As the number of measles cases in California and at least 25 other states continues to rise, becoming the highest number of reported cases in the U.S. since 1994, dental practices should ensure that they are screening patients for the highly contagious virus and other aerosol transmissible diseases prior to providing treatment.
Asking patients about their vaccination status or any international travel completed recently is a reasonable measles screening procedure for dentists to follow.
The Centers for Disease Control and Prevention recommends that health care providers consider measles in patients who present with fever and rash and “clinically compatible measles symptoms” like cough, runny nose and pink eye, particularly in patients who live in a community where measles is currently occurring and for whom one or both of the following are true:
Dental practices should reschedule a patient with suspected measles or other ATD for a time when the patient no longer exhibits ATD symptoms or has been cleared by a physician.
Cal/OSHA regulations require that health care providers follow specific exposure control processes for ATDs. However, because dentists don’t treat symptoms caused by ATDs and don’t perform procedures that the CDC considers cough-inducing, they are “conditionally exempt” from these requirements if the following three conditions are met:
1. Dental procedures are not performed on patients identified to them as ATD cases or suspected ATD cases.
2. The Injury and Illness Prevention Program includes a written procedure for screening patients for ATDs that is consistent with current guidelines issued by the CDC and prevention for infection control in dental settings and this procedure is followed before performing any dental procedure on a patient to determine whether the patient may present an ATD exposure risk.
3. Employees have been trained in the screening procedure in accordance with Section 3203.
4. Aerosol generating dental procedures are not performed on a patient identified through the screening procedure as presenting a possible ATD exposure risk unless a licensed physician determines that the patient does not currently have an ATD.
At the time of this writing, 47 adult and pediatric measles cases had been confirmed year-to-date in California. One to two cases have occurred in at least five counties while higher numbers of cases have been reported in Butte, Los Angeles, Placer, Sacramento, San Francisco, San Mateo, Santa Clara and Santa Cruz Counties. Outbreaks in Butte County and the Los Angeles, Sacramento and San Francisco regions are linked to low-vaccination rates or to patients who recently traveled internationally or were in contact with someone who traveled internationally.
The CDC in May published the Measles Outbreak Digital Toolkit for providers that includes printable fact sheets that can be displayed in the office and shared with parents.
Reference the CDC’s page on measles for health care professionals.
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