In the first two weeks of August 2013, a considerable amount of media hype was devoted to the exploits of Tung Sheng (David) Wu performing dentistry without a licence. According to various reports this so called rogue dentist had been “practicing” dentistry in the Burnaby/Richmond area of BC as far back as the 1990s. Seemingly he operated out of a bedroom with non-approved materials and supplies and with minimal — if any — recommended infection control procedures. According to the National Post (August 16th, 2013), “dirty dental supplies were strewn about, and an old sterilizer for equipment laid unplugged and dusty.”
The possibility that these less than sanitary operating conditions could have exposed patients to blood-borne viruses was the reason why the Fraser Health Authority and the College of Dental Surgeons of BC recommended that approximately 1,500 of Wu’s patients be tested for hepatitis B, hepatitis C and HIV. At first blush this appears to be a prudent response to an apparent infection control disaster. However, further analysis of the case questions the value of the exercise.
A critical factor in the analysis is a consideration of Wu’s patients. As reported by the CBC on August 7th 2013, Wu relied on word-of-mouth referrals, specifically within the Chinese-Canadian community which is prominent in the Burnaby/Richmond region. Indeed, Alison Helewka, a neighbour of Wu’s informed the CBC that it was always Chinese people who parked outside his house. In the same report, the executive director of the BC Dental Association was not surprised at this patient base as, according to her, patients are more comfortable discussing their concerns with someone who speaks their language and shares the same country of origin and cultural heritage. Accordingly, it is a safe bet that for the 20 plus years that Wu was in “practice” the overwhelming majority of his patients were of Chinese extraction among which would be a significant number of recent immigrants.
It is also a reasonable assumption that the medical histories of the patients would-if they existed-be less than comprehensive. Therefore, it is highly likely that Wu had no knowledge of his patients having hepatitis B, hepatitis C, HIV, or details on their prescribed and illicit drug use, STDs or receipt of blood products. The extent of Wu’s patients’ dental records has not been divulged. If these are a reflection of his operating conditions there are liable to be sketchy and of minimal value in attempting to reconstruct the nature of his treatments. The suspected absence of adequate baseline medical and dental records means that it will not be possible to attribute a positive test result to a lack of infection control. To-date, there have been no adequately substantiated incidences of hepatitis C and HIV transmissions occurring during dental treatment. Testing Wu’s patients is unlikely to change this history.
According to the 2013 information pamphlet by the Centers for Disease Control and Prevention on hepatitis B, people from the Far East and Southeast Asia; have among the highest rates of chronic hepatitis B infection in the world, commonly become infected as infants, are unaware of their infected status, have cultural beliefs and practices leading to fears of the stigma associated with a hepatitis B diagnosis, and avoid access to western healthcare due to language difficulties. These facts suggest that a high percentage of Wu’s patients had or were at high risk of contracting the infection due to their country of origin or close family contacts. While testing such patients for hepatitis B might identify those who could benefit from appropriate medical care including vaccination, it will not provide the evidence to relate the infection to unsanitary operating conditions. There is a certain irony to this conclusion, as of the three infections for which testing has been recommended, hepatitis B has, under certain conditions, been transmitted during dental procedures.
It is possible that the recommendations made by the Fraser Health Authority and the BC College of Dental Surgeons will result in positive findings. If this causes the patients to seek appropriate treatment, the recommendations will have been beneficial. However, it does appear as if they were made to align any positive results to a lack of adequate infection control. As explained above, such an outcome is highly unlikely.
As of mid-August the BC College of Dental Surgeons was unaware of any serious infections or other significant medical conditions being associated with Wu’s clinical activities. This raises an interesting question. How would the effectiveness of current infection control recommendations be interpreted if not one of Wu’s patients has a positive result for hepatitis B, hepatitis C or HIV? OH
