Oral Health and Zoonotic Diseases

Abstract

Zoonotic diseases, transmitted between animals and humans, have significant implications on public health, including oral health. This chapter aims to provide a comprehensive overview of the oral manifestations of zoonotic diseases and their prevention, highlighting the importance of early recognition and management by dental professionals. The chapter will discuss the various oral manifestations associated with common zoonotic diseases, such as periodontal manifestations, mucosal lesions, and salivary gland disorders, emphasizing the need for accurate diagnosis and timely referral to appropriate healthcare providers. Moreover, the chapter will delve into the role of dental professionals in preventing zoonotic disease transmission in clinical settings. It will explore the significance of education and training in recognizing and managing the oral manifestations of zoonotic diseases. Additionally, the chapter will emphasize the implementation of preventive measures, including the appropriate use of personal protective equipment, adherence to stringent infection control protocols, and the development of animal handling policies. By highlighting the intricate relationship between oral health and zoonotic diseases, this chapter aims to underscore the critical role of dental professionals in safeguarding the health and well-being of their patients and communities.

1. Introduction

Zoonotic diseases, also known as zoonoses, are infectious diseases that can be transmitted between animals and humans. These diseases are caused by a variety of pathogens, including viruses, bacteria, parasites, and fungi. Zoonotic diseases can be spread through various mechanisms, such as direct contact with animals, contact with animal products or waste, ingestion of contaminated food or water, and transmission by vectors like insects [1]. Zoonotic diseases have been a part of human history for centuries, with some of the most well-known examples being rabies, Lyme disease, and the H1N1 influenza (swine flu) [2]. The emergence and spread of zoonotic diseases are influenced by several factors, including human encroachment on wildlife habitats, increased interactions between humans and animals, climate change, and global trade and travel [3]. As the human population continues to grow and expand, there is increasing pressure on ecosystems and natural habitats. This encroachment often leads to closer interactions between humans, domestic animals, and wildlife, creating more opportunities for zoonotic diseases to emerge and spread. Urbanization, deforestation, and changes in land use are some of the factors that contribute to this phenomenon [4].

1.1 Oral health and zoonotic disease

Oral health plays a crucial role in the overall well-being of individuals. While it is often overlooked, oral hygiene has significant implications not only for dental health but also for general health, including the prevention and control of zoonotic diseases. Zoonotic diseases are infectious diseases that can be transmitted between animals and humans, with pathogens including viruses, bacteria, parasites, and fungi. Oral health and zoonotic diseases are closely interconnected, with various mechanisms linking the two. Poor oral hygiene can create an environment conducive to the growth and proliferation of harmful microorganisms, including those responsible for zoonotic diseases [5]. Moreover, some zoonotic pathogens can be transmitted through saliva, making oral health an essential factor in preventing disease transmission. For instance, rabies, a viral zoonotic disease, is primarily transmitted through the saliva of infected animals via bites or scratches [6]. A compromised oral health status can weaken the immune system, making individuals more susceptible to infections, including zoonotic diseases [7]. A healthy oral environment is essential for maintaining a strong immune system and reducing the risk of contracting and spreading zoonotic diseases. Table 1 describes zoonotic diseases and their transmission modes.

Sl No	Condition	Causative organism	Vector	Transmission mode
Viral zoonotic diseases
1	Monkeypox	Monkeypox virus	Rodents and primates	Human-to-human transmission through respiratory droplets or contact with bodily fluids
2	COVID-19	SARS-CoV-2 virus	Originated in bats, transmitted to humans through an intermediate host, possibly a pangolin	Transmission through respiratory droplets or contact with bodily fluids
3	Hand, foot, and mouth disease	Coxsackie A virus	Not a zoonotic disease itself, but the virus can infect animals and be transmitted to humans	Close personal contact, coughing, contact with infected objects
4	Herpes B Virus infection	Herpes B virus (Macacine herpesvirus 1)	Macaque monkeys	Contact with infected saliva, feces of the macaque monkeys
Fungal zoonotic diseases
5	Candidiasis	Candida albicans	—	Contact with contaminated hands or medical devices.
6	Histoplasmosis	Histoplasma capsulatum	Cattle, sheep, horses (target animals)	Infected by inhaling fungal spores from contaminated soil
7	Blastomycosis	Blastomyces dermatitidis	Direct animal-to-human transmission is rare. Dogs, cats, horses, marine mammals (target animals)	Infected by inhaling fungal spores from moist soil and decaying organic matter
8	Paracoccidiodomycosis	Paracoccidioides brasiliensis and Paracoccidioides lutzii,	Direct animal-to-human transmission is rare. Dogs and domesticated wild animals, especially; armadillos and monkeys (target animals)	Infected by inhaling fungal spores from the environment, injuries of; the skin and mucosal; membranes
9	Sporotrichosis	Sporothrix schenckii	Cats; occasionally; dogs, horses, cows,; camel, dolphin, goat,; mule, bird, pig, rat,; armadillo (target animal)	Through contact with infected plant material, soil, or animals, especially cats
10	Aspergillosis	Aspergillus genus	All domestic animals; and birds	By inhaling fungal spores from the environment
11	Cryptococcosis	Cryptococcus neoformans and Cryptococcus gattii	Found in the environment, particularly in soil or bird droppings, such as those from pigeons	Mainly by inhalation of; fungus, occasionally; through breaks in; the skin
12	Zygomycosis (mucormycosis)	fungi from the Mucorales order	Not directly transmitted from animals to humans	Inhalation of spores from the environment.
Bacterial zoonotic diseases
13	Cat-Scratch Disease	Bartonella henselae	Infected cats, particularly kittens	Through contact with cat saliva on broken skin or mucous membranes, such as the eyes, nose, or mouth
14	Plague	Yersinia pestis	Rodents such as rats, mice, and squirrels	Inhaling respiratory droplets from infected individuals

Table 1.

Zoonotic diseases and their transmission modes.

2. Zoonotic viral diseases with oral manifestations

Viral zoonotic diseases are caused by viruses and can be spread through direct contact with infected animals, consumption of contaminated food, or through vectors like mosquitoes or ticks [8, 9].

2.1 Monkeypox

Monkeypox is a rare viral zoonotic disease primarily found in Central and West Africa. The disease is caused by the Monkeypox virus, a member of the Orthopoxvirus genus, which also includes the now-eradicated smallpox virus (Variola virus). Monkeypox is similar to smallpox in terms of symptoms and clinical presentation, but it is generally less severe. The virus is transmitted to humans from animals, primarily rodents and primates, and human-to-human transmission can occur through respiratory droplets or contact with bodily fluids. Monkeypox can cause fever, headache, and a rash that progresses to pustules [10].

Monkeypox typically presents with a prodromal phase characterized by fever, headache, muscle aches, and general malaise. This is followed by the development of a characteristic rash, which begins as macules and progresses to papules, vesicles, pustules, and finally crusts. The rash commonly involves the face, palms, and soles but can also spread to other parts of the body, including the oral cavity. Oral lesions in monkeypox may present as painful ulcers or vesicles on the tongue, buccal mucosa, palate, or gingiva (Figure 1). These lesions can be accompanied by inflammation and bleeding of the gingiva (gingivitis) or severe inflammation and destruction of the supporting structures of the teeth (periodontitis). In some cases, the oral lesions may precede or coincide with the onset of the characteristic skin rash. The presence of oral lesions can contribute to difficulty eating, drinking, and swallowing, which may result in dehydration and malnutrition, particularly in severe cases [12]. The presence of oral manifestations in monkeypox patients can be a valuable diagnostic clue, particularly in the early stages of the disease when the characteristic rash may not be fully developed. Identifying oral lesions in conjunction with systemic symptoms can help healthcare professionals differentiate monkeypox from other conditions that may present with similar symptoms, such as chickenpox, measles, or other viral infections [13].

Figure 1.

Ulcerations of the tongue (Adapted from Benslama et al. Monkeypox oral lesions. J Stomatol Oral Maxillofac Surg. 2022; Permission granted for free by Elsevier) [11].

2.2 COVID-19

COVID-19 is caused by the SARS-CoV-2 virus; this pandemic began in 2019 and has affected millions worldwide. The virus is believed to have originated in bats and transmitted to humans through an intermediate host, possibly a pangolin [14]. The SARS-CoV-2 virus, responsible for COVID-19, can cause a wide range of symptoms, including oral manifestations [15, 16]. Some patients with COVID-19 have reported symptoms such as dry mouth, loss of taste (ageusia), tongue pain, and oral ulcers [17].

Although respiratory symptoms are the most common manifestations of COVID-19, recent studies have identified various oral symptoms associated with the infection. Some of these oral manifestations include:

• Xerostomia (dry mouth): COVID-19 patients may experience a reduction in salivary flow due to dehydration, fever, or mouth breathing during the illness. This can lead to dry mouth, which increases the risk of dental caries and periodontal disease.

• Dysgeusia (altered taste): Many COVID-19 patients have reported a loss or alteration of taste sensation, which could be related to the virus’s impact on the taste buds or the central nervous system.

• Oral ulcers and lesions: Some COVID-19 patients have presented with oral ulcers, blisters, or other lesions, which may be related to the virus’s direct effect on oral tissues or a secondary response to the systemic inflammation caused by the infection (Figure 2).

• Gingivitis and periodontitis: The inflammatory response associated with COVID-19 may exacerbate pre-existing periodontal diseases or contribute to the development of new periodontal problems [16].

Figure 2.

(A) Clustered ulcers covered with crusts occurring on the lower lip. Ulcerative painful lesions with superficial necrosis affecting the anterior dorsal tongue. (B) Lower lip mucosal ulcers covered with a mucopurulent membrane. (Adapted from: Brandao, et al. Oral lesions in patients with SARS-CoV-2 infection: Could the oral cavity be a target organ? Oral Surg Oral Med Oral Pathol Oral Radiol. 2021; Permission granted for free by Elsevier) [18].

2.3 Hand, foot, and mouth disease (HFMD)

HFMD is caused by the Coxsackie A virus, which is not a zoonotic disease itself, but the virus can infect animals and be transmitted to humans. HFMD primarily affects infants and young children. The disease is caused by several strains of enteroviruses, most commonly Coxsackievirus A16 and Enterovirus 71 [19]. HFMD is characterized by the presence of a rash and/or blisters on the hands, feet, and mouth, as well as fever, sore throat, and other flu-like symptoms. The disease is characterized by fever, sore throat, and small painful blisters or ulcers in the mouth [20, 21].

Oral manifestations of HFMD can be one of the first and most noticeable symptoms of the disease. Some common oral manifestations include:

• Oral vesicles and ulcers: The primary oral manifestation of HFMD is the appearance of small, painful vesicles and ulcers in the mouth. These lesions typically form on the buccal mucosa, tongue, and soft palate. As the vesicles rupture, they leave shallow, red ulcers with a white or yellow base (Figure 3).

• Gingivitis: Inflammation of the gingiva (gingivitis) may occur in conjunction with the oral lesions, resulting in red, swollen, and painful gingiva that may bleed easily.

• Difficulty seating and drinking: The oral lesions and gingivitis associated with HFMD can cause significant discomfort, making it challenging for affected individuals to eat, drink, and swallow. This can lead to dehydration, malnutrition, and weight loss, particularly in young children who may be unable or unwilling to communicate their pain.

Figure 3.

Oral ulcers on the labial mucosa of lower lip (Rao et al. Hand, foot and mouth disease: Changing Indian scenario. Int J Clin Pediatr Dent. 2012; this work is licensed under a creative commons attribution 3.0 Unported License and is free to share and adapt) [22].

The oral manifestations of HFMD can significantly impact the quality of life and overall health of affected individuals [23]. The pain and discomfort associated with oral lesions and gingivitis can lead to poor oral hygiene, as the individual may avoid brushing and flossing due to pain. This, in turn, can exacerbate gingival inflammation and increase the risk of secondary bacterial infections. Furthermore, the difficulty in eating and drinking due to oral lesions can have severe consequences for the overall health and well-being of the affected individual, particularly in young children [24]. Proper nutrition and hydration are crucial for maintaining a healthy immune system and supporting the body’s ability to fight off the viral infection.

2.4 Herpes B virus infection

Herpes B virus, also known as Macacine herpesvirus 1, is a virus that primarily infects macaque monkeys but can also infect humans. In humans, Herpes B virus infections are rare but can be serious, even fatal [25]. In humans, the virus can cause vesicular lesions in the oral cavity, similar to those caused by herpes simplex virus [26].

Oral manifestations of Herpes B virus infection in humans can include:

• Oral ulcers: Herpes B virus infection can cause painful ulcers to develop on the gingiva, tongue, or inside the cheeks.

• Gingivitis: The virus can cause inflammation of the gingiva, leading to redness, swelling, and bleeding.

• Pharyngitis: Herpes B virus can cause sore throat, difficulty swallowing, and inflammation of the pharynx.

• Oral herpes: In some cases, Herpes B virus infection can lead to oral herpes, characterized by cold sores or blisters on the lips, inside the mouth, or on the tongue.

Herpes B virus infection can also cause the lymph nodes in the neck to become swollen and tender. A high fever is a common symptom of Herpes B virus infection, along with headache, muscle aches, and fatigue. It’s important to note that Herpes B virus infection can be extremely serious and potentially life-threatening, especially if left untreated [27].

3. Fungal zoonotic diseases with oral manifestations

Fungal zoonotic diseases are infections caused by fungi that can be transmitted between animals and humans. Although oral manifestations are relatively rare, some fungal zoonotic diseases can present with symptoms in the oral cavity [28]. The oral manifestations of fungal zoonotic diseases can often be mistaken for other conditions, making accurate diagnosis and appropriate treatment crucial. Treatment for these conditions typically involves antifungal medications, and in some cases, surgical intervention may be necessary [29].

3.1 Candidiasis

Candidiasis, commonly known as thrush, is caused by the Candida species, particularly Candida albicans. While Candida is a commensal organism and is commonly found in the human body, it can cause infections in individuals with weakened immune systems or predisposing factors. Oral candidiasis presents as white patches on the tongue, inner cheeks, and other oral mucosal surfaces [30]. These patches may be painful and can bleed when scraped. In severe cases, the infection can spread to the esophagus and cause difficulty swallowing [29].

3.2 Histoplasmosis

Caused by the fungus Histoplasma capsulatum, histoplasmosis primarily affects the lungs. The fungus is found in soil, especially in areas with bird or bat droppings [31]. Although not directly transmitted from animals to humans, people can become infected by inhaling fungal spores from contaminated soil. Histoplasmosis can occasionally present with oral manifestations, especially in immunocompromised individuals [32]. Oral histoplasmosis may present as ulcers, nodules, or granulomatous lesions on the oral mucosa, tongue, or palate. These lesions can be painful and may mimic other oral conditions, such as squamous cell carcinoma or tuberculosis [33].

3.3 Blastomycosis

Caused by the fungus Blastomyces dermatitidis, blastomycosis primarily affects the lungs and can also involve the skin, bones, and other organs. The fungus is found in moist soil and decaying organic matter. Humans can become infected by inhaling fungal spores from the environment; direct animal-to-human transmission is rare [34]. Blastomycosis can occasionally involve the oral cavity, particularly in disseminated cases. Oral manifestations of blastomycosis may include ulcers, nodules, or verrucous lesions on the oral mucosa, tongue, or palate [35]. These lesions can be painful and may be mistaken for other oral conditions, such as oral cancer or fungal infections like histoplasmosis.

3.4 Paracoccidioidomycosis (South American blastomycosis)

Paracoccidioidomycosis, caused by the fungi Paracoccidioides brasiliensis and Paracoccidioides lutzii, primarily affects the lungs and can also involve the skin, lymph nodes, and other organs [36]. The fungi are found in soil, and humans can become infected by inhaling fungal spores from the environment. Direct animal-to-human transmission is rare. Paracoccidioidomycosis can present with oral manifestations, especially in the chronic form of the disease. The classic oral presentation, known as “mulberry-like stomatitis,” consists of granulomatous lesions with a mulberry-like appearance on the oral mucosa, lips, and gingiva [37, 38]. These lesions can be painful and may cause difficulty eating or speaking.

3.5 Sporotrichosis

Caused by the fungus Sporothrix schenckii, this disease is commonly transmitted to humans through contact with infected plant material, soil, or animals, especially cats [39]. Infection occurs when fungal spores enter the skin through cuts or scratches, resulting in skin lesions, nodules, and sometimes more severe systemic infections [40]. Although oral involvement in sporotrichosis is uncommon, there have been reported cases where the fungus Sporothrix schenckii has caused oral manifestations. These can include ulcers, nodules, or granulomatous lesions on the oral mucosa, tongue, or palate. The lesions may be painful and can mimic other oral conditions, making diagnosis challenging [41].

3.6 Aspergillosis

Aspergillosis is caused by fungi from the Aspergillus genus, which are found in soil, decaying vegetation, and other organic matter. While Aspergillus is not directly transmitted from animals to humans, people can become infected by inhaling fungal spores from the environment. Aspergillosis primarily affects the lungs and can cause a range of symptoms, from mild allergic reactions to severe, invasive infections [42]. Although primarily a respiratory infection, it can sometimes involve the oral cavity, particularly in immunocompromised individuals. Oral manifestations of aspergillosis may include necrotizing ulcers, palatal perforations, or fungal masses (aspergillomas) within the oral cavity [43]. These lesions can be painful and may cause difficulty eating or speaking. Accurate diagnosis is essential, as oral aspergillosis can resemble other oral conditions, such as malignancies or other fungal infections [44].

3.7 Cryptococcosis

Cryptococcosis, caused by the fungi Cryptococcus neoformans and Cryptococcus gattii, is primarily a pulmonary and central nervous system infection. While these fungi are not directly transmitted from animals to humans, they are found in the environment, particularly in soil or bird droppings, such as those from pigeons [45]. Humans can become infected by inhaling fungal spores from the environment. However, in rare cases, it can involve the oral cavity, especially in individuals with weakened immune systems. Oral manifestations of cryptococcosis may include ulcers, nodules, or granulomatous lesions on the oral mucosa, tongue, or palate [40, 46]. These lesions may be painful and can mimic other oral conditions, making accurate diagnosis crucial.

3.8 Zygomycosis (Mucormycosis)

Zygomycosis, also known as mucormycosis, is caused by fungi from the Mucorales order, which are found in soil, decaying organic matter, and certain foods. Although not directly transmitted from animals to humans, people can become infected through inhalation of fungal spores or direct contact with contaminated materials, particularly if they have a weakened immune system or existing health conditions [47]. It is a rare but potentially life-threatening infection that can affect various organs and tissues, including the oral cavity. Oral manifestations of zygomycosis may include necrotizing ulcers, black eschars, or destruction of oral tissues, such as the palate or gingiva [48]. These lesions can be extremely painful and may cause significant morbidity and mortality if not treated promptly (Figure 4).

Figure 4.

Intra-oral photograph showing total denudation of the entire palate with extensive necrosis of overlying mucosa (Verma et al. Necrosis of maxilla, nasal, and frontal bone secondary to extensive rhino-cerebral mucormycosis. Natl J Maxillofac Surg. 2013; this is an open-access article distributed under the terms of the creative commons attribution-noncommercial-share alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction) [49].

To minimize the risk of contracting fungal zoonotic diseases, individuals should take precautions such as wearing gloves and protective clothing when handling soil or animals, avoiding areas with heavy accumulations of bird or bat droppings, maintaining good hygiene practices, and ensuring proper ventilation in indoor environments [50]. For individuals with weakened immune systems or underlying health conditions, additional preventive measures may be necessary, such as wearing masks in high-risk environments or taking antifungal medications as prophylaxis.

4. Bacterial zoonotic diseases with oral manifestations

4.1 Cat-scratch disease

Cat-scratch disease (CSD), also known as cat-scratch fever, is a bacterial zoonotic infection caused by Bartonella henselae. The disease is primarily transmitted to humans through scratches or bites from infected cats, particularly kittens [51]. While CSD typically presents with symptoms such as fever, fatigue, and swollen lymph nodes, it can also manifest with oral health issues. Bartonella henselae, the bacterium responsible for the cat-scratch disease, is commonly found in the saliva of infected cats. Transmission to humans usually occurs when an infected cat scratches or bites a person, introducing the bacteria into the skin. In some cases, the bacteria may also be transmitted through contact with cat saliva on broken skin or mucous membranes, such as the eyes, nose, or mouth. The primary symptoms of cat-scratch disease include swollen and painful lymph nodes near the site of the scratch or bite, fever, headache, and fatigue. These symptoms generally appear within one to three weeks after exposure to the bacteria and can last for several weeks or months [52].

While the most common manifestations of cat-scratch disease involve lymph nodes and flu-like symptoms, the infection can also affect oral health in several ways. CSD may cause oral ulcers or sores in the oral cavity [53]. These ulcers can be painful and make eating or drinking difficult. Infected individuals may experience periodontitis or gingivitis, which can cause redness, swelling, and bleeding of the gingiva. In rare instances, CSD may cause erythema or redness of the oral mucosa, leading to discomfort and potential complications if left untreated [54]. Once these bacteria are introduced into the oral cavity, they can potentially cause secondary infections that may lead to more severe oral health issues, such as periodontitis or dental abscesses.

4.2 Plague

Plague, a severe and potentially fatal zoonotic infection, is caused by the bacterium Yersinia pestis. The primary mode of transmission to humans is through the bite of infected fleas, which commonly infest rodents such as rats, mice, and squirrels. Additional transmission routes include direct contact with infected animals or their tissues and inhaling respiratory droplets from infected individuals. Plague presents in three main forms: bubonic, septicemic, and pneumonic, each with distinct symptoms and health consequences [55]. Although the primary symptoms of plague involve swollen lymph nodes (buboes), fever, chills, and weakness, the disease may also manifest with oral complications in some instances.

Infections caused by Yersinia pestis can result in acute gingival bleeding, characterized by swollen, tender gingiva that bleed easily. This symptom is particularly worrisome in the context of septicemic plague, where the bacteria have disseminated through the bloodstream, causing intravascular coagulation and potential bleeding in various body parts, including the oral cavity. Plague may also cause the formation of oral ulcers or sores in the mouth, which can be painful and interfere with eating or drinking. In severe cases of septicemic or pneumonic plague, the infection might lead to necrosis or tissue death in different parts of the body, including the oral cavity [56]. Necrotic lesions in the mouth can be extremely painful and result in significant damage to the oral tissues.

5. Zoonotic disease prevention in dental practice settings

In dental care setups, practitioners may come into contact with zoonotic pathogens through direct contact with infected animals or indirectly through contaminated instruments, surfaces, or airborne transmission [57]. Therefore, it is crucial for dental care professionals to adopt preventive measures to minimize the risk of zoonotic diseases in their practice.

5.1 Education and training

Continuous education and training of dental professionals on zoonotic diseases are vital for effective prevention. Dental care professionals should be knowledgeable about the different types of zoonoses, their transmission modes, and the necessary precautions to take. This knowledge can be acquired through formal education, professional development courses, and regular workshops. Dental professionals should also be trained in identifying potential zoonotic disease symptoms and handling suspected cases.

5.2 Personal protective equipment (PPE)

The use of appropriate PPE, including gloves, masks, eye protection, and gowns, is essential in preventing the transmission of zoonotic pathogens. Dental professionals should adhere to strict protocols regarding the use, disposal, and replacement of PPE to minimize the risk of cross-contamination and infection [58].

The following PPE components should be considered:

1. Gloves: Disposable gloves should be worn during all procedures involving potential exposure to blood, body fluids, or contaminated surfaces. Gloves should be changed between patients and disposed of properly.

2. Masks: Dental professionals should wear surgical masks or respirators to protect against the inhalation of aerosols or droplets containing pathogens. Masks should be replaced regularly and disposed of properly.

3. Eye protection: Safety goggles or face shields should be worn to protect the eyes from splashes, sprays, or airborne particles.

4. Gowns: Disposable gowns should be used to protect clothing from contamination. Gowns should be changed between patients and disposed of properly.

5.3 Infection control and sterilization procedures

Dental care professionals should follow strict infection control protocols, including regular cleaning and sterilization of dental instruments, surfaces, and equipment. The use of disposable items, such as single-use dental needles and saliva ejectors, can help minimize the risk of cross-contamination. Proper disposal of contaminated waste, such as used gloves, masks, and sharps, should be practiced to prevent environmental contamination.

1. Instrument sterilization: All reusable dental instruments should be thoroughly cleaned and sterilized between patients using appropriate methods such as autoclaving or chemical sterilization.

2. Surface disinfection: Surfaces in the dental operatory, including countertops, dental chairs, and light handles, should be regularly cleaned and disinfected using EPA-registered disinfectants.

3. Equipment maintenance: Dental equipment, such as handpieces and ultrasonic scalers, should be maintained, cleaned, and sterilized according to the manufacturer’s recommendations.

4. Use of disposable items: Whenever possible, single-use items such as dental needles and saliva ejectors should be utilized to minimize the risk of cross-contamination.

5. Proper waste disposal: Contaminated waste, including used gloves, masks, and sharps, should be disposed of in designated biohazard containers.

5.4 Animal handling policies

In cases where dental care professionals encounter animals in their practice, such as service animals or therapy pets, strict animal handling policies should be in place. These policies should include guidelines on hand hygiene, avoiding direct contact with animals when possible, and immediately reporting any incidents of bites or scratches. Additionally, dental care setups should ensure that animals present in the clinic have been properly vaccinated and are free of any known zoonotic diseases.

1. Hand hygiene: Dental professionals should practice proper hand hygiene before and after handling animals, including washing hands with soap and water or using alcohol-based hand sanitizers.

2. Avoiding direct contact: Whenever possible, dental professionals should avoid direct contact with animals, especially if they have open wounds or broken skin.

3. Reporting incidents: Any incidents of bites or scratches should be immediately reported, and appropriate medical attention should be sought.

4. Animal vaccination and health checks: Dental care setups should ensure that animals present in the clinic have been properly vaccinated and are free of any known zoonotic diseases. Regular health check-ups should be conducted by a veterinarian to ensure the animals’ well-being and to minimize the risk of disease transmission.

5.5 Airborne transmission prevention

To minimize the risk of airborne transmission of zoonotic pathogens, dental care setups should invest in proper ventilation systems, air purifiers, and high-efficiency particulate air (HEPA) filters. Regular maintenance and cleaning of these systems are essential to ensure their efficiency in preventing the spread of airborne pathogens [59]. The following measures can be taken to prevent airborne transmission:

1. Ventilation systems: Dental care setups should have adequate ventilation systems in place to ensure proper air circulation and reduce the concentration of airborne pathogens.

2. Air purifiers: The use of air purifiers with HEPA filters can help remove airborne particles, including pathogens, from the air, reducing the risk of transmission.

3. Regular maintenance and cleaning: Ventilation systems and air purifiers should be regularly maintained and cleaned according to the manufacturer’s recommendations to ensure their efficiency in preventing the spread of airborne pathogens.

5.6 Surveillance and reporting

Dental care professionals should be vigilant in monitoring for signs and symptoms of zoonotic diseases in both patients and staff. Any suspected cases should be promptly reported to relevant public health authorities, and appropriate measures, such as isolation and contact tracing, should be implemented to prevent further transmission [60]. The following steps can be taken to enhance surveillance and reporting:

1. Monitoring for symptoms: Dental professionals should be trained to identify potential signs and symptoms of zoonotic diseases and to report any suspected cases to the appropriate public health authorities.

2. Reporting incidents: Any incidents of potential zoonotic disease transmission, such as animal bites or scratches, should be promptly reported to the relevant public health authorities.

3. Implementing control measures: In the event of a suspected case, dental care setups should implement appropriate measures, such as isolation, contact tracing, and enhanced infection control procedures, to prevent further transmission.

As zoonotic diseases continue to pose a significant threat to global health, it is crucial for dental care setups to prioritize preventive measures to minimize the risk of transmission. By adopting comprehensive policies and protocols, including education, the use of PPE, infection control, animal handling, airborne transmission prevention, and surveillance, dental care professionals can contribute to the global effort to combat zoonotic diseases and protect the health of their patients and auxiliary staff.

6. Conclusion

The connection between oral health and zoonotic diseases highlights the importance of maintaining good oral hygiene to reduce the risk of disease transmission. By adopting a comprehensive approach that includes oral health practices, public awareness, vaccination and disease control, and interdisciplinary collaboration, we can effectively address the challenges posed by zoonotic diseases and promote better health outcomes for both humans and animals. By implementing a One Health approach and addressing the root causes of zoonotic disease emergence and spread, we can work toward reducing the impact of these diseases on human, animal, and environmental health. Preventing and controlling zoonotic diseases require a collaborative, interdisciplinary approach known as One Health, which recognizes the interconnectedness of human, animal, and environmental health. This approach involves cooperation among various sectors, including public health, veterinary medicine, agriculture, and wildlife management, to monitor and respond to zoonotic disease threats effectively.

Conflict of interest

The authors declare no conflict of interest.