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News Bulletin : ADA News Bulletin April 2011
36 APRIL 2011 EndOdOnTIC InSTRUMEnTS – SInGLE USE? Sir, There still remains controversy as to whether endodontic instruments can be safely used on multiple patients. The suggestion that they be single use only came about when there was a concern about CJD [Creutzfeldt-Jakob Disease] because it was thought the pulp may contain prions, the infective particle of CJD that resisted sterilisation. A concession at the time was that files could be used on the same patient at a subsequent appointment, once they had been sterilised. We now know that prions do not occur in the pulp, or any other dental or oral tissue, and that patients suspected of having CJD require only standard precautions – those precautions we apply to all our patients (including those with HIV, HBV and HCV). The justification for insisting that endodontic instruments be single use can no longer be based on the risk of CJD transmission. Some have suggested that endodontic files cannot be cleaned adequately, therefore cannot be successfully sterilised, and therefore should be single use only. However, a number of studies have clearly demonstrated that both stainless steel and NiTi files can be cleaned, and therefore successfully sterilised. Two are supplied,* the first outlining a proven protocol for cleaning files. Cleaning is designed to reduce biological debris and microorganisms to such a low level as to allow successful sterilisation. Cleaning does not have to be perfect, for if it was then instruments would already be sterile and there would be no need to autoclave them. Cleaning is made more difficult if the bioburden dries out. It is suggested that, immediately after use, visually contaminated endodontic files be rotated backwards on the outside of a wet cotton roll, and that all files be pre-soaked prior to cleaning. In the case of stainless steel files, discard the smaller sizes (#08, #10, #15) as they more difficult to clean, and are more likely to be bent and worn. They should be single use only. In the case of NiTi files, they should be discarded (say) after use in three canals or after use in a single, severely curved canal – not for infection control reasons but to avoid the fracture of the instrument subsequently. Insisting on endodontic files being single use only, except as outlined above, is not based on science. Some may choose to do this but it is not mandatory. Being critical instruments, endodontic files should be cleaned and sterilised when new and unused, and then after each subsequent use. They should be bagged and only opened immediately prior to use. Michael Payne West Pymble 2073 Letters to the Letters are published at the Editor’s discretion and customary editorial rights are reserved. We request that letters be brief, of interest to the general membership and signed. 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ADA News Bulletin March 2011
ADA News Bulletin May 2011