I am clearly distressed that Dr. Merchant was unhappy with my article. The World Health Organization guidelines were published in 1999.1 These guidelines did suggest that instruments used on patients with confirmed or suspected transmissible spongiform encephalopathy should be considered to be of low infectivity. A variety of options for decontamination of heat-resistant instruments, including autoclaving at 134 C for 18 minutes, were suggested. But the guidelines noted that there did remain the possibility of material not being destroyed.
Indeed, the WHO guidelines also stated, "the safest and most unambiguous method of ensuring that there is no risk of residual infectivity on contaminated instruments is to discard and destroy them by incineration."
The guidelines2 from the Centers for Disease Control and Prevention, which I could not have quoted as they were published after my JADA article was accepted, are reassuring and would seem to be in accord with that of the risk analysis3 that JADA kindly added as an update close to the intended date of publication.
As the CDC indicates, relevant issues concerning the control of transmission of prion disease in the dental health care setting are "unresolved." This would seem to contrast with Dr. Merchant’s belief that dental instruments will not cause transmission of prions.
I provided what I hoped was an accurate review of the issues surrounding this difficult subject, and as a consequence of publication limitations, was unable to include some areas of concern that remain unresolved.
Infection control in the health care setting will always remain of concern and perhaps be controversial, particularly as infections emerge and re-emerge.
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