By Mary Otto
One of the major dental dramas of 2013 was a story followed closely by Tulsa World reporter Shannon Muchmore.
Early in the year, an inspection at the office of a local oral surgeon, W. Scott Harrington, raised concerns that lax sanitation practices had put patients at risk. Widespread testing followed and, in September, health officials announced that one of Harrington’s former patients had contracted hepatitis C while receiving care at his office. It was the first documented report of patient-to-patient transmission of the virus associated with a dental setting in the United States, the officials said.
Muchmore stayed in constant contact with local and state health officials in writing her stories. Her reports also came as a reminder of the important role that the U.S. Centers for Disease Control and Prevention (CDC) often plays in such major investigations.
The CDC is just one of the federal bodies charged with overseeing and regulating the safety of America’s dental care system. Here is a look at a few of these agencies, with links to information about how their work relates to dental care. You might want to use them as resources to expand the focus of your local stories.
U.S. Centers for Disease Control and Prevention (CDC)
This branch of the U.S. Department of Health and Human Services lacks regulatory power but has major clout in promoting health and fighting disease. In addition to supporting investigations such as the one in Oklahoma, the CDC developed the “Guidelines for Infection Control in Dental Settings – 2003,” evidence-based recommendations that have been used to guide infection-control practices in dental offices nationwide for more than a decade.
The CDC’s Division of Oral Health, which provides expert guidance on topics such as appropriate fluoride and dental sealant use; assistance with community fluoridation efforts, local and state oral health data collection and web-based systems for national oral health disease surveillance.
Occupational Safety and Health Administration (OSHA)
Part of the U.S. Department of Labor, OSHA uses its regulatory power to make dental clinics safer for health care workers and patients.
The administration sets and enforces safety standards and supports their implementation with training and technical assistance.
Dental care employers and workers are required to follow or state safety plans that have been approved by OSHA. Those found to be out of compliance may risk fines or imprisonment.
An example is OSHA’s Bloodborne Pathogens Standard which lays out the precautionary measures and safety practices that employers must follow to protect their workers from infection.
OSHA also protects workplace whistleblowers, such as the two Maine dental hygienists who were awarded damages after a court found they were subjected to retaliation by their dentist-boss for raising concerns about perceived lapses in infection control procedures in her office.
U.S. Environmental Protection Agency (EPA)
The year 2013 brought new stories of struggles over community water fluoridation, including a battle in Portland, Ore., that ended in May when voters rejected fluoridation for the fourth time.
Fluoride occurs naturally in water but at different concentrations in different places in the country. For more than 65 years, communities across the United States have been supplementing naturally occurring fluoride in water supplies to promote oral health. At what are considered optimum levels, numerous studies have shown fluoride reduces cavities. But too much fluoride can be a bad thing, public health officials have acknowledged. Consumption at excess levels may cause fluorosis and skeletal deformities, research has found. Americans are now getting fluoride from a variety of sources, including fluoridated dental products that were not available when community water fluoridation programs began.
It falls to the EPA to regulate fluoride in drinking water to protect human health. In 2011, in a joint statement, officials from the EPA and the U.S. Department of Human Services announced that the recommended level of fluoride in drinking water should be set at the lowest end of the current optimal range to prevent tooth decay, and that a review of the maximum amount of fluoride allowed in drinking water.level was underway.
The recommended level is set at 0.7 parts per million, at the lowest end of the range of 0.7 to 1.2 parts per million set in 1962. The review continues.
U.S. Food and Drug Administration (FDA)
This branch of the U.S. Department of Health and Human Services regulates a range of dental products and devices from fluoride toothpaste to X-ray machines.
In response to concerns about the safety of mercury contained in amalgam tooth restorations the agency issued a 2009 final rule reclassifying amalgam as a Class II (moderate risk) dental device. While stating that research had not found a causal link between amalgam and adverse health effects, the administration recommended new product labeling summarizing scientific evidence on the benefits and risks of the material.
There may be limits to the agency’s regulatory reach, however, as highlighted by recent stories about questionable conditions in some of the nation’s dental laboratories.
All told, the FDA “has inspected less than 300 domestic and foreign dental labs over the past decade,” noted Kiera Butler in a piece for Mother Jones. And many of the labs are exempt from registering with the FDA.
After her story appeared I contacted the FDA for more information about how the FDA oversees dental labs. Here is what David Gartner, chief of the Regulatory Policy and Systems Branch, Division of Risk Management Operations, at the FDA’s Center for Devices and Radiological Health had to say.
“Domestic dental labs that manufacture dental devices are subject to FDA jurisdiction, but may qualify for certain exemptions depending on the nature of their activities. For example, dental labs that provide common devices, such as crowns, bridges and dentures, to consumers and dentists have an exemption under the law (21 CFR 807.65(i)) from registering with FDA and listing their products. FDA handles questions associated with these dental device exemptions on a case-by-case basis.”
As Butler pointed out, dental labs often fly below state and local oversight as well. She noted that both the National Association of Dental Labs (NADL) and the American Dental Association (ADA) are urging states to require dental labs to register, which she called “a step that would make it easier for authorities to inspect them for cleanliness and safety.”
