Infectious diseases without oral symptoms - Infectious diseases in oral care practice

This category includes everyday colds and various flu variants, some of which are certainly not innocent. In addition, there is also a risk of contamination in dental practice in a number of other known 'everyday' diseases.

Infectious diseases without oral symptoms - Infectious diseases in oral care practice
The causative agent of chickenpox is the herpes sun virus. The disease causes itchy blisters that can spread all over the body, even on the hairy scalp! The incubation period is two weeks and the disease is contagious from a few days before the outbreak to a week after. The transfer takes place by contact with the fluid from the vesicles or via a droplet infection in the air: aerosol (by coughing or sneezing).

Infectious diseases without oral symptoms


This category includes everyday colds and various flu variants, some of which are certainly not innocent. In addition, there is also a risk of contamination in dental practice in a number of other known 'everyday' diseases.


Child diseases without symptoms in the mouth



Red dog is caused by the rubella virus, which only occurs in humans. Contamination takes place via droplets in the air, for example when coughing and sneezing. Whoever has a rubella infection, affects seven to eight other people on average. An infected mother can infect her unborn child through the placenta. Between infection with rubella and the outbreak of the disease are on average fourteen to sixteen days (incubation period). The disease is contagious from ten days before the outbreak of the skin rash until one week after. About half of the infected people show no significant signs of disease. The other patients have a spotty, pinkish skin rash, starting in the face and rapidly expanding to the upper body, arms and legs. In older children and adults there are also flu-like symptoms and swollen lymph nodes behind the ear and in the neck. If a woman becomes infected with rubella in the first three months of her pregnancy, there is a great risk of congenital abnormalities in the unborn child such as heart and eye disorders, hearing impairment or even deafness. The pregnancy can also end in a miscarriage. It is important that pregnant women who suspect that they are infected with rubella, contact their doctor. Despite the vaccination program for children, rubella still occurs, albeit less often than before. The severity of the possible complications during pregnancy was the main reason for including this disease in the BMR vaccination cocktail (mumps, measles and rubella).



The causative agent of chickenpox is the herpes sun virus. The disease causes itchy blisters that can spread all over the body, even on the hairy scalp! The incubation period is two weeks and the disease is contagious from a few days before the outbreak to a week after. The transfer takes place by contact with the fluid from the vesicles or via a droplet infection in the air: aerosol (by coughing or sneezing). After the disease, the virus remains (just as with herpes simplex) throughout life in the body. With reduced resistance, the chickenpox virus can resurface in the form of shingles.


Whooping cough

Whooping cough is caused by the bacteria Bordetella pertussis and Bordetella parapertussis. The disease is easily transferable via the aerosol. The bacterium infects the mucous membrane of the respiratory tract and initially causes common cold symptoms. Then there is a period of about four weeks with coughing ('barking cough'). The transfer can take place from the first moment of 'being fluent' to more than four weeks (!) Thereafter. Despite the fact that vaccination against whooping cough in children has been used systematically for many years, an epidemic of this disease occurs with a certain regularity.


Hepatitis A, B, C, D, E, G

This concerns various infectious diseases in which the liver is affected (hepar = liver, itis = inflammation). Poor liver function leads to the accumulation of breakdown products in the blood, causing yellowing of the skin and the whites of the patients. A frequently heard name for hepatitis is jaundice. Various viruses are responsible for these symptoms. All hepatitis variants expire at the latest in the same way and only by blood tests can it be determined which virus caused the infection. Some viruses are spread via blood contact (HBV, HCV, HDV and HGV), others can enter the body via food (HAV and HEV). The contagiousness of hepatitis B is very high. The disease is not only transmitted through blood, but also via saliva, wound fluid, semen and vaginal discharge. Only a minuscule amount of contaminated material in a micro-injury is needed to cause an infection. Of all needle-stick accidents with contaminated blood, as much as 25% (!) Leads to an infection. One out of four lancing accidents is therefore 'hit'. This makes hepatitis B a very high risk for the staff in oral care practices and vaccination is urgently recommended.


Since 2011, the HBV vaccine has been included in the National Vaccination Program, so that in the long term most employees can be protected under this program. A titer must then be determined by means of a blood test to assess the vaccination status before taking up employment.


Results blood test after vaccination is a measure of the protection against HBV

Titer <10 IU / L: No significant protection
Titer 10-100 IU / L: Little protection, additional testing is necessary
Titer> 100 IU / L: Long-term protection, according to current insight for life


Until then, vaccination is urgently required when entering into an employment contract in oral care. 


In hepatitis C, the risk of transmission is smaller than for hepatitis B. In this disease, the infection is not transferred until actual blood-to-blood contact (by blood transfusions) and one in ten needlestick injuries is 'hit'. The incubation period is usually long and is sometimes half a year for hepatitis B and hepatitis D. After experiencing an acute illness, full healing occurs in hepatitis A, but hepatitis B, C and D can cause a chronic form. As long as the body is unable to ward off the attack with repairs to the liver cells, the liver damage increases. Patients usually have no complaints, but are in fact not cured. They carry the live virus and can therefore be a permanent source of infection, depending on the amount of circulating virus in their blood. This carrier status occurs in hepatitis B in about 10% of cases. In the liver, malignant tumors can eventually develop in the liver. Nowadays the chance appears to decrease, because better medicines are available. PhD research by J. Brouwer at Erasmus University shows that at the beginning of this century only 20% of hepatitis C patients remain carriers after having experienced an infection.


If someone develops hepatitis after a needle stick accident, this must be reported to the local GGD for registration and follow-up.


Team members who turn out to be infected can, just like infected patients, form a source of contamination for dental treatments. There are special guidelines for such situations.


Pfeiffer disease (kissing disease)

The pathogen in Pfeiffer's disease is the epstein-barrvirus, which nests in lymphocytes and therefore affects the immune system. It is a herpes virus, which is known to be present in the body after the first infection (see earlier in herpes simplex and chickenpox). The infection is caused by blood and saliva.


Even before the disease of Pfeiffer erupts, the saliva is already contagious. Most patients are between 15 and 25 years old.


Progress of Pfeiffer's disease

First, a flu-like feeling develops with fever and fatigue, poor appetite and muscle pain for about two weeks. Thereafter, the disease can slowly fade away without symptoms or reach a more serious phase. High fever peaks, sore throat and swollen lymph nodes develop in the armpits, groin and neck. The disease can be much more severe in older patients. The fever often lasts much longer and there is severe sore throat. Liver function is impaired and jaundice develops in half of the patients. After a few weeks, the symptoms decline, but the full recovery takes weeks to months.



Tuberculosis, which is caused by the rod-shaped bacterium Mycobacterium tuberculosis, is becoming more common. The tubercle bacillus is a very strong type of bacteria that is acid-resistant and resistant to high temperatures and dehydration. Due to dehydration, the bacillus is weakened, but the contagiousness is undiminished! Inhalation of dust in a room (treatment room) where the tubercle bacillus has been present in the air, may already be sufficient for an infection especially in electronic devices, such as computers and monitors, unexpected amounts of dust can accumulate. Housekeeping of critical rooms is therefore of great importance!


Dust in the treatment room poses a contamination risk


The course of tuberculosis

The tubercle bacilli spread after inhalation through the blood and the lymph tracts throughout the body. Without causing symptoms, the bacillus can nest everywhere and form a hearth from which the infection can only start to play much later. The disease is activated in a small percentage of infected people within two years (the hearth can become active due to reduced resistance). In an even smaller group, symptoms do not occur until after many years due to the flare-up of sleeping hearths. When activating the disease, in principle all organs can be involved, depending on the localization of the hearth. In pulmonary tuberculosis, the tubercle bacilli end up in the aerosol of the treatment room due to coughing or sneezing. The bacilli remain alive outside the body and healthy people are infected by inhalation of the aerosol. At a localization in the lungs, the disease occurs as a cold. Only after long-lasting complaints will the patient (finally) go to the doctor. Subsequently, a treatment is often started that is aimed at curing a cold. Because this treatment does not work, the diagnosis of tuberculosis will only be made much later. During the long period between outbreak and recognition, the patient is a major source of contamination due to coughing. In an increasing number of cases there is tuberculosis in other organs besides pulmonary tuberculosis. For example, tuberculosis is found in the mouth with some regularity. The disease can then express itself as a swelling of the jaw that resembles a submucosal abscess. Even then it often takes a long time before the diagnosis of tuberculosis can be made.


The treatment of tuberculosis

Administering tuberculostatics, medicines that kill the pathogen. The tubercle bacillus, however, can rapidly develop resistance to antibiotics, which on the one hand is encouraged by insufficient knowledge about the right medication for doctors and on the other hand because the therapy must be applied consistently for a very long time (months). Unfortunately, adherence to therapy is not always sufficient in such a long period of time. The often multiple resistance leads to enormous problems in the control of the disease and constitutes a substantial threat to public health. Periodic screening of health professionals at high risk of infection may need to be (re) introduced.


There is a duty to report to the GGD for tuberculosis. After each report, group research will determine whether there are people in the immediate vicinity of the patient who turn out to be carriers of the bacterium without symptoms of illness. This can be demonstrated from three to eight weeks after the infection using the mantoux reaction ('scratch').


HRMO: Particularly resistant micro-organisms

Nowadays the number of bacterial strains that no longer reacts to the usual antibiotics increases enormously. This is usually referred to as 'hospital bacteria'.


The best-known examples are two staphylococcal strains:

  1. MRSA (Methicillin Resistant Staphylococcus Aureus); and
  2. MRSE (Methicillin Resistant Staphylococcus Epidermidis).


Patients infected with such a micro-organism pose a threat to the members of the treatment team and to all fellow patients. The resistant bacteria can multiply undisturbed during the developed disease, despite treatment with the usual antibiotics, of course with often serious consequences for the patient, which in fact remains untreated.


The cause of the resistance is:

  • Too low a dose of antibiotics, which allows the bacterium to survive and develop resistance against the administered agent;
  • The non-completion of an antibiotic treatment by a patient. There is a chance that the micro-organism will survive and forms defense mechanisms.


This type of resistance occurs frequently in the countries around the Mediterranean. The resistant bacteria are regularly transported to Europe by patients who have been in hospital in one of those countries (during their holidays). In Europe, protocols have been drawn up for the use of antibiotics to prevent the number of resistant strains from increasing.


Treatment in the oral care practice of patients with MRSA or MRSE requires no special precautionary measures (anymore), because the normal infection prevention offers sufficient protection.


Prion disease, Creutzfeldt-Jakob disease

This rare disease is caused by abnormally shaped prions and leads to brain softening. The prions are detectable in brain tissue, spinal cord and perhaps even in other neural tissue. It may be possible that they can also be detected in pulp tissue. According to the Deutscher Arbeitkreis für Hygiene in der Zahnartzpraxis (DAHZ) it is not excluded that transmission takes place via blood, saliva and nasal fluid. Originally, the disease only occurred in people older than 60 years. The incubation period can be up to twenty years. Nowadays, a variant of this disease is known that manifests itself in many younger individuals, namely in people around 30 years of age. The incubation period is much shorter (up to two years) and the course of the disease is much more serious. The disease is almost certainly the human form of BSE (mad cow disease) and the infection takes place by eating contaminated beef. The origin of the disease is linked to the amount of prions that are consumed. The patients hoist spiritually and physically. They have all kinds of neurological abnormalities and in the course of the disease, there are so many paralysis that the patient dies.


Extra hygienic measures are necessary in patients who are suspected of a prion disease or in those who have already been diagnosed with a prion infection. The prions are not rendered harmless by the standard sterilization process. In general, it is recommended to use as many disposables as possible and to burn them after the treatment. If this is not possible, it is advisable to refer the patient to a treatment center where one is equipped for these hygienic measures.