by Mary Govoni, CDA, RDA, RDH, MBA
In the past several months, the news reports of infectious disease outbreaks in the United States have been numerous, especially in light of infections not previously diagnosed within U.S. borders. The most serious outbreak is that of Ebola virus disease (EVD). Ebola cases have been reported primarily in West Africa. As of early October, a man who traveled to Texas from Liberia became the first individual to be diagnosed with Ebola in the United States, and he later died from the disease. A nurse who cared for him in the hospital was also diagnosed with EVD. Several health-care volunteers working in West Africa have been diagnosed with the virus in Africa and flown home to the United States for treatment, along with a news cameraman who was in West Africa documenting the events surrounding the outbreak.
According to the Centers for Disease Control and Prevention (CDC), the Ebola virus has reached epidemic status in several countries in Africa, with a 50% mortality rate and more than 4,000 deaths. The CDC has stated that travel-related cases, such as the one in Texas, would inevitably occur, although the CDC reports that risk of a widespread outbreak of Ebola within the United States is extremely low.
Ebola is a viral infection with an average incubation period of about eight to 10 days. It presents with multiple symptoms, including vomiting, diarrhea, stomach pain, muscle aches, high fever, and unexplained bleeding or bruising. Currently, there is no vaccine against the virus; however, antiviral drugs have been used to successfully treat patients, including the two U.S. health-care workers. Ebola is not spread through air, water, or food. It is spread in all body fluids, including saliva; therefore, it is possible to spread Ebola in a dental setting.
The second major infectious disease threat is enterovirus D68 or EV-D68, as it is referred to by the CDC. Enteroviruses commonly circulate in the late summer or early fall and are common in children. EV-D68 has caused severe respiratory infections in children, resulting in hospitalizations and several deaths. In addition, some infected children have experienced paralysis, which is believed to be related to the enterovirus (polio is also an enterovirus). Symptoms include fever, cough, runny nose, and muscle aches. Severe cases may also include wheezing and shortness of breath, especially in children with asthma. These respiratory infections can be spread through respiratory secretions, including saliva, and can also be spread in a dental setting.
So what does this mean for dental care teams? First and foremost, dental team members need to be aware and informed about these infectious disease threats, since many patients may have questions about whether these diseases could be transmitted in a dental setting. The best resource for information regarding Ebola and EV-D68 is the CDC (cdc.gov). Another excellent resource for information pertaining to Ebola and dentistry is the Organization for Safety Asepsis and Prevention (OSAP) (osap.org/?page=Ebola).
Second, every dental practice should review their screening protocols for patients who have respiratory or other reported symptoms to determine whether it is appropriate to treat patients while they are symptomatic. Although it causes issues with scheduling and production when patients cancel, or when we choose to defer treatment, it is far better to err on the side of caution rather than have an infectious disease outbreak. With regard to Ebola infections, it is very important for dental teams not only to assess patients' physical statuses and possible symptoms, but to get information on their travel histories. This also applies to MERS (Middle East Respiratory Syndrome), which has been identified in people who have traveled to the Arabian Peninsula.
There is no need for panic at this point, but certainly a good dose of caution is in order with regard to any and all potential infectious disease threats.
Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Mary Govoni & Associates, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at [email protected] or www.marygovoni.com.