CONCORD — Public health agencies are investigating the office procedures of Manchester dentist Nicholas Marshall to determine if patients are at risk for serious infectious diseases.
Patients have been told to check with their physicians about whether to be tested for infection by the hepatitis B, hepatitis C or HIV viruses after the state Board of Dental Examiners suspended Marshall’s license to practice dentistry because of “imminent threat to the life, safety and/or health of his patients.”
Specifically, the dental board found “improper infection control procedures” that could put patients at risk of infection by blood-borne pathogens.
The investigation is complicated by Marshall’s recent indictment on 160 counts of Medicaid fraud and 29 counts of falsifying medical records provided to the grand jury in the case.
Dr. Jose Montero, the state’s director of public health, said the agency is contacting former employees of the Marshall dental practice to determine procedures used in sanitizing equipment and to identify the procedures performed on his orthodontics patients.
“Based on those findings, we will determine the level of risk to possible exposures and provide specific recommendations,” he said.
The dental board and the state Attorney General’s Office conducted a surprise inspection at Marshall’s Manchester office on April 24. His license was suspended April 28; a public notice of the potential public health risk was issued Monday.
Montero said since Marshall practiced orthodontics — a specialty with procedures that do not normally involve bleeding — the state assumes the risk of infection is low.
“Certainly that can change if we determine that a lot of extractions were performed or procedures with more blood were involved,” Montero said.
He said the Marshall case is not comparable to the hepatitis C infections caused by Exeter Hospital employee David Kwiatkowski, who was sentenced last August to 30 to 40 years in prison.
“This is different; back when we had the hepatitis C infections, we had someone who was contagious using syringes that then went into other people’s bodies,” Montero said. “We want to make that clear — we do not have here a known infected person using medical equipment again and again and again.”
Also being investigated is whether the Manchester dentist properly cleaned dental instruments before placing them in an autoclave, which uses high-pressure steam to sterilize medical utensils.
“If the equipment was not properly washed before, it is hard for the machine to get rid of the infection because there are substances there,” Montero said. “It’s like how you need to remove the gross things before putting things in the dishwasher; this is the same principle.”
Manchester public health officials are assisting in the investigation. Testing will be made available for people without insurance or a personal physician, Tim Soucy, the city’s public health director, Soucy said.
The Board of Dental Examiners has set a May 22 public hearing on Marshall’s suspension.