Thanks for an excellent post. Same thoughts and problems in Finland.

I’m interested in the legal aspect – how stressful is it to think of it? In the US, it seems to be much more disturbing than in Europe. I mean, there are moments when I’m not sure what to do and I end up thinking “hmmm, if I end up in jail, I guess that must be a cosy place”. Not very afraid of it!

We had a bad incident in HUSLAB (main blood sampling laboratory in Helsinki) in March this year. A lab assistant normally working somewhere else had come in for a day and was meant to take blood samples in one of the lab rooms. She knew how to do it and worked all morning without problems. She ran out of needles by midday and after searching for new ones, found a box where the previous worker had put used “safety” needles the previous day. She thought they were new and unused, and she had never seen a safety needle before. Only a few hours later she found another box where there were actual unused safety needles. At that moment she realized what the unused ones really look like. She panicked. She got home and called the boss, telling what had happened. She had taken about 20 blood samples using the contaminated needles.

What would’ve happened in the US after this?

In Helsinki, they instantly reacted on the phone call of the worker, investigated the whole case thoroughly, made the report public yesterday and by new safety standards, prevented the same thing from happening again. But no-one ended up in jail. No worker had to pay for anyone. It was _just_ a bad mistake, and many separate factors led to the outcome.

Somehow I really like that – it’s not always someones fault only. Things just happen and we STILL can learn from them.

Would you be willing to update your piece with a few comments on how you currently view this confusing situation? Hopefully, that would invite further comments from patients and practitioners. With this week’s headline news about a new E. coli superbug that is resistant to all antibiotics, this topic couldn’t be more important or timely.

Thanks.

I am 66 years old, female, in good health, and take no other medications. However, I do have periodontal issues that are being mostly stabilized by regular dental cleanings that have increased from every 3 months to every 8 weeks. Each time, I premedicate — 2 grams Amoxicillin one hour before. I am what I think dentists call a “compliant” patient. Very compliant.

I trust and respect my dental hygienist and my dentist who have worked together with me over 20 years. My personal dental hygiene practices verge on the obsessive, but in the end, despite all our best efforts, it looks like bad genes might well win out. They usually do — which brings me back to antibiotic prophylaxis.

After reading ADA recommendations, revised recommendations, other dental and medical recommendations, not to mention various “hedging my bets” and “covering my ass” recommendations, I have decided to no longer premedicate — starting with my root canal tomorrow. I think my regular dentist (who won’t be doing the root canal) will be just fine with my decision. The problem will be to convince my conscientious, meticulous hygienist.

Great blog. Thanks.

I recently attended a Grand Rounds session at the big ortho hospital here, and they were all about prophylaxis in all JR patients, for life! And they’re what I would consider a fairly big ortho group here. Interesting contradiction.

Most of my patients are migrants Hispanics, and rarely show up for elective dental work. Thus, I end up giving them antibiotics immediately following their OS anyway. The ones that do have JR are sickly looking anyway, and meet, “my,” inclusion criteria for prophylaxis.

I’m going to share this on my page, Alan!

http://www.startribune.com/sports/gophers/192404901.html