Dental Education Australia

Know More About Blood-borne Viruses

Tuberculosis is caused by the spread of respiratory droplets or through direct contact. A profession like dentistry puts health professionals at a dangerously close vicinity to patients infected with Tuberculosis, increasing the risk of disease transmission. Patients with sputum that tests positive for pulmonary tuberculosis are likely to cause disease transmission in a dental setting. The bacterial infection undergoes a lengthy incubation period, producing a chronic disease that may potentially be reactivated if the patient's immune system becomes compromised due to corticosteroid treatment or other illnesses. All around the world, tuberculosis is one of the leading causes of death by infectious disease.


In the United Kingdom, incidences of tuberculosis started rising from 1987 onwards. 7,000 new cases are reported per annum, with London leading the highest number of reported cases at 41.3 out of 100,000 population on average, which was significantly higher than England and Wales' figure of 12.8 our of 100,000 population on average back in 2003. Infection is more rampant in males between the ages 15 and 44 who are born in high endemicity areas outside the United Kingdom.


Syphilis

There has been a reemergence of syphilis in recent years across Europe and a number of them are cases that involve transmission between two men. The outbreak was first identified in United Kingdom back in 2001 and is still prevalent, despite the decline of new cases. Majority of the cases involve bisexual or homosexual men between the ages of 17 to 64. Inevitably, a smaller percentage of the reported cases of syphilis involve females, including a syphilis transmission to a pregnant woman.


In several of the notified cases, the vehicle for syphilis transmission was identified as oral sex. Patients with oral lesions that are suspiciously suggestive of primary syphilis (an indurated ulcer that often affects the lips) or secondary syphilis (mucosal lesions that are usually found on the tongue and/or an oral ulceration) should be referred to the proper health authority.


Syphilis is known to be at its most infectious stage in its early stages. While the general belief is that syphilis can only be contracted by sexual contact, it can actually spread through direct contact with a lesion on the oral mucosa or lips, provided that it is still active. Surgical gloves act as effective barriers against transmission. Treponema pallidum, which is the causative agent, goes through the bloodstream and could result in a possible transmission through a percutaneous inoculation through a sharps or needlestick injury. In such cases, antibiotic prophylaxis must be carried out and the proper health authority should be sought out.


Mumps

Mumps is an acute viral disease that is carried from one person to another through saliva or aerosolised saliva droplets from a person infected through the GI tract, eye or respiratory tract. An increase in new cases has been seen steadily in the past few years, most of which involve people ages 15 to 24. This is to be expected since the MMR vaccine was introduced at a later period when the said age group had surpassed the general vaccination age.


Affected patients may confuse their symptoms as those of acute sialadenitis, and may think that dental procedure is needed for cure. Usually symptoms are marked by an initial fever and headache for the first two days followed by a swelling of parotid glands, typically painfully affecting one or both glands. Mumps do not solely affect parotid glands as it had been found that 10% of cases affect the submandibular glands as well.


Trismus, or the swelling of the papilla in Stenson's duct, usually accompanies the mumps. There has been no evidence of dry mouth or xerostomia. The incubation period for the infection usually takes 14 to 21 days, after which the symptoms start to show up. A case of mumps is usually infectious an average of six days before the swelling begins to show at about five days later. Mumps treatment is palliative which involves adequate hydration and analgesics.


Mumps can be fairly contagious - about 45% of non-immune people within daily vicinity may be affected, 25% having subclinical infection. Outbreaks have been reported to take place in public places such as schools, work places and hospitals. MMR vaccination is used to prevent mumps, with the recommendation of having two doses to maximize In 1996, the MMR vaccination was given to children averaging four years of age, later on carrying out the immunization to children between 12 to 15 months of age in the year 1998, not limiting the shots to a ceiling age.


When two doses are preferred, a three-month interval must separate the two vaccinations. People over the age of 25 are most likely immune to the infection through previous exposure. A system for controlling infection such as removal of aerosols through the use of high-volume suction, proper disposal of soiled garments and the practice of proper hand hygiene will help eliminate the instances of mumps infection in the dental setting. In the event of an infection within the dental staff, proper medical authority must be sought. The dental personnel is then advised to stay in isolation for at least five days after the first signs of swelling in order to contain the infection spread.


Influenza and Avian Flu

Several influenza outbreaks that affected thousands, even millions, of people took place all around the world in the years 1918, 1957, 1968 and 1977. New strains of influenza were largely responsible for the pandemics, all of which were thought to have started from a gene combination that involved both human and avian influenza. There is a rising concern for the emergence of new and highly pathogenic avian influenza that can penetrate a human's immune system, causing a viral infection in the long run. The first avian-human influenza vaccine was approved in the United States of America in 2007.


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