For more information: Doug McDonough AMERICAN DENTAL ASSISTANTS ASSOCIATION

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1 For more information: Doug McDonough AMERICAN DENTAL ASSISTANTS ASSOCIATION Shared Causes, Controls for Oklahoma and Colorado Tragedies (Chicago: April 3, 2013) The cases under investigation in Oklahoma and Colorado involve oral surgeons suspected of not following standard precautions in areas of infection control. The suspected breaches of protocol may have put thousands of dental patients at risk for HBV, HCV and HIV. Testing is being conducted and patients anxiously await the results. The root of both of these health care upheavals seems to be lack of adherence to known standards or lack of knowledge concerning these standards or both. In any dental practice, recommendations are set by the Center for Disease Control and by state s regulations. But the question is Who is responsible for ensuring that these standards are met? In most dental practices the day to day enforcement of infection control protocol is delegated to a clinical dental assistant. Carolyn Breen, Ed.D., CDA, RDA, RDH, President of the American Dental Assistants Association (ADAA) states that ADAA supports education and credentialing of dental assistants nationwide in order to assure that dental assistants have a comprehensive understanding of state dental practice acts containing legally delegated responsibilities for dental assistants, as well as a thorough knowledge of infection control and appropriate treatment protocols and knowledge of many other critical aspects of dental assisting responsibilities related to high standard quality care and patient protection. In the absence of an informed, educated clinician directing the infection control in a practice, standards of the CDC or the state may not be met and patients health may be placed at risk. What do these two cases have in common? Both practices may have employed dental assistants who were not fully educated about the law and not properly trained to sterilize instruments or monitor sterilizers. According to the Associated Press (AP), Dr. Harrington of Oklahoma left questions on how to sterilize instruments and drug procedures up to his employees. Educated, credentialed assistants could be expected to know how to meet infection control standards. Dr Breen concludes by saying ADAA believes that dental assistants have a responsibility to monitor themselves and inform their patients about the importance of licensed or registered dental assistants as part of the dental team. Unfortunately many trained-on-the-job assistants can be taught improper sterilization techniques by others who were also improperly trained. A means to address this issue is for strict guidelines and training for infection control and sterilization to be instituted in the same way that several states have instituted guidelines with radiography and itraoral expanded functions these guidelines should be applied equally in all states and not just a few. The ADAA is America's oldest and largest dental assisting association serving an estimated 300,000 dental assistants in the United States. It is dedicated to the development and

2 recognition of professionalism through education, membership services and public awareness programs. The ADAA is a strong advocate for legislation mandating credentialing for clinical dental assistants and greater recognition of the assistant's role in the professional dental team. DANB Statement on Delegating Duties to Dental Assistants CHICAGO (April 3, 2013) - On March 28, 2013, the Oklahoma Board of Dentistry filed a 17-count complaint against a Tulsa, Oklahoma, oral surgeon, with charges of being a menace to public health and of gross negligence. Specific allegations include using rusty instruments, reusing needles, not properly sterilizing instruments, not properly maintaining or using the autoclave, using expired medications, keeping incomplete drug logs and allowing unlicensed dental staff to start IVs. Dental offices across the United States will likely receive an increase in questions regarding delegation of dental assisting duties, including infection control requirements. The Dental Assisting National Board, Inc. (DANB) is the only national certification board for dental assistants recognized by the American Dental Association (ADA). DANB's mission is to promote the public good by providing credentialing services to the dental community. To this end, we are alarmed by the recent news and share our deepest sympathy and concerns for the patients involved. We are saddened that events like this occur that compromise public safety. DANB provides a number of services to assist in public protection, including offering national certifications and exams for dental assistants, such as DANB's Certified Dental Assistant (CDA), Certified Orthodontic Assistant (COA) and Certified Preventive Functions Dental Assistant (CPFDA) certifications.* After thorough research, we have determined that neither of the dental assistants involved in the Oklahoma case are DANB certified, nor have they ever taken any DANB exams. Dentists are ultimately responsible for ensuring the practice is in compliance with state law. To assist dentists in their hiring decisions, DANB provides a free online credential verification database to verify the names of dental assistants who have earned DANB national certifications, as well as those who have earned certificates of knowledge-based competency in important areas such as Radiation Health and Safety (RHS), Infection Control (ICE), Coronal Polish (CP), Sealants (SE), Topical Anesthetic (TA) and Topical Fluoride (TF). DANB supports the dental community and promotes public safety by publishing DANB's Code of Professional Conduct. All dental professionals who apply for or take a DANB exam or earn DANB certification must also abide by this code. According to DANB's Code of Professional Conduct, the dental assistant has a duty to know the law, to act within the law, and to report to the proper authorities those who fail to do so. DANB compiles and publishes information on dental assisting regulations and requirements for each state, including permitted and prohibited duties. This information is available online to dental professionals and the public, and DANB encourages all patients and dental

3 professionals to know the requirements in their state. While each state determines its own education, exam and credentialing requirements for dental assistants, DANB is available to assist state agencies in meeting their public protection missions. Currently, 38 states, the District of Columbia, the Department of Veterans Affairs, and the U.S. Air Force recognize or require DANB exams, and there are more than 35,000 DANB certificants nationwide. More than 125,000 dental assistants have passed DANB's RHS exam and more than 68,000 dental assistants have passed DANB's ICE exam since April DANB is independent of state regulatory agencies and has no authority over legislative or regulatory decisions. When requested, DANB acts as a resource to state dental boards by providing information and research. DANB views licensure as an issue best addressed at the state level. However, DANB supports mandatory education and credentialing of dental assistants and believes it is in the public and profession's best interest for these requirements to be as uniform across states as possible. American Dental Association: - 5k March 29, 2013 ADA cites infection control resources as media focuses on Oklahoma oral surgeon The ADA is closely monitoring a news story involving the investigation of a Tulsa, Okla., oral surgeon for allegedly poor infection control practices and delegation of dental procedures. The Association ed an Issues Alert statement to its members Friday citing resources on infection control and health practices in U.S. dental offices. The ADA also issued a press release, which can be found at The ADA has long recommended that all practicing dentists, dental team members and dental laboratories use standard precautions as described in the Centers for Disease Control and Prevention's Infection Control in Dental Health Care Settings guidelines. Studies show that following proper infection control procedures greatly reduces risk to patients to the point of an extremely remote possibility. Infection control procedures are designed to protect patients and health care workers by preventing the spread of diseases like hepatitis and HIV. Examples of infection control in the dental office include the use of masks, gloves, gowns, eyewear, surface disinfectants and sterilizing reusable dental devices. In addition, dental health care providers are expected to follow procedures as required by the Occupational Safety and Health Administration. The following links may be helpful to dentists: Policy Statement on Bloodborne Pathogens, Infection Control and the Practice of Dentistry; Statement on Infection Control in Dentistry; and CDC Guidelines for Infection Control in Dental Health-Care Settings (2003). If patients express concern, dentists may find the below talking points helpful: I'm glad you asked me about this because I want to assure you that in my dental practice, we follow stringent infection control procedures. Also, as your doctor, I would only delegate procedures to my staff that they are licensed or qualified to perform per state regulations. I care about my patients and your health and safety are my foremost priorities. Studies show that following proper infection control procedures greatly reduces risk to patients to the point of an extremely remote possibility. The Centers for Disease Control and Prevention has developed special recommendations for use in dental offices. Let me describe just a few of the things that we do in my practice in terms of infection control.

4 All dental staff involved in patient care scrub their hands before each and every patient and use appropriate protective garb such as gloves, masks, gowns and eyewear. A new set of gloves and masks are used for each patient. Before you enter the examining room, all surfaces, such as the dental chair, instrument tray, dental light, drawer handles and countertops, have been cleaned and decontaminated. Nondisposable dental instruments are cleaned and sterilized between patients. In my office, we sterilize instruments using [describe whether you use an autoclave which involves steam under pressure, dry heat or chemical sterilization. If you wish, you could offer to show your patients your sterilization or set-up area.] Disposable items like needles or gauze are placed in special bags or containers for special, monitored disposal. Your well-being is important to me and my staff, which is why we follow stringent infection control procedures and comply with all state regulations for the protection of patients. You can visit the American Dental Association's website at and use the search term "infection control" to see a video on this topic. The website has a lot of information to help you take care of your oral health, too. Patients may also ask if the dentist's office is regularly inspected. Inspection requirements vary from state to state, so dentists who are unsure about their state's requirement are encouraged to contact their state dental board. American Dental Hygience Assn. ADHA STATEMENT (undated) Response to Allegations of Unsanitary Practices at Oral Surgeon s Office in Tulsa The American Dental Hygienists Association (ADHA) wants to reassure the public that dental hygienists maintain the highest standards in infection control to optimize patient safety and health. The isolated incident in Tulsa, Oklahoma, in which an oral surgeon allegedly exposed as many as 7,000 patients to HIV, hepatitis B and hepatitis C through unsanitary dental practices, in no way reflects the level of care expected of dental hygienists. As part of its Standards for Clinical Dental Hygiene Practice (adha.org/practice), ADHA advocates for dental hygienists to maintain compliance with established infection control standards that follow the most current evidence-based guidelines to reduce the risks of healthcareassociated infections in patients, and illnesses and injuries in healthcare personnel. The standards are used by dental hygienists to shape their knowledge, attitudes, beliefs, practices and behaviors that support and enhance oral health with the ultimate goal of improving overall health. ADHA urges all dental hygienists to maintain the highest standards and employ the best practices for infection control, said ADHA President Susan Savage, RDH, BSDH. Adherence to recognized infection control practices ensures patient health and safety. As part of ADHA policy, the organization advocates the development and

5 utilization of emerging technologies that maximize human health and safety. ADHA also supports the Occupational Safety and Health Administration standards relating to workplace training and safety, according to ADHA policy. Kathy Eklund RDH MHP, Secretary, Board of Directors, Organization for Safety, Asepsis and Prevention, said OSAP has assembled information from CDC, OSHA, other federal agencies and organizations to help hygienists and other oral healthcare workers with training and education to ensure the safe and infection-free delivery of care (see As dental hygienists we can demonstrate our skills as prevention experts and educators to let our patients know about the policies, protocols and procedures in place to keep them safe, Eklund said. ADHA encourages patients to discuss proper infection control procedures with their dental hygienists and dentists.