The Dental Board of California has amended its regulations on the minimum standards for infection control to require water or other methods used for irrigation to be sterile or contain recognized disinfecting or antibacterial properties when performing dental procedures that expose dental pulp. (See full text of AB-1277.)
We have long stated that surgical procedures that expose dental pulp should be conducted only with sterile water delivered by sterile means. Therefore, dental delivery systems plumbed to a VistaClear system should NOT be used for surgical procedures. This is in accordance with the 2003 CDC guidelines that state:
Delivery of Sterile Surgical Irrigation
Sterile solutions (e.g., sterile saline or sterile water) should be used as a coolant/irrigation in the performance of oral surgical procedures where a greater opportunity exists for entry of microorganisms, exogenous and endogenous, into the vascular system and other normally sterile areas that support the oral cavity (e.g., bone or subcutaneous tissue) and increased potential exists for localized or systemic infection (see Oral Surgical Procedures). Conventional dental units cannot reliably deliver sterile water even when equipped with independent water reservoirs because the water-bearing pathway cannot be reliably sterilized. Delivery devices (e.g., bulb syringe or sterile, single-use disposable products) should be used to deliver sterile water (2,121). Oral surgery and implant handpieces, as well as ultrasonic scalers, are commercially available that bypass the dental unit to deliver sterile water or other solutions by using single-use disposable or sterilizable tubing (316).
We do not make a specific, numeric claim about bacteria reduction in the output water from dental delivery systems, in part because these results are so dependent on the age, configuration and maintenance history of the delivery units. Even sterile water introduced to a delivery system becomes contaminated quickly.
For the practice that does not want to fill dental bottles and prefers to connect delivery systems directly to a municipal source for water used for cooling and irrigation during routine dental procedures, the three primary benefits of the VistaClear system are:
- Submicron filtration of municipal source water (to protect dental equipment)
- CSA-certified backflow prevention (to protect the public water supply and eliminate the need for costly RPZ devices and annual inspections of separate backflow preventers)
- Centralized method for delivering periodic antimicrobial “shock” treatments (a critical part of dental unit waterline maintenance protocols).