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FACT SHEET: Methicillin Resistant Staphylococcus Aureus Carriage/Infection (also known as “MRSA”; includes “community-associated MRSA” [CA-MRSA] and “healthcare-associated MRSA” [HA-MRSA]; caused by Staphylococcus aureus bacteria that are resistant to certain antibiotics) {Staphylococcus aureus is also known as Staph aureus and S. aureus.}

Date of Publication: March 11, 2013
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Is the initiation of non-invasive dental hygiene procedures* contra-indicated?

  • No.

Is medical consult advised?  

  • No.

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

  • No, as long as there is no active infection in the oral cavity.

Is medical consult advised? 

  • Only if active infection in the oral cavity is suspected.

Is medical clearance required? 

  • No. 

Is antibiotic prophylaxis required?  

  • No.

Is postponing treatment advised?

  • Possibly, depending on result of the medical/dental consult if oral infection is suspected.

Oral management implications

  • Mode of transmission is via skin-to-skin contact, contact with infected bodily fluids (e.g., pus), or objects which have become contaminated with infected bodily fluids (e.g., contaminated medical equipment). While about one in three persons is colonized in the nose or on the skin with methicillin sensitive Staphylococcus aureus (MSSA), only 1% to 5% of people are colonized with MRSA. [Colonized: When a person carries the organism but shows no clinical signs or symptoms of infection. For Staph aureus, the most commonly colonized body site is the nose.] MRSA involves resistance to the antibiotic methicillin and other more common beta-lactam antibiotics such as penicillin, amoxicillin, and oxacillin.1 Persons with weakened immune systems and chronic illnesses are more susceptible to MRSA infections, and spread in hospitals and long-term care facilities is frequent. Most MRSA infections in the community setting — and therefore most likely to be encountered by dental hygienists — are skin infections.
  • If a person picks up MRSA on the hands, that person can spread it to others if the hands are not cleaned properly. A person can also infect one’s self through an open wound on one’s own body.
  • In healthcare settings, MRSA is typically spread from patient/client to patient/client on unclean hands of healthcare personnel or through the improper use or reuse of equipment. To prevent the spread of MRSA, ensure appropriate hand hygiene (i.e., washing with soap and water or using an alcohol-based hand sanitizer) along with other appropriate infection prevention and control practices.
  • Disinfectants effective against “ordinary” methicillin sensitive Staphylococcus aureus are likely also effective against MRSA. Most disinfectant manufacturers provide a list of microbes on their product’s label that their product can destroy.

Oral manifestations

  • No specific oral lesions are associated with MRSA. However, Staph aureus is implicated in several infective oral pathologies, including angular cheilitis, mucositis, parotitis, dental abscess2, and dental implant failure.
  • While the mouth is not typically a site of MRSA concern, there are increasing reports of Staph aureus and MRSA carriage in the oral cavity.
  • In a known MRSA carrier, a higher index of suspicion is warranted in the presence of unusual oral lesions.

Related signs and symptoms

  • Staph aureus (including MRSA) is both a commensal microbe and a human pathogen.
  • In the community setting, most MRSA infections (and Staph aureus infections in general) are skin and skin structure infections3, which can be successfully treated on an outpatient basis in most cases (e.g., via incision and drainage and/or certain antibiotics). These skin infections may manifest as pustules or boils, which are often red, swollen, and painful, and/or have pus or other drainage. These lesions commonly occur where skin trauma occurs (e.g., cuts and abrasions), and areas of the body covered by hair (e.g., back of neck, groin, buttock, armpit, and beard area of men). Infected skin may be warm to touch, and fever may be present.
  • More rarely, MRSA infections — particularly in institutional settings amongst patients/clients with immunosuppression or chronic diseases — can result in serious and potentially life-threatening complications. These include septicemia (infection of the bloodstream), osteomyelitis (infection of the bones), pneumonia (infection of the lungs), endocarditis (infection of the endocardial lining of the heart), and septic arthritis (infection of the joints).
  • Risk factors for community-associated MRSA include participating in contact sports, living in crowded or unsanitary conditions, men having sex with men, having HIV infection, and using illicit injected drugs.
  • Risk factors for healthcare-associated MRSA include being hospitalized, having an invasive medical device (e.g., intravenous line or urinary catheter), and residing in a long-term care facility.

References and sources of more detailed information


Date: December 16, 2012
Revised: August 31, 2015; April 1, 2020; March 11, 2025


FOOTNOTES

1 Of ongoing concern is the spread of MRSA strains that are refractory to mainstays of MRSA antibiotic therapy for serious infections, such as daptomycin, linezolid, and vancomycin.
2 A dental abscess usually has polymicrobial etiology, with Staph aureus being isolated in up to 15% of abscess cultures (MSSA in 90% of these cases and MRSA in 10%).
3 Superficial skin infections caused by Staph aureus include impetigo, furuncles (boils), folliculitis, carbuncles, abscesses, erysipelas, and infected lacerations.


* Includes oral hygiene instruction, fitting a mouth guard, taking an impression, etc.
** Ontario Regulation 501/07 made under the Dental Hygiene Act, 1991. Invasive dental hygiene procedures are scaling teeth and root planing, including curetting surrounding tissue.