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Dentistry's Role in Combating Bioterrorism

To develop a consensus on a potential role for dentistry in dealing with bioterrorism, the American Dental Association (ADA) called together experts in bioterrorism issues and representatives of key organizations for a Workshop on the Role of Dentistry in Bioterrorism. Convening in June 2002, attendees included representatives from organized dentistry, government, the military, and academia.

Workshop panelists concluded that dentistry has assets in personnel and facilities that could be of great value in responding to a major bioterrorist attack.

  • Dentists may be called on to play a role in education. With knowledge of scientifically based information about disease agents that may be used in bioterrorism, dentists can educate patients and correct misinformation that may be circulating throughout the general public. Further, dental workers are well-versed in infection control procedures; they can apply their knowledge in reducing the spread of infections.
  • In diagnosis, surveillance, referral, and treatment, dental workers can detect characteristic intraoral or cutaneous lesions if they are present and report them to public health authorities. Dentists can refer suspicious cases to the appropriate specialists, collect salivary and/or nasal swabs for laboratory testing, and prescribe or dispense chemotherapeutic or chemoprophylactic medications for the public.
  • Many dentists may be able to augment and assist medical and surgical personnel in providing treatment for victims of bioterrorist attacks. Dentists who have hospital experience may be especially well-suited to provide services that require a close working relationship with physicians.
  • In the event that rapid inoculation or vaccination of the public is required to prevent the spread of infection by a biological agent, dentists may be recruited to assist in a mass inoculation program.
  • Local dental societies are encouraged to develop a dental response plan that can be integrated into each community's mass disaster response plan.
  • Educational programs for dentists should be developed to prepare them to provide services they may be recruited to perform in an emergency.
  • In a major bioterrorist attack, traditional medical resources will be overwhelmed. The ADA predicts that it will fall to nonphysicians to provide many services ordinarily supplied by physicians (e.g., triage, dispensing medications, and providing general medical support). As hospitals become filled, alternate sites for the provision of health care may be required. Located throughout any given community and equipped with many resources that hospitals have (sterilization equipment, air and gas lines, suction equipment, radiology capabilities, instruments, needles), dental offices may be called on to serve as local "minihospitals" when local hospital facilities become overwhelmed or when the concentration of patients is to be avoided, as in attacks involving contagious agents.

In his presentation at the 143rd ADA Annual Session in October 2002, OSAP Board Member Louis DePaola, DDS, MS, presented an educational session on "Bioterrorism: Dentistry's Role." In summation:

  • Dental practitioners should be familiar with the signs and symptoms of mass-destruction biological agents because some have oral-facial manifestations.
  • The role of dental practitioners includes recognizing bioterrorist disease signs.
  • It is essential that oral health and other professionals know about the various diseases, and the systemic oral-dental manifestations of naturally occurring and bioengineered infectious agents.
  • If the unthinkable should occur, oral health providers could play a key role in the early identification and subsequent control of a bioterrorist attack.

Dr. DePaola advises practitioners to have a high level of suspicion, keep bioterrorist agents in their differential diagnoses for patients with unusual symptoms and be aware of unusual clinical presentations.

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General information about bioterrorism from the CDC.
Bioterrorism Agents/Diseases

Bioterrorism Agents/Diseases A to Z By Category

Ready America: Biological Threat

A biological attack is the deliberate release of germs or other biological substances that can make you sick. Many agents must be inhaled, enter through a cut in the skin or be eaten to make you sick. Some biological agents, such as anthrax, do not cause contagious diseases. Others, like the smallpox virus, can result in diseases you can catch from other people.


The FDA Center for Veterinary Medicine (CVM) is working with other federal agencies to help the country prepare for a biological emergency, natural disaster or terrorist attack by making sure there is a safe and adequate supply of animal drug products and a safe animal feed supply system. This page contains information on CVM's role in counterterrorism.


a ‘new' global environmental health threat

Biological weapons represent a unique "environmental” hazard. The pathogens involved are natural in the sense that they are risks that naturally occur in our environment. However they are unnatural in the way in which they are inflicted upon society.


Dentistry considered its potential role in responding to a significant bioterrorism attack during the first part of 2002 and reached a consensus on its role. That consensus was reported in The Journal of the American Dental Association in September 2002.

Emergency Planning & Disaster Recovery in the Dental Office

This publication was developed to assist dentists in emergency planning and disaster recovery preceding and following a natural or an-made catastrophe.

APIC State-of-the-art Report: The role of the infection preventionist in emergency management

This report summarizes the scope and role of infection preventionists in emergency management for all types of disasters. Preventing the transmission of infectious agents during a disaster is an essential component of emergency management. Previous disasters have illustrated the need for better infection prevention and the involvement of an infection prevention professional in planning for and responding to such events.


Bioterrorism and Drug Preparedness

To help prepare our country for possible bioterrorism attacks, FDA is working with other federal agencies to make sure adequate supplies of medicine and vaccines are available to the American public. This page provides links to the most current information on drug therapy and vaccines, plus advice on purchasing and taking medication.

Bioterrorism Act of 2002 The events of Sept. 11, 2001, reinforced the need to enhance the security of the United States. Congress responded by passing the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 (the Bioterrorism Act), which President Bush signed into law June 12, 2002.
Countering Bioterrorism Questions and Answers CBER continues to be very active in the President's Countering Bioterrorism Initiative. CBER staff have participated in numerous meetings, briefings, and conferences representing FDA with staff from the Department of Defense, the Department of Health and Human Services (DHHS), and the Office of Management and Budget as well as other DHHS Agencies including the National Institutes of Health and the Centers for Disease Control and Prevention.


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Bird flu paper that raised bioterrorism fears published The journal Nature has published the first of two controversial papers about laboratory-enhanced versions of the deadly bird flu virus that initially sparked fears among US biosecurity experts that it could be used as a recipe for a bioterrorism weapon.
US debuts life sciences dual-use research policy Federal health officials have unveiled a new policy for overseeing life sciences dual-use research, such as two recent H5N1 transmission studies that have sparked bioterror concerns as well as cries of censorship.
HHS issues medical surge guidance for healthcare systems The US Department of Health and Human Services (HHS) recently released a new planning tool to help hospitals and health systems prepare for medical surges that could result from a bioterror attack, natural disaster, or other public health emergency.
How Ready Are We for Bioterrorism? The specter of a biological attack is difficult for almost anyone to imagine. It makes of the most mundane object, death: a doorknob, a handshake, a breath can become poison. Like a nuclear bomb, the biological weapon threatens such a spectacle of horror — skin boiling with smallpox pustules, eyes blackened with anthrax lesions, the rotting bodies of bubonic plagues — that it can seem the province of fantasy or nightmare or, worse, political manipulation. Yet biological weapons are as old as war itself.
NIH contracts target broad-spectrum therapies for bioterror threats The National Institutes of Health (NIH) yesterday announced it has awarded contracts, which could total $150 million over 5 years, to four companies to develop broad-spectrum therapies that could help the nation respond to a bioterror attack or other public health emergency.
Preparedness report card spells out programs at risk for cuts Public health programs that detect and respond to bioterror events and disease outbreaks are at risk from federal and state budget cuts, a threat that could worsen over the next year if automatic across-the-board cuts kick in, according to an annual preparedness report card released today.
GAO finds gaps in bioterror countermeasure planning, budgeting The US Department of Health and Human Services (HHS) has continued to modify its bioterror countermeasure priorities based on current risk assessments, but it hasn't updated formal plans or fleshed out budget priorities, the Government Accountability Office (GAO) said
Infection Preventionists Play Key Role in Emergency Management Bioterrorism events such as the anthrax cases and global outbreaks such as severe acute respiratory syndrome (SARS) and pandemic influenza underscore the need for hospitals and their staff to remain vigilant. As Rebmann (2009a) explains, "Infection transmission and infectious disease outbreaks can occur during or following any type of disaster. The greatest risk of infection transmission occurs during a disaster involving an infectious disease/agent (i.e., an infectious disease disaster), such as a bioterrorism attack, outbreak of an emerging infectious disease or pandemic."
Biodefense report card says US still unprepared Though the United States has improved its ability to respond to small-scale bioterror events, it is still unprepared to protect its citizens against large attacks, according to the latest assessment from a bipartisan commission established to advise Congress.
Dentistry's Role in Responding to Bioterrorism and Other Catastrophic Events Not only can health professionals help educate the public, they can contribute a broad range of technical skills and practical experience to terrorism response plans that will enable the country to meet an imminent threat or an overt catastrophe.
Dentistry's response to bioterrorism

A report of a consensus workshop

In the event of a bioterrorist attack, dentistsmay be called on to fulfill several functions: education, riskcommunication, diagnosis, surveillance and notification, treatment,distribution of medications, decontamination, sample collectionand forensic dentistry. Local dental societies should developa plan for the dental response to potential bioterrorist attacksthat can be integrated into each community's mass disasterresponse plan. Educational programs for dentists should be developedto prepare them for providing services they may be recruitedto perform in an emergency.
Dentists' preparedness for responding to bioterrorism

A survey of Hawaii dentists

A low prevalence of prior training coupled witha high degree of willingness to provide assistance indicatesthe need for additional BT preparedness training. This shouldbe provided as continuing education offerings to practicingdentists and incorporated into the dental school curriculum.

Incorporating Bioterrorism Training into Dental Education: Report of ADA-ADEA Terrorism and Mass Casualty Curriculum Development Workshop

The dental profession could potentially play a significant role in the emergency response to a major bioterrorism attack.1 If a major attack were to occur, little time will be available to develop a response. In preparation for fulfilling such a role if called upon, it is vital to identify the specific areas in which the dental profession can provide emergency assistance and to prepare dentists adequately.
Bioterrorism update--information for the dentist This article gives a general overview of the biological agents that terrorists are most likely to use and provides the dentist with information about how to contribute to an effective response in the event of such an attack.
The dental emergency responder Natural disasters, the potential for terrorism andweapons-of-mass-destruction events occurring within the continentalUnited States necessitate that all licensed health care providersunderstand the National Incident Management System and be ableto contribute to inoculation, mass casualty assistance and triagecare of the populace.

Detection of Disease Outbreaks by the Use of Oral Manifestations

Oral manifestations of diseases caused by bioterrorist agents could be a potential data source forbiosurveillance. This study had the objectives of determining the oral manifestations of diseases caused by bioterrorist agents, measuring the prevalence of these manifestations in emergency department reports, and constructing and evaluating a detection algorithm based on them.


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