Letter to the Editors: Hepatitis B has been established as an important occupational hazard for healthcare personnel by Byrne. It must also be considered a hazard for the dental patient, even though there have not been numerous reports of hepatitis in dental practice populations or among den tists. Hepatitis B (formerly designated as serum hepati tis) was considered classically transmissible via percu taneous means such as instruments or injection needles contaminated by infected blood or blood products. The advent of routine autoclaving of instruments after being in contact with blood and the introduction of disposable injection needles brought about a feeling that success had been achieved in interrupting the chain of transmission from one patient to another via the dental office. However, evidence began to accumulate pointing to the existence of nonparenteral means of transmission of this disease in addition to the classic route. Ward et a l . reported hepatitis B antigen in saliva and mouth wash ings. 1
2
Now on the basis of work reported in The New England Journal of Medicine it seems that saliva is probably the main vehicle of transmission of nonparenterally acquired type B hepatitis. They state that transmis sion may be either airborne through large droplets expelled by sneezing and coughing or directly from mouth-to-mouth by kissing. The antigen was found in none of 120 fecal extracts, and in three of 130 urine specimens but was present in the saliva of 76% of patients with acute hepatitis during the first three weeks after clinical onset and 86% of chronic carriers intermittently. The significance of these findings poses the dual prospect of the dentist contracting the disease and/or transmitting it from patient to patient. Such a situation was reported recently by Public Health officials in a dental office in Baltimore where the dentist and many of the patients contracted active cases of hepatitis. Sterilization measures necessary to ensure elimination of hepatitis in the dental office pose problems which at this time have no solution. Adequate sterilization be tween patients of handpieces, cavitron inserts, etc., is not feasible. Assuming such sterilization was possible, the droplet dissemination generated by the airotor and ultrasonic instruments would still be a major factor in the transmission of hepatitis virus to the dentist and his office staff. A n important consideration should be an in-depth history of each patient to determine his exposure to hepatitis contacts. The history should include a reference to liver disease, jaundice, blood poisoning, refusal for blood donor participation, and any other key words to expose any history of hepatitis contact by the patient or members of his immediate family. The notation of positive history on the patient's chart should be similar to that bold marking used to indicate a drug allergy and could be followed up by serologic and saliva tests for Australian antigen. The findings reported indicting saliva as the major 3
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means of nonparenteral hepatitis B dissemination means that a major change in our office routine is necessary. Elliott H . Dickler, D.D.S., M . S . Washington, D . C . 1. Byrne, E. B.: Viral Hepatitis: an occupational hazard of medical personnel. Experience of the Yale New Haven Hos pital, 1952-1965. JAMA 195:362, 1966. 2. Ward, R., Bordiert P., Wright A . , et al: Hepatitis Bantigen in saliva and mouth washings. Lancet 2: 726, 1972. 3. Villarejos, V. M . , Visona, K. A., Gutierrez, A., and Rodriquez A.: Role of saliva, urine, and feces in the trans mission of type B hepatitis. N Engl J Med 291: 1375, 1974.
Letter to the Editors: A disturbing trend is perceptible in recent periodontal literature. Many authors are failing to credit adequately the creators of a technique or the originators of a concept from which their own work derives. We think this bodes ill for periodontics and for the field of scientific investiga tion generally. According to a Louis Harris poll taken in 1972 the proportion of the public expressing "great confidence" in the people "running science" has fallen from 56% in 1966 to 37% in 1972. Perhaps the lack of a sense of continuum and perspective by some investigators contributes to this situation. We recognize the sad fact that the need for research funds may generate the hurried submission of papers, and thus lead to inaccuracies and shortcuts. But science suffers when there is accidental or deliberate failure to research adequately the background of concepts and techniques. Most investigators and contributors to the literature are positioned in major universities with excel lent libraries and so it is difficult to reconcile these omissions in the articles in the presence of so much research effort on the particular work submitted for publication. We believe the arrow of culpability shoots in other directions as well. The custodians of the standards of a publication are the editors and editorial consultants of that publication. It is a shortcoming on the part of these reviewers to permit obvious bibliographical omissions to occur. These individuals should be charged with the responsibility of securing adequate and accurate biblio graphical coverage in the papers accepted for publica tion. After all, they are, in a sense, sentinels of science. Finally, in the interests of our field of endeavor, as well as scientific integrity, we enter a plea to all budding investigators as well as to senior researchers—your contribution will not be diminished by relating a specific development to the body of work which precedes it. Herbert I. Oshrain Albert Salkind Irwin D. Mandel Melvin L . Morris New York, N . Y .
2
Now on the basis of work reported in The New England Journal of Medicine it seems that saliva is probably the main vehicle of transmission of nonparenterally acquired type B hepatitis. They state that transmis sion may be either airborne through large droplets expelled by sneezing and coughing or directly from mouth-to-mouth by kissing. The antigen was found in none of 120 fecal extracts, and in three of 130 urine specimens but was present in the saliva of 76% of patients with acute hepatitis during the first three weeks after clinical onset and 86% of chronic carriers intermittently. The significance of these findings poses the dual prospect of the dentist contracting the disease and/or transmitting it from patient to patient. Such a situation was reported recently by Public Health officials in a dental office in Baltimore where the dentist and many of the patients contracted active cases of hepatitis. Sterilization measures necessary to ensure elimination of hepatitis in the dental office pose problems which at this time have no solution. Adequate sterilization be tween patients of handpieces, cavitron inserts, etc., is not feasible. Assuming such sterilization was possible, the droplet dissemination generated by the airotor and ultrasonic instruments would still be a major factor in the transmission of hepatitis virus to the dentist and his office staff. A n important consideration should be an in-depth history of each patient to determine his exposure to hepatitis contacts. The history should include a reference to liver disease, jaundice, blood poisoning, refusal for blood donor participation, and any other key words to expose any history of hepatitis contact by the patient or members of his immediate family. The notation of positive history on the patient's chart should be similar to that bold marking used to indicate a drug allergy and could be followed up by serologic and saliva tests for Australian antigen. The findings reported indicting saliva as the major 3
432
means of nonparenteral hepatitis B dissemination means that a major change in our office routine is necessary. Elliott H . Dickler, D.D.S., M . S . Washington, D . C . 1. Byrne, E. B.: Viral Hepatitis: an occupational hazard of medical personnel. Experience of the Yale New Haven Hos pital, 1952-1965. JAMA 195:362, 1966. 2. Ward, R., Bordiert P., Wright A . , et al: Hepatitis Bantigen in saliva and mouth washings. Lancet 2: 726, 1972. 3. Villarejos, V. M . , Visona, K. A., Gutierrez, A., and Rodriquez A.: Role of saliva, urine, and feces in the trans mission of type B hepatitis. N Engl J Med 291: 1375, 1974.
Letter to the Editors: A disturbing trend is perceptible in recent periodontal literature. Many authors are failing to credit adequately the creators of a technique or the originators of a concept from which their own work derives. We think this bodes ill for periodontics and for the field of scientific investiga tion generally. According to a Louis Harris poll taken in 1972 the proportion of the public expressing "great confidence" in the people "running science" has fallen from 56% in 1966 to 37% in 1972. Perhaps the lack of a sense of continuum and perspective by some investigators contributes to this situation. We recognize the sad fact that the need for research funds may generate the hurried submission of papers, and thus lead to inaccuracies and shortcuts. But science suffers when there is accidental or deliberate failure to research adequately the background of concepts and techniques. Most investigators and contributors to the literature are positioned in major universities with excel lent libraries and so it is difficult to reconcile these omissions in the articles in the presence of so much research effort on the particular work submitted for publication. We believe the arrow of culpability shoots in other directions as well. The custodians of the standards of a publication are the editors and editorial consultants of that publication. It is a shortcoming on the part of these reviewers to permit obvious bibliographical omissions to occur. These individuals should be charged with the responsibility of securing adequate and accurate biblio graphical coverage in the papers accepted for publica tion. After all, they are, in a sense, sentinels of science. Finally, in the interests of our field of endeavor, as well as scientific integrity, we enter a plea to all budding investigators as well as to senior researchers—your contribution will not be diminished by relating a specific development to the body of work which precedes it. Herbert I. Oshrain Albert Salkind Irwin D. Mandel Melvin L . Morris New York, N . Y .
