Department of Health and Social Care
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Precautionary advice given to dentists on re-use of instruments
As a precautionary measure the Chief Dental Officer, Dr Barry Cockcroft today issued new guidance to all dentists in England regarding single use of reamers and files, instruments used only in the root filling of teeth.
The guidance to dentists follows on from precautionary advice from the Spongiform Encephalopathy Advisory Committee to the Department of Health and early results from ongoing research conducted by the Health Protection Agency, indicating a potential risk of vCJD associated with endodontic procedures.
Dr Barry Cockcroft said:
"There are no reported definite or suspected cases of vCJD transmission arising from dental procedures - this new guidance to dentists is purely an extra precaution. The public should continue to attend their dentist as normal."
Notes to Editors:
1. The guidance applies to all primary and secondary care dentists in England.
2. Endodontics relate to treatment to the dental pulp of a tooth. A major part of this is root canal work. No other aspect of dental work is affected by this precautionary advice.
3. There are approximately 1 million NHS endodontic treatments every year in England and Wales. Since 1996 there have been 165 cases of vCJD. There is no current evidence of vCJD being transmitted by any form of dentistry.
4. Variant Creutzfeldt-Jakob Disease (vCJD) is one of the Transmissible Spongiform Encephalopathies, the group of prion diseases that include Bovine Spongiform Encephalopathy (BSE), Creutzfeldt-Jakob Disease (CJD), and scrapie.
5. This letter reflects precautionary advice from the Spongiform Encephalopathy Advisory Committee (SEAC) and early results on the potential infectivity of dental tissues from research in progress by the Health Protection Agency. This research supports the view that dental instruments (files and reamers) used in root canal treatment could possibly pose an effective route of vCJD transmission.
6. Almost everyone is at some risk of being infected with vCJD due to dietary exposure to BSE. Any additional risk from a root canal treatment could only arise if the instruments had been previously used on an infective patient. The proportion of people carrying infection is highly uncertain. Published information suggests that this may be between 1 in 1,400 and 1 in 20,000 people, though it may well be less for some age groups. It is also not clear how many of those carrying the infection are likely to develop symptoms of vCJD: given the much smaller number of cases actually seen so far, the majority may never do so (Clarke and Ghani, 2005). Even if instruments had been used on someone carrying the infection, it is not clear how great the risk of vCJD being passed on would be. Nevertheless, a precautionary approach is justified in view of the number of endodontic procedures carried out.