science & practice10 AEEDC Dubai 2015 More than three decades have passed since the emergence of human immunodeficiency virus (HIV) as a global pandemic. More thananyotherinfection,itispossible tosingleoutHIVastheprimarystim- ulus for changing infection control practices in dentistry. Prior to the mid-1980s,itwasuncommonforden- tistsandalliedprofessionalstowear gloves during routine dental proce- dures. Many dental clinics did not use heat sterilisation, and disinfec- tion of surfaces was limited to a cur- sory wipe with an alcohol-soaked gauze sponge. This was despite our knowledge that hepatitis B virus (HBV)hadbeenspreadinclustersin theofficesandclinicsofinfectedden- tistsandthatdentistswereclearlyat occupationalriskforacquiringHBV. Today,manytakesafedentalcare forgranted,butthereisstillreasonto remainvigilantinensuringaninfec- tion-free environment for providers and patients. HIV has fortunately proven to be easily controlled in a clinicalenvironmentusingthesame precautions as those effective for preventing the transmission of HBV and hepatitis C virus.1 These stan- dard precautions include the use of personal protective attire, such as gloves, surgical masks, gowns and protective eyewear, in combination with surface cleaning and disinfec- tion, instrument sterilisation, hand hygiene, immunisations and other basic infection control precautions. Sporadic reports of transmission of blood-borne diseases associated with dental care continue, but are most often linked to breaches in the practiceofstandardprecautions.2 Emerging and re-emerging infec- tious diseases present a real chal- lenge to all health care providers. Threeofthemorethan50emerging andre-emerginginfectiousdiseases identifiedbytheCentersforDisease Control and Prevention and the World Health Organization (WHO) include Ebola virus disease (EVD), pandemic influenza and severe acute respiratory syndrome.3,4 These previously rare or unidenti- fied infectious diseases burst into the headlines in the past several years when they exhibited novel or uncharacteristic transmission pat- terns. Concern about emerging infec- tious diseases arises for several rea- sons.Whenfacedwithaparticularly deadly infectious disease such as EVD, which can be spread through contactwithanillpatient’sbodyflu- ids, health care workers are natu- rally concerned about how to pro- tectthemselvesifanillpatientpres- ents to the dental clinic. With dis- eases such as pandemic influenza and severe acute respiratory syn- drome, which may be spread via in- halation of aerosolised respiratory fluids when a patient coughs or sneezes, the concern is whether standard precautions will be ade- quate. In addition to standard precau- tions, treating patients with these diseases requires the use of trans- mission-based precautions. These encompass what are referred to as contact, droplet and airborne pre- cautionsfordiseaseswiththosespe- cific routes of transmission. Trans- mission-based precautions may in- cludepatientisolation,placingasur- gicalmaskonthepatientwhenheor she is around other people, additio- nal protective attire for care providers,andinsomecasestheuse of respirators and negative air pres- sure in a treatment room. In most cases, patients who are contagious for infections requiring droplet or airborne precautions should not be treated in a traditional dental clinic setting. Updating a patient’s medical his- tory at each visit will assist dental health professionals in identifying patientswhoaresymptomaticforin- fectious diseases. Patients with res- piratory symptoms, including pro- ductive cough and fever, should havetheirdentaltreatmentdelayed until they are no longer symp- tomatic. Additionally, health care professionals who are symptomatic should refrain from coming to work until they have been free of fever without taking fever-reducing med- icationfor24hours. In most cases, a patient with symptomsassevereasthoseexperi- enced with EVD will not present for dentalcareandthereforeextraordi- naryscreeningandprotectionproto- cols are not recommended. If a pa- tientissuspectedofhavingahighly contagiousdisease,heorsheshould be referred to a physician, hospital orpublichealthclinic. Dentalprofessionalsshouldtake action to remain healthy by being vaccinated according to accepted public health guidelines, under- standingthattherecommendations may differ according to country of residence. Performing hand hy- gieneproceduresatthebeginningof the day, before placing and after re- moving gloves, changing gloves for each patient, wearing a clean mask and gown or laboratory coat, and wearing protective eyewear are all positive actions that help prevent occupationalinfections.Inaddition, cleaning and heat sterilisation of all instrumentsanddisinfectionofclin- ical surfaces ensure a safe environ- ment for patients. There is solid evi- dence that dental care is safe for pa- tientsandproviderswhenstandard precautions are followed, but pa- tients and dental health care work- ers are placed at risk when precau- tions are compromised and breachesoccur. EveCunyisanassociateprofessor attheArthurA.DugoniSchoolofDen- tistry at the University of the Pacific in San Francisco in California in the US. She is also a consultant to the AmericanDentalAssociation’sCoun- cilonScientificAffairsandexpertre- viewer for the Centers for Disease Control and Prevention. At AEEDC Dubai 2015, she will be presenting two papers discussing infection con- trol in dentistry on Tuesday and Thursday. References: 1. Centers for Disease Control and Preven- tion,“OccupationalHIVtransmissionandpre- vention among health care workers”