Saliva during dental procedures as infectious material

February 15, 1996

Dr. Richard W. D'Eustachio
[Recipient address omitted]
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 [the Office of Health Enforcement at (202) 693-2190].

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

[Requester letter reproduced on OSHA page; omitted here.]

[Corrected 12/6/2024]