The Stauffer family, from Guelph, Ont., were among the 3,600 patients of Guelph Dental Associates advised by public health officials to get tested for hepatitis B, C and HIV due to sterilization concerns.
“It was really shocking, I was really worried,” said Stauffer, who took her boys Atlas, 5, and Tenzin, 9, to get tested. “I know it was a low risk but it’s still a risk. The worst-case scenario is the whole family has HIV, or hep B or hep C.”
The warning, from Wellington-Dufferin-Guelph (WDG) Public Health sent out in June, advised patients that anyone who received a dental procedure at the location between Jan. 21, 2015 and June 21, 2017 to talk to their doctor about getting tested. Fortunately, there have been no reports of actual infections, according to Guelph health officials.
In Ontario, public health units do not perform regular inspections at dentists’ offices, as they would with restaurants, tattoo parlours or hair and nail salons. Instead, health inspectors operate on a complaint-based system and only visit dentists’ offices if a formal complaint is made by a member of the public.
Public health inspectors discovered the issue after receiving a complaint about the clinic from the public. Following an inspection, they temporarily closed the business over concerns dental instruments may not have been sterilized properly.
“It was a really big slap in the face,” Stauffer said. “You do the best you can for your kids and you try to keep them as healthy as you can – and then something like that happens.”
Guelph Dental Associates, which operates under the name Growing Smiles, is just one of several dental offices across the province to be investigated by public health officials for infection prevention and control (IPAC) lapses. Southend Dental Clinic and Barry White Orthodontics, were temporarily closed in July after health inspectors found several infractions. The clinics reopened days later after being-reinspected by public health officials . Global News reached out to Southend and Barry White for comment but have not yet received a response.
Guelph Dental Associates reopened on Sept. 16 after being cleared by WDG Public Health.
“Throughout this process, Guelph Dental Associates has worked closely with the Public Health Unit, which has subsequently inspected the clinic and is satisfied that the clinic has implemented their recommendations and has approved the clinic’s reopening,” a statement on the office’s website reads. “We have taken these steps to ensure that we are able to provide you with the safe and pleasant dental care experience you deserve.”
WATCH: Toronto dentist Natalie Archer speaks about need for regular health inspections
But it’s not just Guelph. Several clinics across Ontario have been investigated for health and safety violations, sometimes resulting in serious health violations.
In Burlington, Ont. 9,000 past and current patients of Upper Middle Dental operated by Dr. Vick Handa were advised to be tested for hepatitis B, C, and HIV as they may have been exposed to improperly cleaned instruments used for procedures. Handa did not respond to a request from Global News for comment.
Statistics on how many infection prevention and control (IPAC) investigations are carried out by public health officials involving dental offices are not tracked by Ontario Public Health. And unlike other complaints made regarding dental practices in the province, they are not published annually by the Royal College of Dental Surgeons of Ontario (RCDSO).
Figures obtained from the College, showed that in 2016 there was a total of eight IPAC investigations (five where disciplinary action was taken). In 2015, there were 20 IPAC investigations (11 where action was taken); four investigations in 2014 (three where action was taken); and 11 investigations in 2013.
Global News contacted all 36 health units in the province to obtain 2017 statistics and found at least 20 IPAC investigations so far this year. Some of the common violations discovered by health inspectors include the use of expired sanitation products, single-use devices were reprocessed and re-used, and improper sterilization of equipment.
Stauffer believes more incidents of health violations at dentists’ offices would be discovered if those offices received regular inspections.
“There really needs to be a change in the system,” Stauffer said. “I think most people have no clue that this is sort of how things are going.”
Dr. Natalie Archer, a dentist based in Toronto, said while most dental offices practice proper health and safety protocols on a regular basis the province should look at moving towards bi-annual or annual inspections.
“I think an annual check or some sort of system is a really great idea,” Archer told Global News. “I know that there are guidelines available to the dental offices…working together with the ministry, working together with our members to ensure the public feels safe.”
Health and safety are vital to dental clinics, said Archer, and no family should have to go through the experience of having a child tested for HIV or Hepatitis.
She added that the recent infectious disease investigations in Guelph and Burlington have been stressful for the public but also for those in the dental profession.
“It’s been a wake-up call,” she said. “It’s been stressful for dentists and dental teams. Stressful for the public.”
What happens in other provinces?
Other provinces like B.C., Alberta and Nova Scotia do provide some kind of regular health inspection.
The Alberta Dental Association and College, for example, conducts what are called practice visits designed to help dentists implement the college’s Infection Prevention and Control Standards. In 2016, the college completed a total of 73 visits.
In Nova Scotia, dentists are subjected to a yearly, randomized self-assessment that is then reviewed by a committee of three other dentists who have practiced dentistry for at least five years. The Provincial Dental Board of Nova Scotia also said it undertakes regular inspection of “radiography equipment in all dental offices (X-ray units, panoramic, cephalometric, and CBCT) and a sedation inspection team is inspecting dental offices performing moderate and deep sedation.”
British Columbia operates under a complaint-based system similar to Ontario’s but carries out health inspections for offices or clinics that use sedation or anesthesia.
“We currently do proactive inspections of dental facilities that provide deep sedation and general anaesthesia,” said Anita Wilks, director of communications for the British Columbia College of dental surgeons. “The inspection framework is being expanded to include facilities that provide moderate sedation as well.”
Raymond Ramdayal, president of the Ontario branch of Canadian Institute of Public Health Inspectors (CIPHI) said regular public health inspections “play a crucial role” to ensure the health and protection of all Canadians, and are currently conducted on everything from swimming pools to restaurants to child care centres.
“Inspections provide not only an opportunity for us to enforce but also to educate as well,” Ramdayal said. “Our members have received the training, we have the skills necessary to conduct these inspections if required.”
WATCH: Should Ontario dental clinics be subject to regular inspections?
Ramdayal said currently, CIPHI is not mandated to conduct routine compliance inspections at dental offices as they are a regulated profession covered by the RCDSO.
He called routine inspections at dentist’s offices “critical” and his members would be more than willing to get involved if they were legislated to do so.
“We would be the people you would call upon to conduct these inspections,” Ramdayal said. “If directed to do so we will certainly enforce that.”
How is the Royal College of Dental Surgeons of Ontario responding?
Kevin Marsh, communications director for the Royal College of Dental Surgeons of Ontario, said the college has its own guidelines and own complaints process and currently works with all health units in the province to follow up on any complaints involving dental clinics.
“If we have an inspector available we will go in and see what’s going when [the public health inspector] goes in,” said Marsh. “There would probably need to be a change in the law to let the college inspect all dentists’ offices in the province.”
A spokesperson for the Ontario Ministry of Health said it has not received a regulation proposal from the RCDSO that would allow it to inspect dental clinics.
“We are always open to continued dialogues with any of the regulatory colleges on how to strengthen patient health and safety,” spokesperson David Jensen said in statement.
The RCDSO also currently operates inspection programs where clinics use dental CT scanners or provide sedation and general anesthesia services.
Marsh said the college is looking at implementing mandatory or even random inspections of dental clinics. He noted the college’s standards of practice – last updated in 2010 – is currently being reviewed by a panel of dentists, health inspectors and the Ministry of Health.
“Currently we are examining various possibilities to improve infection prevention and control compliance,” he said, noting there are about 10,000 dentists in Ontario. “That includes the possibility of inspections.”
“We don’t have any doubt that the vast majority of dentists are rigorous about infection prevention and control,” Marsh said.