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Hepatitis B
LETTERS TO THE EDITOR
killed by the ambient room oxygen. Studies involving the sampling of bacteria should use needle aspiration if possible. . .. Dr. Shuford’s conclusion that cephalexin may have a unique use in dentistry does not address the fol lowing points: — The use of ce p h a le x in in anaerobic infections is not approved by the FDA (Package insert 1975). —Ninety percent of cephalexin is excreted unchanged in the urine; therefore it is a poor drug for a patient in renal failure. —AMA Drug Evaluations says that “Despite the fact that cephalosporins have been effective in many different infectious diseases, they generally should not be regarded as a firstchoice group of antibiotics.”6 —The preferred drug for odon togenic infections is penicillin V potassium, unless culture reports show B acteroides fragilis, in which case clindamycin is preferred.7 —A 250-mg dose of cephalexin costs the pharmacist ten times what a 250-mg dose of penicillin V potas sium costs. . . . CLAIRE L. GILL, PharmD LOS ANGELES 1. Gordon, D.F.; Stutman, M.; and Loesche, W.J. Improved isolation of anaerobic bacteria from g in g iv a l c re v ic e . A ppl M icro b io l 21:1046-1050,1971. 2. Crawford, I.J., and others. Bacteremia after tooth extraction studied with the aid of pre reduced anaerobically sterilized culture media. Appl Microbiol 27:927-932,1974. 3. Sabiston, D.B., and Gold, W.A. Anaerobic b a c te r ia in o ra l in f e c tio n s . O ral Surg 38(2):187-192, 1974. 4. Gabrielson, M.I., and Stroh, E. Antibiotic efficacy in odontogenic infections. J Oral Surg 33(8):607-610,1975. 5. Hunt, D.E.; King, T.J.; and Fuller, G.E. An tibiotic susceptibility of bacteria isolated from oral infections. J Oral Surg36(7):527-529,1978. 6. American Medical Association. AMA Drug Evaluations, 3rd ed. Acton, Mass, Publish ing Sciences Group, Inc., 1977. 7. Mehrohof, A.I., Jr. Clindamycin: an evalu ation of its role in dental patients. J Oral Surg 34(9):811-817, 1976. 8. Drug Topic’s Red Book. Oradell, NJ, Litton Industries, 1979.
A blood test (unnamed in the re port, but assumed to be a third gener ation test for hepatitis B surface anti gen, HBsAg) cannot “protect” den tists from hepatitis B. It can only identify patients who are potentially infectious for hepatitis B to dental personnel. Protection from infection comes from adoption of recom mended clinical dental practices and sterilization techniques.1 Use of high speed handpieces in treatment of patients suspected to be infectious for hepatitis B is not con traindicated.1 Airborne spread of the disease does not seem likely, al though indirect transmission can probably occur from contact with surfaces contaminated by impacted droplets containing hepatitis B sur face antigen.2'3 Adoption of precau tions that have been clearly stated in the literature1allows treatment of po tentially infectious patients in normal settings without need for re ferral to “specifically set up” clinics, as suggested in the report. Instruments used in treatment of patients carrying HBsAg do not need to be “specially sterilized”, as stated in th e s to ry . A u to c la v in g is adequate.1 The Center for Disease Control has recognized the increased incidence of HBsAg in Indochinese refugees. Recommendation has been made that HBsAg testing be routine for these re fugees, and that precautionary mea sures be adopted during dental treatment of these or other high-risk people.4 The dental treatment of patients carrying HBsAg does not lend itself to discussion in an abbreviated news report. The story serves only to further the notion that dental pa tients with complicating medical conditions (in this case, suspected hepatitis B) should be avoided rather than treated. I suspect that the infor mation attributed to Dr. James Main in the story does not do justice to his intentions. MICHAEL J. TOLLMAN, DDS, MPH PHILADELPHIA
Hepatitis B □ The news story on page 870 of The Jo u r n a l for November, entitled “Blood test can protect dentists from hepatitis B i s a confusing collection of only partially accurate informa tion. 174 ■ JADA, Vol. 100, February 1980
1. American Dental Association, Council on Dental Materials and Devices, Council on Den tal Therapeutics. Infection control in the dental office. JADA 97(4):673-677, 1978. 2. Petersen, N.J.; Bond, W.W.; and Favero, M.S. Air sampling for hepatitis B surface anti gen in a dental opeiatory. JADA 99(3):465-467, 1979. 3. Maynard, James E. Modes of hepatitis B
virus transmission. In Oda, T., (ed.). Hepatitis viruses. Baltimore, University Park Press, 1978, p 126. 4. Center for Disease Control. Health status of Indochinese refugees: malaria and hepatitis B. MMWR 28(39):464, 469-470, 1979.
National Health Service □ Please permit me to respond to Dr. Avetoom’s letter (The Journal, De cember 1979) regarding the British National Health Service, for it is dis maying to read any diatribe against a system which has, from its inception and despite serious economic dif ficulties, maintained dentistry as an integral part of a comprehensive na tional health care plan. The word “socialized” may have been used, however inadvertently, to disturb those of us Americans weaned on the concept of rugged individualism and unequivocal superiority of private enterprise. If, as assumed by Dr. Avetoom, Dr. Waldman’s impressions were indeed molded by the British academic es tablishment, he can be assured that mine were formed by involvement at the grass roots level of the National Health Service. I have to say that my many years of practice in Great Brit ain have been the most gratifying and pleasant in my practicing career de spite the demands made on my time and abilities. . . . I have been able to apply what I have learned and am continually learning—to restore and maintain the health and function of the oral apparatus in the best way possible, under all existing circum stances, as part of total patient care. The dentist in the United Kingdom . . . is free to practice anywhere in the country and even in some parts of the Commonwealth without regional li censing restrictions. He is subjected to the same moral and socioeconomic restraints that affect us all no matter where we practice. In the face of the severe economic difficulties that have afflicted the na tion, the British National Health Ser vice has made a population previ ously denied access to dental care increasingly aware of the importance of dentistry. For a country with the third lowest per capita income in the European Economic Community to maintain such a service is praisewor thy and deserving of majority sup port.
killed by the ambient room oxygen. Studies involving the sampling of bacteria should use needle aspiration if possible. . .. Dr. Shuford’s conclusion that cephalexin may have a unique use in dentistry does not address the fol lowing points: — The use of ce p h a le x in in anaerobic infections is not approved by the FDA (Package insert 1975). —Ninety percent of cephalexin is excreted unchanged in the urine; therefore it is a poor drug for a patient in renal failure. —AMA Drug Evaluations says that “Despite the fact that cephalosporins have been effective in many different infectious diseases, they generally should not be regarded as a firstchoice group of antibiotics.”6 —The preferred drug for odon togenic infections is penicillin V potassium, unless culture reports show B acteroides fragilis, in which case clindamycin is preferred.7 —A 250-mg dose of cephalexin costs the pharmacist ten times what a 250-mg dose of penicillin V potas sium costs. . . . CLAIRE L. GILL, PharmD LOS ANGELES 1. Gordon, D.F.; Stutman, M.; and Loesche, W.J. Improved isolation of anaerobic bacteria from g in g iv a l c re v ic e . A ppl M icro b io l 21:1046-1050,1971. 2. Crawford, I.J., and others. Bacteremia after tooth extraction studied with the aid of pre reduced anaerobically sterilized culture media. Appl Microbiol 27:927-932,1974. 3. Sabiston, D.B., and Gold, W.A. Anaerobic b a c te r ia in o ra l in f e c tio n s . O ral Surg 38(2):187-192, 1974. 4. Gabrielson, M.I., and Stroh, E. Antibiotic efficacy in odontogenic infections. J Oral Surg 33(8):607-610,1975. 5. Hunt, D.E.; King, T.J.; and Fuller, G.E. An tibiotic susceptibility of bacteria isolated from oral infections. J Oral Surg36(7):527-529,1978. 6. American Medical Association. AMA Drug Evaluations, 3rd ed. Acton, Mass, Publish ing Sciences Group, Inc., 1977. 7. Mehrohof, A.I., Jr. Clindamycin: an evalu ation of its role in dental patients. J Oral Surg 34(9):811-817, 1976. 8. Drug Topic’s Red Book. Oradell, NJ, Litton Industries, 1979.
A blood test (unnamed in the re port, but assumed to be a third gener ation test for hepatitis B surface anti gen, HBsAg) cannot “protect” den tists from hepatitis B. It can only identify patients who are potentially infectious for hepatitis B to dental personnel. Protection from infection comes from adoption of recom mended clinical dental practices and sterilization techniques.1 Use of high speed handpieces in treatment of patients suspected to be infectious for hepatitis B is not con traindicated.1 Airborne spread of the disease does not seem likely, al though indirect transmission can probably occur from contact with surfaces contaminated by impacted droplets containing hepatitis B sur face antigen.2'3 Adoption of precau tions that have been clearly stated in the literature1allows treatment of po tentially infectious patients in normal settings without need for re ferral to “specifically set up” clinics, as suggested in the report. Instruments used in treatment of patients carrying HBsAg do not need to be “specially sterilized”, as stated in th e s to ry . A u to c la v in g is adequate.1 The Center for Disease Control has recognized the increased incidence of HBsAg in Indochinese refugees. Recommendation has been made that HBsAg testing be routine for these re fugees, and that precautionary mea sures be adopted during dental treatment of these or other high-risk people.4 The dental treatment of patients carrying HBsAg does not lend itself to discussion in an abbreviated news report. The story serves only to further the notion that dental pa tients with complicating medical conditions (in this case, suspected hepatitis B) should be avoided rather than treated. I suspect that the infor mation attributed to Dr. James Main in the story does not do justice to his intentions. MICHAEL J. TOLLMAN, DDS, MPH PHILADELPHIA
Hepatitis B □ The news story on page 870 of The Jo u r n a l for November, entitled “Blood test can protect dentists from hepatitis B i s a confusing collection of only partially accurate informa tion. 174 ■ JADA, Vol. 100, February 1980
1. American Dental Association, Council on Dental Materials and Devices, Council on Den tal Therapeutics. Infection control in the dental office. JADA 97(4):673-677, 1978. 2. Petersen, N.J.; Bond, W.W.; and Favero, M.S. Air sampling for hepatitis B surface anti gen in a dental opeiatory. JADA 99(3):465-467, 1979. 3. Maynard, James E. Modes of hepatitis B
virus transmission. In Oda, T., (ed.). Hepatitis viruses. Baltimore, University Park Press, 1978, p 126. 4. Center for Disease Control. Health status of Indochinese refugees: malaria and hepatitis B. MMWR 28(39):464, 469-470, 1979.
National Health Service □ Please permit me to respond to Dr. Avetoom’s letter (The Journal, De cember 1979) regarding the British National Health Service, for it is dis maying to read any diatribe against a system which has, from its inception and despite serious economic dif ficulties, maintained dentistry as an integral part of a comprehensive na tional health care plan. The word “socialized” may have been used, however inadvertently, to disturb those of us Americans weaned on the concept of rugged individualism and unequivocal superiority of private enterprise. If, as assumed by Dr. Avetoom, Dr. Waldman’s impressions were indeed molded by the British academic es tablishment, he can be assured that mine were formed by involvement at the grass roots level of the National Health Service. I have to say that my many years of practice in Great Brit ain have been the most gratifying and pleasant in my practicing career de spite the demands made on my time and abilities. . . . I have been able to apply what I have learned and am continually learning—to restore and maintain the health and function of the oral apparatus in the best way possible, under all existing circum stances, as part of total patient care. The dentist in the United Kingdom . . . is free to practice anywhere in the country and even in some parts of the Commonwealth without regional li censing restrictions. He is subjected to the same moral and socioeconomic restraints that affect us all no matter where we practice. In the face of the severe economic difficulties that have afflicted the na tion, the British National Health Ser vice has made a population previ ously denied access to dental care increasingly aware of the importance of dentistry. For a country with the third lowest per capita income in the European Economic Community to maintain such a service is praisewor thy and deserving of majority sup port.