von Hans – Willi Herrmann

Nachfolgend 2 Statements zur Frage der Einmalverwendung von Wurzelkanalinstrumenten, zum einen (via ROOTS durch Rob Kaufmann) eine aktuelle Stellungnahme der CAE zusammen mit der AAE. Es gibt auf der CAE – Homepage ein PDF – Dokument zum Herunterladen mit dem offiziellen Paper, allerdings passwortgeschützt. Die CAE schreibt::

„A concern had arisen in Alberta regarding the ability to sterilize and reuse packaged instruments marked as single use only.  Recognizing the importance of preventing cross contamination and transmission of disease, the AAE and CAE struck a joint committee to investigate the scientific basis for the endodontic instrument packages labeled single use only.

The final report endorsed by the executive committees of both the CAE and the AAE is an official position paper of both national organizations.  The findings of the report are that the most consistent and effective infection control protocol appears to be one that includes hand and ultrasonic cleaning of instruments immediately after use, followed by processing in an autoclave that is constantly monitored to assure sterility.  These methods appear to be effective in eliminating disease transmission caused by most microorganisms found within the root canal system but have been shown to be less effective in eliminating prion protein.  However, based upon best current scientific evidence and the very low risk of prion transmission to patients during endodontic treatment in the USA and Canada, the Special Committee on SUI feels that it is not currently warranted for clinicians to change the way in which they select endodontic files and reamers for re-use and sterilization.  The Special Committee does recommend that practitioners prepare and sterilize instruments for re-use in accordance with „best evidence“ currently available (See references).

The CAE and AAE  take this opportunity to thank the committee members, Dr. Gary Hartwell, Chair, Dr. Walter Bowles, Dr. Ove Peters, Dr. Marshall Peikoff, and Dr. Calvin Torneck, who worked on behalf of the dental profession to address this issue.

This position paper will be widely distributed in Canada to inform dentists and regulators. The CAE Standards of Practice document reflecting the standard of care will also reference the position paper. The Standards of Practice document is currently being updated, it will be distributed to our membership in 2012.“

Die zweite Stellungsnahme (des UK DHSSPS) ist vom April 2007. Sie lautet wie folgt:

„To

All General Dental Practitioners Clinical Directors of Community Dental Service Dental Directors and Consultants in Dental Public

Health HSSBs Head of School and Clinical Director, School of Dentistry Chief Executives of HSSBs Chief Executives of Trusts

Dear Colleague

T el: Fax: Email:

Your Ref: Our Ref:th

IMPORTANT: ADVICE FOR DENTISTS ON RE-USE OF ENDODONTIC INSTRUMENTS AND VARIANT CREUTZFELDT-JAKOB DISEASE (vCJD)

This letter is being issued to advise all dentists that endodontic files and reamers must be treated as single use instruments. This advice follows on from preliminary findings from research in progress by the Health Protection Agency in England. Similar advice in relation to single use of endodontic files and reamers has been issued in England, Scotland and Wales.

Background

Previous risk assessments for the transfer of vCJD infectivity via dental surgery have concluded that the risk is low. In 2006, the Spongiform Encephalopathy Advisory Committee (SEAC) issued a position statement on vCJD and endodontic dentistry based on a revised risk assessment produced by the Department of Health. The SEAC statement noted that there were uncertainties around the data and assumptions underpinning the assessment but that research underway should address some of these uncertainties. They recommended that “Once the research is complete and/or other data became available, the risks should be reassessed. A watching brief should be maintained”.

The SEAC statement concluded, “It is unclear whether or not vCJD infectivity can be transmitted via endodontic files and reamers. However, given the plausibility of such a scenario and the large number of procedures carried out annually, it would be prudent to consider restricting these instruments to single use as a precautionary measure. Since sufficiently rigorous decontamination of these instruments is difficult, single use of these instruments would eliminate this risk, should it exist”.

Date:

18April 2007

The Department of Health has now received preliminary findings from research in progress by the Health Protection Agency. Early results from studies in mice suggest that TSE (Transmissible Spongiform Encephalopathies, the group of diseases that include BSE, vCJD and scrapie) infectivity can be found in dental tissues. The research is ongoing and further advice is being sought form SEAC. However, the results support the possibility that files and reamers could pose an effective route of transmission of infection, and therefore support the restriction of these instruments to single use on a precautionary basis in order to reduce any risk of vCJD transmission.

This risk needs to be seen in context. Since 1996 there have been 165 cases of vCJD in the UK .There are approximately 1 million NHS endodontic treatments undertaken every year in England and Wales, 125,000 in Scotland and 50,000 in Northern Ireland. There is however no current evidence of vCJD being transmitted by any form of dentistry.

Advice

All dentists must ensure that endodontic files and reamers are treated as single use instruments. In view of the microbiological evidence which shows that endodontic reamers and files cannot be reliably decontaminated it is advised that these instruments be treated as single use and disposed of appropriately after each patient. This should be done whether or not the instruments are labelled as single- use.

The DHSSPS will review the resource implications for the general dental services.

Further advice on local decontamination procedures will be issued soon from the DHSSPS.

Yours sincerely

Donncha O’Carolan

Dr Michael McBride“