The Dentist’s Dirty Secret

"Someone has said it is like sharing spit."

Thus began the latest TV newsmagazine expose aimed more at alarming the public than educating them to the true status of a problem that dentistry has been dealing with for some time now. In mid-February, the ABC News "20/20" story titled "The Dentist’s Dirty Secret" rewrote the how-to manual on pulling out all of the emotion-filled stops to grab the attention of the viewer. Only time will tell how effective their effort was in damaging the image of the dental profession. Lack of media attention immediately after the broadcast suggests that it may have failed to grab the public emotion it was seeking.

Make no mistake, dentistry does have a problem that requires closure, whether that be in the form of better dental unit waterline design or more practical procedures to ensure compliance with the 200 cfu/ml water standard that was set as a goal by the American Dental Association in 1995. However, network television continues to take great liberties in creating a sensational story.

For example, veteran TV news journalist Barbara Walters initiated the piece in a tone laced with disgust, "We did comparison tests, dental water vs. toilet water. What we found is enough to make you sick!" A researcher is shown going into a men’s restroom and scooping water from a toilet and a urinal. Fortunately, it appeared that both vessels were clean and had been flushed. Other emotion-filled narrative included a description of water from the syringe in the dental office as being "so slimy, so dirty, it’s been compared to pond scum." And finally, "Most dentists are still squirting bacteria-filled water into their patients’ mouths."

Our concern is the emotion-grabbing manner in which it was presented. As might be expected, similar to past media presentations on dental issues, the tone was decidedly anti-dentistry. The emphasis was on "most" dentists doing nothing to prevent the problem with little discussion devoted to procedures or devices that would decrease the dangers of the biofilm. We wonder why positive information on steps that dentists are now taking to minimize the biofilm hazard cannot be shared with viewers in an educational manner? Could it be that positive information was lost at the editing console?

In an ADA News release prior to the airing of the 20/20 program, it was announced that noted microbiologist John Molinari, PhD, who is the ADA spokesperson on dental unit water, had been interviewed for 40 minutes in preparation for a story that was timed at approximately 12 1/2 minutes. Less than 1 1/2 minutes of the Molinari interview was aired, much of it focusing on findings that immunocompromised patients may be the only ones at risk for infection from the organisms found in the dental office waterlines. One can only suspect that the other 38 1/2 minutes of that interview discussed the important things that well-meaning dentists are doing to reduce the risk of biofilms, such as flushing of water lines, sterilization of syringe tips or use of disposable syringe tips, use of suck-back prevention devices, and sterilization of handpieces. Use of sterile water or saline in surgical procedures was addressed, but management of air-water syringes and handpieces in the general dental office was ignored, leaving the viewer with the distinct impression that in most general offices, "dentists are still squirting bacteria-filled water into their patients’ mouths" without any effort to reduce or remove the risk.

Irrespective of the impact of this recent news spectacular on dentistry or its image, it is clear that dentistry does have a problem until research, development, and leadership place some clear choices in front of the profession for adoption. Until that happens, dentists are left to scramble individually to address ADA, Centers for Disease Control and Prevention, and Dental Board of California (formerly the Board of Dental Examiners) recommendations and infection control guidelines by purchasing costly sterile water systems or devices or by utilizing unproven filters or water cleansing products such as antimicrobials. Adding to the general practitioner’s dilemma, the literature reveals scientific data such as that in the February 2000 issue of the Journal of the American Dental Association, "Dental Unit Waterline Antimicrobial Agents’ Effect on Dentin Bond Strength," which concluded that "Dental unit waterline antimicrobial agents may adversely affect dentin bonding strength."

The major problem we see in this scenario is that progress toward a possible and practical universal solution has been incredibly slow, given its somewhat lengthy history. Now that "The Dentist’s Dirty Secret" has been splashed across TV screens nationwide, it is hoped that the pace toward a complete solution of this problem will increase with deliberation.