12/11/2018

Clarification on new infection control requirement for dental pulp procedures


Dentists have contacted CDA Practice Support with questions about the new infection-control requirement that all licensed dentists in California should be following as of Jan. 1, 2019. 

As explained in a December Update article and according to the new law, when performing procedures on exposed dental pulp, water or other methods used for irrigation must be “sterile or contain recognized disinfecting or antibacterial properties.”

“Members have asked if treated dental unit water is considered as containing recognized disinfecting or antibacterial properties,” said CDA Regulatory Compliance Analyst Teresa Pichay. “It is not.” Dental unit water is treated to control bacterial cfus/ml; it is not treated to confer antibacterial action on tissues upon which it is used.

With regard to the new requirement, Pichay said that because dental handpieces are cooled by treated dental unit water, it is understood and accepted that treated dental water will be used during handpiece operation. However, a dentist must anticipate both expected and unexpected pulp exposure and should have sterile water or other solution with disinfecting or antibacterial properties immediately available to irrigate the area upon pulpal exposure.

“It is a dentist’s responsibility to prevent the introduction of pathogens into the pulpal tissue,” Pichay said. Appropriate oral irrigants include chlorhexidine, BioPure MTAD and sodium hypochlorite.

The new infection-control requirement stemmed from a 2016 outbreak of mycobacterial infection in a Southern California dental clinic that led to the hospitalization of more than 60 children. Investigation into what occurred suggested that the bacterium that infected the children was likely introduced by water used during the performance of pulpotomies.

CDA worked with the state Legislature to ensure the new requirement appropriately addressed the vulnerability that occurs during treatment of exposed dental pulp and stated it is pleased that the requirement “sets a clear standard for infection control during dental pulp procedures.”

The new requirement is in addition to existing dental board regulations on water quality, which require that dental water lines be purged with air or flushed with water at the beginning of each workday and flushed between each patient.

Because waterline maintenance is also essential to water quality, the Centers for Disease Control and Prevention recommends that dentists consult with the dental unit manufacturer for appropriate methods and equipment to maintain the quality of dental water. Additionally, the Food and Drug Administration in July published a dedicated webpage on infection control in dental unit waterlines.

CDA Practice Support has infection-control resources at cda.org/resource-library.



Related Items

When performing procedures on exposed dental pulp, water or other methods used for irrigation must be “sterile or contain recognized disinfecting or antibacterial properties,” according to a new requirement that all licensed dentists in California must follow beginning Jan. 1, 2019. CDA worked with the state Legislature to ensure the new requirement appropriately addressed the vulnerability that occurs during treatment of exposed dental pulp.

A webpage published recently by the Food and Drug Administration provides guidance on infection control in dental unit waterlines. Although they typically cannot be sterilized, dental unit waterlines “should be routinely cleaned and disinfected” to prevent risk of infection to patients, “particularly during surgical procedures by direct exposure of waterborne pathogens.” The webpage provides more than a dozen “do’s and don’ts” for dental practitioners.

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