Reports on HIV/AIDS: 1990

JULY 27, 1990, MMWR, Vol. 39, No. 29, pp. 489-493

Possible Transmission of Human Immunodeficiency Virus
to a Patient during an Invasive Dental Procedure
CDC received a case report of acquired immunodeficiency syndrome (AIDS) in a
young woman for whom an epidemiologic investigation had not established a source
for her human immunodeficiency virus (HIV) infection (i.e., documented behavioral or
other risk factors, including intravenous [IV]-drug use, sex with an HIV-infected
person, or receipt of a blood transfusion or blood components). However, investigation revealed that 24 months before her AIDS diagnosis she had two teeth extracted
by a dentist who had AIDS. Information on the dental procedure was obtained from
interviews with the patient and reviews of her dental records and radiographs. This
report summarizes the epidemiologic and laboratory findings of the investigation.*
The patient had two maxillary third molars extracted under local anesthesia in the
dentist's office. The dentist had been diagnosed with AIDS 3 months before performing the procedure. Written documentation of the procedure was limited. Review of
the radiographs indicated that the maxillary third molars were not impacted in bone.
The patient reported that she received no general anesthetic or sedative and that
during the procedure the dentist wore gloves and a mask. She did not recall, nor did
review of the dental records reveal, any circumstances that would have exposed her
to the dentist's blood (i.e., an injury to the dentist, such as a needlestick or cut with a
sharp instrument). The patient had not received dental care from this dentist before
the dental extractions.
Four weeks after the dental procedure, the patient sought medical evaluation for a
sore throat. Review of her medical records revealed that she was afebrile, with
moderately enlarged tonsils with ulcerations and moderately enlarged nontender
anterior cervical lymph nodes. Rash, generalized lymphadenopathy, or fatigue were
not reported or noted on the medical record. A "strep antigen" test was negative. The
patient was diagnosed with pharyngitis and aphthous ulcers. Seventeen months after
the procedure, she was diagnosed with oral candidiasis; 24 months after the procedure, she was diagnosed with Pneumocystis carinii pneumonia and was seropositive for HIV antibody. The patient reported no previous test for HIV infection.
Multiple interviews of the patient and her family and friends by health department
staff and review of her medical and previous dental records did not identify factors
that may have potentially placed her at risk for HIV infection. The patient reported no
history of blood transfusions, IV-drug use, acupuncture, tattoos, or artificial insemination. Additionally, she denied a history of sexually transmitted diseases or pregnancies. VDRL and hepatitis B serologies were negative. The patient has never been
employed in a health-care or other setting where she could have been exposed to
HIV-infected blood or other body fluids. She reported two boyfriends before her
diagnosis of AIDS; both were tested for HIV infection and were seronegative.
Blood specimens were obtained from the patient and the dentist. To determine the
relatedness of the HIV strains from both persons, DNA was extracted from their
peripheral blood mononuclear cells (PBMC). HIV sequences encoding the variable
*Single copies of this article will be available free until July 27, 1991, from the National AIDS
Information Clearinghouse, P.O. Box 6003, Rockville, MD 20850; telephone [phone].

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