Drilling for Danger – Prions found to be Transmissible in Aerosols

A study has confirmed that prions – responsible for diseases like Mad Cow – can be transmitted and infective through aerosolized droplets of fluid, such as those produced during a dental procedure.

Dental professionals may be in a unique position of risk and transmission for prion diseases, a new study shows. While the 2003 Mad Cow scare is old news, Creutzfeldt–Jakob (CJD) disease is still a significant concern in medical facilities. The focus of this concern is preventing transmission of this incurable and dangerously resilient pathogen, which has been shown to linger on traditionally-sterilized equipment, leading to the iatrogenic infection of two otherwise healthy patients. As a result, decontamination measures were improved and no further patients have been infected while under medical care in the US.

However, dental professionals are still at risk for transmitting prion diseases, as prions can resist temperatures of up to 1,112 degrees Fahrenheit. This is far above the standard autoclave temperature, and furthermore, antibacterial agents like alcohol and even formaldehyde are ineffective. Only extremely high temperature treatment or certain chemical denaturants are effective in preventing the disease from spreading, most of which are not commonly kept in the dental office.

Dentistry isn’t brain surgery though, so the risk of infection should be minimal, or should it? As it turns out, teeth arise from highly innervated neural crest cells, and thus dental pulp may represent a reservoir of infective prions that could in theory be transferred between patients even if proper sterilization and biohazard procedures are followed. It is arguably only the low incidence and difficult traceability of CJD (which has an incubation period of up to 20 years) that has kept more stringent containment measures from being instituted.

The risk may not be solely to the patient, a study published in the Journal of General Virology suggests. Prions have been confirmed as transmissible through inhaled fluid droplets in mice with Chronic Wasting Disease, another prion-induced condition. Because CJD is so dangerous to humans, similar studies have not been attempted on this variant, but it suggests that CJD aerosolized by the action of the handpiece could potentially infect the doctor and dental office staff.

Prion diseases remain shrouded in mystery due to the difficulty of observing their method of action and experimenting under safe protocols, but the rarity of contracting this disease should not excuse unsafe practices. As always, it only takes one source of infection to poison an entire community.

Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4860911/

http://www.jendodon.com/article/S0099-2399(08)00640-7/pdf

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