The transition from bare hands to the routine use of protective gloves in dentistry represents a significant chapter in the history of infection control. This shift resulted from decades of medical advancement and a public health crisis that mandated change. The introduction of standardized protective equipment (PPE) fundamentally altered the safety of both patients and dental professionals. Understanding this change requires examining the initial use of gloves in medicine and the specific risks inherent in the dental environment.
Early Medical Use of Protective Hand Coverings
The concept of using rubber gloves in a medical setting dates back to the late 19th century, starting in surgery rather than dentistry. Dr. William Halsted, a prominent surgeon at Johns Hopkins Hospital, introduced the first rubber surgical gloves in 1889. His initial motivation was not to prevent patient infection but to protect a staff member.
Halsted arranged for the Goodyear Rubber Company to create thin rubber gloves for his scrub nurse, Caroline Hampton, who developed severe contact dermatitis from the harsh antiseptic chemicals used at the time. Other members of the surgical staff quickly adopted them for their own protection. It was observed later that the use of gloves dramatically reduced the rate of post-operative infections, demonstrating their value in asepsis. Despite this early adoption in the operating room, the use of gloves for routine procedures in dentistry remained uncommon for many decades.
Infection Risk in Pre-Protocol Dentistry
Before mandatory barrier techniques, the dental operatory was an environment ripe for cross-contamination. Dental procedures inherently involve contact with blood and saliva, which are primary vectors for various pathogens. The use of high-speed drills and ultrasonic scalers, which became common in the late 1950s, created fine mists containing oral microorganisms. This bioaerosol settled on surfaces, potentially transmitting infection to the dental team and subsequent patients.
Without gloves, the dentist’s bare hands became easily contaminated with patient blood and saliva. This contamination was transferred to instruments, equipment, and surfaces, creating a pathway for disease transmission between patients and the practitioner. Routine barrier protection was neglected, leading to a higher incidence of infectious diseases among dental professionals. This lack of protection established a clear danger that was often overlooked until a catalyst forced a policy change.
The Public Health Crisis That Forced Change
The widespread and mandatory use of gloves in dentistry began in the mid-1980s, driven by the emergence of the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS). Although the risk of bloodborne illnesses like Hepatitis B (HBV) was already known, the highly publicized threat of HIV/AIDS dramatically changed perceptions of disease transmission. The focus shifted to treating all patients as potentially infectious, regardless of their medical history.
The Centers for Disease Control and Prevention (CDC) first recommended “Universal Precautions” in 1985. This required all healthcare workers to treat blood and certain body fluids as if they were infectious for HIV and HBV. These guidelines specifically included the mandatory use of protective barriers, such as gloves, for procedures involving exposure to blood or saliva.
The Occupational Safety and Health Administration (OSHA) followed this with regulatory enforcement, issuing the Bloodborne Pathogens Standard in 1991. This standard made the use of personal protective equipment, including gloves, a legal requirement for protecting workers from infectious materials. This regulatory action solidified the shift, ensuring gloves became a standard part of every dental examination and procedure.
Modern Protocols and Universal Precautions
Today, the use of gloves is a fundamental element of Standard Precautions, the updated version of Universal Precautions. This protocol mandates that gloves must be worn whenever there is potential contact with a patient’s blood, saliva, mucous membranes, or contaminated surfaces. Non-sterile examination gloves are used for routine exams, while sterile surgical gloves are required for oral surgical procedures.
Modern dentistry employs gloves made from various materials, including latex, nitrile, and vinyl, to accommodate different needs and allergies. Nitrile and vinyl provide alternatives for practitioners or patients with latex hypersensitivity. Strict protocols require a new pair of gloves for every patient, which must be removed immediately after the procedure.
Gloves must never be washed or reused. Hands must be thoroughly cleaned immediately after glove removal because microscopic tears or punctures can allow contamination to reach the skin. These procedures ensure the glove acts as a single-use barrier, preventing the transfer of microorganisms between patients and the dental team.