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shelter). In the 1990s it was gloves, mask and eyeware to “cover” the skin and
stop the spread of AIDS, which can only be transmitted from unprotected sex
and IV drug use.
The first case of AIDS was reported in 1959, and since there have been no
documented cases of occupational HIV infection in any dental health care
worker. 1,13 There have been billions of dental patient visits worldwide with no
disease transmission. There is one botched CDC investigation involving Dr.
David Acer, an openly gay Florida dentist with HIV, who was alleged to have
infected some patients (with secret high-risk behaviors). But even Dr. Acer
wore gloves during all patient contact. In 1992, the U.S. General Accounting
Office investigated and reported that this case was so bizarre, and the CDC
did such a poor job in its investigation, that no reliable public policy should
be drawn from the matter. 14,15 The GAO report did state that “gloves do not
prevent most injuries caused by sharp objects, however, and so do not necessarily
reduce contact rates.” 14 The CDC also published six to seven “possible”
HIV transmissions in dentistry, but these, in the words of CDC officials, “were
short on science.” 17
Primarily because of HIV-AIDS concerns, universal barrier protection, including
the wearing of gloves, has been recommended and/or mandated for all
dental staff when in direct contact with a patient. 1,2,3,7 This recommendation is
still in effect. This has increased the use of gloves, along with problems associated
with their use, for both staff and patient. Knowledge of these problems
and hazards and the option of wearing gloves in appropriate situations are
important for the health of the dentist, the dental staff and the patient.
Figure 1: “Cover-up” garb, worn by the 14th
century physician, was believed to shield the
practitioner from the plague.
Mechanical Hazards of Gloves
Gloves pose a number of mechanical problems for the wearer:
Gloves do not offer protection against needle punctures, the leading cause
of HBV and HIV infections in health care workers. 1,2,13,14,16 Eighteen of the
25 healthcare workers in North America and Europe who reported HIV occupational
seroconversion during the years when AIDS first became a concern
developed their infections from large-gauge needle puncture wounds. 1,13
This percentage has increased substantially over the years as the few new
contamination cases reported needle stick-sharps injuries as the prime cause of
seroconversion among medical staff. There have been no documented cases of
dental staff occupationally seroconverting. Sharp punctures are not prevented
by gloves. 1 In fact they have been shown to increase penetrating injuries. 17,18
The hazards of reduced touch sensation caused by gloves tends to contribute
to clumsiness, which often results in increased skin penetrations due to
the insulation of proprioceptive nerve endings in the skin of a dentist’s
hands. 17,18 Solovan, et al. reported 2.3 times as many tissue lacerations in dental
prophylaxis patients treated with gloves compared with work done barehanded.
8
1. In the largest clinical dexterity study to date, 50 dentists who practice in
Lake County, Ill., were tested for the average threshold for perception of light
touch using a dynanometer. 18 Results were 4.4 grams without gloves and 6.7
grams with their favorite gloves, which represents a 52 percent reduction in
light-touch proprioception. There was a 16-fold increase in percutanious injuries
while manipulating endo files (gloved) in a manual dexterity exercise as
compared to the same dentists working bare-handed. 18
2. Dental burs, especially those designed to cut acrylic, tend to snag the latex
Figure 2: A dental bur snags a latex glove
and drives into the flesh of the dentist’s hand.
Figure 3: These gloves were burned while a
dental assistant was using a Bunsen burner in
a dental laboratory.
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