Clinical and medico-legal aspects in the first case of legionnaire's disease contracted in a dental practice

Objectives. In order to lower the incidence rate of infection in the dental practice, it is necessary to monitor the possible risk of transmission of pathogenic agents and of contamination. The light of the case report published by the Italian Istituto Superiore di Sanita (the leading technical and scientific public body of the Italian National Health Service) and appearing in The Lancet, the aim of this work, is to increase the compliance and the raise the awareness of dental care workers regarding procedures directed at prevention and hygiene measures for dental unit waterlines and also to define the relative medico-legal responsibilities. Materials and methods. An overall analysis of the existing risk, the procedures most suitable for efficient hygiene and prevention in dental unit waterlines and the correlated medico-legal problems has been carried out through a critical revision of both scientific literature and the most recent jurisprudential and normative positions. Results and conclusions. In the case report published by the Italian Istituto Superiore di Sanita it was demonstrated, for the first time globally, the fortuitous correlation between the Legionella spp pathology, its consequences and the contamination of dental unit waterlines. The death, caused by Legionnaire's disease, of an elderly patient in the city of Forli, in Central-Northern Italy, was indisputably related to the very same pathogenic family found inside the dental unit of her dentist. This case, without wanting to raise unnecessary alarmism, underlines how important it is to reduce to the very minimum the exposure risk for patients and dental staff and, at the same time, emphasizes how the professionals involved need to be able to prove the dental staff's ignorance of the event (i.e., an event in no way avoidable). Such requirements have warranted this critical re-examination of the problems and the singling out of specific preventive strategies of guaranteed effectiveness and ones capable of protecting the professional responsible for the dental surgery and practice in the medico-legal domain. The risk of Legionella spp contamination of dental unit waterlines has been demonstrated for some time. However the clinical and practical importance of the Forli's event is unquestionable, even more so if related to issues of civil and penal responsibility. The professionals in question will be summoned to prove their ignorance regarding the inauspicious event.