Dental professionals with bloodborne viruses such as HIV had been restricted to working on edentulous patients in the United Kingdom before the Department of Health replaced the ban in 2014 with testing and registration. Now, Public Health England (PHE) has released a new risk-based categorization of exposure-prone procedures that will enable infected professionals to perform more work.
“We know that affected oral healthcare professionals are keen to continue in their chosen profession, and the combination of the confidential register and new categorization means that the worry of a sudden loss of income will no longer compound worries about their own health to anything like the same extent,” said Kevin Lewis, dental director at Dental Protection, which provides dental risk management.
PHE has categorized a broad range of procedures based on their risk of bleed-back where an injury to the dental worker via a sharp instrument, for example, could result in the worker’s blood contaminating the patient’s open tissues. The organization notes that the list is not exhaustive of all dental procedures and should be used only as a guide.
Level zero procedures have no risk of bleed-back. They include intraoral and extraoral radiographs, visual and digital examinations of the head and neck, routine oral exams using a mirror and necessary probes, impressions, fissure sealings, topical application of or irrigation with therapeutic agents, and more.
Level one procedures have the lowest risk of bleed-back. They include local anesthetic injections, interdental stripping with a rotary device or abrasive strips for orthodontic purposes, lip biopsies and sutures, teeth and restoration polishing using finishing burs in high-speed handpieces, and scaling of teeth using hand instruments.
Level 2 procedures have intermediate risk of bleed-back. They include the use of high-speed handpieces, periodontal surgery, root canal therapy, tooth extractions, apicectomies, orthodontic procedures with fixed appliances, surgical removal of intraoral soft tissues, and frenotomies and frenectomies.
Level 3 procedures have the highest risk of bleed-back, but they are not considered part of general dentistry. More extensive oral and maxillofacial surgical procedures are considered part of general surgery instead. In these procedures, fingertips are out of sight for a significant amount of time, and patient exposure to blood from an injury to the dentist may go unnoticed.
“Once on the Department of Health register, and as long as medical supervision is followed and standard infection control precautions are taken, the majority of normal dental procedures pose no risk of transmission of bloodborne viruses from an infected clinician to a patient,” said Lewis.