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Hepatitis is an inflammation of the liver with a variety of causes that include 5 hepatotropic viruses (HAV, HBV, HCV, HDV, HEV), nonhepatotropic viruses (cytomegalovirus, Epstein-Barr virus, herpes simplex virus, and varicella virus), infectious agents other than viruses (bacteria, fungi, parasites), drugs and toxic agents, autoimmune conditions, and metabolic disorders such as Wilson disease and α 1 -antitrypsin deficiency. 1 – 3 Hepatitis can be self-limiting, resolving on its own, or it can progress to cirrhosis or hepatocellular

diseases” versus “physical proximity to others.” Historically, professionals in dentistry have been vulnerable to a number of infectious diseases, including hepatitis B (HBV), hepatitis C, herpes simplex virus, Epstein-Barr–derived infectious mononucleosis, tuberculosis (TB), cytomegalovirus, rubella, gonorrhea, syphilis, influenza, and HIV. 4 Dental literature from 1989 5 cited 14% of general dentists and “nearly twice that number of oral and maxillofacial surgeons” testing positive for viral HBV markers. Accordingly, the American Dental Association (ADA) developed

In the fall of 2013, the first documented report in the United States of a patient-to-patient transmission of the hepatitis C virus (HCV) associated with a dental office was issued by the Centers for Disease Control and Prevention (CDC). Using sophisticated genetic testing, it positively linked the transmission of HCV between 2 patients treated at the office of a Tulsa Oklahoma oral surgeon. Dr. Christy Bradley, an epidemiologist with the Oklahoma Department of Health, indicated that while it may be impossible to trace exactly how the virus

access to these drugs to adequately treat patients, and, unfortunately, this abuse eventually will devastate the dental practice. However, an equally dangerous threat to the absolute survival of an office practice and the dentist's financial security involves the consequences of an unlicensed employee with a drug problem who has open access to the controlled substances. A recent example, according to an Associated Press news article, involved a Colorado ambulatory surgery center's surgical technician who had hepatitis C. She had easy access to fentanyl syringes, which

resulted from 2 major problems. The first involved an unjust, ridiculous medical-legal verdict involving a major generic drug manufacturer, Teva Pharmaceuticals, which had an estimated 40% of the U.S. marketshare of propofol. The manufacturer announced that they will no longer produce propofol because it is difficult and expensive to manufacture the emulsion, its profit margin is small, and a court ordered it to pay $356 million to 1 man who was among 144 people to develop hepatitis C from a practitioner who connected the same large, single-use vial of propofol to the

the mandible. The proposed treatment was closed reduction in the operating room under general anesthesia. Her past medical history was significant for liver transplantation performed 6 months earlier, secondary to fulminant hepatitis caused by hepatitis C. Current medications were prednisone and tacrolimus for immunosuppression and dapsone for P. carinii pneumonia (PCP) prophylaxis. The patient was taken to the operating room and standard monitors were placed by the anesthesiologist. Presurgical vital signs revealed a normal sinus rhythm, blood pressure of

containing sterile saline was not contaminated because viruses probably don't swim upstream in the IV line. In truth, the CDC indicates that everything entering in or connected to the IV line once it is connected to the patient's blood is considered contaminated with that patient's blood. Lack of aseptic technique by an Oklahoma oral surgeon clearly led to the over 60 cases of hepatitis and HIV inoculation in 2013, including the first documented case of transfer of hepatitis C between patients in a dental office. Were any of these cases related to sedation with lack of

Review of the Literature (brief review), 21 Walker LA, see VanCleave, 21 Watanabe M, see Ogawa, 53 Watanabe T, see Sanuki T, 162 Weaver JM, Confirmed Transmission of Hepatitis C in an Oral Surgery Office (editorial), 93 Weaver JM, Multiple Risks for Patients Using the Transdermal Fentanyl Patch (editorial), 1 Weaver JM, The Importance of Anesthesia Progress to Dental Anesthesiology (editorial), 133 Weaver JM, When Can a Normal Dose Be an Overdose? Who Is at Risk? (editorial), 45 Yabuki A, see

multifaceted propofol shortage of the early 2010s. The propofol deficit kicked off following a verdict against Teva Pharmaceuticals, a major supplier of ∼40% of the US market share at the time, for unsanitary drug practices after a hepatitis C outbreak. Despite being tangentially involved, Teva and Baxter (their partner) were found responsible and ordered to pay almost half a billion dollars, causing many drug companies to rethink their risk tolerance for producing high-liability products. 1 Around the same time, Hospira shut down a major US propofol plant due to

rickettsiae, 14 viral hepatitis, 15 – 21 dental caries, 16 salmonella, 17 – 19 and beta-hemolytic streptococci, 20 have been implicated. Quereshy et al. 16 describe a case of a G6PD-deficient patient who developed hemolytic anemia secondary to a maxillofacial infection due to a grossly carious tooth. The factors responsible for accelerated destruction of G6PD-deficient red cells during infection are not known. One possible explanation is that the red cells are damaged by oxidants generated by phagocytosing macrophages—a mechanism similar to that seen with drug