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Cited Expert Not On-Board With Circumcision Protocol

In the circumcision protocols recently released, there’s the following:

C. The person performing metzizah b’peh must do the following:
1. Wipe around the outside of the mouth thoroughly, including the labial folds at the corners, with a sterile alcohol wipe, and then discard in a safe place.
2. Wash hands with soap and hot water for 2-6 minutes.
3. Within 5 minutes before metzizah b’peh, rinse mouth thoroughly with a mouthwash containing greater than 25% alcohol (for example, Listerine®) and hold the rinse in mouth for 30 seconds or more before discarding it (Reference 2).

Reference 2 is:

Meiller TF et al: Efficacy of Listerine® Antiseptic in reducing viral contamination of saliva. J Clin Periodontol 2005; 32: 341-346.

The lead author of that paper, Dr. Timothy F. Meiller, is a professor in the Diagnostic Sciences and Pathology Department of the Baltimore College of Dental Surgery Dental School.
We spoke by phone today after I faxed him a copy of the state’s procedures.
Meiller said he was not contacted by the state health department in its development of the procedures, and had never before heard of metzitzah b’feh and the controversy surrounding it in New York. “I certainly don’t think that the recommendation to do a pre-procedural rinse is going to eliminate the risk of infection,” he said.
“Certainly trying to sterilize the oral cavity was not the goal of my paper, the goal of my paper was to show that rinsing does reduce the recovery of infectious viral organisms,” he explained. The paper was intended to provide data for practicing dentists, for whom infection with herpes from patients’ saliva is a concern. “It was a very simplistic paper, it was not meant to be extrapolated as it’s being here in these procedures,” he said.
Meiller read a sentence from the conclusion of his paper that he felt accurately summed it up. “The value of such a rinse cannot be accurately assessed, however any reduction in infectious virus levels should at least theoretically reduce the risk of transmission to uninfected individuals.” He was quick to note that “the necessary level for infectivity in saliva has never been determined…We don’t know whether it takes 100 particles per ml or 1 particle per ml” and so the reduction of risk that comes with the rinse should not be taken as eliminating that risk, and the level of diminished risk is essentially unknown.
By way of example, he said, “If a dentist called me and asked, having read my paper, if a patient rinses with Listerine, do I have to wear gloves? My answer to them would be: Are you crazy? Of course you have to wear gloves.” He noted “In this procedure, it’s slapping that in the face and saying I’m gonna use some superficial technique and say I’m now ok; you’re not.”
“As a scientist who knows a little bit about virus, I would recommend against the procedure. I would not rely on a surface disinfectant, it’s just too variable. I can’t rely on that being a trustworthy procedure.”
Asked how he would have responded if the state’s health department had contacted him when formulating its protocol, Meiller replied “I would have said that I didn’t think it was enough data to make a decision on anything…it’s like having unprotected sex; in today’s world, it’s just not worth it.”
“Clearly, this is not a procedure that I would think should be condoned,” he said.
For background on this deal, see: 1, 2, 3, 4.

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