Dental professionals are frequently exposed to pathogens and infection-transmitting organisms by contacting either contaminated equipment or bodily fluids. Patients are also at risk of exposure to biological contaminants, which may be present in dental unit water lines, unsterilized surfaces, and/or patients and staff suffering from or carrying a transmissible disease.1 Therefore, not surprisingly, dental practices have long been among the healthcare facilities other than hospitals that implement infection control and prevention protocols—including wearing protective gloves during surgical and non-surgical procedures.
Not only does glove use for personal protection and prevention of disease transmission make sense, but it’s also specifically recommended by the Centers for Disease Control and Prevention, Occupational Safety and Health Administration, and Organization for Safety and Asepsis Procedures.2 According to these organizations, dental professionals should wear gloves to prevent their hands from becoming contaminated when touching mucous membranes, saliva, blood, or other potentially infectious materials, as well as to reduce the likelihood of transmitting microorganisms on their hands to patients during dental procedures.3,4
Fortunately, a variety of gloves are available to ensure that all dental professionals can exercise barrier hand protection during both surgical and non-surgical procedures, regardless of their skin sensitivities and/or their or their patients’ allergies. These include gloves manufactured from natural rubber latex, nitrile, chloroprene blends, neoprene, nitrile, and butyl rubber, and which can be powdered or unpowdered.
However, the unfortunate consequence of the wide array of available gloves at different price points is confusion about when to wear which type of glove: sterile surgical, sterile or non-sterile examination, or non-medical. Also contributing to the confusion is recent research that contradicts best- and safest-practice recommendations.5-8
Regulated by the Food and Drug Administration (FDA) and considered a medical device, surgical gloves are indicated for surgical and clinical procedures that are invasive, involve cutting soft tissue or bone, and/or expose tissues that are usually sterile. Typically manufactured from natural rubber latex, nitrile, or a combination of latex or synthetic materials, these gloves are anatomically shaped for right/left hands and sealed in individual pair packages. Sterile surgical gloves are disposable and intended for use with only one patient, after which they should be properly discarded.
Because they are required by the FDA to meet sterility assurance standards, surgical gloves are much less likely to harbor pathogens that could contaminate the operative dental field compared to non-sterile examination gloves.9 For example, studies comparing the presence of bacterial organisms in freshly opened boxes of examination gloves to the same glove boxes after being in clinical use found a difference in bacterial loads between the new and nearly empty boxes.10,11
Additionally, sterile surgical gloves—which demonstrate more precise sizing to promote greater surgical precision and sensitivity—typically have lower pin-hole rates, which is an important factor differentiating them from non-sterile examination gloves. Sterile surgical gloves have an acceptable quality level of pinholes of between 1.0% to 1.5%; the acceptable quality level of pinholes for non-sterile gloves is approximately 1.5% to 2.5%.
Although sterile and non-sterile examination gloves are available, both types are also regulated and considered medical devices by the FDA. Typically made from natural rubber latex, nitrile, vinyl, and other types of synthetic materials, examination gloves are intended to be single-use, disposable, and worn for only one patient when procedures are non-surgical but involve contact with the mucous membrane.
Non-medical gloves are not regulated by the FDA and are worn when cleaning, disinfecting, and handling contaminated instruments. They should not be worn during patient care, even though they may be resistant to punctures and chemicals.12 Non-medical gloves that are not disposable should be sanitized after use.
When to Wear What & How
Any dental procedure involving direct or indirect exposure to blood or saliva requires glove use, in addition to proper hand hygiene. Hands should be washed immediately before putting gloves on and immediately after removing them. Small, undetectable defects may be present in the gloves, they could tear during use, or bacteria could infiltrate underneath the gloves.13 For the latter reason in particular, gloves with an adequate cuff extension are desired.
Nonsterile examination gloves can be worn for any patient care procedures that are not surgical, as previously described. However, it’s worth noting that one study found that after being worn to place a rubber dam prior to endodontic treatment, examination gloves demonstrated a higher bacterial colony count than before placement.11 This suggests that prior to opening a tooth, hand hygiene should be performed and new gloves used.
Sterile surgical gloves that fit well, enable comfortable finger movement, and promote good tactile sensitivity without instrument slippage should be worn during procedures that are invasive and involve cutting soft tissue or bone. Note that gloves that are too tight can impinge hand muscles and impede finger movements, while gloves that are too loose often lead to exertion of too much pressure.
Without question, cross-contamination and infections related to dental operatories are likelier to occur when infection control protocol are not followed—including the correct use of appropriate gloves.14 Additionally, even when meticulous attention is paid to glove selection, the integrity of sterile surgical gloves can be compromised when exposed to such chemicals as glutaraldehyde, hydrogen peroxide, acrylic monomer, and acid etchants, among others. Therefore, depending upon the task and procedures at hand—such as non-surgical procedures versus surgical procedures; sterilization duties and/or non-clinical tasks—it behooves dental professionals to wear the recommended protective gloves, and change them as necessary throughout any given patient appointment.
- Saccucci M, Ierardo G, Protano C, Vitali M, Polimeni A. How to manage the biological risk in a dental clinic: current and future perspectives. Minerva Stomatol.2017 Oct;66(5):232-239.
- OSAP. Frequently asked and answered questions. Infection control & safety. Dent Assist. 2012 Nov-Dec;81(6):10, 12-4, 16-7.
- Olsen RJ, Lynch P, Coyle MB, Cummings J, Bokete T, Stamm WE. Examination gloves as barriers to hand contamination in clinical practice. JAMA 1993;270:350–353.
- Kotilainen HR, Brinker JP, Avato JL, Gantz NM. Latex and vinyl examination gloves: quality control procedures and implications for health care workers. Arch Intern Med 1989;149:2749–2753.
- Chiu WK, Cheung LK, Chan HC, Chow LK. A comparison of post-operative complications following wisdom tooth surgery performed with sterile or clean gloves. Int J Oral Maxillofac Surg.2006 Feb;35(2):174-9.
- Brewer JD, Gonzalez AB, Baum CL, et al. Comparison of sterile vs nonsterile gloves in cutaneous surgery and common outpatient dental procedures: a systematic review and meta-analysis. JAMA Dermatol.2016 Sep 1;152(9):1008-14.
- Heal C, Sriharan S, Buttner PG, Kimber D. Comparing non-sterile to sterile gloves for minor surgery: a prospective randomized controlled non-inferiority trial. Med J Aust.2015 Jan 19;202(1):27-31.
- Creamer J, Davis K, Rice W. Sterile gloves: do they make a difference? Am J Surg.2012 Dec;204(6):976-9.
- Klein RC, Party E, Gershey EL. Virus penetration of examination gloves. Bio Techniques 1990; 9:196–199.
- McDaniel TF, Daugherty D, Wilson S. Bacterial contamination of clinical examination gloves. Gen Dent. 2007 Jan-Feb;55(1):33-5.
- Luckey JB, Barfield RD, Eleazer PD. Bacterial count comparisons on examination gloves from freshly opened boxes versus nearly empty boxes and from examination gloves before treatment versus after dental dam isolation. J Endod. 2006 Jul;32(7):646-8.
- Mellstrom GA, Lindberg M, Boman A. Permeation and destructive effects of disinfectants on protective gloves. Contact Dermatitis 1992; 26:163–170.
- Doebbeling BN, Pfaller MA, Houston AK, Wenzel RP. Removal of nosocomial pathogens from the contaminated glove: implications for glove reuse and handwashing. Ann Intern Med 1988;109:394–398.
- Volgenant CMC, de Soet JJ. Cross-transmission in the dental office: does this make you ill? Curr Oral Health Rep.2018;5(4):221-228.