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Although the potential for transmission of bloodborne infections from DHCP to patients is considered limited (53--55), precise risks have not been quantified by carefully designed epidemiologic studies (53,56,57). Reports published during 1970--1987 describe nine clusters in which patients were thought to be infected with HBV through treatment by an infected DHCP (58--67). However, transmission of HBV from dentist to patient has not been reported since 1987, possibly reflecting such factors as 1) adoption of universal precautions, 2) routine glove use, 3) increased levels of immunity as a result of hepatitis B vaccination of DHCP, 4) implementation of the 1991 OSHA bloodborne pathogen standard (68), and 5) incomplete ascertainment and reporting. Only one case of patient-to-patient transmission of HBV in the dental setting has been documented (CDC, unpublished data, 2003). In this case, appropriate office infection-control procedures were being followed, and the exact mechanism of transmission was undetermined.

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