Guidelines for Glove Usage and Hand Care
in General Dental Practice

(A joint initiative between the Children's Section, Dundee Dental Hospital and
Professor Mike Martin, Liverpool Dental Hospital, author of the BDA Advice Sheet A12).
(With audit data from 106 dental practitioners in Primary care in Scotland).

The reasons for this are;

• Patients expect it! 94% think dentists should wear gloves, and 72% would not attend a dentist who didn't. Kearns et al 1998 BDJ 185;2:87-89
• Wearing gloves reduces your risk from needlestick injuries, by decreasing the volume of blood transferred by over 50%. Mast et al. 1993 J Infect Dis. 168:1589-92

What dentists reported; 84% of respondents used gloves for all clinical procedures, and 98% for all or most procedures (exceptions, where indicated, being mainly examinations, but also prosthetics, young children and endodontics).

Why the need to move over to powder free gloves?

• Using powdered gloves increases the chance of developing latex allergy, possibly by inhalation of latex attached to powder particles suspended in the air. Brehler et al 1997 Eur J Surg 579;23-25
• Gloves should carry a CE mark, as this shows the brand has achieved a minimum acceptable quality level (equivalent to BS 455).

What dentists reported; 69% of respondents used a powder-free brand of glove as their first choice of glove.

Why use a disinfectant soap?

• Chlorhexidene gluconate (Hibiscrub) is at least twice as effective as soap at removing micro-organisms from dentists hands. Field et al 1986 BDJ 160; 278-280

Why wash or disinfect hands at every glove change, rather than just changing gloves?

• Gloves can puncture during use, and some dental materials increase glove porosity. Tinsley et al 1997 J Dent 25:65-70

What dentists reported; 44% of respondents always washed their hands when changing gloves, while 59% always or usually did so. Around 6% reported using an alcohol based hand rub.

Why change gloves between patients?

• Washing gloves can be ineffective at removing contamination, and may cause perforations. Martin et al 1988 BDJ. 165;321-324

What dentists reported; 70% of respondents always used a new pair of gloves for every patient, while 97% always or usually used a new pair for every patient, with the reported exceptions being mainly for family check ups.

Why after every session?

• There is some evidence that using hand cream before a session can increase absorption of protein allergens from latex gloves, so use after. Beezhold et al. 1995 Assoc. O. R. Nurse J. 59: 605-613
• There is, however, growing anecdotal evidence (see below) that using a hand cream after every session, and at home at weekends, can help reduce skin problems.

What dentists reported; 47% of respondents used hand cream on a daily basis.

Why not?

• Rings and watches have been shown to prevent effective decontamination of the hands before dental procedures. Field et al 1996 J. Dent. 24; 65-9

What dentists reported; 74% of respondents always or usually wear a watch/ bracelet during patient treatment.

This is really just a good practice point.

What dentists reported; 65% of respondents always or usually covered cuts and abrasions.

Dentist's overall comments

39% of respondents had experienced glove-related skin problems in the last 5 years, and for 40% of these, it was a recurrent problem. If the problem was resolved by a change of glove brands, then in all cases the change was to an un-powdered glove. Over half of dentists added points they had found helpful in hand care. By far and away the most often mentioned were;

• Dry hands really thoroughly before donning gloves
• Use un-powdered gloves
• Use hand cream at the end of a session

Audit sponsored by Tayside University Hospitals NHS Trust Audit Group and Regent Medical Ltd.Printing sponsored by Regent Medical Ltd; manufacturers of Hibiscrub, Hibisol and Biogel gloves, which are trade marks of the SSL group.