Sir, issues concerning dentists carrying a blood-borne virus continue to challenge regulatory authorities worldwide. We have a recent case in Australia which may help inform your current debate regarding management of the infected dental health care worker.

A 44-year-old dentist was discovered to be carrying the Hepatitis C virus genotype 1 (7 log IU/ml) following a routine insurance blood test. The dentist had no known risk factors. The dentist immediately restricted practice by ceasing to perform exposure-prone procedures, and notified the local regulatory authority (Dental Practice Board of Victoria). Shortly after this, the State Health Department was also notified by the dentist's medical practitioner and the pathology laboratory.

The Health Department's initial plan was to require cessation of practice and patient look-back. An inspection of the practice revealed compliance with Australian Infection Control Guidelines. At a Health Panel meeting, consisting of a dental infection control expert, an infectious diseases physician, the dentist and a representative of the Dental Practice Board of Victoria, the dentist offered a series of modified work practices to the regulatory authority, which included not performing exposure prone procedures, using higher-quality gloves, and forwarding a report at regular intervals to the Board from the treating physician. The Health Panel and the Health Department noted that the international literature does not demonstrate transmission of Hepatitis C from a dental practitioner.

It was agreed by all that, according to the Australian Infection Control Guidelines, the definition of what constitutes an exposure prone procedure can be determined by a profession's expert body. For this particular practitioner, exposure-prone procedures were defined as surgical extractions, dento-alveolar surgery, implant surgery and periodontal surgery.

To its credit, the Health Department reconsidered its initial view, and agreed the Board should continue to manage this dentist under the suggested restriction. No look-back was carried out for the practice's patients. The dentist is not obliged to inform patients of this condition. Hundreds of patients have been saved from unnecessary testing and concern, and a competent practitioner continues to function in the community providing dental services.