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Prions in dentistry--what are they, should we be concerned, and what can we do?
Amir Azarpazhooh1, James L Leake
1Department of Community Dentistry, Faculty of Dentistry, University of Toronto, Toronto, Ontario. amir.azarpazhooh@utoronto.ca
Objective:
To briefly review the characteristics of prions, the risk of transmission and implications for infection control in dentistry.
Methods:
The literature on prion disease in the context of dentistry up to March 2005 was reviewed using the PubMed, MEDLINE, Cumulative Index to Nursing & Allied Health Literature, Google Scholar databases and the Web sites of the departments of health of countries affected by the disease.
Results:
The sporadic form of Creutzfeldt-Jakob disease (CJD) is the most common human prion disease; the mean age of those affected to date is 68 years, the mortality rate is 85% within 1 year, and the average death rate is 1 per million persons. Variant CJD (vCJD) affects people (mean age 26 years) with a history of previous extended periods of residence in certain countries, mainly in the United Kingdom. Currently, there is no evidence of human-to-human transmission of CJD or vCJD following casual or intimate contact or blood transfusion, nor is there evidence of iatrogenic transmission of vCJD in a health care setting. Furthermore, there is no evidence indicating increased occupational risk of CJD or vCJD among health workers or clustering of vCJD among people associated with a dental practice. The risk of transmission of prions through dentistry is unknown but is thought to be very low if appropriate infection control measures are taken.
Conclusions:
The theoretical risk of transmission of prion disease through dental treatment emphasizes the need to maintain optimal standards of infection control and decontamination procedures for all infectious agents, including prions.
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