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Some patients with acute hepatitis B do not report one of the usual behavioral risks for infection. Diligent investigation into one such case has resulted in the first known instance of patient–patient transmission of HBV within a U.S. dental setting.
A 60-year-old woman developed acute hepatitis B with systemic symptoms and elevated transaminases in 2002. She reported none of the usual risks for infection. She had teeth extracted 4 months previously at an oral surgery center, where an investigation identified the presumed source of her infection: a 39-year old woman with chronic HBV infection and a high concentration of circulating viral DNA who underwent oral surgery about 2 1/2 hours before the index case. Viral isolates from source and i…