“Snazzy safety glasses,” I said to the dental hygienist who was just about to ask me to open wide. Something about the pink rims caught my eye and led me to a remark that showed my age:
“I remember when dentists didn’t wear gloves, or masks, or eye protection.”
I not only recall the bare hands of my dentist circa 1970-1980, I also remember the hullabaloo from dentists when new federal regulations were proposed in 1989 requiring them to provide such protection for their hygienists. At the time, the term “AIDS’ was less than 10 years old, and exposure to HIV in the U.S. was considered a death sentence.
The OSHA proposal was based in part on guidelines from the Centers for Disease Control and Prevention (CDC) on methods to reduce healthcare workers’ exposure to bloodborne pathogens, such as HIV and Hepatitis B. The guidelines embraced the concept of “universal precautions” to protect against exposure to blood and other body fluids. The CDC noted that in dental settings, saliva should be considered a hazardous body fluid because it is likely to be contaminated with blood during typical dental procedures. The dentists scoffed. No, they did more than scoff.
The sky was falling, and it would be the end of dental care as we knew it. Children would be frightened by hygienists in surgical masks. Gloves would hinder a dentist’s fine motor skills. The excuses went on and on. The letters flooded OSHA’s offices. I worked at OSHA during the time and remember it well. We answered letter after letter from Members of Congress who were writing on behalf of the dentists in their districts. Why was OSHA killing the tooth fairy?
It was ridiculous at the time, and looking back, still ridiculous.
The American Dental Association (ADA) was leading the charge against OSHA’s bloodborne pathogens rule. The ADA argued, among other things, that there was little evidence to show that dentists or hygienists were at risk of exposure to bloodborne pathogens. “I don’t have any hygienists who’ve developed AIDS or contracted hepatitis,” the dentists would say. Even if they admitted that they or their employees were at risk of exposure to bloodborne pathogens, the ADA insisted that dentists were highly trained professionals. They could decide for themselves and for their employees if, or when gloves, masks for goggles should be worn. Dentists didn’t need the government telling them how to run their businesses.
The ADA pulled out all the stops to try to avoid the OSHA regulation. They participated actively in the public rulemaking process, organized letter writing campaigns and sought Congressional intervention. In an op-ed published in the New York Times on November 12, 1989, New Haven, CT periodontist Avrum Goldstein expressed his opposition this way:
“…these regulations will bring about changes in the dentist-patient relationship and make it more difficult to practice dentistry. By its nature, dentistry is an intimate occupation. The dentist works within an inch of a patient’s head, probing sensitive, often tender areas of the patient’s body. The mouth embodies our ability to smile, kiss, talk and eat—all very emotional qualities. Patients needs a warm and trusting relationship with their dentist to help overcome fears and make necessary dentistry possible. It will be more difficult to establish this relationship when the dentist is gowned, shielded, and masked. [These barriers] will have a profound effect on the relationship between the dentist and patient.”
But shielding against deadly viruses with common sense protections would eventually trump arguments about emotions. When the rule was finalized in December 1991, the ADA exercised their right under the OSH Act to challenge the rule before the U.S. Court of Appeals. The court didn’t buy their arguments either. In January 1993, the OSHA rule was upheld and would apply to dental practices.
Seeing my dental hygienists snazzy eye protection and matching gloves, the ADA’s opposition to OSHA’s bloodborne pathogens rule now seems so ludicrous. But their claims about the demise of dentistry because of OSHA were just another in a long list of over-reaction to proposed worker safety regulation. Some can probably be attributed to innocent misunderstanding, but others are orchestrated campaigns that spread false information to rally opposition to a new public protection. (One recent example of the latter was the Farm Bureau’s attack on the Labor Department’s rule to protect young workers employed on farms from certain hazardous tasks. Sadly, even the Obama Administration caved to their false claims.)
The Cry Wolf Project has compiled loads of quotes from industry representatives and others who alleged the terrible harm that will come from regulating wages, auto emissions, pharmaceuticals and other hazards. Some date back decades, others are more recent. A few key themes emerge from all the wolf cries: regulations are burdensome, costly and unnecessary.
During my next visit to the dentist, I’m going to ask him flat out: are the steps you take to protect yourself and your employees from bloodborne pathogens burdensome, costly or unnecessary?