Montrose Star interviews trusted dental authority Dr Randy Mitchmore from his Montrose practice called LifeSmiles.
M.S.There was horrible news out of Tulsa Oklahoma last week. The headlines are that 7,000 patients of a Tulsadentist are being tested to see if they got any infections from dirty instruments. What’s up with THAT!
Dr M.It should never have happened. He was an oral surgeon that had more extensive training in hospital grade sterile procedures than general dentists receive. There is simply no excuse in today’s world.
I was shocked at the news. At the same time it is a good thing that we have the media around to make it public. These sorts of behaviors should be exposed so the bad guys can be gotten rid of and the public better informed.
M.S. So fill me in on what happened.
Dr M. The chatter that is coming down the wire in the Dental Association is that this guy was ignoring all standard protocols on basic sanitation, much less sterile technique. What really bothers me is that he had an office full of employees with heads on the shoulders that were basically as bad as the guy in charge. The charges are that he was using the same vials of medicine on different people, that instead of running instruments through a steam autocalve they were disinfecting them with bleach. The problem there is that bleach makes instruments corrode or rust. Germs love to live and hide in corrosion and rust. Evidently the autoclave that they did use on some instruments was not tested and was not functioning properly in killing all germs and spores.
It seems like a few people in Tulsa got sick that were healthy. They could not find a good reason for them to be sick. So just like in food poisoning incidents, the investigators had to be detectives and start piecing together clues to find a common element for those people to be sick. The evidence pointed to all of those people had one thing in common – they had seen this oral surgeon. Of course this made for a sensational story and I condemn the charges as they stand now. I do want to clarify that 7,000 people were not infected, there were a very few. The authorities are asking 7,000 former patients that are apparently healthy to voluntarily be tested for any infectious diseases.
M.S. What is the difference between disinfection and sterile?
Dr M. I like to use going to a restaurant as an example. We use silverware and glasses that go into our mouth and potentially we leave germs on those utensils. I feel completely safe if that restaurant washes the dishes with soap and hot water before I use those same utensils. Those utensils have been disinfected. They were not exposed to blood. However, you could not do surgery with those utensils. That is because when you do surgery, skin is cut open instruments go inside and under the skin and then sewed up. ANY germs or spores introduced deep inside could grow, fester and become an infection. Also, any germs that were inside the flesh can be passed on to the instruments. Those types of germs like Hepatits are not killed with just soap and water. Interestingly the most publically feared germ- the one that causes HIV – is easily killed by soap and water. Hepatitis is the one that professionals are really worried about. Those germs and spores are killed in a machine called a steam autoclave.
M.S. What is so special about an “autoclave” and what do you do?
Dr M Here is our standard procedure with instruments. First they are rinsed and cleaned. Then they go into an ultrasonic cleaner with enzymes to completely clean and disinfect the instruments. Then they are placed into special pouches or bags and sealed. Then that pouch is processed in an Autoclave.
An autoclave is a metal chamber kind of like an expensive pressure cooker. The instruments are subjected to high heat, steam and pressure. That combination kills any germs known to man.
We are required to place a test tablet in the autoclave on a regular basis. That test tab is then sent to an independent laboratory to make certain the autoclave is up to specs and kills all germs. It seems this rat in Tulsa did not do that. So even if he did have an autoclave, we do not know if it was working correctly.
Purely a coincidence, but my office has invested over $18,000 just this year in upgrading to larger autocalves and ultrasonic baths to handle our growing demand. These are important behind the scenes activities that usually go un-noticed.
Furthermore there are pretty well known guidelines from OSHA called universal precautions. Those guidelines are really there to make sure that the employees that work in hospitals and offices are safe from contracting germs from patients.
M.S.Got it. So why didn’t the guy in Tulsa do that?
Dr M. This is pure speculation on my part, but they guy had to be either stupid or greedy in wanting to make an extra dollar by cutting corners. I do not think he was stupid.
M.S. So what can the average Joe do to feel safe going to the dentist?
Dr M. Ask questions! Use your built in crap detectors! When you go in the office does it look, feel and smell really clean? Here is my secret check: What does the bathroom look like? I expect the bathroom to be as clean as an operating room. That is a pretty good indicator as to what kind of standards that office has. Check out the dentist on the internet. It is OK to ask about sterilizations procedures. You have the right to know.
Dr Mitchmore is active in the community. He serves as Vice-Chairman of the Monstrose District. His passion is Dentistry. He has also been a City Councilman and Chairman of the American Academy of Cosmetic Dentistry’s Charitable Foundation, Give Back A Smile. The foundation helps survivors of intimate partner abuse regain their smile.