OCCUPATIONAL RISK AND PRECAUTIONS RELATED TO HIV-INFECTION AMONG DENTISTS IN THE LOTHIAN REGION OF SCOTLAND

This retrospective study used a postal questionnaire to measure occupational risks and to assess infection control procedures among 310 dental practitioners. The study comprised general dental practices in the Lothian region of Scotland, Lothian Health Board Community Dental Service and Edinburgh Dental Hospital. Altogether, 217 dental practitioners responded by the due date giving recall of inoculation injuries within the previous 5 years and infection control measures employed. The study revealed that 191 practitioners (88 %) had completed a course of hepatitis B vaccination but one-third of them had not been tested for post-vaccination antibody. In 1991, two thirds of dentists (66 %: 137 of 207 respondents) wore the same pair of gloves, and 80 % of dentists (142 of 177 respondents) wore the same mask, for dealing with more than one patient. The usual practice was to change gloves during sessions (44 %: out of 71 dentists) and to change masks for each session or less often (75 %: 73 out of 97 dentists). The proportion of dentists who never used gloves fell from 56 % in 1981 to 1 % in 1991. An autoclave was used for sterilisation by 85 % of practitioners in 1991. Reported non-sterile inoculation injuries averaged 1·7 (s.d. = 3·2) injuries per dentist in the previous year with 56 % of practitioners having had an injury. The average was 6·8 (s.d. = 15.9) injuries per dentist in the previous 5 years with 76 % of practitioners having had an injury. Of recent non-sterile inoculation injuries described by dental practitioners, 30 % constituted a moderate or high risk of transmission of infection to the practitioner (43 of 141 described injuries). Combined with HIV seroprevalance rates, probabilities of transmission and numbers of practising dentists, the mean reported number of non-sterile inoculation injuries in the previous 5 years may be used to provide estimates of expected numbers of dental practitioners occupationally infected with HIV in the previous 5 years. U.K. estimates were 0·004 dentists in Lothian region and 0·05 dentists in the Thames region occupationally infected with HIV in the previous five years. Non-sterile inoculation injuries appear to be a common hazard of dental practice. In any year, most dentists are exposed to the risk of blood-borne viral infection. Despite a high reported incidence of such injuries, dental practice within the U.K. appears to carry a low risk of acquiring HIV infection from occupational exposure. © 1994 The British Society for the Study of Infection.