Can you remember when dentists practiced dentistry without the use of gloves? About one-half of my career took place in the gloveless era, but now it is nearly impossible to contemplate practicing without gloves. (I tend to forget all bad memories.) I welcomed the advent of glove use in dentistry. However, there are a few negative aspects of glove use that deserve your attention and that may influence your ability to practice dentistry, your overall health and your satisfaction with dentistry. This article discusses several important topics of interest to glove users in dentistry.
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HOW MANY GLOVES IN A DAY?
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General dentists see different numbers of patients, ranging from a few patients per day to as many as 60 or more patients per day, exclusive of dental hygiene. As an example of glove use, I will describe a typical dentist as seeing 20 patients per day, plus 16 hygiene patients, for a total of 36 patients per day.
- – At least one pair of new gloves is required for the dentist for each patient (36 pairs).
- – Working with two hygienists requires the dentist to remove and replace gloves at least once during each of the dentist’s patients (20 pairs) to allow for checking dental hygiene patients.
- – The hygienists each wear at least one pair of gloves per patient (16 pairs).
- – At least two dental assistants would be present in the described practice. They would use at least one pair of gloves per patient each (40 pairs).
- – Allow an additional quantity of gloves 10 percent above the described use pattern to account for gloves that are torn or otherwise destroyed (11 pairs).
The total glove use for the described practice is about 123 pairs of gloves or 246 single gloves per day. At an average cost of about 7 cents per glove, the total cost of gloves per day in the described practice is about $17 per day, or about $4,000 per year. Although this sum is significant, it is not a high cost for the protection offered to both clinical personnel and to dental patients.
For people on the dental staff who have allergies to latex, vinyl and nitrile gloves are available, although they cost more than latex gloves. Additionally, nonlatex gloves must be used in the treatment of patients who have allergic reactions to latex.
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THE USE OF AMBIDEXTROUS GLOVES
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A major, largely unrecognized challenge is the use of ambidextrous glove by most dental personnel. The majority of clinicians use an ambidextrous glove size that feels comfortable to them. The ambidextrous gloves are preferable to dentists and staff members because they eliminate the confusion of selecting right or left gloves. Some dental staff members use ambidextrous gloves that are loose, and others prefer gloves that have a tight fit. Very few of those who wear ambidextrous gloves have considered the difference between the shapes of their left and right hands and how an ambidextrous glove fits those differently shaped hands. Hand shape varies significantly on the thumb and the little finger sides. The thumb side is much more convex, and the glove should have more space on the thumb side than on the little finger side of the hand. One negative result of wearing ambidextrous gloves is that thumbs receive significant force on their most convex sides, as well as on the top aspects of the hands.
Ambidextrous gloves were intended as examination gloves to be worn intermittently during the day for a few moments only. However, dental personnel wear ambidextrous gloves for many minutes or even up to an hour at a time. It is possible that a dentist or other members of the dental staff could have gloves on their hands for six or seven of their eight hours in the clinical office each day.
The influence of these tight gloves is well-known to mature dentists who have worn gloves for many years. After years, or even merely months, of glove use, their hands become painful, particularly in the thumb area. This pain subsides only when the person does not wear the gloves for a time. After a clinician has worn tight ambidextrous gloves for a period of years, his or her hands may not become free of pain even after an extensive time of not wearing gloves.
There are ways to reduce the ambidextrous glove problem, including wearing ambidextrous gloves that are one size larger than the ones worn previously. The obvious disadvantage of this solution is that the loose gloves and excess glove material make practicing dentistry more difficult. A better alternative is to use sized gloves that fit each hand separately. Sized right-and left-handed gloves are slightly more expensive than ambidextrous gloves, but the relief of pain compensates for the higher cost. Many young dental staff members are not aware of the potential danger associated with wearing ambidextrous gloves. Judging from my polls of thousands of dentists taken on the international lecture circuit, pain in the hands after wearing ambidextrous gloves appears to be directly related to the age of the affected person. In other words, the older the practitioner, the more likely he or she is to have glove-related pain in the hands.
In spite of the challenges that glove use poses, it offers many advantages—foremost among them the protection of patient and dentist alike from infection.
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LATEX ALLERGY
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Latex allergies influence a significant portion of the general population. Additionally, a survey of practicing dentists by Clinical Research Associates1 showed that about 12 percent of dental personnel have experienced adverse reactions to latex, and 1 percent reported severe reactions that were diagnosed as shock.
To minimize ill effects of latex on patients and personnel who have latex allergies, there are a few alternatives. Both vinyl and nitrile gloves may satisfy the challenge. Some popular brands are Touch N Tuff (nitrile) by Ansell-Edmont (Coshocton, Ohio) and +Ammex Vinyl Powder Free exam gloves by Ammex (Kent, Wash.). I suggest that dentists place a direct question about latex allergies on their patient health questionnaires, and that they have non-latex gloves available at all times for use with their latex-allergic patients, as well as non-latex rubber dam such as the Hygenic Non-Latex Dental Dam (Coltène/Whaledent, Mahwah, N.J.).
Some gloves have a peculiar taste or smell, and some brands have a significant amount of powder on them. All of these characteristics are negative either to patients or to dental personnel.
Clinical Research Associates, or CRA, has tested gloves for many years as they have evolved from nearly unusable to acceptable. To be acceptable, gloves should have, from year to year, a consistent combination of the following characteristics:
- – a low number of manufacturing defects (pinholes);
- – an economical cost;
- – good clinical characteristics (fit, tactile sensitivity, appropriate amount and texture of powder, no bitter taste, no tackiness after wetting, resistance to tearing and adequate cuff length).
The following gloves have been shown in CRA testing to have these characteristics: Ammex Gloves (Ammex), APO Health Gloves (APO Health, Oceanside, N.Y.), Bio-Flex Gloves (Bio-Flex, Hallandale, Fla.), Biogel D (Regent Hospital Products, Knutsford, Cheshire, England), Glove Plus Textured Latex (Ammex), Golden Gloves (Audra Inc., Sturgis, Mich.) and Perfect Touch (Plak Smacker, Riverside, Calif.).
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SUMMARY
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The use of gloves in all types of dentistry has been a major benefit to both patients and dentists. However, operating gloves are not without challenges. Tight ambidextrous gloves can produce significant and debilitating hand pain; latex allergies are a problem for many dental personnel and patients; and the disagreeable taste, odor and powder of some brands of gloves has frustrated both professionals and patients. In spite of the challenges that glove use poses, it offers many advantages—foremost among them the protection of patient and dentist alike from infection.
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