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Prior to 1981, most dental lab technicians were not aware of the dangers that could be connected to working with impressions, dental crowns, bridges, or dentures that had been worn in a patient’s mouth where contact with saliva and blood occurs.
For the most part, it was thought to be just dental clinicians that were at risk for contracting a bloodborne disease due to working in the direct patient care environment. However, in late 1981, one of the first recorded cases of a bloodborne disease transmission through indirect contact from a dental patient to a dental lab technician was discovered. Bernard M. Sabatini, CDT, was diagnosed with Hepatitis B, a dangerous bloodborne virus that can cause an illness that may last for an extended time, develop into liver cancer, liver failure, and even cause death. Six months prior to Mr. Sanbatini’s diagnosis, he had received a small cut to his finger from the metal portion of a partial denture he was repairing. It was discovered the patient who had been wearing the denture was a carrier of Hepatitis B, and thus the perfect opportunity for cross contamination occurred through what we now refer to as the Chain of Infection (Figure 1).1-3
Hepatitis B and C are bloodborne diseases that are capable of being transmitted through blood and bodily fluids and present a potential risk to those working in the environment where contact may occur. Because the hepatitis B virus can live outside of the host at room temperature for at least 1 month, there is an opportunity for transmission in the dental laboratory setting, as with the Sabatini case. Therefore, dental lab technicians are at risk of contracting hepatitis B from indirect contact.
The good news is that a safe and effective hepatitis B vaccine is available and strongly recommended for all members of the dental team, including dental lab technicians. The vaccine is given in two to four doses (depending on the brand of vaccine) over a 6-month period. Dental infection prevention experts and the Center for Disease Control and Prevention (CDC) recommend getting tested for immunity 1 to 2 months after completing all injections. 4,5
Alternatively, there is no hepatitis C vaccine available, and the hepatitis C virus is the cause of approximately 30% of acute viral hepatitis cases in the United States. Only about 1% of the cases of transmission are recorded as having occurred in healthcare workers and usually happen through needlestick exposure. However, there is still a danger that the hepatitis C virus can be transmitted through indirect contact, as studies have shown it is capable of living in dried blood on surfaces at room temperature for up to 6 weeks.
Human immunodeficiency virus (HIV), the disease that causes the acquired immunodeficiency syndrome (AIDS), is another bloodborne pathogen that lives in blood and bodily fluids. HIV typically requires a host to survive and does not live outside a body for extended periods of time. Unless an injury is acquired from a needle exposure that has recently been used on a patient with HIV, it is very unlikely a transmission will occur through indirect contact. In most cases, there would not be a reason for a dental lab technician to be exposed to contaminated needles used in dental treatment. The chance of contracting HIV in a dental lab work-related environment is very low.4
All three of these bloodborne pathogens have the potential to live on surfaces outside the body host. Obviously, some survive much longer than others, as indicated above. However, research has found that many disinfectants are able to effectively kill viruses on inanimate surfaces. This is why the disinfecting process of items that have been in a patient’s mouth, and those surfaces that have been contaminated with saliva and blood, must be performed correctly and routinely to help prevent the possibility of cross-contamination.
Occupational Safety and Health Administration
The discovery that bloodborne pathogens could be transmitted to healthcare workers while performing routine duties in the work environment prompted the Occupational Safety and Health Administration (OSHA), a federal government regulatory agency, to develop mandatory rules known as the Bloodborne Pathogens Standard. The standard to protect healthcare workers against occupational exposures began development in 1986 and was implemented in the United States in 1992. The standard requires all employers to create, implement, and enforce a written exposure control plan (ECP) that provides a safe work environment for their employees.4,6,7
Exposure Control Plan
The exposure control plan (ECP) should be included in a dental lab’s Standard Operating Procedures (SOPs) manual, must document the job description exposure levels of all employees and implement specific processes for prevention of disease transmission and injury to assure that safe practices are clearly understood and followed.
OSHA provides a detailed template for employers to use to insert specific information for each dental facility. Although some of the information in the ECP template may not be applicable in a dental lab, using it eliminates the need to create and design one. Go to https://www.osha.gov/sites/default/files/publications/osha3186.pdf for the template. To be in compliance with OSHA regulations, the written document must be easily accessible by employees as well as reviewed and updated annually.8
Dental lab owners and those who employ dental lab technicians who may be exposed to bloodborne pathogens must also ensure the following training occurs9:
• At the time of initial hire
• Annually
• When operational changes occur that involve potential bloodborne pathogen cross-contamination.
Respiratory Diseases
Respiratory diseases that are most common, according to the CDC, and that have the potential of being transmitted in the dental laboratory are viruses such as influenza (flu), COVID-19, and respiratory syncytial virus (RSV). There are hundreds of thousands of cases of people requiring hospitalization from contracting these diseases and even thousands of deaths each year in the fall and winter, when most cases occur.10
These viruses can all be transmitted easily from person to person through droplets that are projected from a cough, sneeze, or just talking. Some of the droplets become aerosolized, suspended in the air, and are breathed in, carrying the virus from one person to another. A less likely scenario, but still an opportunity for these diseases to be transmitted, is by touching a surface such as a countertop, chair, doorknob, keyboard, or any other surface that has been contaminated with the disease. When a person touches the contaminated surface and then touches their face prior to washing their hands, there is the potential they could contract the virus and become ill. Once again, this is referred to as indirect contact.
The symptoms of these diseases can be mild or severe depending on each person’s risk factors. There are vaccines available for all three of these viruses, which is considered the best method of protection. The options for vaccination should be discussed with personal healthcare providers to determine which is most appropriate.
Respiratory diseases may not be considered a transmissible threat from a dental patient to a dental lab technician, but there are still many opportunities in the dental lab setting to contract respiratory diseases directly or indirectly while working alongside others. The flu, COVID-19, and RSV can live on surfaces for hours to days depending on the surface and temperature. There is the potential to contract or transmit a respiratory disease not only in the workplace but also there is a risk of taking it home and spreading it to family and friends. Following and adhering to infection control guidelines can create a culture of safety that provides protection in the workplace and at home.
CDC Guidelines
The CDC, a non-regulatory government agency, created guidelines that are directly related to the field of dentistry. The CDC’s “Guidelines for Infection Control in Dental Health-Care Settings” were published in 2003, updated in 2016, and continue to be the main source of reference for dentistry. These guidelines are recommendations that eliminate the need for guesswork for the dental interpretation and implementation of the OSHA Bloodborne Pathogens Standard and the Hazardous Communications Standard.6,11 When dental employers follow the CDC Guidelines, they are not only adhering to the OSHA Bloodborne Pathogens Standard, but it also creates a “culture of safety” that helps protect the employees and the dental patients they serve. It forms a link between prevention and compliance.9,12
In the initial CDC report from 2003, recommendations were made for managing safety and health concerns using scientific infection control methods. This included a list of “Personnel Health Elements of an Infection-Control Program,” which became the cornerstone of infection control education, training, and maintenance in dental practices and dental laboratories across the United States. The elements include education and training; exposure prevention and post-exposure management; immunization programs; medical conditions, work-related illness, and work restrictions; hand hygiene; personal protective equipment; and more. “Sterilization and Disinfection of Patient-Care Items” is also of great importance for dental clinicians as well as dental lab technicians. It requires consistent adherence to details of daily processes that are required to be in compliance with regulatory standards that help prevent disease transmission and create a safe working environment.12
The 2016 update to the CDC’s “Guidelines for Infection Control in Dental Health Care Settings” includes a detailed checklist to help dental facilities assure they are following the recommendations through observation and evaluations. The publication is available for free in English and Spanish from the CDC’s website.13,14
Additionally, the CDC DentalCheck mobile app was introduced in 2018, which allows users to have full access to all the same information and evaluation checklists as in the publication.15
“Culture of Safety”
The steps to building a solid “culture of safety” in a dental lab begins by providing education and encouraging the lab technicians to participate. A dental lab infection prevention and control program must be easily accessible in printed or online format by all employees. It should be written so that employees understand how the guidelines are to be implemented in their daily work and the importance of adherence. The lab owner is responsible for providing education, implementing the guidelines, and enforcement. This might sound overwhelming for the dental lab that does not have a program currently in place, but by working together with employees and using the guides that the CDC provides, an efficient plan can be established and maintained.
Start by providing access to OSHA’s Bloodborne Pathogens and Hazardous Communication Standards and the CDC’s “Guidelines for Infection Control in Dental Health-Care Settings” in the lab. All employees should be familiar with these documents and know where they are located within the workplace.
The development of an infection prevention and control plan must include an ECP and a post-exposure guide. Creating a customized plan for a dental lab is important and the most time-consuming part of building a program. By using a template available in the “Model Plans and Programs for the OSHA Bloodborne Pathogens and Hazard Communications Standards,” it can reduce the time burden, and it can be altered to best fit each lab. Following guidance in the pamphlet is much easier than trying to develop a plan from scratch.8
World Health Organization
The basics of any infection prevention and control plan circulate around handwashing. Improper use of gloves may lessen the effectiveness of infection prevention. Routinely adhering to the World Health Organization’s “Five Moments For Hand Hygiene” for healthcare professionals will result in a greater reduction in transmission of disease.16
The “Summary of Infection Prevention Practices in Dental Settings, Basic Ex-pectations for Safe Care” is an excellent reference for a lab starting or maintaining an infection control program. The fundamental elements provide topics and categories that will build a foundation for creating a “culture of safety” in the workplace.12
About the Author
Ginny Jorgensen, CDA, EFDA, EFODA, CDIPC, AAS
President, Oregon Dental Assistant Association
Oregon Board of Dentistry
Wilsonville, Oregon
Conclusion
The information in this article is meant to provide directions for developing and reviewing an infection prevention and control plan for a dental lab. It is important to read, understand, and have the OSHA Standards, the CDC Guidelines, and state and local regulatory requirements accessible. Referencing these original resources is encouraged to maintain accuracy. Although a bloodborne pathogen exposure is rare in a dental lab, experiencing such an event can be life-altering and affect the lives of not only the lab technician but also that of colleagues, family members, and friends. Contracting respiratory diseases is common among those who work in close proximity to others. Following the CDC work-related illness recommendations and environmental surface disinfection procedures are also extremely important. Developing an infection prevention and control plan is the responsibility of the lab owner, but involving all employees will build a “culture of safety” that ensures the environment becomes a safe place to work.
References
1. Runnells RR. Infection Control in the Wet Finger Environment. 1st ed. Salt Lake City, Utah: Publishers Press; 1984:52-53.
2. Bird DL, Robinson DS. Modern Dental Assisting. 13th ed. Elsevier; Saunders.
3. Chain of Infection Components. CDC The National Institute for Occupational Safety and Health (NIOSH). https://www.cdc.gov/niosh/learning/safetyculturehc/module-2/3.html. Updated April 28, 2022. Accessed July 21, 2025.
4. Miller CH. Infection Control and Management of Hazardous Materials for the Dental Team. 6th ed. Elsevier; Mosby; 2017.
5. Responding to HBV Exposures in Health Care Settings. Center for Disease Control and Prevention. https://www.cdc.gov/hepatitis-b/hcp/infection-control/index.html#:~:text=The%20clinician%20should%20then%20receive,be%20documented%20for%20future%20exposures. May 16, 2024. Accessed August 3, 2025.
6. Bloodborne pathogens. US Department of Labor Occupational Safety and Health Administration. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030. Updated May 14, 2019. Accessed July 21, 2025.
7. Dentistry. US Department of Labor Occupational Safety and Health Administration. https://www.osha.gov/dentistry/enforcement#:~:text=Dentists%2C%20dental%20hygienists%2C%20dental%20assistants,and%20other%20potentially%20infectious%20materials. Accessed July 21, 2025.
8. Model Plans and Programs for the OSHA: Bloodborne Pathogens and Hazard Communications Standards. Occupational Safety and Health Administration. https://www.osha.gov/sites/default/files/publications/osha3186.pdf. Accessed July 30, 2025.
9. OSHA Standards and Requirements. Association for Dental Safety (ADS). https://www.myads.org/index.php?servId=10923&limitstart=3&id=253&option=com_content&id=253. Updated December 30, 2024. Accessed July 30, 2025.
10. Respiratory Illnesses. US Centers for Disease Control and Prevention. https://www.cdc.gov/respiratory-viruses/index.html. Accessed July 30, 2025.
11. Hazard communication. US Department of Labor Occupational Safety and Health Administration. https://www.osha.gov/hazcom. Accessed July 30, 2025.
12. Guidelines for Infection Control in Dental Health-Care Settings – 2003. US Department of Health and Human Services Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/pdf/rr/rr5217.pdf. December 19, 2003. Accessed July 30, 2025.
13. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. US Centers for Disease Control and Prevention. https://www.cdc.gov/dental-infection-control/media/pdfs/2024/07/safe-care2.pdf. March 2016. Accessed July 30, 2025.
14. Infection Prevention Checklist for Dental Settings: Basic Expectations for Safe Care. US Centers for Disease Control and Prevention. https://www.cdc.gov/dental-infection-control/media/pdfs/Infection-Prevention-Checklist-for-Dental-Settings-fillable-form.pdf. March 2016. Accessed July 30, 2025.
15. CDC DentalCheck Mobile App. CDC Dental Infection Prevention and Control. https://www.cdc.gov/dental-infection-control/hcp/cdcdentalcheck/index.html. May 15, 2024. Accessed July 30, 2025.
16. Five moments for hand hygiene. World Health Organization. https://www.who.int/publications/m/item/five-moments-for-hand-hygiene. March 4, 2021. Accessed August 29, 2025.