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Battling Cognitive Bias in Dental Infection Control


Unveiling the cognitive biases around dental infection control!
Learn about the cognitive biases we face regarding dental infection control, along with common pitfalls and tips for managing cognitive dissonance.

Those of you who follow me on my socials probably know that I’ve been a long-term advocate of dental infection control practices — which I not only apply in real settings but also educate my colleagues on via my content, courses, and speaking engagements. However, sometimes, I feel like I’m banging my head against a wall, trying to improve infection prevention protocols. I recently found myself in a whirlwind of disbelief when a comment on one of my webinars for OSAP accused me of having an "unrealistic understanding of the private practice environment." 


Newsflash: I've been knee-deep in the trenches of private practice for over 15 years, crafting Standard Operating Procedures (SOPs) that literally guide dental offices while also donning the temporary hygienist cape to rescue practices in distress. In fact, during the webinar, I spoke about how creating SOPs and labeling the office helps new hires and team members understand how to ensure safe patient visits. I feel this is an excellent example of someone who probably doesn't have their protocols together and is experiencing some cognitive bias when their comfort zone is challenged.


In this expose, let's dive headfirst into the murky waters of legacy errors in dentistry, dissecting why change is met with resistance and how we can begin to scrub away antiquated practices for safer dental visits.


Legacy Errors in Dentistry: The Silent Spreaders of Infection

Like those pesky plaque deposits, legacy errors in dentistry are hard to spot but are wreaking havoc beneath the surface. Passed down from one practitioner to another, these outdated infection control (mal)practices are rarely questioned until disaster strikes. Remember the infamous case of NJ oral surgeon Dr John Vecchione from 2016? His negligence led to a bacterial outbreak that claimed a patient's life. It's a grim reminder that lax infection control in dentistry isn't just a minor oversight; It's a matter of life and death.


From irregular or failed spore tests to expired medicaments, dental board violations regarding infection prevention are alarmingly common. But I get it. It’s often hard to hear that our office could be doing something better and/or different. Many people go on the defensive when confronted with new information or possibly the notice of legacy errors being committed in their practice. Comments I often hear include “I have always done it this way” and “It’s fine, no one has died.” But don’t you think this approach does nothing but set the bar for safe dental visits even lower? 


It's time to stop sweeping these issues under the rug and start scrubbing away the legacy errors that put patients at risk. And the only way to do that is by accepting constructive criticism and being more open to change.


Understanding Cognitive Dissonance 

Cognitive dissonance is the uncomfortable clash between two interconnected yet contradictory thoughts, like new information and entrenched beliefs. Psychologist Leon Festinger introduced this concept in 1957, suggesting that these conflicting ideas can either align harmoniously (consonance) or clash (dissonance). 


In a dental setting, consider a practitioner who advocates for patient safety and acknowledges the importance of infection control measures. This is consonance. However, if the same practitioner neglects to adhere to proper dental infection control protocols, their values and actions are in direct contradiction, resulting in dissonance. The discomfort stemming from the inconsistency between such conflicting ideas prompts individuals to employ 3 common defense mechanisms:


1. Avoidance: They may evade or disregard the dissonance by steering clear of situations that highlight it, discouraging discussions about it, or distracting themselves with other activities.


2. Delegitimization: This involves undermining evidence of the dissonance by discrediting sources or situations that bring it to light. For instance, they might question the credibility or integrity of the information presented (ring a bell?).


3. Minimizing Impact: Individuals may downplay the significance of the dissonance by portraying it as isolated or inconsequential (painfully familiar), providing rationalizations to justify their behavior.


Recognizing the mental gymnastics, we perform to justify sticking to outdated practices is the first step toward overcoming cognitive dissonance.


When Change Feels Like Pulling Teeth

By addressing cognitive dissonance, individuals can foster personal and social change, aligning their actions with their values to promote consistency and integrity in their professional conduct. 


This can be achieved through:


1. Behavioral Change: Adjusting one's actions to align with one’s beliefs, even through incremental steps or compromises. For example, a dental hygienist committed to dental infection control might advocate for safer practices within their office.


2. Cognitive Shift: Reevaluating the importance of conflicting beliefs or adopting new ones that bridge the gap between actions and values. This introspective process may lead to a realignment of beliefs with behaviors.


3. Perceptual Adjustment: If changing behaviors or beliefs proves challenging, individuals may reinterpret their new course of action to reduce dissonance. This could involve acknowledging constraints or limitations and reframing the changed behavior in a more positive light.


4. Growth Mindset: As healthcare professionals, it’s important to confront cognitive dissonance head-on by seeking out opposing viewpoints, challenging assumptions, and embracing a growth mindset. 


Remember, change may feel like pulling teeth, but from an infection prevention viewpoint, the result is a healthier, safer practice for everyone involved.


As we bid adieu to legacy errors and embrace a culture of continuous improvement, let's remember that complacency has no place in dentistry. By addressing cognitive bias, confronting legacy errors, and prioritizing dental infection control, we're not just protecting our patients — we're elevating the standard of care.


Ready to bolster your infection control protocols?

Check out my courses and invite me to your next study club!


So, my fellow healthcare providers, let's roll up our sleeves (and put on our gloves) as we scrub away the remnants of the past and pave the way for a brighter, safer future in dentistry.




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