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As adopted by the ADA House of Delegates October, 1999 and
amended October, 2004
Introduction
The dental office is a safe place to provide and receive dental
care. Current and generally accepted epidemiological
information supports the conclusion that there is no significant
risk of contracting bloodborne diseases through the provision
of dental treatment when appropriate infection control procedures
are followed.
The dental profession in the United States
has a long tradition of providing appropriate
and compassionate care to the public,
including individuals with special needs.
The American Dental Association (ADA) believes that it has the
responsibility to articulate a clear position on issues related
to bloodborne pathogens and diseases and to formulate policy based
on current and generally accepted scientific knowledge and accepted
moral, ethical and legal imperatives.
This policy statement, addressing bloodborne
pathogens, infection control and
the practice of dentistry, will be reviewed
on a regular basis and may be modified
as scientific knowledge of bloodborne pathogen
transmission and prevention in heath care settings evolves. The
Association urges dentists, other dental workers who may participate
or assist in dental procedures, and dental laboratories to follow
all ADA policies that deal with bloodborne pathogens.
A key element of infection control is
the concept of standard precautions, introduced by the Centers for Disease
Control and Prevention (CDC) as a means
to reduce the risk of bloodborne pathogen
transmission (e.g., the Human Immunodeficiency Virus [HIV], Hepatitis
B Virus [HBV] and others) in healthcare settings. The primary
principle behind standard precautions centers on the premise that
medical history and examination cannot reliably identify all patients
infected with bloodborne pathogens. All patients, therefore, must
be regarded as potentially infectious. As such, applying
standard precautions requires that infection
control procedures (e.g., HBV vaccination, routine handwashing,
use of protective barriers and care in the use and disposal of
needles and other sharp instruments) are used for every patient.
Most studies suggest that the prevalence of HCV infection among
dentists is similar to that among the
general population. Furthermore data historically
indicate a higher HBV seroprevalence
rate among dentists than the general population,
however, declining overall seroprevalence rates and significantly
lower rates among dentists under age 40 reaffirm the safety and
efficacy of currently recommended infection control
measures with respect to bloodborne pathogens.
The dental profession, therefore, is strongly urged to continue
to adhere to current infection control recommendations as set
forth by the ADA and the CDC.
Since the implementation of standard
precautions in the United States
as a main element of infection
control, and with the exception of the Florida
case-cluster where HIV may have been
transmitted from a dentist to six patients,
there have been no documented cases of HIV transmission
from dentist to patient, patient to dentist,
or patient to patient as a result of dental treatment.
Similarly, since 1987 and the implementation
of standard precautions, there have been
no documented outbreaks of HBV or HCV associated with the practice
of dentistry.
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Patient Issues
Infection Control: Patients infected with bloodborne pathogens
can be safely treated in the private dental office. Current epidemiological
evidence indicates that there is no significant risk of contracting
bloodborne diseases through the provision of dental treatment
when standard precautions are routinely followed. The practice
of standard precautions is an effective means of reducing blood
contacts that can result in bloodborne pathogen transmission,
minimizing even further the already low risk of disease transmission
in the dental office.
Vaccination: The Association urges dentists and other dental workers
who may be at reasonable risk for infection to take advantage
of the hepatitis B vaccine, and other vaccines, to protect themselves
and patients from infectious organisms. In addition, the Association
supports having all dental, advanced dental and allied dental
education programs encourage the vaccination of students, faculty
and staff against infectious organisms.
Referral for Medical Evaluation: Dentists should be alert to signs
and symptoms of bloodborne disease that may be identified during
the provision of dental care. Patients with medical histories
or conditions possibly indicative of infection should be referred
to their physicians for diagnostic procedures, counseling and
medical follow-up.
Patient Disclosure: The Association believes that all patients
infected with a bloodborne pathogen(s) should disclose their bloodborne
pathogen status as part of their medical history; dentists, like
physicians, need to know every patient’s medical history
in order to make appropriate treatment decisions that are in the
best interests of the patient.
Access to Care: The Association believes that individuals infected
with a bloodborne pathogen(s) should be treated with compassion
and dignity and should have access to dental treatment. Treatment
considerations should be based on current and generally accepted
scientific knowledge. A dentist should not refuse to provide oral
health care that is within the dentist’s current realm of
competence solely because the patient is
infected with a bloodborne pathogen.
Furthermore, the ADA’s Principles of Ethics and Code
of Professional Conduct states that a dentist has the general obligation
to provide care to those in need. A decision not to provide treatment
to an individual based solely on the fact that the individual
is infected with a bloodborne pathogen is unethical.
Professional Judgment: The ADA supports the right and responsibility
of each dentist to exercise his or her best professional judgment,
based on current and generally accepted scientific knowledge and
the ethics of the profession, in all situations regarding when
and how to treat and whether to refer each patient.
Exposure Incidents: The Association recommends that dentists be
familiar with current CDC postexposure protocols for the management
of occupational exposures to bloodborne pathogens and that dentists
institute office policies to ensure appropriate and efficient
management of exposure incidents. The ADA recommends that the
costs associated with postexposure prophylaxis and exposure sequelae
be a benefit of Workers’ Compensation insurance coverage.
Confidentiality: The Association urges dentists to maintain strict
confidentiality of a patient’s bloodborne pathogen status
and medical condition. Under the Association’s Principles
of Ethics and Code of Professional Conduct, dentists are ethically
obligated to safeguard the confidentiality of patient records
and to maintain patient records in a manner consistent with the
protection of the welfare of the patient. This does not prevent
dentists from sharing information about the patient’s bloodborne
pathogen status and medical condition with the patient’s
other health care providers when allowed by state or federal law.
Dentists are encouraged to have an office protocol, in accordance
with applicable laws, for the confidential handling of information
about patients infected with a bloodborne pathogen(s).
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Provider Issues
Practice Restrictions/Disclosure: The ADA affirms that dentists
infected with bloodborne pathogens can safely
provide dental care, and that bloodborne pathogen infection alone
does not justify the limiting of professional duties or automatically
mandate disclosure provided proper infection control procedures
are implemented. Infected dental health care workers must practice
in compliance with CDC or equivalent infection-control recommendations,
as required by applicable law.
If the government mandates testing for bloodborne
pathogen infection and disclosure for
health care workers who test positive, the ADA Council on Government
Affairs will investigate and pursue national
legislative possibilities of a government-sponsored insurance
program that would guarantee reasonable financial compensation
to health care workers who may be discriminated against upon disclosure
of their disease status.
Infection Control: Current epidemiological evidence
indicates that there is no significant risk of contracting bloodborne
diseases through the provision of dental treatment when standard
precautions and recommended infection control procedures are routinely
followed. Practicing standard precautions is an effective means
of reducing blood contacts that can result in bloodborne pathogen
transmission, minimizing even further the already low risk of
disease transmission in the dental office.
However, because the foremost concern of
the dental profession must continue to
be protection of the patient, the Association
strongly encourages all dental health care workers to undergo
personal evaluation and assess their need
to determine their bloodborne pathogen status. Furthermore, dental
health care workers who believe they are at risk for bloodborne
pathogen infection should regularly monitor their status. All
dental health care workers testing positive for a bloodborne pathogen
must practice only in strict compliance with the current infection-control
recommendations of the CDC for infected providers or their equivalent,
as required by applicable law; this includes submitting to, and
adhering to any objective and appropriate restrictions imposed
by expert review panels with competent jurisdiction, as outlined
by the CDC.
The high ethical standards of the dental
profession establish the welfare of the
patient as the dentist’s
primary ethical obligation. The Association’s Council on
Ethics, Bylaws and Judicial Affairs has stated in an advisory
opinion to the ADA Principles of Ethics and Code of Professional
Conduct that a dentist who contracts any disease or becomes impaired
in any way that might endanger patients or dental staff shall,
with consultation and advice from a qualified physician or other
authority, limit the activities of practice to those areas that
do not endanger patients or other health care providers.
Exposure Incidents: The Association’s Principles
of Ethics and Code of Professional Conduct requires that all dentists, regardless
of their known bloodborne pathogen status, have an ethical obligation
to immediately inform any patient they suspect may have been exposed
to blood or other potentially infectious material in the dental
office of the need for postexposure evaluation and follow-up and
to refer the patient, as needed, to a qualified healthcare practitioner
who can provide postexposure services. The dentist’s ethical
obligation in the event of an exposure incident extends to providing
information concerning the dentist’s own bloodborne pathogen
status to the evaluating health care practitioner, if the dentist
is the source individual, and submitting to testing that will
assist in the evaluation of the patient. If a staff member or
other third person is the source individual, the dentist should
encourage that person to cooperate as needed for the patient’s
evaluation. Dentists should document in the patient’s record
the actions they have taken in response to a patient’s exposure
to blood or other potentially infectious material. Care should
be taken not to include in the patient record confidential medical
information about the dentist or a staff member, to avoid unauthorized
disclosure of this information with the patient record.
Insurance Coverage: If a dentist infected with a bloodborne pathogen
discontinues the practice of dentistry because of a legal requirement
to disclose his/her bloodborne pathogen status to patients, the
Association believes the dentist to be totally disabled with respect
to the practice of dentistry. The ADA will assist and support
infected dentists in sustaining meaningful professional careers
and will encourage insurance carriers to provide disability benefits
for such dentists.
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Education
Public Information and Education: Appropriate agencies of the Association
should continue efforts to educate the public
about both the efficacy of standard precautions and the absence
of a significant epidemiological risk of contracting bloodborne
diseases through the provision of dental treatment when recommended
infection control procedures are routinely followed.
The healthcare and communications communities
also should work together, in consultation
with government agencies, to develop
public service announcements and other educational messages regarding
bloodborne diseases. Public education to increase awareness of
how bloodborne diseases are transmitted should include information
aimed at diminishing irrational fears about transmission of such
diseases through dental treatment.
Professional Education: The Principles of
Ethics and Code of Professional Conduct of the ADA states that the privilege
of dentists to be accorded professional status rests primarily
in the knowledge, skill and experience with which they serve their
patients and society. All dentists, therefore, have the obligation
of keeping their knowledge and skill current.
The Association recommends the development
of national educational programs for
the dental team that address infection control recommendations
for preventing bloodborne pathogen transmission in health care
settings as well as programs that address the management of the
oral and systemic implications of bloodborne diseases. The Association
further recommends that dental schools,
dental auxiliary schools and advanced dental education programs
incorporate these programs in curriculum content and clinical
activities. The Association will further assist the profession
in addressing bloodborne disease issues by assuring the widespread
dissemination of current infection-control recommendations and
information on bloodborne diseases to the dental community through
Association publications, conferences and videotapes.
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Legal and Legislative Issues
Antidiscrimination: The ADA supports clarifying
or amending antidiscrimination laws and regulations, either legislatively
or through the courts, in consideration of the rights of the patient
to be free from acts of prejudice and the rights of others to
be protected against an unreasonable risk of disease.
The Association also strongly supports state
and federal legislation that protects
a dentist from charges of discrimination if a dentist, in a sincere
effort to protect a patient’s health, elects to refrain from performing a dental
procedure on a patient who fails to disclose medical information
that, in the dentist’s professional judgment and based on
current and generally accepted scientific knowledge, may significantly
impact the patient’s treatment. The Association further
strongly supports state and federal legislation that gives an
infected patient’s health care providers the right to share,
when medically indicated, knowledge of the patient’s bloodborne
pathogen status and current medical condition without risking
a violation of state or federal antidiscrimination laws and confidentiality
laws.
Professional Judgment: The Association, where appropriate, will
pursue legal and legislative means to effect changes to existing
statutes, regulations, guidelines and interpretations which impose
inappropriate restraint on the exercise of the dentist’s
professional judgment in the treatment of persons with disabilities
and/or infectious diseases.
Classification of Bloodborne Pathogens: The ADA supports the classification
of bloodborne pathogens as infectious and communicable disease
agents and, as such, will take every appropriate opportunity to
publicly support such classification.
National Policies: The Association supports initiatives to develop
national policies on bloodborne disease/infection that can become
the basis for coordinated efforts by the public and private sectors.
The oral health aspects of bloodborne disease/infection and issues
related to the practice of dentistry should be included in national
policies.
Mandatory Testing: The ADA opposes any laws or regulations that
require mandatory testing of dentists and other health care workers
to determine their bloodborne pathogen status.
Enforcement of Infection Control Guidelines: Enforcement of CDC
or equivalent infection-control guidelines should be assigned
to state boards of dentistry.
Statement on Infection Control Standards of Care and Compliance: The ADA encourages and supports infection control standards of
care, provided those standards are based on and justified by scientific
research, and advocates and pursues fair systems of compliance
as well as appropriate penalties for noncompliance.
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Statement updated online: March 15, 2005
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