Is Hepatitis B still a problem in dentistry?

Answered by: Dr. John Molinari

The success of vaccination and use of standard precautions patient care have significantly decreased the risks and incidence of hepatitis B in healthcare settings. The overwhelming majority of health care providers have been vaccinated and protected from infection with this occupational pathogen. Despite this, occasional outbreaks of hepatitis B virus (HBV) infection still occur in medical and dental facilities. The most recent episode of transmission appears to have occurred in a West Virginia dental clinic. In June 2009 medical screening and dental services were provided to over 1,100 patients in a Mission of Mercy free clinic. Subsequently, five cases of hepatitis B were reported in November 2009 to local West Virginia health departments. Three of the infected individuals received dental treatment at the clinic along with two volunteers. While health officials have not confirmed that these persons were infected at the dental clinic, molecular fingerprinting tests have shown that four of the five may have been infected by the same source. The fifth patient refused further testing. As a result, letters were sent to all 1,100 patients and those volunteers who were involved in direct care or who were in contact with the patient care “environment.” It is important to note here that no cases of hepatitis C or HIV have been associated with the free clinic. There was an extensive investigation of the outbreak and a review of the clinic’s infection control practices. According to the state’s public health department, dental care providers generally practiced acceptable precautions; however, some equipment did not function as expected and other treatment items were not cleaned properly. Recommendations have been made to improve infection control at future mass scheduled clinics. A complicating factor is West Virginia has the highest rate of HBV infection in the United States, and investigators continue to search for the common infection source.