Possible Transmission Of Human Immunodeficiency Virus To A Patient During An Invasive Dental Procedure
CDC received a case report of acquired immunodeficiency syndrome in a young woman for whom an epidemiologic investigation had notestablished a source for her human immunodeficiency virus infection -drug use, sex with an HIV-infected person, or receiptof a blood transfusion or blood components). However, investigationrevealed that 24 months before her AIDS diagnosis she had two teethextracted by a dentist who had AIDS. Information on the dentalprocedure was obtained from interviews with the patient and reviews ofher dental records and radiographs. This report summarizes theepidemiologic and laboratory findings of the investigation.*
The patient had two maxillary third molars extracted under localanesthesia in the dentist’s office. The dentist had been diagnosed withAIDS 3 months before performing the procedure. Written documentation ofthe procedure was limited. Review of the radiographs indicated that themaxillary third molars were not impacted in bone. The patient reportedthat she received no general anesthetic or sedative and that during theprocedure the dentist wore gloves and a mask. She did not recall, nordid review of the dental records reveal, any circumstances that wouldhave exposed her to the dentist’s blood . Thepatient had not received dental care from this dentist before thedental extractions.
Managing Dental Patients With Hiv
The dental team can play an important role in all phases of the human immunodeficiency virus care continuum from diagnosis to disease management.
This course was published in the November/December 2015 issue and expires 12/31/18.
The authors have no commercial conflicts of interest to disclose.
This 2 credit hour self-study activity is electronically mediated.
Death And Posthumous Controversy
On December 8, 1991, Bergalis died of AIDS-related complications at her home in Fort Pierce, Florida. Her funeral was held on December 12 in her hometown of Tamaqua, Pennsylvania, after which she was buried in Saints Peter and Paul RC Lithuanian Cemetery.Shortly after Bergalis death, a small park on Hutchinson Island South, Florida, was renamed Kimberly Bergalis Memorial Park in her memory.
Nearly three years after Bergalis death, in June 1994, CBS aired an episode of 60 Minutes that included a segment covering Acer and the patients he allegedly infected. The episode alleged that Bergalis, who said she was a virgin, had been treated for genital warts, a sexually transmitted disease, and showed her on videotape allegedly claiming to have had sex with two different men during her life. However, none of Bergalis’ former serious boyfriends tested positive for HIV. In addition, the 60 Minutes anchors argued that the CDC may have botched the genetic tests that proved that Bergalis had the same strain of HIV as her dentist. The television broadcast was dismissed by CDC scientists as misleading and inaccurate. Stephen Barr, a journalist who contributed to the show, rebutted this dismissal.
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Oklahoma Dental Patients Test Positive For Hepatitis Hiv
Oklahoma dentist W. Scott Harrington is under investigation.
April 18, 2013& #151 — At least 60 people have tested positive for hepatitis or HIV after visiting an Oklahoma dentist slammed by the state dental board for poor sterilization practices, the Tulsa Health Department said today.
Dr. W. Scott Harrington allegedly re-used needles, a practice that can contaminate ostensibly sterile drugs with dangerous diseases. He is also accused of using rusty equipment that was not properly cleaned.
More than 7,000 patients from Harrington’s Tulsa and Owasso clinics were sent letters in late March outlining the risk of infection and steps to obtain free blood testing. Of 3,122 patients tested by county health departments so far, 57 tested positive for hepatitis C, three tested positive for hepatitis B, and at least one tested positive for HIV.
“We understand these first reported test results may be of concern,” Tulsa Health Department Director Dr. Bruce Dart said in a statement.
The Tulsa and Oklahoma health departments are in the process of notifying patients of the results. Patients who tested positive will be personally contacted, counseled about the disease and directed to resources for care, the agencies said in a statement. Testing may also be recommended for their spouses or partners.
The Tulsa Health Department has set up a hotline at 595-4500 for people with questions.
Dentist Infects Patients With Hiv
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Dozens of patients of an Oklahoma dental clinic shut down for unsanitary conditions have tested positive for HIV, Tulsa health officials said Thursday.
We toldya the clinic of oral surgeon W. Scott Harrington was closed in March after an investigation. So far 57 current and former patients who may have been treated with dirty equipment have tested positive for hepatitis C and three tested positive for hepatitis B, the Tulsa Health Department said in a statement.
We understand these first reported test results may be of concern, said THD Director Dr. Bruce Dart. Thorough investigations are routinely conducted upon notification of a positive report for these infections. This response will be handled in the same manner, as disease investigation is a core public health service and staff are well trained to conduct this type of response.
Positive results for HIV have also been reported, but Oklahoma law prohibits public reporting of cases fewer than three. On March 28, investigators from the Oklahoma State Department of Health and Tulsa Health Department urged as many as 7,000 patients of the Tulsa dental clinic to be screened for hepatitis B, hepatitis C and HIV, after a patient of Harringtons had tested positive for hepatitis C.
Its possible at least some of the positive infections are not related to exposure to procedures at the dental practice, health officials said.
What do you think?
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Good News: Dentists Not At Risk Of Acquiring Hiv/aids From Infected Patients And The Illusion Of Infection Control
February 14, 2018
PreambleSince the appearance of HIV/AIDS in the mid-1980s, clinical dentists, academics and the professions regulatory agencies have been concerned about the possibility of an HIV/AIDS positive patient transmitting the infection to the attending dentist. A recent report in the American Journal of Infection Control categorically refutes this possibility. Prior to discussing these new findings, it is appropriate to provide pertinent historical details.
In 2001 Neiburger published a Letter to the Profession in which he expanded on the non-necessity of these recommendations.8 His paper offers a comprehensive critique of the questionable practices used by government agencies to enact policies for which there is little- if any- justification. He rightly asks why subject all patients to mandated and not inexpensive procedures when, prior to their enactment, there was not a single case of a dentist occupationally acquiring HIV/AIDS.8
In this study, a percutaneous injury was defined as a needle stick injury, laceration injury, or any injury that leads to a break in the skin barrier resulting in exposure to an HIV contaminated body fluid.11 A mucocutaneous exposure was defined as a splash that results in exposure of mucous membranes or skin to HIV positive body fluids.11
Disclaimer:A future article that will appear in Oral Health will provide a more detailed critique of District Health Units investigations.
References
A New Book Reconsiders The Early 90s Dentist Accused Of Transmitting Hiv To His Patients
Steven Reigns is the author of the new book “A Quilt For David”
Does the name Kimberly Bergalis ring a bell? She was the woman who publicly claimed in 1990 that she got HIV from her dentist, David Acer. He was a gay man who lived quietly with HIV and practiced dentistry north of Palm Beach before dying of AIDS that same year at the age of 40. Bergalis, who died of AIDS the following year at age 23, used the time before her death to lobby with her parentsunsuccessfully, ultimatelyfor a law that would make all medical and dental workers test for HIV, then force those who tested positive to inform their patients.
Many experts believe Acer infected his patients deliberately, citing a friend of his who recalled that Acer, in 1988, complained that AIDS would not get the attention it deserved until it started affecting grandmothers and younger people. And yet, such a dark theory doesnt seem to fit a man generally described as kind, thoughtful, and quiet.
We may never know exactly how Acers patients got HIV, but A Quilt for David returns us vividly to a pre-U=U , pre-PrEP era of widespread anxiety around AIDS transmissionone in which social and moral narratives played as much a role as science in defining how those living with the virus were portrayed.
TheBody talked to Reigns about his new book.
Tim Murphy: Hi there, Steven, and thank you for talking to us. So what sparked you to write this book?
Murphy: What do you think happened?
Reigns: Not completely.
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Complications Of Oral Procedures
The data from five articles were abstracted for the review of Key Question 1 comparing the complication rates associated with dental treatment in HIV-positive persons to the complication rates for similar dental treatment in individuals who are HIV negative. Only two of the seven dental procedures specifically mentioned in Key Question 1 were the objects of study in the five articles. One article examined endodontic procedures , while four studies examined tooth extraction. None reported on orthognathic surgery, periodontal surgery, prophylaxis, scaling and root planing, or implants.
A Staff Report From The Straight Dope Science Advisory Board
Dear Straight Dope: Regarding your recent article about intentionally infecting people with AIDS, I read a pretty persuasive article maintaining it was far more likely this dentists patients contracted AIDS in the more traditional ways. Kimberly Bergalis, for instance, who became the poster girl for mandatory testing of health workers, was alleged to have been quite promiscuous. But she looked so damn tragic testifying to Congress in her wheelchair, barely able to talk, that no one brought this up. And it was alleged that no one has YET come up with a plausible way for the patients to get AIDS from the dentists instruments. Do you know anything about this? JOHNVARLEY
SDStaff Jillgat replies:
It is far more likely that health care workers would be at risk of contracting HIV from their patients than the other way around. Thats one reason this case was so unusual. As far as I know, no states have laws requiring mandatory HIV testing of health workers. I have also seen no epidemiological studies that report sexual risk factors for Kimberly Bergalis. Four of the other five infected patients also had no obvious risk factors for HIV, and most had blood samples available from earlier medical procedures or blood donations that tested negative, establishing that they became infected after having dental procedures done by this doctor. These patients also tested negative for other sexually transmitted diseases and hepatitis.
Dear Straight Dope:
polyhistor@aol.com
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Reviewing And Abstracting The Articles
Determining which articles identified in the literature searches were to be included in the review involved a number of steps:
- First, the titles of articles for each of the questions received independent dual review by two of the authors, with copies obtained of any abstracts suggested by either one of them.
- Copies of the abstracts were reviewed by two of the authors.
- Articles were identified for abstraction only when both reviewers agreed. The abstracts of all of the excluded articles were independently reviewed by another of the authors to ensure that no articles were incorrectly excluded from the review.
- Eligible articles were given to one of three trained abstractors who extracted the data to be included in the evidence tables using specially designed forms.
Rogue Dentist May Have Exposed 7000 Patients To Hiv Hepatitis
An Oklahoma dentist may have exposed patients to HIV and hepatitis.
March 28, 2013 & #151 — The Tulsa Health Department is warning 7,000 patients of a local dentist’s office that they could have contracted HIV, hepatitis B or hepatitis C from poor sterilization practices.
Dr. Wayne Harrington, an oral surgeon with a practice in Tulsa, Okla., is being investigated by the state dental board, the state bureau of narcotics and the federal Drug Enforcement Agency because one of his patients recently tested positive for hepatitis C and HIV without known risk factors other than receiving dental treatment.
Upon hearing of the infected patient, the Oklahoma Board of Dentistry conducted a surprise inspection of Harrington’s practice on March 18, allegedly finding numerous problems, including regular use of a rusty set of instruments on patients with known infections, and the practice of pouring bleach on wounds until they “turned white.”
Susan Rogers, executive director of Oklahoma’s Board of Dentistry, called the incident a “perfect storm.” On top of his many violations in sanitary practice, the dentist was a Medicaid provider, which means he had a high proportion of patients with HIV or hepatitis, she said.
Harrington and his staff told investigators that he treated a “high population of known infectious disease carrier patients,” according to a complaint filed by the Oklahoma Board of Dentistry.
ABC News’ Dr. Richard Besser and Katie Moisse contributed to this story.
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Update: Investigations Of Patients Who Have Beentreated By Hiv
Investigation of the patients of a Florida dentist withacquired immunodeficiency syndrome concluded that humanimmunodeficiency virus was transmitted to five ofapproximately 1100 patients who were evaluated . Although theprecise events resulting in transmission of HIV to these patientsare not known, the findings of the investigation support directdentist-to-patient transmission, rather than a patient-to-patientroute. This report summarizes information from other publishedstudies of patients who were treated by HIV-infected health-careworkers , as well as from completed and ongoingunpublished investigations that have been reported to CDC.
In addition to the patients in the Florida dental practice, asof May 13, 1992, CDC was aware of HIV test results for 15,795patients who were treated by 32 HIV-infected HCWs. The total numberof patients treated by these HCWs and the number of patients whounderwent invasive procedures are not known. No seropositivepersons were reported among 10,270 patients who were tested fromthe practices of 23 of these 32 HCWs. The 23 HCWs comprised 11dentists/dental students, six surgeons/obstetricians, and six otherphysicians in various nonsurgical subspecialties. For the remainingnine HCWs , 5525 oftheir patients were tested, and 84 HIV-infected patients wereidentified.
The 37 HIV-infected persons for whom investigations are inprogress were patients treated by the following three HCWs:
What Precautions Need To Be Taken With Patients Who Are Hiv Positive In Dentistry
Since HIV is primarily transmitted through exposure to blood and bodily fluids, the American Dental Association stipulates that standard precautions should be taken with all patients . At Penn, we strictly adhere to these safety initiatives which include:
- Personal protective equipment for all dental personnel
- Protective eyewear
Its important to note that the average risk of HIV transmission is extremely lowonly 0.3%.
Can a Dentist Refuse to Treat a Patient with HIV?
They shouldnt. According to the ADA:
All dental practices should be able to provide routine dental care for adult or pediatric HIV-positive patients. Nearly all patients with HIV are able to tolerate routine dental care and procedures, including oral surgery.
As we mentioned earlier, we provide comprehensive dental care here at Penn for people living with HIV.
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Oral Conditions As Indicators Of Severe Immunosuppression
Key Question 2B involved assessing evidence supporting the use of selected oral conditions as indicators of the progression of HIV infection to the stage of severe immunosuppression and a diagnosis of AIDS. The question suggests the use of the CD4 lymphocyte cell count as a measure of immunosuppression. The question identified the following seven oral conditions of interest: hairy leukoplakia, oral candidiasis, necrotizing ulcerative periodontitis, oral ulcers, parotid swelling, linear gingival erythema, and Kaposi’s sarcoma.
The data from 10 articles were abstracted and included in the review for this question. All 10 articles reported CD4 count alone as their measure of immunosuppression.
This question also uses the medical “testing” dimensions of the oral conditions as an indicator of immunosuppression to evaluate their usefulness. In this context, an oral condition with high sensitivity would represent a screening tool for identifying HIV disease that has progressed to the next stage.
The oral conditions on which studies reported were quite varied. None of the articles reported on parotid swelling however, all 10 articles reported on oral candidiasis, six reported on hairy leukoplakia, and four on oral ulcers. Only two studies reported on linear gingival erythema, two on necrotizing ulcerative periodontitis, and three on Kaposi’s sarcoma.
Oral Conditions As Markers Of Seroconversion
Only one study was abstracted in the review for Key Question 2A. The question asked for evidence on a set of specific oral conditions-oral candidiasis, hairy leukoplakia, necrotizing ulcerative periodontitis, oral ulcers, and parotid swelling-as markers for recent HIV seroconversion. The study investigated the prevalence of a variety of signs and symptoms among two groups of initially seronegative hospital patients. All of the patients received blood transfusions for a variety of reasons, but half were transfused with seropositive blood while the “matched controls” received seronegative blood.
The question uses the medical “testing” dimensions of sensitivity , specificity , positive predictive value , and negative predictive value of the oral conditions as a marker of recent seroconversion as the way of evaluating their usefulness. Positive enzyme-linked immunosorbent assays and Western blot tests for HIV, obtained from patients who were confirmed previously seronegative for up to 3 months after the presumed time of infection/exposure, were considered evidence of recent seroconversion. No special conditions were imposed on the diagnosis of the oral conditions.
- The majority of patients with oral candidiasis had seroconverted by the end of 3 months , but only a small proportion of those who had seroconverted had oral candidiasis . Very few who did not seroconvert had oral candidiasis , and most of those who did not have oral candidiasis did not seroconvert either .
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