Infectious Diseases of Uncertain Transmission
The American Dental Association considers the delivery of necessary dental care to patients to be the fundamental responsibility of every practicing dentist. This obligation is expressed in the principles of beneficence and justice in the ADA Principles of Ethics and Code of Professional Conduct.
Occasionally, a dentist may be called on to provide care to a patient with an infectious disease for which there are no recommended infection control procedures to prevent or reduce the risk of disease transmission within an otherwise adequately equipped dental operatory. For example, during the outbreak of severe acute respiratory syndrome (SARS) in 2003, many questioned whether a dentist could safely treat an infected patient without endangering himself or herself, other patients or members of the dental team.
To maintain patient and provider safety in the delivery of oral health care, the dentist and the dental team should be adequately trained in infection control measures as recommended by the U.S. Centers for Disease Control and Prevention (CDC). When concerned about uncertain transmission of infectious disease, dentists are encouraged to consult the recommendations of appropriate public health authorities, such as the CDC. Dentists can also check with the local or state health department for the latest epidemiological information for their community.
In most circumstances, the decision to treat a patient with a suspected infectious disease depends primarily on the particular infectious organism and whether recommended infection control procedures will allow the dentist to treat the patient without compromising the safety of dental health care workers and other patients. For example, in the case of patient with suspected active tuberculosis, elective dental treatment should be deferred until a medical evaluation confirms that the patient is not infectious. Consulting with the patient’s current treating physician and/or facility to review the course and outcome of treatments rendered may inform the dentist as to the appropriate and safe time for providing dental treatment. In the case of a dental emergency, treatment of such a patient should be provided in a facility equipped with the capacity for airborne infection isolation.
As is the case with all patients, when an individual is suspected of having an infectious disease of uncertain transmission where effective infection control procedures have not been identified or scientifically supported, dentists should balance the needs of the patient with the safety of other individuals to arrive at an appropriate treatment decision. If it is believed that the patient may have an undiagnosed disease that poses a significant public health risk, the dentist should, while balancing and respecting the patient’s privacy rights, consider contacting the proper public health authorities.
Adopted by the Council on Scientific Affairs, and the Council on Ethics, Bylaws and Judicial Affairs April 2012.