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One confirmed hepatitis C infection in ongoing investigation of Tulsa dental office

Tulsa, Okla.—Epidemiological investigators at the Centers for Disease Control and Prevention have confirmed one event of patient-to-patient transmission of hepatitis C virus among the patients of a dental office under investigation for alleged infection control violations.

"This is the first documented report of patient-to-patient transmission of hepatitis C virus associated with a dental setting in the United States," said Oklahoma state epidemiologist Kristy Bradley, D.V.M. "While dental procedures are generally safe, this reinforces the importance of adhering to strict infection control procedures in dental settings." 

The patient-to-patient transmission of the hepatitis C virus resulted from improper infection control procedures.

ADA President Robert A. Faiella pointed out the aberrant nature of the infection transmission: "This is a highly atypical and disconcerting case. Every day, hundreds of thousands of dental procedures are performed safely and effectively thanks to the diligence of dentists who follow standard infection control precautions developed by the Centers for Disease Control."

Dr. Faiella added, "While this is an isolated case, it understandably raises questions about infection control in the dental office. The ADA encourages people to talk with their dentists, who will be glad to explain or demonstrate their infection control procedures."

John Molinari, Ph.D., is an ADA spokesperson and a microbiologist and director of infection control for the Dental Advisor, a research publication in Ann Arbor, Mich. "You're going to get an outlier such as this case," said Dr. Molinari. "But the overwhelming majority of dentists, assistants and hygienists" follow proper procedures.

The announcement of the transmission Sept. 18 is part of an interim status report from the Oklahoma State Department of Health and the Tulsa Health Department on the results of their joint investigation of the dental surgical practice with offices in Tulsa and Owasso. In March, health officials recommended patients be tested for hepatitis B, hepatitis C and HIV infection at free screening clinics established at the Tulsa Health Department, Oklahoma City-County Health Department and other county health departments in the state. The free screening clinics were available through June 28.

The CDC is performing genetic testing of HIV specimens collected from patients to determine if any infections occurred in the dental practice. Health officials plan to release test results of the HIV specimens in upcoming weeks and publish a final report summarizing the oral health care-associated public health investigation and response after all aspects of the investigation have been completed.

Said Dr. Timothy Fagan, president of the Oklahoma Dental Association, "We are saddened that this unfortunate health breach has placed patients at risk, and it is clearly an aberration that in no way reflects the way dentists typically operate."

Public health officials announced March 28 that they were notifying the practice's current and former patients that they may have been exposed to blood-borne viruses.

The Oklahoma Public Health Laboratory completed testing for 4,202 persons. Eighty-nine patients tested positive for hepatitis C, five for hepatitis B, and four for HIV.  An unknown number of patients sought testing through private health care providers. Based on current Oklahoma disease prevalence data for hepatitis B and C and HIV, health officials recognized some of the screening results would be positive for infection unrelated to dental procedures at the practice they are investigating.

"While our investigation documents the transmission of hepatitis C, we have no reason to believe the hepatitis B cases resulted from exposure in this dental practice," Dr. Bradley said.

The ADA, the Centers for Disease Control and Prevention and the Organization for Safety, Asepsis and Prevention have information resources available to dentists on standard precautions for infection control and prevention:

 • The ADA's website, ADA.org, includes an Infection Control section under Oral Health Topics.
 
• Another ADA resource, the ADA Practical Guide to Effective Infection Control, is also available as an information resource. (See story, September 16, 2013, ADA News)

• The Association distributed an Issue Alert to member that includes talking points dentists may use if their patients express concerns about safety.

The ADA has long recommended that all practicing dentists, dental team members and dental laboratories use the standard precautions as described in the CDC guidelines for Infection Control in Dental Health Care-Settings.

 CDC resources include:
 
• Safe Injection Practices in Dentistry. Visit CDC.gov and search for this title.

• The One and Only Campaign. Visit www.oneandonlycampaign.org for details about this CDC campaign with the goal of raising awareness among patients and health care providers about safe injection practices.

• The ADA is also working with the OSAP in reaching out to the dental community.

• OSAP's website at www.osap.org also provides information about proper infection control, and patient and provider safety.