Ready to report, part 2: The state agency

March 1, 2009
I have an infection control problem with my employer. I read your infection control column faithfully.

by Noel Kelsch, RDHAP
[email protected]

Dear Noel:
I have an infection control problem with my employer. I read your infection control column faithfully. I often clip it out and put it on my dentist's desk. You give really great information, but nothing is changing in our office. I have tried talking to the dentist directly, but he just shrugs and says, “I know.” I am so concerned for my safety and my patients' safety. I am afraid that I need to take the next step and report him. Where do I start?

Ready to Report

I explained in the February 2009 issue of RDH how to report if the employee is at risk. This month, we discuss the course of action if the patient is put at risk.

If you see a dental professional putting a patient at risk by not complying with infection control guidelines, you must act. All dental professionals have an ethical responsibility to keep patients safe. Sometimes this will require us to operate outside of our comfort zone.

Stop the action now!

You need to assess how threatening the infraction is. Is the dental professional putting a patient's life at risk? If so, you need to move quickly. All dental professionals have the responsibility to do no harm. Is your silence doing harm? If the patient is in danger, it is every dental professional's responsibility to remove the danger immediately. That means that the dental professional has to inform the operator and the patient of the risk that is occurring. This is not an easy process but it is our ethical responsibility.

Each state's dental practice act has a section on infection control, as well as policies and methods for reporting infractions. These are developed to keep patients safe from harm. State governing boards (such as the health department, the dental board, or department of consumer affairs) oversee these issues.

Most states have a Web site (see Table 1 on next page) developed for anonymously reporting infractions of the dental practice act. You can feel safe when reporting a problem. Filling this form out as completely as possible will ensure that the agency has a full understanding of the situation. States have a safety net for those who report so that the employer cannot administer consequences.

Where not to report

There are sources where it is not appropriate to report these infractions:

  • Peer review and professional organizations: If the dental professional is a member of their professional organization, there may be a peer review process for their members. This process does not include infection control issues.

Normally a peer review committee will attempt to mediate the problem for their members only. They may meet to discuss the case, talk to the dental professional, and aid in education. The organizations do not have the authority to take disciplinary action against a member of the organization. According to a spokesperson for the American Dental Association, “There is no ADA peer–review process for infection control.”1

  • Centers for Disease Control and Prevention: According to a spokesperson for the CDC, “When the CDC investigates outbreaks, it is at the invitation of the state health department. It is most likely that when the CDC has been involved, it is because a cluster of cases of a particular problem or bacteria has been found. A state health department has asked for our help and then through an epidemiological investigation, a link with a dental office is identified.”

Dr. Srinivasan of the CDC stated, “If a breach of infection control from a dental office was reported to us, we would direct them to the state or local health department.”2

Utilizing the system for reporting infection control infractions is our ethical responsibility. Patient safety must be our first concern.


  1. Interview and correspondence with Fred Peterson, spokesperson for the American Dental Association. November, 2008.
  2. Interview and correspondence with Nicole Coffin and Christine Pearson spokespersons for the CDC. November, 2008.