Infection Control Manual

Section XIV: Care of the Dental Patient Who is Hepatitis B, Hepatitis C, or HIV Positive

Patients with HBV, HCV, or HIV can be treated confidently in the clinics of the UNC School of Dentistry. In nearly all regards, such patients can be treated as would any other patients, in accordance with the School of Dentistry Manual of Infection Control Manual (revision August 2001). The occupational risk of HBV transmission in dentistry is known and measurable (one in three percutaneous injuries in a non-vaccinated health care worker or patient - 33%), while the risk of HIV transmission is much lower. (one in 250 - 300 injuries - 0.3%). The risk of HCV transmission is approximately 3% following a percutaneous injury. The following protocols and recommendations should facilitate a practical and low-risk approach to treating a patient with a known transmissible infection.

1. Do not refuse to treat a patient solely on the basis of the presence of a transmissible disease/ infection. All patients appreciate professional competence and sensitivity in the handling of their treatment needs.

2. Members of the dental team who will have direct, hands-on contact with the patients should be informed confidentially (in private) of the patient's status. Students should make this communication with supervising faculty and chairside dental assistants prior to, or at the beginning of, a treatment session. The patient's confidentiality must be protected. Breech of confidentiality of health records is a criminal misdemeanor in North Carolina, punishable by up to 2 years in jail and an unlimited fine.

3. When making a referral to a specialist or other practitioner, the referring dentist may directly inform the other practitioner of the patient's HBV or HIV status, according to the N.C. Communicable Disease Laws and Regulations.

4. Contact his/her physician to determine current health status, medications, tuberculin reaction status, T4 cell count (with the date of the count), and any potential harm to the patient that may result from treatment. Enter the patient's diagnosis and T4 cell count in the chart.

5. It is not required that all patients with low T4 cell counts be seen in the hospital dental clinic. Referral should be accomplished on an individual case basis with consideration given to the patient's medical health. When a patient with HIV infection develops a T4 cell count less than 100, intraoral Kaposi's sarcoma, or an oral infection, which does not respond to customary therapy, he/she will require a consultation with, and possible referral to, a hospital dental clinic. Faculty in the DFP may refer patients directly after consulting with a UNC Hospital Dental Clinic Attending. Students should bring the patient's chart to their Attending Faculty who will contact the UNC Hospital Dental Clinic Attending and assist the student in making a referral if indicated.

1. Observe standard universal precautions with all patients, regardless of infectious status. As usual, establish a clean operatory area for the chart and uncontaminated instruments.

2. Treatment gloves should always be worn when handling items contaminated with saliva or blood (also when opening intraoral X-ray films).

3. Use standard precautions for treatment procedures. If there are cuts or sores on hands, use double gloves. Only use sterile surgical gloves when performing surgery, not for other procedures.

4. Use a protective sheath prop and the "one hand scoop" technique when recapping anesthetic needle. Do not pass uncapped needles between dentist and assistant. Instead, place it directly onto the instrument tray.

5. Change clinical overgarment before and after treating the patient.

6. Wear a disposable surgical cap when performing surgical procedures or when using a cavitron or a prophy-jet.

7. During surgery, avoid the use of fingers to manipulate suture needles. Use a forceps or other instrument to support the mucosa during suturing and to reorient the suture needle on the needle holder for subsequent stitches. Remove needles from the surgical field prior to tying knots.

8. Access one of the School's autoclavable handpieces to use when treating the patient.

1. Follow standard infection control precautions as presented in the Manual of Infection Control Manual.

2. Disinfect protective eyewear and pen (or change pen cover).

3. Discard contaminated disposable items inside the plastic chair cover and then drop in the operatory trash bin.

4. Place the scrubbed instruments back into the cassette and the paper bag, and turn it in. Place a label of the patient's chart number inside the wrapped instruments.

5. Disinfect impressions and prostheses as usual before transfer to a laboratory. No special labeling is required.

Last modified: