Management of MRSA patients on the dental chair

Nandini Manjunath, Faima Banu, Aditi Chopra, Parimala Kumar, Fathimath Nishana


Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staphylococcus bacteria that is resistant to certain antibiotics, including methicillin, penicillin and amoxicillin. For decades, MRSA primarily has affected people who are immunocompromised, such as patients in hospitals and long-term care facilities. Recently, it has been detected in otherwise healthy people. These infections typically show up as skin infections, like abscesses or boils. Less often, these infections can be more severe, causing pneumonia, sepsis or other potentially life-threatening infections. Most of the MRSA infections are of skin origin in the community. Its main mode of transmission is through the hands i.e., of the health care workers. So, hand washing is the most crucial factor in preventing the spread of infection. In a treatment area, the dental chair including the seat and arm rest, floor beneath the chair, sink, towel dispenser, counter top, and suction chamber remain the sources of infection. These usually are not directly contacted with the patient. Other routes of transmission of MRSA include body fluid exposure to non-intact skin of health care personnel, mucous membranes, or through the sharp or percutaneous injuries. In dentistry, MRSA is known to colonize the saliva and so considered as potentially infected material and often contains blood. The present case report is to create awareness about MRSA transmission, as well as infection prevention and control measures for dental practitioners. 


Immunocompromised, MRSA, Staphylococcus aureus

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Roberts MC, Soge OO, Horst JA, Ly KA, Milgrom P. Methicillin-resistant Staphylococcus aureus from dental school clinic surfaces and students. Am J Infect Control. 2011;39(8):628-32.

Appelbaum PC. MRSA-the tip of the iceberg. Clin Microbiol Infect. 2006;12(2):3-10.

Livermore DM. Can β‐lactams be re‐engineered to beat MRSA? Clin Microbiol Infect. 2006;12(2):11-6.

De Lencastre H, De Jonge BL, Matthews PR, Tomasz A. Molecular aspects of methicillin resistance in Staphylococcus aureus. J Antimicrob Chemother. 1994;33:7-24.

Hall DL. Methicillin‐resistant Staphylococcus aureus and infection control for restorative dental treatment in nursing homes. Spec Care Dentist. 2003;23(3):100-7.

Bradley S. Methicillin-resistant Staphylococcus aureus: long-term care concerns. Am J Med. 1999;106(5):2-10.

Williams REO. Healthy carriage of Staphylococcus aureus: its prevalence and importance. Bacteriol Rev. 1963;27:56-71.

Staat RH, Stewart AV, Stewart JF. MRSA: an important consideration for geriatric dentistry practitioners. Spec Care Dentist. 1991;11:197-9.

Clinical Guideline. Guideline for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA); Version 2.4, May 2016. Approved SA Health Safety and Quality Strategic Governance Committee on: 10 December 2013. Available at

Guilhermetti M, Hernandes SED, Fukushigue Y, Garcia LB, Cardoso LC. Effectiveness of hand-cleansing agents for removing methicillin-resistant Staphylococcus aureus from contaminated hands. Infect Control Hosp Epidemiol. 2001;22(2):105-8.

Millar MR, Walsh TR, Linton CJ, Zhang S, Leeming JP, Bennet PM. Carriage of antibiotic-resistant bacteria by healthy children. J Antimicrob Chemother. 2001;47(5):605-10.

Selecky MC, Goldoft MJ. Methicillin resistant Staphylococcus aureus. epi TRENDS-Washington State Department of Health. Vol.12, No.11 Available at

Brown DFJ, Edwards DI, Hawkey PM, Morrison D, Ridgway GL, Towner KJ, et al. Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA). J Antimicrob Chemother. 2005;56,1000-18.

Dental asepsis review; Sterilization Monitoring Service Indiana University School of Dentistry 2006; 27(12). Available at

Kurita H, Kurashina K, Honda T. Nosocomial transmission of methicillin-resistant Staphylococcus aureus via the surfaces of the dental operatory. Br Dent J. 2006;201(5):297-300.

Zimmerli M, Widmer AF, Dangel M, Filippi A, Frei R, Meyer J. Methicillin-resistant Staphylococcus aureus (MRSA) among dental patients: a problem for infection control in dentistry? Clin Oral Investig. 2009;13(4):369-73.

Harte JA. Standard and transmission-based precautions: an update for dentistry. JADA. 2010;141(5):572-81.

De Carvalho MJ, Pimenta FC, Hayashida M, Gir E, Da Silva AM, Barbosa CP, et al. Prevalence of methicillin-resistant and methicillin-susceptible S. aureus in the saliva of health professionals. Clinics (Sao Paulo). 2009;64(4):295-302.

Micik RE, Miller RL, Mazzarella MA, Ryge G. Studies on dental aerobiology, part I: Bacterial aerosols generated during dental procedures. J Dent Res. 1969;48(1):49-56.

Siegel JD, Rhinehart E, Jackson M, Chiarello L. Health care infection control practices advisory committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control. 2007;35(10):164-5.