PPE and Hand Hygiene in Dentistry: Getting It Right Every Time

Infection control isn’t just about following rules—it’s about protecting yourself, your patients, and your team every single day. And when it comes to PPE and hand hygiene, the details matter.

Yet, despite the regulations, guidelines, and best practices we have, breaches in infection prevention still happen. PPE is worn incorrectly, hand hygiene is rushed or skipped, and cross-contamination happens before anyone even realizes it.

So, let’s break it down—what PPE should be used, how it should be worn, and why hand hygiene remains the single most important step in infection control.

The Role of PPE in Dentistry: Your Last Line of Defense

Personal Protective Equipment (PPE) is the last barrier between you and a potential exposure to blood, saliva, aerosols, or contaminated surfaces. It’s not just about compliance—it’s about keeping you safe.

What PPE is Required in Dentistry?

The OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) requires dental professionals to wear:

✔ Gloves – Single-use for patient care; utility gloves for handling instruments and disinfection.

✔ Masks or Respirators – Chosen based on risk assessment of aerosols and fluid exposure.

✔ Protective Eyewear or Face Shields – Must have side protection; loupes are not protective unless rated for impact resistance.

✔ Protective Clothing (Gowns or Lab Coats) – Fluid-resistant and worn during patient care.

Employers are responsible for providing appropriate PPE, training staff on its use, and ensuring compliance.

How to Choose the Right PPE for the Procedure

1. Protective Gowns: What to Look For

✔ Fluid-resistant material – Protects against blood and saliva splatter.

✔ Fitted cuffs, high neck, and long sleeves – Prevents skin exposure.

✔ Disposable vs. reusable – Disposable gowns should be discarded after each use; reusable gowns must be laundered daily.

🚨 Common Mistake: Wearing the same gown throughout the day. If it’s visibly soiled, it’s contaminated. Change it between patients.

2. Masks: Not All Are Created Equal

Dental masks have ASTM ratings based on fluid resistance and filtration efficiency. Here’s what you should know:

ASTM Level 1 – For exams and non-aerosol procedures.
ASTM Level 2 – Moderate fluid resistance for prophy, sealants, and endo.
ASTM Level 3 – High fluid resistance for ultrasonic scaling, air polishing, and surgery.

✔ Change your mask between patients or if it becomes damp.

✔ Make sure your mask fits snugly—gaps around the nose allow aerosols in.

🚨 Common Mistake: Pulling the mask below the chin and reusing it. Your mask is medical waste—treat it that way.

3. Eye and Face Protection: Stop Overlooking This

✔ Protective eyewear should have side shields—your regular glasses do not count.

✔ Face shields add extra protection but should be worn with a mask.

✔ Check if your loupes are ANSI-rated for impact protection.

🚨 Common Mistake: Adjusting eyewear with contaminated gloves. Either remove gloves first or use a disinfectant wipe before touching them.

4. Gloves: You’re Probably Using More Than You Think

In a single month, a dental professional may use over 600 gloves. That’s a lot of opportunities for contamination.

✔ Patient care gloves (non-sterile or sterile) – Single-use, worn during treatment.

✔ Utility gloves – Worn when handling instruments and disinfecting surfaces.

🚨 Common Mistake: Wearing patient exam gloves when disinfecting. These gloves are not chemical-resistant—they break down and fail to protect your skin.

Proper Donning and Doffing of PPE: Where People Get It Wrong

Wearing PPE is one thing. Taking it off without contaminating yourself? That’s another story.

Correct PPE Removal Sequence (Doffing):

1️⃣ Gloves – Always first. Peel off without touching your skin.

2️⃣ Gown – Roll it inside out and remove carefully.

3️⃣ Eyewear/Face Shield – Handle by the arms or strap.

4️⃣ Mask/Respirator – Remove last, handling only by the ear loops or straps.

5️⃣ Hand Hygiene – Immediately after removing PPE.

🚨 Common Mistake: Removing gloves last. If you do this, you’ve just spread contamination everywhere.

Hand Hygiene: The #1 Infection Control Practice

Let’s be honest—we know hand hygiene is critical, but do we always do it correctly?

CDC guidelines recommend hand hygiene:

✔ Before and after every patient interaction

✔ After touching contaminated surfaces or removing gloves

✔ Before performing an aseptic task (like placing an implant or working in a surgical site)

Handwashing vs. Hand Sanitizer: When to Use What

🛑 Use soap and water when:

Hands are visibly soiled.
After treating a patient with C. difficile or norovirus.
After handling blood, bodily fluids, or contaminated instruments.

✔ Use alcohol-based hand sanitizer (ABHR) when:

Hands aren’t visibly dirty.
Moving between clean and contaminated tasks.
Before putting on and after removing gloves.

🚨 Common Mistake: Topping off hand sanitizer dispensers. This can lead to contamination and reduced effectiveness.

Hand Health Matters: Don’t Ignore Skin Irritation

Hand hygiene only works if your skin is intact. Dry, cracked skin is an entry point for pathogens—so protecting your hands is part of infection control.

✔ Use fragrance-free, non-petroleum-based lotion to prevent dryness.

✔ Avoid heavily scented products—they can degrade gloves.

✔ Keep fingernails short and avoid artificial nails—they harbor bacteria.

🚨 Common Mistake: Wearing nail polish, gel polish, or artificial nails. Studies show they trap pathogens and increase contamination risks.

Key Takeaways: PPE and Hand Hygiene Done Right

1️⃣ PPE is your last line of defense—wear it properly and remove it correctly.

2️⃣ Not all PPE is created equal—choose the right mask, gown, and gloves for the procedure.

3️⃣ Hand hygiene is non-negotiable—do it before and after patient care, and after PPE removal.

4️⃣ Your skin health matters—moisturize with lotion that won’t degrade gloves.

5️⃣ Don’t cut corners—if PPE is dirty, damaged, or improperly worn, it’s not protecting you.

Final Thoughts: Take Infection Control Seriously

PPE and hand hygiene aren’t just about checking a box for compliance. They’re about keeping yourself and your patients safe.

If you take shortcuts, you’re not just breaking a rule—you’re putting your health on the line.

So, take a second look at how your office handles PPE and hand hygiene. Is everyone following best practices? If not, what’s stopping you?