipients who develop cardiac valvulopathy.
***Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of CHD.
It depends on what kind of heart surgery you’ve had.
Patients who’ve had surgery for placement of prosthetic heart valves or prosthetic intravascular or intracardiac materials are at high risk for developing an infection and should be given premedication according to the 2007 AHA guidelines.
Patients who’ve had coronary artery bypass graft surgery do not require antibiotic prophylaxis. It may be reasonable to prescribe prophylactic antibiotics for patients who’ve undergone heart transplantation and developed cardiac valvulopathy.
You should tell your dentist. Antibiotics should be taken in a single dose 30-60 minutes before dental treatment. This time period is recommended so that there will be high blood levels of antibiotic at the time when bacteria from the mouth enter the bloodstream.
Dentists are required by law to retain patient records. In general, patient records must be maintained for at least ten years after the date of the last entry in the patient’s record. In the case of a minor, these records must be kept for at least ten years from the date the patient turned 18.
Financial records should be kept for the same retention period described above. Copies of paper dental claim forms must be maintained for at least two years. However, dentists can decide whether and how long to retain copies of other correspondence with insurance companies about dental insurance claims.
Diagnostic or study models are considered part of the patient’s record. Working models do not have to be retained for any specific period of time. A decision to keep working models should be based on the complexity of the case and is left to the judgement of the individual practitioner.
Dentists must maintain patient confidentiality when disposing of dental records. Chart records and other documents must be properly destroyed either by shredding or incineration. Dentists must ensure that appropriate safeguards are taken to protect the patient’s personal health information . They may discard photographs, x-rays and models in the garbage once patient identification/identifying labels have been removed, obliterated or rendered illegible.
Patients’ dental records must be stored in secure premises to prevent unauthorized access. Dentists should take reasonable steps to protect them from theft and damage from fire or flood. It is also recommended that stored records be organized so they can be easily retrieved if a patient returns to the practice or they are needed for another purpose.
It is not necessary to notify patients if the records are archived in the basement or in some other area of the dental office. If the records are moved to premises that are not under the control of the dentist, such as a private record storage facility, patient consent must be obtained before records are stored in such a facility.
E-mail is not a secure means of communication. Your dentist should avoid using e-mail to communicate your personal health information, unless they employ a secure e-mail service with strong encryption. Alternatively, digital x-ray files can be saved and delivered on a CD-ROM or a USB key.
As a patient, you have the right toget copies of any or all of your dental records. If you and/or your authorized representative requests a copy of your complete file from your dentist (chart records, x-ray images, referral slips, study models, photographs, correspondence), this information must be provided.
No. Dentists are required by law to keep original patient records. Patients are entitled to diagnostic quality duplicate radiographs, whether in film, on photographic quality paper or in appropriate digital formats. Digital images can be provided on removable media or by encrypted e-mail .
While many dentists will provide copies of dental records at no charge as a courtesy to their patients, a dentist can charge you a fee that is consistent with the direct costs incurred in copying and releasing them. This may include out-of-pocket expenses such as mailing costs, charges from a dental laboratory or radiograph duplicating facility, and other costs. It is not considered appropriate to charge an administrative fee for staff time.
In most cases, a parent can request and obtain copies of dental records for their children who are under the age of 16 years. While a person may request copies of dental records for their spouse or child 16 and over, the dentist will require consent from these individuals prior to releasing their records.
The release and transfer of dental records should be accomplished within one to two weeks . Whether this is possible may depend on the number and type of dental records that have been requested and whether the services of an outside duplication facility (for dental radiographs and study models) are required.
No. It is unacceptable to withhold the transfer of records because of an outstanding account balance. College regulations must be followed, regardless of any financial dispute between a patient and a dentist.
If dental records are required for urgently needed dental treatment at another dental practice and it is not possible to make duplicates in time for the appointment, a dentist could lend original dental records to another dentist at the patient’s request. In such cases, the original dental records should be sent directly from dentist to dentist by courier and, after consultation and treatment, the original dental records should be returned. The dentist should document the patient’s consent for this, as well as the subsequent return of the records.
The person legally authorized to consent to the release of the patient’s personal health information is the deceased’s estate trustee or the person who has assumed responsibility for the administration of the deceased’s estate. The dentist may ask to retain a copy of the consent documentation in the patient’s record.