Viruses dental office

McCarthy Published 1 November Medicine Journal In addition to the bloodborne pathogens BBPs — human immunodeficiency virus HIV and hepatitis B and C viruses HBV and HCV — other viruses of concern in the dental office include rubella, mumps and measles viruses; the herpes viruses herpes simplex virus [HSV] types 1 and 2, varicella-zoster, Epstein-Barr virus [EBV], cytomegalovirus and human herpes virus 6 ; human papilloma viruses; adenovirus; coxsackie viruses; and the upper respiratory tract pathogens influenza A and B viruses… Expand.

View on PubMed. Save to Library Save. Create Alert Alert. Share This Paper. Background Citations. Topics from this paper. Citation Type. Has PDF. Publication Type. More Filters. In the literature, there is a lack of available reports regarding HDV infections in dentistry.

One paper reported an outbreak of HDV in the s where dentists were involved Viruses are mainly associated with a specific disease whilst for many bacteria this is not the case. Often transmission of bacteria does not result in a real infection, especially when opportunistic bacteria are involved. In the following sections, some severe pathogens are discussed that are potentially transmitted in the dental office.

Furthermore, special forms of commensal bacteria that are multi -resistant to antibiotics are discussed, since they can result in severe and even lethal infections. Mycobacterium tuberculosis causes the disease tuberculosis TB. Other Mycobacterium spp. TB continues to be a major health burden in the twenty-first century with an estimated 1. In the UK the number of reported cases of TB have been rising in recent years Furthermore, the emergence of multi-drug resistant strains of M.

Transmission of M. It is thought that as few as 1—5 bacilli are required to initiate infection In latent infection the bacteria remain viable in the body for many years without causing an active infection but retain the ability to activate under favorable conditions.

It is not possible to predict who will develop active TB at some point Other risk factors include alcoholism, and poor nutrition The possibility of M. Most dental clinics in the US were considered to fall within a very low risk category 56 , Despite the putative low risk, evidence for the transmission of TB in dental practice is present. In the UK a report documented cases of intraoral and pulmonary TB in patients that had been infected by their dental surgeon All of the patients had tooth extractions performed by the dental surgeon who had active pulmonary TB.

Furthermore, dental team-to-dental team and possibly patient-to dental team TB infection was documented 59 , Hospital dental staff may be at increased risk of exposure to TB 60 , The risk of TB transmission in the dental practice appears to be low. However, transmission of TB remains possible, primarily through patients from high risk areas in the world or from patients with reactivated TB infections such as the present-day elderly who may have been exposed to TB in their youth. The opportunistic pathogen Pseudomonas aeruginosa is frequently recovered from DUWLs where it can form biofilms in the tubing.

Pseudomonas spp. Furthermore, P. Patients with cystic fibrosis, known to be exceptionally susceptible to Pseudomonas spp. Others reported two patients with solid tumors that developed gingival abscesses with pyocin-matched P. Furthermore, 78 subjects with no underlying medical condition were transiently colonized for 3—5 weeks with P. Given that the incidence of Pseudomonas spp.

Although reports in this area are conflicting 73 , 74 ; DUWL endotoxin from gram-negative bacteria such as Pseudomonas spp.

Therefore, further studies will be needed to verify this potential health hazard. Legionella spp. Legionella pneumophila , particularly L. Inhalation of aerosols contaminated with Legionella spp. DUWLs harbor microbial biofilms that are seeded by the mains water supply and can provide a suitable environment for the multiplication of Legionella spp. In particular, prevalence rates vary with differing geographic location While the prevalence of Legionella spp.

The number of colony forming units CFU's of Legionella spp. The infective dose of Legionella spp. Recently a case was published of a patient that was infected with L. After hospitalization because of the pulmonary problems, the patient died from this infection. By using molecular typing methods, it was clearly shown that the source of the Legionella infection was the DUWL in a dental practice, where both the tap water and the unit water were contaminated.

It is remarkable that only one patient acquired this Legionella. Even Pontiac fever was not found within the other patients in this office. To date, there are no known cases of Pontiac fever in patients, resulting from visits to, or treatment in, a dental clinic.

This would indicate that the risk to patients posed by Legionella spp. However the risk is not absent and infection can have dramatic consequences. In addition, cases of Pontiac fever that appear 1 week after a dental visit may not be recognized as such and the link between disease and dental treatment is not acknowledged. There is a single documented fatal case of Legionnaire's disease in a US dentist. In this case the infection was attributed to exposure of the dentist to DUWL aerosols containing Legionella spp.

The evidence in this case was not conclusive. Studies have found dental staff to have higher serum levels of antibodies specific to Legionella spp. This is indicative of an increased occupational exposure to Legionella spp. However, the lack of investigation into the DUWLs of the dental clinics in other cases of Legionnaire's disease or Pontiac fever in dental staff could have led to under-reporting. Multi-resistant bacteria pose a major health risk and are increasing the cost of healthcare worldwide Multi-resistant bacteria are mainly transmitted by direct contact or indirectly via contaminated surfaces.

Increased risk of colonization by multi-resistant bacteria is associated with long hospital stays, living in a nursing home, institutional and international patient transfers, surgical procedures and the presence of invasive devices, severe medical conditions, immune suppression and antimicrobial therapy 91 , Among hospitalized patients receiving treatment for oral conditions, oral cancer patients have been reported to be at increased risk for MRSA colonization 96 — Carriage rate is influenced by the age and the overall disease status of the host In a recent literature review, MRSA carriage in healthcare workers was found to be 4.

In most studies, MRSA carriage in dental healthcare workers has not been above the level of the normal adult population In the greater Houston metropolitan area 4.

During 1 year of surveillance in a dental hospital clinic, 8 out of patients were colonized or infected with MRSA after treatment. The air—water syringe and the chair arm of the dental chair were contaminated with MRSA. The antibiograms revealed that the isolated MRSA strains were similar between patients and the contaminated chair and it was concluded that the patients were colonized or infected by parts of the dental chair Furthermore, MRSA has been isolated in dental clinics outside of the hospital environment Moreover, devices such as dental impression guns were reported to be contaminated with MRSA in routine use Dental impressions and gypsum casts were also shown to be heavily colonized by MRSA They have spread particularly via international hospital transfers from epidemic areas.

In healthy individuals oral colonization by Enterobacteriaceae or Pseudomonas spp. Even transiently colonizing bacteria can be part of the flora of oral cavity related abscesses and source of cross-transmission There are no published reports available on the possible association of ESBL- or carbapenemase-producers and oral infections nor evidence for transmission of these bacteria through the dental practice.

Hence, MRSA has been shown to be transmitted in dental care. However, evidence for the transmission of ESBL- and carbapenemase-producers does not exist yet, although transmission in the dental practice is possible. This paper aimed to report and discuss the current literature on the transmission of relevant viruses and bacteria in dentistry. All viruses and bacteria discussed above can be, and most have been, proven to be transmitted to the patient or the dental team in the dental practice.

It appears that the transmission of, and infection with, Hepatitis B virus poses the greatest risk for both patients and the dental team, based on the incidence and risk of transmission. Literature on the transmission of the other bacteria and viruses is scarce and it seems that the risk for transmission resulting in an infection with these microorganisms is low.

It should be noted, however, that transmission of pathogens may result in an asymptomatic infection that can last weeks or even months until symptoms appear Table 1. In addition, it is likely that some patients that visit the dental practice are not aware of their infectious status and may carry an asymptomatic infection. There is a lack of prospective longitudinal studies that investigate the incidence of healthcare-associated infections in patients after dental treatment.

Incubation period of microorganisms associated with healthcare infections in dentistry. Another important point to keep in mind is that the likelihood of healthcare-associated infections, particularly in dentistry, of being detected, reported, documented and published is small Therefore, healthcare-associated infections are under-reported in literature from the developed world 27 , In developing countries the risk of transmission of several microorganisms, for instance the blood borne viruses, is high since a large section of the population is infected.

However, literature on the subject from these countries is scarce. Based on the number of reported cases, most of which were of blood borne viruses, the actual risk for developing an infectious disease through the dental practice appears to be low.

However, the real transmission rate of the viruses and bacteria that are discussed in this paper is probably higher. As long as accurate data are absent, the dental team should be fully aware of the risk of dissemination of potentially hazardous microorganisms and ensure that efficient cross-infection control procedures are well in place Every member of the team must follow the standard procedures required to prevent the transmission of microorganisms.

Besides preventing disease by vaccination, these include hand hygiene, personal barrier protection, instrument disinfection and sterilization protocols, surface decontamination strategies, approaches to maintain the quality of DUWLs, as well as the emergency procedures in case of accidents that would increase the risk of cross-transmission.

These procedures substantially lower the risk of the transmission of microorganisms. Every patient should be treated as potentially infectious. The dental team should be acquainted with the biological principles behind these procedures. The cross-infection control regulations should undergo regular monitoring and need to be subjected to revision whenever necessary. National Center for Biotechnology Information , U. Journal List J Oral Microbiol v.

J Oral Microbiol. Published online Jun Kistler , 2 G. Belibasakis , 3 H. Author information Article notes Copyright and License information Disclaimer. Email: ln. Laheij et al. This article has been cited by other articles in PMC. In other words, many of the high-touch areas in your office could be vectors for the spread of virus. And the more colleagues that touch them, the higher the risk of contamination. Jonathan Sexton, a researcher at the College of Public Health at the University of Arizona, found that places such as refrigerators, drawer handles, faucet handles, push-out exit doors and coffee pots tend to have the highest concentrations of germs.

Refrigerators, drawer handles, faucet handles, push-out exit doors and coffee pots tend to have the highest concentrations of germs.

Credit: Getty Images. And they travel quickly, according to a study from the American Society for Microbiology. Researchers placed a sample of a harmless virus on a single doorknob or table-top in an office building.

The first area that was contaminated was the coffee break room, says study researcher Charles Gerba, a microbiologist at the University of Arizona. JADA ; Use of infection control guidelines by workers in healthcare facilities to prevent occupational transmission of HBV and HIV: results from a national survey. Infect Control Hosp Epidemiol ; 15 4 Pt 1 Preventing bloodborne pathogen transmission from health-care workers to patients.

Surg Clin North Am ; Lethal outbreak of hepatitis B in a dental practice. An outbreak of hepatitis B in a dental practice. Ann Intern Med ; Hepatitis B outbreak traced to an oral surgeon. N Engl J Med ; Injections given in healthcare settings as a major source of acute hepatitis B in Moldova. Int J Epidemiol ; Hepatitis B virus, Hepatitis C virus and human immuno deficiency virus infection in health care workers: a multiple regression analysis of risk factors.

J Hosp Infect ; Polakoff S. Acute hepatitis B in patients in Britain related to previous operations and dental treatment. Occupational risk for hepatitis C virus infection among New York City dentists. Lancet ; Occupational risk of hepatitis C infections among general dentists and oral surgeons in North America. Am J Med ; 5.