Recent Oklahoma Case Highlights Importance of Reviewing Office Sterilization
By Thomas J. Weber, Esq.
As a licensed practicing dentist, either you are aware, or should be, of the
Oklahoma dentist who recently had his office shut down due to violations of
appropriate infectious disease controls.
The state of Oklahoma’s investigation began when one of the dentist’s
patients was found to be HIV positive and all other likely causes had been
eliminated. The Oklahoma Board of Dentistry’s surprise inspection uncovered the
regular use of a rusty set of instruments and the practice of pouring bleach on
wounds until they “turned white.” The dentist also allegedly reused needles.
The incident has not only caused concern in the dental community, but also
with those who regulate dentists. Just as the Watkins case
resulted in heightened scrutiny on the administration of anesthesia in the
practice of dentistry and eventually the overhaul of the regulations pertaining
to its administration, it is safe to assume the Oklahoma incident will have a
similar affect in terms of office sterility protocols and infectious disease
While it is uncertain whether the Pennsylvania Department of State is likely
to launch a series of random office inspections, it nonetheless is a good time
for every dental office to examine its infectious disease protocols.
Furthermore, it is likely that anytime an investigator has reason to visit an
office they will pay closer attention to infection control even if that is not
the reason for their visit.
Currently the regulations define it as unprofessional conduct for a dentist
to fail to follow current infection-control recommendations issued by the Federal Centers for Disease
Control or to ensure that auxiliary personnel and other supervisees follow
these guidelines. 49 Pa. Code §33.211(a)(7). Likewise it is unprofessional
conduct for a dental hygienist or expanded function dental assistant to fail to
follow current infection-control recommendations issued by the Federal Centers
for Disease Control. 49 Pa. Code §33.211(b)(4) and §33.211(c)(4). There are a
number of steps that dental offices can take to ensure their compliance with
their regulatory obligations, as well as protect the health and safety of their
patients. Please allow me to set forth some of the most important.
The Commonwealth of Pennsylvania will rely on the “Guidelines for
Infectious Control in Dental Health-Care Settings, 2003,” as developed by
the Centers for Disease Control and Prevention.” A copy of the guidelines can be
obtained by a simple Internet search for “CDC dental guidelines.” It can also be
accessed at cdc.gov/oralhealth/infectioncontrol/guidelines. Every dentist
should have a thorough understanding of these guidelines.
In addition to reviewing the guidelines, dentists should review the
manufacturer’s suggested guidelines for the sterilization products used in the
office. However, caution must be used in relying on the verbal instructions
provided by sales representatives due to the possibility of an error occurring
during the communication. Furthermore, should there be a discrepancy between the
manufacturer’s guidelines and those of the CDC, the Commonwealth will rely on
Finally, it is essential that all staff involved in the
sterilization process receive proper training, and are informed of and
understand, the importance of adhering to the required sterilization protocols.
The CDC website contains a slide presentation that can be used to assist in
staff training. This training should be conducted regularly and be made a part
of every new employee’s orientation. Recognize that although it is appropriate
to delegate the sterilization procedures, as the regulations state, a dentist
commits unprofessional conduct if he or she fails to ensure that auxiliary
personnel and other supervisees follow these guidelines. Therefore, although it
may be the employee who violates the guidelines, the dentist’s license will be
subject to discipline as well.