Embracing a face shield: Federal guidelines on infection control are clear about protecting the face

Jan. 12, 2016
Dental hygienists perform many tasks in the line of duty that create the possibility of cross contamination, and a face shield is an important consideration in providing safety.

Federal guidelines are clear about protecting the face


Dental hygienists perform many tasks in the line of duty that create the possibility of cross contamination. We are in constant contact with hazardous microorganisms.1

We know risks are involved with any task we take on. We work with blood and saliva every day. These elements can and do transmit disease and carry pathogens. Vapors, droplets, and particles that are created during care can spread diseases such as hepatitis B and influenza.2

The Centers for Disease Control and Prevention (CDC) reminds us that mask and eye protection and face shields are for protection of critical areas of the face against dangerous microorganisms.3 In its eye and face protection standard, the Occupational Safety and Health Administration (OSHA) requires that face protection be used. The related OSHA standard requires the use of eye and face protection when workers are exposed to eye or face hazards. In the clinical setting, it is logical to include the use of a face shield in the prevention of the spreading of disease.

The CDC 2003 guidelines for primary PPE used in oral health-care settings include gloves, surgical masks, protective eyewear, face shields, and protective clothing (e.g., gowns and jackets). Yet how many of us include the face shield in our personal protective equipment line up?

On the OSHA website, this question is asked: "Can face shields protect employees instead of safety goggles or spectacles?" The agency answers, "Face shields alone do not protect employees from impact hazards. Face shields may be used in combination with safety goggles or spectacles to protect against impact."

Another question is: "Is training required before eye and face protection is used?" "Yes," the agency confirms, "training must be provided to employees who are required to use eye and face protection. The training must be comprehensive, understandable, and recur annually, and more often if necessary."

OSHA says this training should include at a minimum:

  • Why the eye and face protection is necessary and how improper fit, use, or maintenance can compromise its protective effect
  • Limitations and capabilities of the eye and face protection
  • Effective use in emergency situations
  • How to inspect, put on, and remove
  • Maintenance and storage
  • Recognition of medical signs and symptoms that may limit or prevent effective use

General requirements of OSHA's eye and face protection standard

While masks and eyewear approved by the American National Standards Institute cover much of the face, a shield will cover the rest and prevent contamination of the eyewear and mask from spatter. It is important to note that the face shield does not take the place of a mask or protective ANSI-approved eyewear that is designed to be impact resistant.

A study was done on dentists who were doing both prosthetics and periodontal procedures.4 The focus was on areas of the face that became contaminated during these procedures, including the nose, mouth, eyes, and zygoma. It revealed that the highest areas of cross contamination were around the nose and the inner corner of the eyes. The zygoma was the least contaminated area. The mucous membranes in the corner of the eye are an opening to the rest of the body that could allow pathogens to enter. Protecting that area is vital.

The contaminated areas during periodontal treatments were significantly more noticeable than during prosthetic treatments. This was thought to be because of more bleeding and soft-tissue irritation during scaling, and use of the ultrasonic created greater production of tiny particles. These are tasks the dental hygienist performs all day.1,4,5,6

In choosing PPE, we help prevent disease in our own lives and protect ourselves and those we come in contact with. Simply using a face shield can make a difference.

I have two tips:

1. Contact the manufacturer of your eye wear and face shield for disinfection and cleaning instructions. Reusable eye wear should be cleaned and disinfected between patients.
2. It's important to note the study referenced above also stated that herpes simplex virus is among the important risk factors transmitted in the tasks that dental hygienists commonly perform. Saliva may become infected with the virus not only through blood but also through gingival fluid.1,6,7 Patients with active herpetic lesions should not be seen for elective treatment in the dental setting. RDH


1. Kanjirath PP, Coplen AE, Chapman JC, Peters MC, Inglehart MR. Effectiveness of gloves and infection control in dentistry: Student and provider perspectives. J Dent Educ. 2009;73:571-80.
2. Bentley CD, Burkhart NW, Crawford JJ. Evaluating spatter and aerosol contamination during dental procedures. J Am Dent Assoc. 1994;125:579-84.
3. Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, et al. Guidelines for infection control in dental health-care settings-2003. MMWR Recomm Rep. 2003;52:1-61.
4. Nejatidanesh F, Khosravi Z, Goroohi H, Badrian H, Savabi O. Int J Prev Med. 2013 May; 4(5): 611-615. Risk of contamination of different areas of dentist's face during dental practices.
5. Mandel ID. The functions of saliva. J Dent Res. 1987;66:623-27.
6. Szymanska J. Microbiological risk factors in dentistry. Current status of knowledge. Ann Agric Environ Med. 2005;12:157-63.
7. Lewis MA. Herpes simplex virus: An occupational hazard in dentistry. Int Dent J. 2004;54:103-11.

NOEL BRANDON KELSCH, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists' Association.