Lack of evidence for patient-to-patient transmission of HIV in a dental practice

This report reviews data pertaining to the hypothesis that transmission of HIV to five patients of a Florida dentist with AIDS resulted from the patient-to-patient transfer of infectious materials through the reuse of contaminated instruments. Findings strongly suggest that patient-to-patient transmission of HIV through contaminated handpieces, prophylaxis angles or anesthetic needles or cartridges did not occur in this practice.

Transmission of human immunodeficiency virus in a dental practice

OBJECTIVE

To determine if patients of a dentist with the acquired immunodeficiency syndrome (AIDS) became infected with human immunodeficiency virus (HIV) during their dental care and, if so, to identify possible mechanisms of transmission.

DESIGN

Retrospective epidemiologic follow-up of the dentist, his office practice, and his former patients.

SETTING

The practice of a dentist with AIDS in Florida.

PARTICIPANTS

A dentist with AIDS, his health care providers and employees, and former patients of the dentist, including eight HIV-infected patients.

MEASUREMENTS

Identification of risks for HIV transmission (if present), degree of genetic relatedness of the viruses, and identification of infection control and other office practices.

RESULTS

Five of the eight HIV-infected patients had no confirmed exposures to HIV other than the dental practice and were infected with HIV strains that were closely related to those of the dentist. Each of the five had invasive dental procedures, done by the dentist after he was diagnosed with AIDS. Four of these five patients shared visit days (P greater than 0.2). Breaches in infection control and other dental office practices to explain these transmissions could not be identified.

CONCLUSION

Although the specific incident that resulted in HIV transmission to these patients remains uncertain, the epidemiologic evidence supports direct dentist-to-patient transmission rather than a patient-to-patient route.

Dentists, allied professionals with AIDS

With about a million people in the United States infected with HIV, health care providers increasingly will encounter infected patients. To minimize transmission in the workplace, recommended infection control measures, including universal precautions, should be followed strictly.