How sanitary is your dentist’s office?

The shocking news that thousands of patients who visited Dr. Scott Harrington’s Oklahoma oral surgery practice since 2007 may have been exposed to hepatitis B, C, and HIV as well as unsanitary and non-sterile conditions, is a wake-up call for doctors, patients, and especially health departments everywhere.

This is not to say that dental practices everywhere fall into the same pattern of inadequately sterilized equipment, reused needles, expired medications, or dental assistants administering intravenous medication without a doctor present.

But what lengths are the state of Oklahoma and other states going to in order to make sure that these gross violations and gross mistreatments aren’t taking place in more than just one dentist’s office?

The greatest concern is viral hepatitis. According to the CDC, more than 4 million Americans are chronically infected and most don’t know it.

The greatest risk from contaminated equipment and reusing needles is from hepatitis B. Despite the fact that 65 percent of health care workers are now vaccinated against hepatitis B (with a rate of effectiveness that approaches 95 percent), nevertheless, 12,000 health care workers are still infected every year and a third of them go on to develop a clinical illness.

After being stuck by a needle contaminated by hepatitis B, close to 30 percent developed the disease. There have been several hundred reported cases of patients who have developed hepatitis B after being exposed to contaminated medical products or stuck by a contaminated needle.

The risk is much lower for hepatitis C, despite the fact that there is no protective vaccine, with a recent study showing that only 0.5- 3% of health care workers developed the disease after being stuck by a contaminated needle.

But despite the fact that hepatitis C is much more difficult to get than hepatitis B from a single blood exposure, worldwide contamination from unsafe injections and the use of contaminated medical equipment are a primary reason for the virus reaching epidemic proportions. In Egypt, 15 percent of the population have hepatitis C, 5 percent in Pakistan, and 3.2 percent in China.

As far as HIV goes, the risk is even less. There are approximately 800,000 needle stick injuries per year, and 2 percent of them are by needles contaminated by HIV blood.

But the chance of converting to HIV positive from one of these needle sticks is approximately 1/300 or 0.3 percent. As a medical intern in the 1980s, when HIV/AIDS was burgeoning as an inpatient disease, I and my fellow interns each sustained multiple needle sticks while taking care of HIV patients, though luckily, none of us contracted.

The greatest risk for the thousands of patients who visited Dr. Harrington is hepatitis B if they were never vaccinated, and hepatitis C if they were. The greatest risk of these viruses and of HIV are from percutaneous needle sticks from the staff who were allegedly reusing needles on multiple patients. Blood or mucous membrane exposure to contaminated equipment was also a risk, though less.

For those who are going to their dentist this week, I would recommend that you look to make sure that careful hand hygiene and sterilization procedures are followed. Only your doctor should be giving you an injection or a medication. If you are ever stuck by a needle that may be contaminated by HIV, then post-exposure prophylaxis with anti-viral drugs have been shown to decrease the risk of transmission. For hepatitis B, the use of immunoglobulin and post-exposure vaccination are helpful.

The chances are extremely high that your dentist is clean and sanitary and his equipment and procedures are well sterilized and safe. The kind of practices alleged in Dr. Harrington’s practice are as disgusting as they are rare. Still, it never hurts to keep your eyes open.