Every dental office should have access to medical kit to manage emerging or emergency situations. The content of the kit depends on the nature of the patients and procedures being performed in the office. In reviewing any office kit, an assessor will consider accessibility and suitability of its contents in consideration of the nature of the practice.


Many of the procedures performed in a dental office are restricted to qualified professionals. Only those authorized legally may perform these procedures. For most other procedures not legally restricted to professionals, proper training and knowledge is critical for patient protection. Every office assessment will include a review of the activities of all dental office personnel and their qualifications.

As mentioned in the section on treatment operatories, the availability and use of appropriate personal protective equipment will be observed. Workplace safety and health legislation mandates employees must use appropriate personal protective equipment consistent with radiation protection and the manufacturer safety documents contained with all dental materials. Compliance with these requirements, as well as policies for management of injuries, exposure to blood borne pathogens and harassment will be reviewed.


A laboratory like a central radiograph processing area is an area with some increased risks for cross contamination to occur if proper procedures are not in place. Further, laboratory equipment can pose increased injury risks for untrained dental office personnel or if not properly maintained.

For offices that perform in-office laboratory procedures, the space used will be reviewed in a similar fashion as a central radiograph processing area with additional focus on equipment maintenance and safety.

Photo of conventional x-ray developer
While not an issue for offices with digital radiography, film based radiography needs a central processing area in the office. With multiple dental office personnel utilizing the area, this is a site with an increased potential for cross contamination between patients or patients and personnel. The fundamental requirement for central processing is to ensure the protocols for producing, transporting, processing and storing the radiographs limits risks of cross contamination for patients and dental office personnel. 

An office process will be evaluated based on any written protocols and observations. Any recommendations will focus on changes to minimize cross contamination in the operatory or processing area. If radiograph processing occurs in the same room as instrument reprocessing, protocols and barriers to separate the two areas will be evaluated as well.

The assessment of the central reprocessing area will focus on the consistency, predictability, organization and appropriateness of the area’s design and activities for instrument cleaning, sterilization and storage.

The physical features of the sterilization area need to be consistent with the requirements of current infection control and prevention standards. They need to allow for distinct areas to:

• hold unprocessed or dirty instruments and devices from operatories;
• clean instruments – which at a minimum requires a designated sink but may include an automated washer or an ultrasonic cleaner;
• rinse instruments – which may be done in the same sink designated for cleaning if proper protocols are established but ideally should be done in a second sink designated for the purpose. An automated washer normally has a rinse cycle appropriate for this purpose;
• inspect instruments. Regardless of  the process for cleaning, all instruments must be inspected prior to sterilization;
• drying instruments. Again regardless of the process for cleaning, all instruments must be dried prior to sterilization. With manual instrument cleaning, inspection and drying may be concurrent.
• instrument or cassette packaging area. Packaging must be appropriate for the intended purpose and comply with manufacturer instructions for its use. Storage and documentation of unsterilized instrument and cassette packages  must prevent unintentional use of the instruments before sterilization.
• sterilizer area. The area must be sufficient to meet manufacturer requirements for ventilation.
• storage area for sterile instruments and cassettes. If instruments are stored in the reprocessing area, it must be distinct from unsterilized instruments or packages and prevent aerosol contamination or physical damage to the packaging.

While other activities than instrument and equipment reprocessing may occur in the same room – supply storage, radiograph processing, laboratory procedures – the physical layout must allow for processes, protocols and barriers to limit risks of dental office personnel injury or instrument, supply or lab procedure contamination.

Activities in the area will be observed to ensure consistency with office protocols and current standard of practice for instrument and equipment reprocessing.
This includes:
contaminated instrument transportation; organized flow of instrument reprocessing; the use of personal protective equipment;
the impact of other activities in the area on reprocessing and
other mechanisms to prevent unintentionally using contaminated instruments in treatment and avoiding cross contamination of sterilized instruments.


As the primary site for dental procedures, an office assessment will focus on the treatment operatories. Cleanliness, patient safety and compliance with legal standards for material use, equipment and activities will be emphasized.

An assessor will begin with a general assessment of each operatory. In considering issues around cleanliness, they will be separated into housekeeping surfaces, clinical contact surfaces and storage areas.

Observation of infection prevention and control procedures in the operatories during set up; initial clean up; transport and storage will occur and be compared with written office policy and accepted standards of practice. 
Handwashing is critical in the reducing the spread of microorganisms. The convenience of handwashing stations and options in each operatory and their use by all dental office personnel will be reviewed during an assessment.

Use of barriers including personal one’s like masks, gloves, or eyewear and surface barriers on equipment and fixtures will be observed throughout the assessment process.

Equipment used intraorally like radiographic alignment devices, intraoral cameras or digital sensors must be cleaned and reprocessed according to manufacturer’s instructions between uses. The use of barriers may reduce reprocessing requirements for certain equipment if recommended by manufacturer.

An assessor will not observe an operatory during active patient care. In order to review certain infection prevention activities that occur during treatment - like instrument retrieval from storage, disinfection of multi-use dental material containers or amalgamator use, an assessor may speak with dental office personnel about how they perform these activities to prevent cross contamination.

Similarly, infection prevention activities in the operatory that may not coincide with the scheduled assessment as they normally need to be done daily or weekly like water or suction line disinfection or floor cleaning will be reviewed by a discussion with office personnel involved in those activities.

Although infection prevention and control is the primary focus of treatment operatory assessment, the function and safety of equipment used for patient care will be reviewed. All equipment must carry appropriate Canadian or provincial safety certification (CSA or CancerCare Manitoba).

Equipment – amalgamators, light curing units, radiograph machines – will be examined for obvious physical defects or dangers to patients or office personnel.
Dental materials including local anaesthetic cartridges will be examined to ensure appropriate use and compliance with manufacturer’s instructions.

It is important to note that office protocols can vary. In assessing these protocols, the focus will be on ensuring office systems and activities minimize the risk of contamination of sterilized instruments and prevent cross contamination between patients and between patients and dental office personnel.

Clinic area corridors are the hallways or stairwells used to access and exit treatment areas by patients and dental office personnel. The corridors will be assessed similarly to the patient waiting area on issues of cleanliness, safety and appropriateness.

In addition, the corridors must allow access by paramedic or other medical personnel to treatment operatories in the case of an emergency. Compliance with existing provincial or municipal building codes will be the expected standard.

The reception area is the hub of most activity in a dental office. It is the first point of contact for patients with you or your staff and access to other critical areas of the dental office. Key principles in the assessment of the reception area are security, confidentiality and professionalism.

As the access point to both confidential patient health records and patient treatment areas, the reception area must ensure a certain level of security.  Administrative and physical controls need to be in place to limit access to these areas to authorized personnel, patients and if appropriate the patient’s family members. In offices with information stored on computers or electronically, mechanisms to secure that information will be reviewed. An assessor will evaluate security issues with a significant amount of discretion and flexibility relative to the nature and style of the dental office’s practices.

Interrelated with security is confidentiality. A reception area must be designed and administered to ensure private patient information such as health, billing, family status is not disclosed by dental office personnel. Physical records and computer monitors must be positioned or stored to prevent access or observation by anyone other than the patient and authorized office personnel. Communications with patients - in person or on the phone – needs to be discreet with consideration given to the nature of the conversation and the proximity to patients in the waiting room.

First contact with dental office personnel usually occurs in the reception area. Professional appearance and communication is critical to establishing confidence in your office and the profession. An assessment will review the organization of the reception desk and written documents provided to patients in this area.

 

The patient waiting area often represents the character of you and your office to patients and the public. Outside of obvious professional or public safety issues, a significant amount of latitude for personal preferences of the owner will be given here. As it reflects on the profession, the patient waiting area needs to be clean, safe and appropriate.

As a general comment on cleanliness, it is a relative term used throughout the office assessment process with expectations varying depending on a number of factors including location in the office, control of space by dental personnel, time of day and even weather. The Assessor will take a reasonable, practical approach to the issue of cleanliness in the waiting area.

In waiting areas under the exclusive control of dental personnel, the Assessor will review cleanliness considering not only the appearance but also office processes in place to maintain cleanliness.

In the context of cleanliness in the waiting area, office processes should consider the use of surfaces and structures with physical attributes that allow for predictable maintenance.

They include:
the use of easy clean or non-porous surfaces for floors, seating, washroom and play structures;
mats in high traffic areas;
adequate storage space for toys,
entertainment systems, and
reading materials..

Other processes include standardizing the evaluation and maintenance of cleanliness in the waiting area. For example, fabric seating and carpeting are acceptable but are more difficult to maintain and will require additional efforts to ensure cleanliness. Similarly children’s’ play areas and entertainment features should have special administrative protocols for maintenance.

Associated with cleanliness are administrative controls to manage patients with potential respiratory infections. This is especially important in dental offices located in communities with a known risk for tuberculosis.

Safety issues in the waiting room will also be a part of the assessment. The condition of furnishings, flooring, play structures, bathrooms and storage will be reviewed. Clear risks for tripping, cutting, falling,, or electrical shocks will be identified.

The appropriateness of posters, reading materials, entertainment and marketing features will be reviewed in the context of the dental office patient base and the Code of Ethics. Unless the reading material or entertainment is offensive or vulgar, it will not be an issue. Posters and digital marketing materials are expected to meet the requirements of the Code for objectivity, truthfulness and verifiability.

Similar to the pre-visit questionnaire, office policy and protocol documents will be reviewed prior to the visit. The documents requested are based on the documents required by various statutes, regulations, bylaws or the standards of practice. A link will list all the specific documents an office should have available as well as to supporting materials to assist you in developing these documents for your office if they are not currently a part of your office policy manual.