To the Editor (Dr. John Hardie, Chairman, Department of Dentistry, King Fahad National Guard Hospital, Riyadh, Saudi Arabia)

I have read the report on "Infection Control in MOH Dental Clinics" which appeared in the Saudi Epidemiology Bulletin, 4 (3-4): 21 & 28, 1997.

For some time I have been critical of such surveys which appear regularly in the dental and medical literature. My reasons for this attitude are that these investigations have nothing to do with infection control but rather are concerned with behavioral modification. If they were related to infection control, it would be necessary to know the following for the clinic which is being surveyed:

· which infectious diseases are being transmitted;

· how and when do the transmissions occur;

· what theoretical methods are available for controlling the transmissions;

· are those methods clinically practical, safe, and cost effective?

Only after such facts are assembled is it possible to state if the modifications in behavior have obtained acceptable results.

Interestingly, there are no well-controlled studies on nosocomial infections of dental origin, and so the value of wearing protective gear is pure conjecture. It is also exceptionally expensive. For example, to comply with all mandatory regulations on infection control, American dentists spent $5.4 billion in 1994. From this, I have calculated that the cost for each Canadian dentist is $Can. 30,000 €” 40,000 per year.

Apart from these comments, my major criticism of those investigations is that they fail to understand the significance of handwashing. For example, your bulletin report does not record when and how handwashing was performed.

I remain convinced that simple, cheap, and effective dental infection control requires only four factors.

1. Appropriate vaccinations of clinical staff.

2. Handwashing before and after intraoral procedures.

3. Confirmed sterilization of invasive surgical instruments.

4. Maintenance of a tidy, clean working environment.

With kind regards,