STANDARDS of hygiene in Hong Kong dental practices are lagging far behind those in the West, according to sources within the profession. Concern is mounting that unless they improve, the territory may suffer its first known case of a dental patient contracting the AIDS virus or deadly hepatitis B. Meanwhile, plans to institute new guidelines to improve hygiene in surgeries, particularly in view of the threat from AIDS, are being delayed because Governor Chris Patten has yet to endorse the committee responsible for them. And with his departure for a month-long holiday, they are unlikely to be implemented for some time yet. Some dentists in Hong Kong employ the strict standards enforced in the United States, where random spot checks are made by government agencies to see that practitioners abide by legally enforceable rules. Dentists found wanting face being struck off unless they improve their methods within a short period of time. Strict regulations there were brought in after it was discovered that a dentist infected with the HIV virus passed it on to six of his patients, one of whom later died from AIDS. However, in Hong Kong no such sanctions exist. Once a dentist is licensed his practice is not monitored. And although the Department of Health issues guidelines from time to time on hygiene, there is no system to see that they are implemented effectively. One dentist we spoke to said he would not allow himself to be treated by the vast majority of the 1,297 private practices operating here and within the membership of the Hong Kong Dental Association. ''There is no standardisation of quality here. There is a lot of talk, a lot of literature but nothing concrete. I would like to see more done. Hong Kong is way behind everywhere else.'' The dentist, who declined to be named, said one of the problems was the cost of implementing standards of hygiene to match America. He also felt that the public should be educated to demand a higher quality of service. ''Patients aren't educated to ask 'What is going in my mouth and is it sterilised?' They put too much trust in the dentist. Many dentists in Hong Kong don't encourage questions. Of course, their standards are not going to be up to date unless people demand better.'' The dentist said that the implementation of good procedures was expensive, prohibitively so to some. Latest practices coming out of the West recommend the sterilisation by heat of the handpiece, a device which holds such tools as the drill, between patients. Previously, many dentists only sterilised the tools between patients and indeed some handpieces were not designed to be sterilised. A recent television documentary in Britain demonstrated that the handpiece could harbour all sorts of harmful bacteria and asserted that it was feasible these bugs could be passed on between patients. Investigators intercepted handpieces being sent for repair and grew cultures of bacteria from them, including the potentially lethal Staphylococcus aureus. Handpieces cost HK$7,000 to HK$10,000 each. In order to heat-sterilise them between patients and treat a steady stream of patients, a dentist would need to possess several. The process, which takes place in a machine called an autoclave, takes more than 40 minutes. Chemical sterilisation has long been considered inadequate. ''Not many dentists can afford to possess enough handpieces to make their practice economic, so they don't bother putting them in the autoclave between patients,'' said our source. ''It's risky but it's very difficult to trace the source of an infection back to the dentist. ''The public needs educating to ask about standards of hygiene, to know what to look for in a safe dentist. We treat every patient as a possible high risk patient. All dentists should do that to improve their standards.'' The dentist said that in America it was obligatory for dentists to wear gloves, masks and glasses as well as to autoclave instruments between patients. ''If you don't see these things you should change dentists,'' he warned. ''The most important thing is to protect yourself. You should ask how your dentist would like to be treated.'' Rupert Chung, secretary to the Dental Council, the authority which licenses and is responsible for the discipline of dentists in Hong Kong, admitted that checks were not made to ensure that hygiene guidelines were followed. He said there were no plans to institute monitoring of hygiene standards. He agreed that the more expensive the dentist was, the better and more hygienic his services were likely to be. But he said that if a patient had a complaint about hygiene they could refer it to the Dental Council, which has powers to suspend or strike off a dentist if they are satisfied he has breached the parameters of professional conduct. However, the complaints procedure is long-winded. Once a complaint is made, the chairman of the Dental Council decides whether there is a case to be made. If he decides there is, the complaint goes before a committee of three dentists. If they believe there is a prima facie case to consider, a full Dental Council hearing is held comprising 12 members including dentists, doctors and a lay member all appointed by the Governor. At this, the dentist can choose to be represented by legal counsel. Last year, 38 complaints were considered by the chairman, 16 made it to the committee stage and five cases came before the council. Of these, one dentist was found not guilty, one was suspended for two weeks and three were warned. The complaints were made up as follows: 21 for disregarding professional responsibilities to patients (including poor hygiene); 12 for improper or misleading advertising, representation or canvassing; one for using unqualified staff; one for abusing his position in order to forman improper relationship; three were described as miscellaneous. Mr Chung said the Dental Council was waiting for universal guidelines from the AIDS Council to be drawn up. ''Once we get them, we will decide how to implement them, whether they should be treated as advice or as part of the professional code.'' Aaron Kwok Wing-on, secretary of the AIDS Council, said the new membership of the council had yet to be approved by Mr Patten. He added that a working party had drafted a report for consideration by the council on dental services and the threat of AIDS. He could not say when this would be considered. Michael Sinclair, a Hong Kong-based dentist who contracted the AIDS virus and who now acts as the education officer for the Hong Kong AIDS Foundation, agreed there was a theoretical risk of infection from dirty dental handpieces, but added that he knew of no case in which one could pinpoint the handpiece as the source of infection. He said it was important to introduce standard hygiene procedures throughout the world and to have monitoring to ensure they are consistently met. ''I believe the guidelines we issue are effective enough but the monitoring and implementation of them is where the weakness lies. ''The guidelines are as close to providing 100 per cent safety as it is possible to get. Of course, the expense of implementing them would be one of the big considerations for dentists,'' he said.
