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On the Other Hand

Feb. 1, 2008
Years ago, it was rare to see anyone other than an oral surgeon or a periodontist wear gloves.

By Anne Nugent Guignon, RDH, MPH

Years ago, it was rare to see anyone other than an oral surgeon or a periodontist wear gloves. Twenty-six years ago, concerns about infection control started getting big press as the public became concerned about the transmission of both bacteria and viruses, especially in health-care settings. Routine use of gloves became a basic standard of personal protection. Initially, product selection was minimal and quality was often questionable.

Requests from dental offices all over the country began to inundate product manufacturers. It took time for manufacturers to build facilities that could keep up with the demand. At first, clinicians paid little attention to the fit, feel, or effectiveness of a specific product. We used whatever was available in our practices, oblivious to the impact of these items on our personal health.

Times have changed. Numerous companies now manufacture gloves. We have the opportunity to select products that contribute to our personal workplace safety. In the health-care setting, it is important to make sure that any glove meets medical-grade standards.

Gloves should provide a barrier to your skin against harmful chemicals and potentially dangerous blood-borne pathogens. To sell medical-grade level exam gloves in the United States, manufacturing facilities overseas must meet FDA 510K registration standards. These standards provide guidelines regarding pinholes and other imperfections; however, these standards do not approve or certify specific brands for medical use. Inexpensive general-purpose gloves are not appropriate for the dental office.

Select gloves for the specific task. Both sterile and nonsterile clinical exam gloves are appropriate for treatment procedures but not instrument cleanup. In the manufacturing world, clinical gloves are known as thin film gloves and are made from latex, nitrile, or chloroprene. Today, two-thirds of all gloves sold are latex, but with the growing trend to reduce or eliminate latex exposure for both the patient and the clinician, nonlatex gloves are increasingly popular.

It is estimated that between 10 and 17 percent of all health-care professionals have sensitivity to latex, compared to 1 to 6 percent of the general population. Since we are at increased risk, it makes sense to consider nonlatex alternatives.

Three different materials are used to fabricate nonlatex gloves. Nitrile is by far the most popular due to its high puncture and chemical resistance. Newer, improved formulations result in gloves that fit well, feel thin, and stretch, with today’s price point comparable to latex. In reality, nitrile gloves are less expensive than other exam gloves because it is rare for a nitrile glove to rip, resulting in more usable gloves per box. Glove sales of nitrile products over the past few years have increased steadily, indicating that clinicians’ glove preferences are changing.

At first, nitrile gloves may feel different than latex, but most clinicians adapt to the gloves in just a few days. Once accustomed to the new feel, it is apparent how much compression natural rubber latex puts on the hand, much like a stretched rubber band putting pressure on the soft tissue, nerves, blood vessels, tendons, and ligaments.

Chloroprene gloves are another nonlatex alternative, but they do not stretch as much as the new nitrile formulations. However, they are appropriate from a barrier standpoint. Vinyl gloves pose the biggest challenge ergonomically and are best for short duration, nonclinical procedures or use as an overglove.

In addition to considering the actual fabric, it is essential to use a glove that fits well. Hand size and shape are unique to each individual. It is unrealistic to expect that everyone will be comfortable with the same type, size, or brand of glove. Select a glove with adequate finger length and one that fits well across the palm and around the wrist. Gloves that are too small can cause unnecessary compression to the soft tissue surrounding the carpal tunnel in the wrist, restrict freedom of movement, or create stress on the fingers. Gloves that are too large also create problems. The user’s musculoskeletal system is under constant challenge to perform exacting procedures while keeping the gloves from slipping. Over time, the seemingly harmless factors created by using the wrong glove size can result in hand fatigue or even development of a workplace-related injury.

The thumb is particularly vulnerable since it sits in a different dimensional plane than the other four digits. Ambidextrous gloves can further exacerbate thumb stress, because the glove is designed with the thumb in the same plane as the other four fingers. Properly fitted, hand-specific, right and left gloves eliminate dangerous thumb torque. More clinicians than ever are choosing this type of glove for procedures other than a very short exam, increasing hand comfort, especially for longer wear times.

Smooth-surface gloves work well for a dry procedure, but gloves that have surface texture either on the fingertips or throughout the entire surface reduce the effort it takes to hold on to an instrument in a wet environment. Remember, just like tires on a car, texture equals traction. Gloves can be ordered that are either thicker at the fingertips or that have a longer cuff length, which increases the total surface area protected by the glove.

All glove fabrics are available in powdered and nonpowdered styles. Powder acts as a dry lubricant and facilitates getting a glove on and off, but other factors come into play when using a powdered glove. Some clinicians report contact dermatitis from constant exposure to the drying effects of the powder, which removes beneficial skin moisture. Most manufacturers now use food-grade cornstarch rather than talc.

In the case of natural rubber latex, potentially harmful latex proteins can bind with the powder and disperse through the office via natural air movement. In addition, powder particles can also be a vector for spreading pathogenic organisms or other chemicals into the environment.

Powder-free latex gloves are increasingly popular. The manufacturing process includes one additional step called chlorination, where gloves are washed in a solution that lowers the latex protein levels, therefore reducing the likelihood of latex sensitivity. Some manufacturers add a polymer coating to make it easier to don powder-free gloves.

One final thought – Have you ever considered whether a glove is clean right out of the box? Unless it is an individually wrapped sterile glove, there is no real way to know. Companies based in the United States are required to follow multiple federal regulations and standards and are responsible for all products they distribute, regardless of the location of the manufacturing facility. Most companies go to great lengths to build and maintain clean plants and perform routine inspections of all manufacturing operations. ISO standards require maintenance of a complex set of standards, regardless of the location.

Hand health is critical. Until robots can scale teeth, we’re going to need gloves that provide adequate protection, proper fit, and are made from materials that do not create additional health issues. Your hands deserve the best, and good quality gloves are one more part of your comfort zone.

About the Author

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Anne Nugent Guignon, RDH, MPH, is the senior consulting editor for RDH magazine. She is an international speaker who has published numerous articles and authored several textbook chapters. Her popular programs include ergonomics, patient comfort, burnout, and advanced diagnostics and therapeutics. Recipient of the 2004 Mentor of the Year Award, Anne is an ADHA member and has practiced clinical dental hygiene in Houston since 1971. You can reach her at [email protected] or (832) 971-4540, and her Web site is