Dr. Stephen R. Porter’s November JADA article, "Prion Disease: Possible Implications for Oral Health Care," includes a statement that can be misleading to readers. The statement is, "All dental instruments used in patients with or suspected of having prion disease must be [sic] not be re-used but should be appropriately discarded immediately after clinical use."
This statement inaccurately reflects the World Health Organization, or WHO, infection control guidelines1 that were cited as a reference. It is also in conflict with the recently released Centers for Disease Control and Prevention, or CDC, guidelines for infection control in dentistry.2
The suggestion that stainless steel clinical instruments cannot be adequately sterilized is not true, although the conditions required for sterilization are much more stringent than those routinely used in dental practice. As recommended in the new CDC guidelines for infection control in dentistry, items that are difficult to clean (endodontic files, burs and so forth) should be discarded after one use when treating a patient known to have a transmissible spongiform encephalopathy.
Other heat-sterilizable dental instruments can be cleaned and sterilized, as long as one of the sterilization methods for prion-contaminated items recommended by WHO is used. The CDC guidelines recommend the least stringent of the WHO’s recommendations (clean instruments thoroughly and steam autoclave at 134 C for 18 minutes), since the risk of transmission in dental procedures is low to nil.
I am disappointed that the article was not reviewed by a knowledgeable individual, who should have pointed out this discrepancy in infection control recommendations.
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