February 15, 1996

Dr. Richard W. D'Eustachio
211 East Chicago Avenue
Chicago, Illinois 60611-2678

Dear Dr. D'Eustachio:

This is a full response to your correspondence of September 29, 1995, regarding classification of saliva in dental procedures under the bloodborne pathogens standard.

The Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogens standard is directed toward protecting employees against occupational transmission of bloodborne disease. The pathogens encompassed by the standard include, but are not limited to, human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus, and non-A non-B hepatitis virus.

The standard lists a number of body fluids in addition to blood that are reasonably likely to transmit bloodborne pathogens. OSHA based this list on the Center for Disease Control and Prevention (CDC) guidelines. These body fluids, along with several substances, have been collectively referred to in the standard as "other potentially infectious materials." With regard to saliva, the CDC guidelines state the following:

Universal precautions do not apply to saliva...Gloves need not be worn when feeding patients and when wiping saliva from skin...Special precautions, however, are recommended for dentistry. Occupationally acquired infection with HBV in dental workers has been documented, and two possible cases of occupationally acquired HIV infection involving dentists have been reported. During dental procedures, contamination of saliva with blood is predictable, trauma to health care workers' hands is common, and blood spattering may occur. (MMWR, 1988; 37:379)

In addition, these CDC guidelines recommend the use of gloves for examination of mucous membranes (including the mucous membranes of the mouth).

While the study attached to your letter concludes that saliva may have some anti-HIV activity, the provisions of the standard would still need to be followed to protect employees against other bloodborne pathogens. Based upon the recommendations of the CDC with regard to precautions in dentistry and the necessity for assuring employee protection against all bloodborne pathogens, we have concluded that retaining "saliva in dental procedures" as an "other potential infectious material" is appropriate and correct.

We appreciate the opportunity to clarify this matter for you. We wish to emphasize that CFR 29 1910.1030 is a standard addressing all occupational exposure to blood or other potentially infectious bloodborne material. Should you have additional concerns, please contact OSHA's Office of Health Compliance Assistance at (202) 219-8036.

Sincerely,



John B. Miles Jr., Director
Directorate of Compliance Programs




September 29, 1995

Honorable Joseph A. Dear
Assistant Secretary for Occupational
Safety and Health
U.S. Department of Labor
200 Constitution Avenue N.W.,
Room S2315
Washington, D.C. 20210

Dear Mr. Dear:

On behalf of the American Dental Association, I am writing for two reasons. First, I want to convey our profession's thanks for your help in resolving some difficult issues, and second, I want to tie up an important loose end before my term as ADA President ends on October 11.

At the top of my thank-you list is the phone-and-fax method for resolving complaints. We appreciate the cooperative manner in which OSHA worked with ADA staff to develop this more flexible enforcement method. We also are pleased that OSHA has invited us to the "stakeholder" meetings about the upcoming tuberculosis standard; we are sending two practicing general dentists to participate. In addition, I want to thank you and Jim Stanley for sending Mr. Ira Wainless to participate in the Association's recent two-day scientific panel on safe use of nitrous oxide in dental offices. In these instances as well as others, your agency has been very helpful.

That said, I would like to return to a topic we discussed briefly when we met last February. At that time, I mentioned a study that had just been completed by researchers at the National Institute of Dental Research (NIDR)--the third NIDR study to conclude that saliva inhibits HIV growth.

This important research has now been published in the Journal of Clinical Investigation (copy enclosed). The paper identifies a human saliva protein responsible for inhibiting the infectivity of HIV, and further substantiates the premise that saliva is a "non-infectious" body fluid with respect to HIV.

In light of these findings, the Association respectfully requests that OSHA re-evaluate the classification of saliva in dental procedures under the Bloodborne Pathogens Standard as an "other potentially infectious material" and, based on this study, consider whether this classification is scientifically justified.

I had hoped to share these thoughts with you in person, but find that my schedule is simply too full between now and our Annual Session, which begins October 7. However, I trust that my successor, Dr. William S. Ten Pas, will continue the constructive dialogue with OSHA that we enjoyed this past year. I know that Dr. Ten Pas will be anxious to learn of OSHA's decision on the saliva issue after reading the study. Thank you for showing interest in this important research finding.

Sincerely,



Richard W. D'Eustachio, D.D.S.
President

(For attached article - McNeely, T.B., Dealy, M., Dripps, D.J., Orenstein, J.M., Eisenberg, S.P., and S.M. Wahl: Secretory Leukocyte Protease Inhibitor: A Human Saliva Protein Exhibiting Anti-Human Immunodeficiency Virus 1 Activity In Vitro. The Journal of Clinical Investigation, Inc., Volume 96, July 1995, pp. 456-64, see printed copy)