Preventing Disease Transmission in Dental Settings

CDC Division of Oral Health

|January 30, 2017

Infection Transmission in Dental Healthcare

Reports of transmission of infectious agents between patients and dental healthcare personnel (DHCP) in dental settings are rare. However, a recent Centers for Disease Control and Prevention (CDC) article in the Journal of the American Dental Association^[1] identified three published reports describing the transmission of hepatitis B virus and hepatitis C virus in dental settings since 2003. In addition, the Morbidity and Mortality Weekly Report^[2]—published April 8, 2016—described a 2015 outbreak of Mycobacterium abscessus infection at a pediatric dentistry practice.

In most cases, investigators have failed to link a specific lapse of infection prevention and control practice with a particular transmission. However, reported breakdowns in basic infection prevention practices included unsafe injection practices, failure to heat-sterilize dental handpieces between patients, failure to monitor (eg, conduct spore testing of) autoclaves, and failure to maintain dental unit waterlines. These reports highlight the need to improve understanding of and compliance with current infection prevention recommendations.

Key information and recommendations relevant to the above identified breaches include:

• When administering local anesthesia, use needles and anesthetic cartridges for one patient only and clean and heat-sterilize the dental cartridge syringe between patients.
• If multidose vials are used (such as for conscious sedation), dedicate multidose vials to a single patient whenever possible.
• If multidose vials must be used for more than one patient, restrict them to a centralized medication area and do not allow them to enter the treatment area.
• If a multidose vial enters the immediate patient treatment area, it should be dedicated for single-patient use and discarded immediately after use.
• Date multidose vials when first opened and discard within 28 days, unless the manufacturer specifies a shorter or longer date for discarding that opened vial.
• Clean and heat-sterilize all handpieces (high-speed and low-speed) and attachments that attach to air and waterlines (including motors) between patients unless they are single-use, disposable items. For handpieces that do not connect to air and waterlines, use US Food and Drug Administration–cleared devices and follow the validated manufacturer’s instructions for reprocessing.
• Monitor sterilizers at least weekly by using a biological indicator with a matching control (ie, biological indicator and control from same lot number). Results of biological monitoring should be recorded and sterilization monitoring records (mechanical, chemical, and biological) retained long enough to comply with state and local regulations.
• Ensure that all dental units use systems that treat water to meet drinking water standards (ie, ≤ 500 colony forming units/mL of heterotrophic water bacteria). Consult with the dental unit manufacturer for appropriate water maintenance methods and recommendations for monitoring dental water quality.

New CDC Resources

In March 2016, CDC released a new resource designed to help DHCP prevent infections. The Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care brings together CDC recommendations from the Guidelines for Infection Control in Dental Health-Care Settings—2003,^[3] which is the standard of practice for clinical dentistry, with other relevant CDC recommendations published since 2003. The new comprehensive, user-friendly resource can help DHCP maintain proper infection prevention practices. It includes the following tools to help DHCP follow infection prevention guidelines:

• A summary of basic infection prevention principles and recommendations for dental settings;
• A checklist to evaluate DHCP compliance with administrative and clinical practice infection prevention recommendations; and
• Key references and resources for each area of focus, including sterilization, safe injection practices, and hand hygiene in dental settings.

The goal of these resources is to make it easier for DHCP to understand and comply with recommended infection prevention practices.

What Can You Do?

Infection prevention should be a priority in all clinical dental care settings. A survey of US dentists looked into implementation of four recommended infection prevention recommendations (have an infection control coordinator in the dental practice, maintain dental unit water quality, document percutaneous injuries, and use safe medical devices such as safer syringes and scalpels) and found that only 25% of practices had routinely implemented three or four of these recommendations.^[4]

Dental practices should do the following:

• Review their state licensure and certification requirements for continuing education credits in infection prevention and control. Some states require annual training on this topic.
• Download and review the Summary of Infection Prevention Practices in Dental Health Care Settings: Basic Expectations for Safe Care.
• Assign at least one individual trained in infection prevention the responsibility of coordinating your practice’s infection prevention program (the infection control coordinator).
• Use the Infection Prevention Checklist for Dental Settings (also available in an easy-to-use fillable PDF format or new mobile app) to perform an annual evaluation of your infection prevention program.

If you suspect that a disease transmission has occurred in your practice, contact your state or local public health officials. CDC is available to provide assistance and specific contacts for state health departments. Contact CDC’s Division of Oral Health or call 770-488-6054.

Web Resources

CDC Division of Oral Health—Infection Prevention & Control in Dental Settings

The American Dental Association

The Organization for Safety, Asepsis and Prevention

Public Information from the CDC and Medscape

Cite this article: Preventing Disease Transmission in Dental Settings. Medscape. Jan 30, 2017.