PFA Dental World Newsletter — March/April • 2004

Table of Contents - March/April • 2004

Dental World

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Page

March/April • 2004

Page 4

Primary Research Article Continued
An Evidence-Based Study on the AIDS Epidemic in Dentistry
by E. J. Neiburger, DDS, Director, Center for Dental AIDS Research

(continued from page 3)

In 1999, the CDC changed the total number, removing one case; thus reporting a new total of 6 “possible” cases of dental worker occupational exposure. Dr. H. Gayle, Director of the CDC’s National Center for HIV, STD and TB Prevention explained that this change was because, “...CDC surveillance data are always presented as ‘provisional’ in these reports... further investigation showed the dental worker had other (behavioral or transfusion-related) risk factors...” The subject had lied to investigators.

After several years of inquiry through innumerable phone calls, Freedom of Information Act (FOIA) requests, litigation and Congressional/government inquiry, the following data describing the “possible” occupational transmissions in dental workers was received from the government and is presented: Of the seven (six) dentists classified as “possible” occupational HIV/AIDS transmission, three were general practitioners, one a periodontist, one a pedodontist and two were dental students. Five had AIDS; two were HIV positive but had no symptoms. Three dentists were mentally impaired. The seven preformed 22,134 procedures on 6,740 patients with no HIV/AIDS being transferred to or from the operators (DNA studies).

Dentist 1. The first case was reported by Klein et al and used by OSHA to extrapolate the dangers of AIDS transmission to dental workers. Klein found a male dentist who tested HIV positive and denied high-risk behavior in a survey of 1,309 dental staff. He lived among and treated New York City “village” patients; a high AIDS risk population. He intermittently used protective equipment. His wife refused to be tested. HIV exposure could not be documented and the CDC authors freely made an assumption; that if the dentist did contract HIV occupationally, then Universal Precautions would have prevented transmission. The problem with this study is that it was based on an unproved assumption (the dentist got HIV occupationally from his patients) with no other supporting evidence concerning false positive testing or other high-risk causes (e.g. bisexual contacts, drugs, etc.). Investigators took his word as fact. OSHA based its decision to include dental workers in its 1991 Blood Borne Pathogen Rule on this one case describing it as proof of... “a risk of dental professionals acquiring HIV.” There is no science supporting this conclusion. It was a guess. Dentists 2 & 3. The 12-6-91 Federal Register (Blood borne Pathogen Rule p. 64021) contains one reference of “further evidence” involving two seroconverted dental workers, among a group of 69 health care workers, with no identifiable risk for infection. OSHA considers these cases “less complete” and states, “it is reasonable to assume that at least some of them resulted from occupational exposure” but gives no scientific references to support this claim.

A 1992 report in MMWR mentions these two dentists and states they worked in a correctional facility (treating high risk patients), experienced needle sticks from equipment used on unidentified patients and died before HIV–DNA studies and in depth interviews could be done. Since there was little information on these two dentists (e.g. their potential high risk behavior), CDC staffers could not rule out occupational transmission and thus they were classified as “possible.” This “possible” designation is problematic because “possible” is often extended to “probable,” then “most likely” and finally being assumed as “actually happened” classifications: data torturing often seen in other government publications with a political bias.

Dentists 4, 5 & 6 (including perhaps dentists 1-3). The CDC, after years of numerous calls and an ignored FOIA request from the American Association of Forensic Dentists, reconsidered its decision and provided more data on “possible” occupational seroconversion cases in 1996 and later, 2003. This change of heart may have been encouraged by pressure of a high ranking Congressional committee chairman (John Porter, MC) during funding hearings. The CDC provided a single “scientific” document in the form of a short abstract from the 1995 meeting of the American Association of Public Health Dentistry. This was the “hard scientific” data the CDC supplied to Congress (and the FOIA requests) on the “possible” dental occupational seroconversions. The objectives were “To describe demographic characteristics and exposure to HIV among dental workers (DW) reported to the CDC through 1994.” The summary of the report stated: “Six Dental Workers (DW) reported without a specific risk had occupational exposures that were possibly associated with HIV transmission: three of those reported percutaneous exposure to patient’s blood or body fluids, although the patients were not known to be HIV-infected. Conclusions: Almost all of the DWs reported to the CDC with AIDS had behavior risks for HIV infection. Adherence to universal precautions by DWs is recommended.”

This report states that “almost” all the possible cases of DWs seroconverting had high-risk behavior, a proven source of HIV/AIDS infection unrelated to dentistry. The first dentist would not admit high-risk behavior. There were no examples of individuals who did not have this probable cause of infection. When asked how accurate this data was in supporting the “possible” designation, one CDC official stated, “The scientific evidence is not very ‘hard.’” There are no documented cases of occupational HIV/AIDS transmission. There are no “probable” cases and the six dentists classified in the “possible” designation appear arbitrary, lacking any scientific veracity.

	Primary Research Article Continued An Evidence-Based Study on the AIDS Epidemic in Dentistry by E. J. Neiburger, DDS, Director, Center for Dental AIDS Research
	Conclusion So where do we stand on the potential of dental workers (dentists, assistants, etc.) of acquiring HIV/AIDS professionally? AIDS/HIV seroconversion rates of dentists have been studied for over 20 years. There is no dependable scientific evidence to substantiate that dental workers are or have been in ANY danger. The historical odds of a dental worker acquiring HIV/AIDS occupationally are zero. This is supported by the facts that in billions of dental patient contacts there have never been any documented cases of occupational HIV/AIDS infection in dentistry anywhere in the world since AIDS was discovered. It appears that the CDC’s proposed seven (six) possible cases of dental worker infection are based on scant, unscientific, poorly substantiated and unreliable/data. Because of the politics, panic, exaggerations, denials, scandals, redefinitions and unscientific epidemiology which form the basis of the governments dental-related recommendations/ regulations (not to mention an ignorant and fear crazed populace), dentistry has spent billions of dollars, person hours and lives lost on infection control schemes addressing the prevention of a disease that does not affect dental personnel. Because of the lack of demonstrative infection transmission over the 20-plus years of AIDS (before and after the advent of Universal Precautions), we are faced with one humbling conclusion. The dental profession has been duped. Dental workers do not get occupational HIV/AIDS. The FRAIDS epidemic in dentistry fueled an extreme infection control movement that was not warranted nor supported by the alleged science identifying a hazard. It has not significantly reduced the already small infection transmission rates of other diseases. Vast resources were diverted from the population’s health care and livelihoods to address a “chicken little” disaster that never existed. Now that mythology and fear has somewhat abated, our		profession should carefully re-examine the research and evidence available and produce clear, practical standards on disinfection, sterilization and patient treatment that more accurately reflect the objective scientific realities of HIV/AIDS hazards in dentistry. We should be skeptical of any alarmist’s tales. Dentistry should not continue the fear and hype that has been embarrassing the dental community and enriching hucksters and false prophets since the 1980’s. I would recommend the following measures: 1. Cease confusing the CDC’s “six possible” occupational dental cases as fact. It is at best, an unsubstantiated guess. Carefully investigate the CDC’s data and publicize the scientific findings. 2. Do not believe everything government tells you. Require the CDC to provide full documentation (e.g. web) on all its data and decision-making processes. Be skeptical and demand hard scientific proof for regulations. 3. Allow the dental workers the option of choosing what protective equipment and measures they will use on a case-by-case basis utilizing their professional judgment. The existing broad governmental mandates (e.g. Universal-Standard Precautions are unsupportable. 4. Establish a mechanism to insure accuracy in future infectious disease reporting and recommendations outside of the CDC (e.g. independent review panel, firing untruthful employees). 5. Insist on objectivity, accuracy and balance in dental organizations and publications. 6. Don’t be so gullible and easily lead. It is time for a change. References (available upon request) Copyright 2003 by E. Neiburger and the Center for Dental AIDS Research. Permission to republish is granted to anyone who wishes to print this document provided that a copy of the article is mailed to E. Neiburger, CDAR. 1000 North Ave. Waukegan IL 60085 USA

	Central Office Report

	As of January 2004, all Fellowship dues for this year are $100 USD. The Initiation fee (one time) is $150 USD. For a new Fellow to be inducted that means $250 USD for the initiation and one year’s dues. We are suggesting that the Initiation be presented at some formal induction affair to give it the level of importance the honor deserves, like a dinner, luncheon meeting, perhaps even a breakfast gathering, preferably in conjunction with an appropriate dental meeting or social function. All new Fellow Certificates, pins, and/or ribbons will be sent to the Section Chair. Allow at least 14-20 days for the preparation of the Certificates so they will be there on time. On short notice requests, call the office at 1-800-232-0099. The Distinguished Dentist of the Year Awards are available to all Sections. All Chairs are recommended to make		such a presentation annually. Be sure to notify the Central Office the full name of the recipient including middle name or initial or whatever exactly you want on the award. Do not forget to include the degree: DDS, DMD, or equivalent. Also send the address of the recipient so that a congratulatory letter can be sent from the Academy President. Allow at least 20 to 30 days for preparation and return mailing to be there for the date of your event. Fellowship lists and/or mailing labels are provided on request. Allow 5 to 7 days for their preparation and return mailing. COMMUNICATION is essential to service with speed and dispatch for your requests of the Central Office. Phone us at 1-800/232-0099; local phone 1-702/651-5527; fax 1-702/651-5537 or 1-702/365-8002; email: Rkozal@aol.com (PFA Secretary General Richard Kozal) or PFAJDK@aol.com for Assistant Secretary/Treasurer Judith Kozal.

	Primary Research Article Continued An Evidence-Based Study on the AIDS Epidemic in Dentistry by E. J. Neiburger, DDS, Director, Center for Dental AIDS Research
	(continued from page 3) In 1999, the CDC changed the total number, removing one case; thus reporting a new total of 6 “possible” cases of dental worker occupational exposure. Dr. H. Gayle, Director of the CDC’s National Center for HIV, STD and TB Prevention explained that this change was because, “...CDC surveillance data are always presented as ‘provisional’ in these reports... further investigation showed the dental worker had other (behavioral or transfusion-related) risk factors...” The subject had lied to investigators. After several years of inquiry through innumerable phone calls, Freedom of Information Act (FOIA) requests, litigation and Congressional/government inquiry, the following data describing the “possible” occupational transmissions in dental workers was received from the government and is presented: Of the seven (six) dentists classified as “possible” occupational HIV/AIDS transmission, three were general practitioners, one a periodontist, one a pedodontist and two were dental students. Five had AIDS; two were HIV positive but had no symptoms. Three dentists were mentally impaired. The seven preformed 22,134 procedures on 6,740 patients with no HIV/AIDS being transferred to or from the operators (DNA studies). Dentist 1. The first case was reported by Klein et al and used by OSHA to extrapolate the dangers of AIDS transmission to dental workers. Klein found a male dentist who tested HIV positive and denied high-risk behavior in a survey of 1,309 dental staff. He lived among and treated New York City “village” patients; a high AIDS risk population. He intermittently used protective equipment. His wife refused to be tested. HIV exposure could not be documented and the CDC authors freely made an assumption; that if the dentist did contract HIV occupationally, then Universal Precautions would have prevented transmission. The problem with this study is that it was based on an unproved assumption (the dentist got HIV occupationally from his patients) with no other supporting evidence concerning false positive testing or other high-risk causes (e.g. bisexual contacts, drugs, etc.). Investigators took his word as fact. OSHA based its decision to include dental workers in its 1991 Blood Borne Pathogen Rule on this one case describing it as proof of... “a risk of dental professionals acquiring HIV.” There is no science supporting this conclusion. It was a guess. Dentists 2 & 3. The 12-6-91 Federal Register (Blood borne Pathogen Rule p. 64021) contains one reference of “further evidence” involving two seroconverted dental workers, among a group of 69 health care workers, with no identifiable risk for infection. OSHA considers these cases “less complete” and states, “it is reasonable to assume that at least some of them resulted from occupational exposure” but gives no scientific references to support this claim.		A 1992 report in MMWR mentions these two dentists and states they worked in a correctional facility (treating high risk patients), experienced needle sticks from equipment used on unidentified patients and died before HIV–DNA studies and in depth interviews could be done. Since there was little information on these two dentists (e.g. their potential high risk behavior), CDC staffers could not rule out occupational transmission and thus they were classified as “possible.” This “possible” designation is problematic because “possible” is often extended to “probable,” then “most likely” and finally being assumed as “actually happened” classifications: data torturing often seen in other government publications with a political bias. Dentists 4, 5 & 6 (including perhaps dentists 1-3). The CDC, after years of numerous calls and an ignored FOIA request from the American Association of Forensic Dentists, reconsidered its decision and provided more data on “possible” occupational seroconversion cases in 1996 and later, 2003. This change of heart may have been encouraged by pressure of a high ranking Congressional committee chairman (John Porter, MC) during funding hearings. The CDC provided a single “scientific” document in the form of a short abstract from the 1995 meeting of the American Association of Public Health Dentistry. This was the “hard scientific” data the CDC supplied to Congress (and the FOIA requests) on the “possible” dental occupational seroconversions. The objectives were “To describe demographic characteristics and exposure to HIV among dental workers (DW) reported to the CDC through 1994.” The summary of the report stated: “Six Dental Workers (DW) reported without a specific risk had occupational exposures that were possibly associated with HIV transmission: three of those reported percutaneous exposure to patient’s blood or body fluids, although the patients were not known to be HIV-infected. Conclusions: Almost all of the DWs reported to the CDC with AIDS had behavior risks for HIV infection. Adherence to universal precautions by DWs is recommended.” This report states that “almost” all the possible cases of DWs seroconverting had high-risk behavior, a proven source of HIV/AIDS infection unrelated to dentistry. The first dentist would not admit high-risk behavior. There were no examples of individuals who did not have this probable cause of infection. When asked how accurate this data was in supporting the “possible” designation, one CDC official stated, “The scientific evidence is not very ‘hard.’” There are no documented cases of occupational HIV/AIDS transmission. There are no “probable” cases and the six dentists classified in the “possible” designation appear arbitrary, lacking any scientific veracity.