Hepatitis B Outbreak Traced to an Oral Surgeon

Abstract

Over a four-year period in a five-county area, 71 patients with clinical hepatitis B had dental work performed in the two to six months before their illness. Fifty-five cases were traced to a single oral surgeon. Seventy-nine per cent of these patients were positive for hepatitis B surface antigen (HBsAg) and most had no other recognized source of hepatitis. An investigation of the implicated dentist uncovered no gross inadequacies in instrument sterilization or general dental procedures; however, the dentist was found to be an asymptomatic carrier of HBsAg of the same subtype (ay) as nine of 11 of his patients who had hepatitis and whose serums were available for testing. Since no HBSAg was found in the dentist's saliva, urine or feces, and since he admitted to having frequent cuts on his fingers, it is possible that a "hemoral" transmission of HBs Ag produced hepatitis in his patients.

Prevalence of hepatitis B virus infection and related risk factors in a rural community of Mexico.

“…It has been reported transmission of HBV to patients treated either by general surgeons 24 or oral surgeons. 25 No further research was conducted to identify potential sources of infection, but an improvement in the quality of these 3 identified risky medical procedures (surgical, dental, and transfusion) will certainly lead to a reduction in the risk of HBV infection in the inhabitants of San Juanito.…”

No longer 'written off' – times have changed for the BBV-infected dental professional

“…Not surprisingly, therefore, the risk to patients from infected HCWs is correspondingly high. The first indications of a possible risk to patients emerged in 1974 [38][39][40] with reports of acute hepatitis in patients of two chronically infected dentists. The evidence for risks from infected dental personnel became more concrete over the next few years.…”

“…43 The preventive role of operating gloves was demonstrated graphically in one study of a dentist who infected 55 patients over a period of approximately three years when he operated un-gloved but did not infect any of 8000 subsequent patients once he commenced routine glove wearing. 44 Whilst procedures such as glove use have had a major impact in reducing risk, it was clear that transmissions could still occur even when infection control procedures were followed , as exemplified by transmissions from a thoracic surgeon to 19 patients reported in 1996. 45 This case, and others, of transmissions from HBeAg positive HCWs resulted in guidance which prevented such individuals from undertaking EPPs in the UK.…”

Decontamination in primary care practice - a curate's egg, good in most parts

“…However, there are a number of incidents of transmission of infectious agents in dental practice, for example hepatitis B [8][9][10][11][12][13][14] and more recently Methicillin Resistant Staphylococcus aureus (MRSA) 15 , which highlight the potential for cross-infection if practice is poor.…”