Resources

Monitoring External Forces that Affect the Practice of Dentistry

Eve Cuny, RDA, BA

Copyright 2001 Journal of the California Dental Association.

Dealing with the varied and often changing requirements and regulations that affect every dental practice can be a daunting task for the dentist and dental staff. Knowing how and where to access accurate and timely information provides relief for the busy dental professional. This article explores the impact of regulatory mandates and government agency standards on dentistry and provides suggestions for simplifying the search for reliable information.

Numerous external forces affect the way dental practices are managed and patient care is delivered. Perhaps the most notable forces in recent years have been the changing landscapes of regulatory policies and legislative mandates. In California, the past 10 years have brought new rules for infection control,^1,2 ergonomics,³ and injury and illness prevention,⁴ among others. All of these regulations came about as a result of the state lawmaking process. Often the process began months or years earlier on a national level and then "trickled down" to the states for implementation and enforcement. Agencies such as the Occupational Safety and Health Administration and the Dental Board of California are charged with enforcement and administration of these programs.

Dentists have also experienced increased pressure for environmental compliance, including controlling amalgam discharge to the sewer, collection and disposal of chemicals such as X-ray fixer and disinfectants, and registration of hazardous materials with the state Environmental Protection Agency or local county regulatory body.

Numerous agencies and groups also affect dental practice through mechanisms of recommendations and nonregulatory health and environmental standards. In the area of health and safety, the Centers for Disease Control and Prevention, the National Institute for Occupational Safety and Health, the American Dental Association, and state dental associations may have recommendations and guidelines of which practitioners should be aware. Infection control, sedation, general anesthesia, infected health care workers, latex allergy, and placement of sharps containers are a few examples of areas where recommendations exist in addition to regulations. Occasionally, when standards are not consistently met, the results are played out in the civil court system and the popular media.

Additionally, dentists are held to a stricter code of conduct than are most nonprofessionals and, indeed, many other professionals. Requirements for relicensure, certification for scope of practice issues, and codes of ethics add to the externally produced pressure dentists must face. The pattern of force and resistance that may emerge as a result of these pressures can be detrimental to the practice and to the dentist personally. Resources are available that assist the practitioner in meeting these demands. Finding, accessing, and implementing these resources can and should be a team effort of the entire practice.

Literature

Numerous print resources are available to the practitioner. However, many dentists, assistants, and hygienists have difficulty finding time to thoroughly review the numerous journals, product catalogs, and other print media they receive.

In addition to the peer-reviewed journals and trade publications supported by industry advertisements, there are subscription newsletters that provide information on products, practices, guidelines, and regulations. These newsletters may vary widely in reliability of the information presented. Additionally, state-specific information may be difficult to obtain but is important in terms of ensuring compliance within an individual office.

Dental School Resources

Dental schools offer some relief to the problem of access, especially for individuals in areas where continuing education programs are available. Often dental schools have a department or individual responsible for regulatory compliance that may be willing to answer questions from dentists in the community. Additionally, dental schools often offer services such as spore testing, courses, workshops, and newsletters that may assist the dental team with compliance.

The Organization for Safety and Asepsis Procedures

The Organization for Safety and Asepsis Procedures was founded in 1984 by a group of leading dental infection control experts, researchers, clinicians, and dental infection-control product manufacturers. OSAP assists dental practitioners, educators, and manufacturers in accessing and disseminating the most current and accurate infection control and safety information. In the more than 15 years since its inception, OSAP has evolved into a well-respected nonprofit organization that offers educational programs in the form of an annual symposium, regional seminars, and an interactive training program for use in dental offices and schools. OSAP members also receive a monthly focus mailing detailing a topic of interest in the area of dental safety. Topics have included latex allergy, ergonomics, dental unit waterlines, emerging infectious diseases, needle safety legislation, hazard communication, disinfectants, microbial resistance, and many other timely topics of interest to the dental office. Recently, OSAP began offering a subscriber category in addition to its already established member category for those individuals who only want access to the publications and do not have a desire to participate in a membership organization.

OSAP also has a newly revamped Web site (see resource box) that provides recent news releases on topics of interest to dental practitioners, announcements of pending regulatory changes, and opportunities to ask the experts a personal infection control or safety question. This Web site also provides access to such valuable information as a chemical disinfectant chart detailing the characteristics of many of the most commonly used dental office products.

Some of the more recent resources developed by OSAP through committees or by nationally recognized experts are a dental unit waterline position paper, the Interact Training Program, and a position paper on instrument processing.

Conclusion

Health and safety laws are not likely to disappear in the coming years, although there may be some slowing in the enactment of new legislation due to the recent election of a conservative leadership in the United States. Most regulations require more than a one-time commitment to achieve compliance. Program development and employee training are the beginning of a process that should include regular checks and updates, modification for changes in requirements, procedures and equipment, and ongoing training of all personnel. Trying to carry this out without accessing outside resources may result in frustration, inconsistency, and noncompliance. Using the many resources available to dental professionals is key to simplifying the regulatory compliance process and ensuring that patients and workers are provided the safest environment possible.

Author

Eve Cuny, RDA, BA, is the director of environmental health and safety at the University of Pacific School of Dentistry.

References

1. California Code of Regulations Title 8. Section 5193. Bloodborne Pathogens.

2. California Business and Professions Code Section 1680. Unprofessional Conduct.

3. California Code of Regulations Title 8. Section 5110. Repetitive Motion Injuries.

4. California Code of Regulations Title 8. Section 3203. Injury and Illness Prevention Program.

To request a printed copy of this issue, please contact/ Eve Cuny, RDA, BA, UOP School of Dentistry, 2155 Webster St., San Francisco, CA 94155, or at ecuny@uop.edu.

Selected Internet Resources

California Dental Association
www.cda.org/cda_member/laws.html
Dental-related laws and regulations

Organization for Safety and Asepsis Procedures
www.osap.org
Numerous resources and membership and subscription information

California Occupational Health and Safety Home Page
www.dir.ca.gov/DOSH
Regulatory information and compliance resources, such as sample written safety programs

Centers for Disease Control and Prevention
www.cdc.gov
Data, statistics, and recommendations for such things as immunizations, infection control, disease transmission, prevalence, and epidemiology

National Institute for Occupational Safety and Health
www.cdc.gov/niosh
Guidelines and recommendations for such things as latex allergy and sharps containers