I am writing to commend Dr. Hardie on his recent critique of the Infection & Prevention Control document proposed by the RCDSO. I appreciate his introduction describing the Precautionary Principle and the resulting unintended consequences when these principles are applied to the health arena. Here in Alberta, an IP & C draft has been formulated by a committee of the Alberta Dental Association and College, and circulated to the membership for their comments. I understand that the document is now before the Office of the Alberta Health Minister for review and further input. The primary weakness of the documents advanced by the ADA & C and the RCDSO is their reliance upon the Precautionary Principle to minimize the risks of infection transmission. Evidence from clinical and scientific studies to support these recommendations is lacking.
Definition of terms is vitally important, and Dr. Hardie succinctly describes the terms “Infection Prevention” and “Infection Control”. Prior to reading his article I had not considered these definitions, nor have they been represented in the IP & C drafts. One would think that a document concerned with providing guidelines to clinical practitioners would be able to identify the various infectious diseases encountered in the dental operatory, quantify the risks experienced by an ambulatory population attending the dental office, and provide a means of surveillance to determine if the pathogens identified are successfully eliminated. The validity of the guidelines and recommendations by the various provincial bodies, in light of the absence of credible studies, is questionable.
If the Precautionary Principle becomes the accepted approach to health care, then one can foresee that our routine dental procedures will soon be transformed into “operating room” experiences, as we attempt to eliminate all potential (and imaginary) risks. Perhaps it is time for the dental profession to lobby our respective provincial associations, encouraging the committees to rework the guidelines, and base them upon the scientific information that is available, as limited as that body of data may be. In closing, I’d like to thank Oral Health for publishing Dr. Hardie’s article, and I hope that it will encourage further dialogue on this contentious issue.
Douglas Haberstock DDS, MDS Edmonton, AB
Kudos to Dr. Hardie regarding his “Critique of the Draft Guidelines on Infection Prevention and Control as Proposed by the RCDSO” presented in the September, 2009 issue of Oral Health.
How refreshing to hear the clear voice of reason in this debate.
I have been in clinical practice for 39 years and I am in full agreement with Dr. Hardie. The profession owes him a vote of thanks for his insightful comments.
Ivan Kominek, DDS Toronto
