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FACT SHEET: Bed Bugs (common bed bug = insect Cimex lectularius; tropical bed bug = insect Cimex hemipterus)

Date of Publication: August 7, 2014

Is the initiation of non-invasive dental hygiene procedures* contra-indicated?

  • No.

Is medical consult advised?  

  • Possibly. While a medical consult for oral health reasons is not required, a referral to a primary care provider (e.g., physician or nurse practitioner) may be appropriate for definitive diagnosis, counseling (e.g., how to get rid of bed bugs; sources of reputable information, such as local public health unit), and treatment (e.g., topical steroid cream and oral antihistamine in severe cases, or antibiotic for secondary infection).

Is the initiation of invasive dental hygiene procedures contra-indicated?**

  • No.

Is medical consult advised? 

  • See above.

Is medical clearance required? 

  • No.

Is antibiotic prophylaxis required?  

  • No.

Is postponing treatment advised?

  • Possibly, if a heavy bed bug infestation is suspected at the patient/client’s home and/or bed bug “hitchhikers” are noted on patient/client’s back-pack or clothing. However, in most cases of bed bug bites in a patient/client, there is no risk to the dental hygienist, because the patient/client is not actually transporting the insect and therefore the dental hygienist cannot be bitten nor can s/he transport the insect back home.

Oral management implications

  • Mode of transmission is most commonly by contact with bed bug-infested bed/mattress/furniture. In Canada, the bed bug of predominant concern is the common bed bug; the tropical bed bug requires a higher average temperature, and is found in tropical and subtropical areas. 
  • These blood-sucking insects reside in crevices of floors and walls, bedding, and upholstered furniture. They prefer to feed on humans, but will feed on other mammals and birds as well. They cannot fly but can travel up to 20 feet in search of a human host. After feeding for about 10 to 20 minutes (typically, but not always, at night), bed bugs return to their place of hiding. They usually feed every 5 to 10 days, but can survive for up to 18 months without feeding. Their lifespan is about 10 months, and they are great hitchhikers on objects such as furniture, bedding, luggage, boxes, backpacks, and clothing. 
  • They are not known to spread disease — there is no evidence that bed bugs transmit blood-borne infectious diseases. 
  • The dental hygienist should avoid being in close proximity to, or in direct contact with, potentially infested personal items if a patient/client is suspected of having bed bug bites. In most circumstances, a client/patient with bed bug bites poses no risk to the dental hygienist, because the bed bugs are not actually on the client/patient, but rather have returned to their place of hiding (e.g., bed mattress) after a nocturnal feeding. Risk reduction may be in order if a heavy home infestation is suspected, which would increase the possibility of bed bugs being transported out of the home on a patient/client’s backpack or clothing. Leaving non-essential personal possessions (e.g., coats and bags) at home, rather than taking them to the dental hygiene office, can reduce “hitchhiking” potential. Clothing that has been thoroughly washed in very hot water and placed in a hot dryer for 30 minutes will be rendered bed bug free. 
  • It is very unlikely, although not impossible, that a bed bug infestation will develop in a non-residential environment such as a dental/dental hygiene office. Particular attention should be paid to reducing clutter, avoiding upholstered furniture in the waiting area, and being vigilant in inspecting and cleaning storage areas (e.g., coat closets) where personal belongings are in constant flux. Daily vacuuming can pick up stray bugs before they settle in. Facility management should be informed if an infestation is suspected, bearing in mind that a single bed bug does not necessarily constitute an infestation. Office treatment with integrated pest management techniques (including possible pesticide use by a licensed pest control company) is indicated if a true infestation with breeding bed bugs is found.

Oral manifestations

  • None

Related signs and symptoms

  • Canada and Ontario have seen an increase in the number of bed bug reports in recent years.
  • Bed bugs should be suspected in any patient/client with nocturnally acquired bites or rashes, although the bites may take as long as 14 days to appear, depending on the person. Bite reactions occur on exposed (i.e., unclothed) body sites such as the face, neck, upper torso, and extremities (arms and hands more commonly than legs and feet). The bites are often, but not always, itchy. Patients/clients may also report seeing small flat bugs, typically at night.
  • The bites are typically small, red, flat sores or bumps, or — less commonly — urticarial papules/welts, although rarer reactions (vesicles and bullae) can occur. The bites may be in a linear or cluster pattern. The classic distribution of the bites in linear groups of three is known as the “breakfast, lunch, and dinner sign”. Some people do not react to bed bug bites at all.
  • Signs of infestation include small, reddish brown stains on sheets or mattresses (caused by crushing of bed bugs); dark spots (excrement) in bedroom furniture, windows, and doorframes; visible live bed bugs; and visible tiny eggs and eggshells, as well as pale yellow skins from shedding nymphs.
  • Adult bed bugs range from 3 to 10 mm in length — typically about the size and shape of an apple seed — and are reddish brown in colour, darkening to blood red after feeding. The young insects are smaller and lighter in colour. Bed bug eggs are white, about 1 mm long and difficult to see. Bed bugs move by walking; they do not jump or fly. They reproduce rapidly; eggs are laid in cracks and crevices.
  • Skin changes secondary to scratching include excoriations, eczematous dermatitis, and infection.
  • Home infestations can cause stress, anxiety, fatigue, and sleeplessness, as well as financial hardship (from pest control, cleaning, and alternative accommodation expenses).  
  • Bed bug infestations most commonly occur in places of high resident turnover (e.g., hotel, hostel, shelter, rooming house, etc.) and/or with use of second-hand upholstered furniture/mattresses and/or in the presence of clutter. However, even the cleanest people can encounter bed bugs, whether at home or at a high-end hotel.

References and sources of more detailed information