Like my dental practice, most clinics in Modena (as well as in the other Italian towns) have one or two dentists. We have a large waiting room, two dental surgery rooms, a separate sterilisation room, a private office and a multi- function room with a technical unit, a photography set and a relax corner for the staff.
We provide comprehensive dental treatments to about 400 patients. This small number of patients per dentist (quite usual in Italy) enables us to offer a very careful, precise and personalised service. Patients are in fact very loyal and are almost all ‘active’ (they answer to the prophylaxis’ recalls).
Our workday begins at 8am and, after a short briefing, we start treatments at 9am, finishing around 5pm. One day a week, the practice is open to the public until 8.30 pm in order to see those working normal professional hours. The practice isn’t open on a Saturday but sometimes we use this day for staff training. Usual patient appointments are also rarely less than an hour long, as we prefer to complete more dental work in fewer sessions when possible.
Infection control
Following the last patient appointment of the day, the team dedicates an hour to cleaning and sterilisation procedures, preparing surgeries for the next day. As part of our care for patients, decontamination and infection control processes are a very important aspect of our practice and so all the protocols are strictly followed.
All the instruments that come into contact with patients’ mouths are single-use or sterilised after every use. The sterilisation procedure adheres to all the legal regulations and requirements set by the Italian National Health Service regarding the protection of health and safety in the workplace, including the following:
- All instruments are collected and transported to the sterilisation room in a rigid tray.
- Instruments are then subjected to manual cleansing, brushing, rinsing and drying (the professional always wears double layered gloves).
- Instruments undergo ultrasonic machine washing in a peracetic acid solution.
- They are then rinsed, dried, bagged (singularly or in a specially designed tray) and dated.
- Bagged instruments are then ready for autoclave sterilisation. We have two class B vacuum autoclaves in our practice – a main machine we use routinely and an auxiliary.
- Finally, all sterilised instruments are stored safely.
The sterilisation effectiveness within the autoclave is checked daily with a Helix test, and during every cycle with a vacuum test. Once a month, the equipment is also checked with a biological test to ensure no spores are present.
In addition to this procedure, we also cover all parts of the dental chair that can’t be sterilised (head rest, chair cover, handpiece cables) with cellophane film.
For the duration of any treatment, a chair-side dental assistant sits beside the dentist, wearing a mask and a face shield. During surgery sessions the assistants are doubled, so there is one chair-side who is ‘sterile’ and another who passes the instruments or anything else needed during the treatment.
All decontamination procedures are overseen by the professional allocated the ‘responsibility of services concerning prevention and protection’ (RSPP). In smaller practices like mine, this person is usually the practice owner.
A challenge in Italian dentistry
In general, the level of the decontamination and infection control standards in Italian dental practices is very high. Unfortunately, a number of situations have been reported for many years describing ‘dentists’ who are not actually authorised to practise dentistry – many are in fact dental technicians, and more rarely people completely uneducated in the field of dentistry, with fake qualification certificates. This is a huge problem and somewhat of an embarrassment in Italian dentistry for those who are properly trained and skilled. It has been estimated that one in four dentists could be fake. In these practices, the decontamination and
infection control protocols can be very deficient, with consequent high risks for the patients.
For this reason, in my opinion, patients should be much more aware of protocols followed in good practices than they are currently. They need to better understand that the expensive and complicated procedures followed in Italian dental practices are implemented for their own safety.
Modena is a historical city, located in Northern Italy. With 200,000 inhabitants it is a lively town, where modernity and tradition come together. Its central geographical location enables easy travel to different areas of Italy, so the town is much quieter in the summer when people go to the mountains or to the coast for a holiday. Modena is also the hometown of Ferrari, Maserati and Balsamic Vinegar!
Life in Modena flows quite easily: distances for going to work aren’t so long and the average working day usually ends at about 5pm.