A Worldwide Issue
British Dental Journal April 28, 2007
G. Condon

Sir, I have read with interest the recent views expressed in your journal about the infected dental health care worker (DHCW).

Appropriate management of the infected dental health care worker is, as has been stated, a worldwide issue. Our Dental Board in Victoria currently oversees some practitioners with blood-borne viruses and, in my view, this issue is one in which a pragmatic evidence-based approach is of benefit to both the public and to the infected DHCW.

A lot of the controversy over the issue of infected DHCWs continuing to practice seems to centre on what an exposure prone procedure is. Some 15 or more years ago, Australian dentistry adopted a procedure-based list of exposure prone procedures. The unjustness and impracticality of such an approach soon became apparent, and this highly restrictive list was abandoned in favour of assessing the real risk to the patient.

So, an individual assessment of each practitioner was conducted by an expert panel. Based on careful assessment of the practitioner’s skills and expertise, the use of standard precautions and risk reduction procedures, the actual infectivity of the DHCW based on viral DNA/RNA levels, it has been possible to allow these infected DHCWs to continue practicing, sometimes with procedure restrictions, and sometimes under some form of ongoing monitoring.

This approach allows practitioners to remain productive to the community in a time of severe shortage of dentists and other dental health care workers; we are not aware that any look-backs in recent times have linked transmission of HIV, Hepatitis B or C to an infected dental health care worker.

I wish my dental colleagues in the UK well as they continue this debate.

G. Condon
President, Dental Practice Board of Victoria,Australia
doi: 10.1038/bdj.2007.332