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Endodontic Instruments
Decontamination of Endodontic Instruments
On 19 April 2007, the Chief Dental Officer (CDO) for England, Barry Cockcroft, issued a Statement which was circulated to all dentists in England. The essence of the advice is that in view of the well-recognised problems associated with cleaning and decontaminating endodontic reamers and files, these and similar instruments should be treated as single use items of dental equipment.
The CDO's Statement deals with the need for the highest standards of decontamination, and also the importance of following manufacturers' advice. The underlying concern leading to this advice, relates to the potential for the transmission of prion material - such as in variant CJD (vCJD) - which in some studies has been detected in tonsillar, gingival and other oral tissues. The CDO stressed, however, that the advice was precautionary since there are no known or suspected cases of vCJD transmission arising from dental procedures.
As recently as May 2006, a position statement issued by SEAC (the Spongiform Encephalopathy Advisory Committee) concluded that it was unclear whether or not vCJD infectivity could be transmitted via endodontic files and reamers. The evidence remained under continuing review but SEAC believed that there were "hypothetical but plausible" scenarios that, given the significant number of endodontic procedures that were being undertaken, justified the same cautious approach that is now advocated by the CDO. It is also acknowledged that any risk of exposure from dental procedures needs to be viewed in the context of other (especially dietary) exposures.
In reviewing their everyday practice arrangements, many dentists will be uncertain about the legal status of a guidance letter, while others will ask whether the CDO's Statement applies to private as well as NHS dentists. In one sense this recent Statement simply firms up the pre-existing situation. For some years, many endodontic reamers and files have of course been clearly labelled by the manufacturers as being suitable for single use only, and whether working in the NHS or privately, current guidance from sources as authoritative as SEAC and the Department of Health, would certainly weigh heavily in the balance of what might be considered a "reasonable body of opinion" in any legal challenge. Ignoring such guidance may leave practitioners vulnerable to legal or disciplinary challenge.
Dental Protection is not the arbiter of clinical or scientific opinion, and it fully recognises the significant practical and financial complications that the CDO's Statement will create, especially for NHS practices whose budget is finite and cash-limited. But guidance on safe practice and infection control is equally relevant to all clinicians, irrespective of the sphere or nature of their practice.
In addition, discarded contaminated reamers and files would need to be safely stored as sharps, and treated as hazardous waste in compliance with the Hazardous Waste Regulations 2005.
Members are advised to review their infection control procedures in the light of the above guidance, and to contact our team of dento-legal advisers for any further information.
Issued 20 April 2007
Following many enquires on this subject from members we have collected the most commonly asked questions and published them here together with Dental Protection's advice. Click here to see the document.