Risk of methicillin-resistant Staphylococcus aureus transmission in the dental healthcare setting: a narrative review

Abstract

Objective: Information on the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection transmission in dental healthcare settings was incomplete only few years ago; therefore, MRSA infection control guidelines were necessarily based on data extrapolated from other fields. Recently, publication of specific studies have made it possible to review such risk.

Methods: Studies of MRSA infection in dentistry were searched for using EMBASE, MEDLINE, and Google and were allocated into the following sections: (1) direct evidence: documented cases of MRSA transmission in dentistry; (2) indirect evidence: carriage rates among dental healthcare providers (DHCPs) and patients (high carriage rates suggest that transmission is likely); (3) speculative evidence: MRSA occurrence in the dental environment (high environmental contamination probably increases the risk of infection); and (4) speculative evidence: MRSA carriage in human dental plaque and saliva (oral carriers may spread MRSA in the environment during dental therapy, with consequent environmental contamination and probable increased risk of infection).

Results: Our findings were as follows. First, transmission has been ascertained during surgical interventions, particularly in surgical units and among head and neck cancer patients. Second, carriage rates among DHCPs were lower than those among other healthcare workers. Carriage rates among adult patients were low, whereas among pedodontic and special care patients rates were higher than those in the general population. Third, MRSA has been detected in the environment of emergency and surgical units and in dental hospitals. Some individuals in poor general condition were oral MRSA carriers.

Conclusions: The occupational risk of MRSA infection among DHCPs is minimal. Among special patients (eg, special care, hospitalized, and cancer patients) the risk of infection is high, whereas among the remaining patients undergoing conventional therapy such risk is probably low.