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I wholeheartedly agree with Dr. Russo that there is a need to monitor developments in the field of prion research; indeed, my review concluded that there was "a need for relevant research to establish the potential susceptibility of oral tissues to be infected by prions of [variant Creutzfeldt-Jakob disease] and [bovine spongiform encephalopathy] and to determine the exact infectivity of prion-containing oral tissues."

With respect to the comment that it may be untrue that prion diseases are unlikely to be transmitted in the dental environment, it must be recalled that there are no data indicating such infection, and the only information available on the probable risk of this has only been recently published.¹

I was slightly surprised by the conclusions of the recent United Kingdom report. Certainly, there are a number of ways in which prion material may infect or could contaminate dental equipment.² However, as the risk appears to be of transmission via such routes, it appears to be extremely low. It would seem that a pragmatic approach is currently being advocated for the management of patients with prion disease.

With respect to the use of bone for dental applications, there are no data regarding the potential infectivity of such material. One study concluded that the risk of prion infection from commercially available bone substitutes was extremely low (for example, less than the risk of death related to lightning or tornadoes).³

A more recent study indicated that the reactivation capacity of the production stage of a bovine bone substitute completely abolished detection of abnormal prions, and reported that the risk of transmission of prion material into commercially available substitutes was so low that the substitutes should be considered safe.⁴

As with other infections that have emerged in the past two decades, dentists should rightly be concerned about the risk of transmission of infection within the dental setting and, as before, there are a number of relevant questions that remain unanswered.

There is a continuing need for research relevant to establishing that prions are not transmitted within the dental setting, and thus not likely to place patients or dental health care workers at risk of acquiring such disease.

	REFERENCES

TOP REFERENCES

1. Department of Health. Risk assessment for vCJD and dentistry. Available at: "www.doh.gov.uk/cjd/dentistryrisk/index.htm". Accessed Jan. 27, 2004.
   
   
2. Porter SR. Prions and dentistry. J R Soc Med 2002;95(4):178–81.[Free Full Text]
   
   
3. Wenz B, Oesch B, Horst M. Analysis of the risk of transmitting bovine spongiform encephalopathy through bone grafts derived from bovine bone. Biomaterials 2001;22 (12):1599–606.[Medline]
   
   
4. Sogal A, Tofe AJ. Risk assessment of bovine spongiform encephalopathy transmission through bone graft material derived from bovine bone used for dental applications. J Periodontol 1999;70(9):1053–63.[Medline]
   
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Porter, S. R. Search for Related Content PubMed Articles by Porter, S. R.