Key Points
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Previous studies have indicated that dental surgery is not a risk factor for sporadic CJD, but in variant CJD the tissue distribution of infectivity is much wider, raising concerns over transmission via dental surgical instruments.
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A range of dental tissues were studied for the presence of the abnormal form of the prion protein, using a combination of immunohistochemistry and a sensitive Western blot assay.
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Abnormal prion protein was detected in the trigeminal ganglia, tonsil and lymph nodes in variant CJD but not in sporadic CJDcases. Alveolar nerves, gingiva, dental pulp, tongue and salivary gland tissue were negative in all cases. Lymphoid tissues (including tonsil) were negative in sporadic CJD.
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Since the presence of the abnormal form of the prion protein is associated with infectivity, these findings indicate that the highest levels of infectivity in dental tissues are likely to be found in the tonsil and associated lymphoid tissues. This does not exclude the presence of lower levels of infectivity in the negative tissues in our study.
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These new findings will be of use to inform the risk assessment on dental tissues and variant CJD.
Abstract
Objective To study the distribution of disease-associated prion protein (PrP) in oral and dental tissues in variant CJD.
Design Prospective single centre autopsy based study.
Setting Within the National CJD Surveillance Unit, UK, 2000-2002.
Materials and methods Patients with suspected variant CJD undergoing autopsy where permission to remove tissues for research purposes had been obtained from the relatives. Fixed and frozen autopsy tissues from the brain, trigeminal ganglion, alveolar nerve, dental pulp, gingiva, salivary gland, tongue and tonsils were studied by Western blot, PET blot and immunocytochemistry to detect disease-associated PrP.
Results Disease-associated PrP was only detected in the brain, trigeminal ganglia and tonsils.
Conclusions The failure to detect disease-associated PrP in most dental and oral tissues will help inform ongoing risk assessments for dental surgery in relation to the possible iatrogenic transmission of variant CJD via dental instruments.
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Acknowledgements
The authors would like to thank all the Neuropathologists and their technical staff in the UK for their support of the National CJD Surveillance Unit. We also thank the laboratory staff in the unit for invaluable technical support. The National CJD Surveillance Unit is funded by the Department of Health and the Scottish Executive. The Unit is a member of the EC funded projects PRIONET (QLK2-CT-2000-00837) and TSELAB (QLK2-CT-2002-81532).
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Head, M., Ritchie, D., McLoughlin, V. et al. Investigation of PrPres in dental tissues in variant CJD. Br Dent J 195, 339–343 (2003). https://doi.org/10.1038/sj.bdj.4810536
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DOI: https://doi.org/10.1038/sj.bdj.4810536
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