Why take the risk?

For decades, the biggest change to air water syringes was adding a single-use air water syringe tip. Current cleaning methods for the air water syringe is covering your dental syringes in plastic and a quck wipe down with high-level disinfectants. Unfortunately, air water syringes are never heat-sterilized. Why? The design is outdated. The air water syringe system is the most used item in the dental practice. Should a patient feel comfortable with a device that is used on every patient and has never been heat-sterilized? Would you?

Public trust in dental health

What if patients were informed of the dangers presented by this high-use, semi-critical dental device? Most air/water syringe systems do not comply with CDC, ADA, FDA, or OSAP recommended device sterilization standards in today's dental office. There are many globally documented cases of dental cross-infection involving dental offices. These occurrences had enormous impact on patient lives, dental practices, and the communities where they occurred.

Dental Infection Control Updates

First case of patient-to-patient transmission

Dr. Scott Harrington's office in Oklahoma is the source of the first case of patient-to-patient transmission of hepatitis C in a clinical setting. Due to the lack of proper infection control protocols, over 7,000 patients were informed to seek medical blood testing to test for HIV, hepatitis B and C. Of the patients tested, 89 tested positive for hepatitis C, 5 for hepatitis B, and 4 for HIV.
September 2013
Patients at risk of infection

Five former patients of HIV-scare dentist Desmond D'Mello test positive for hepatitis C. More than 22,000 patients were called in for testing after dentist was found to be violating multiple infection control protocols. Investigations began after a young woman died weeks after being treated by Dr. Desmond D'Mello.

Mr D’Mello is being investigated by the Care Quality Commission and the General Dental Council and is no longer practicing. The father-of-four was secretly filmed by a whistleblower failing to change his medical gloves between patients or properly sterilise equipment.
September 2015
Dental infection outbreak at Anaheim clinic

Pediatric dental infections contracted at an Anaheim clinic increased to 22 on Tuesday, as Children's Dental Group said most of the 500 children who underwent root canals there have been examined for signs of illness. Among the 22 patients, ages 3 to 9, six remain hospitalized.
September 2016
CDC UPDATE 2018

CDC guidelines for infection prevention and control state that, between patients, dental health care personnel (DHCP) should clean and heat-sterilize handpieces and other intra-oral instruments that can be removed from the air and waterlines of dental units.

If a dental handpiece cannot be heat sterilized and does not have FDA clearance with validated instructions for reprocessing, do not use that device.
September 2018
Unsanitary sterilization practices

The Galveston County Health Department revealed an audit of CHWC's dental offices found unsanitary sterilization practices for the past three years and might have led about 9,500 former patients to have contracted hepatitis B, hepatitis C, and/or HIV.
September 2018
Two high-profile safety breaches

Two high-profile safety breaches have highlighted the importance of close adherence to infection control protocols in dental clinics and offices. In both recent cases, patients have been advised to undergo testing for HIV and hepatitis B and C due to possible exposure to bloodborne pathogens.

In Seattle, and nearby Vashon Island, news broke in early April that nearly 1,300 students face infection risks because equuipment used in school clinics was improperly sterilized. Ten school-based dental clinics operated by Neighborcare, a local health center, have been impacted by the safety breach.
September 2019
COVID-19

COVID-19, an airborne virus, creates a world-wide pandemic and effectively shuts down the world for months. Dental offices are closed to prevent the spread of the disease.
September 2020
Present Day

What has your office done to prepare for the next infection control disaster? Are we using best practice recommended by leading authorities or governing bodies? Are we being proactive or reactive?

Infection control breaches will happen. How we prepare and mitigate risk, liabilities and improve patient safety is only a decision that can be made by you. DCHP, do you believe that an item used on every patient, for every procedure and is never sterilized is not a story waiting to happen?
2023

Department of Health
and Human Services FDA

FDA Dear Doctor Letter

Dear Doctor:
This is to notify you that the Food and Drug Administration (FDA) recommends that reusable dental handpieces and related instruments (such as air/water syringes and ultrasonic scalers) be heat sterilized between each patient use. Handpieces that cannot be heat sterilized should be retrofitted to attain heat tolerance.

September 28,1992

Center of Disease Control
CDC Recommendations

2008 CDC
Dental Instruments

Scientific articles and increased publicity about the potential for transmitting infectious agents in dentistry have focused attention on dental instruments as possible agents for pathogen transmission^{207, 208}. The American Dental Association recommends that surgical and other instruments that normally penetrate soft tissue or bone (e.g., extraction forceps, scalpel blades, bone chisels, periodontal scalers, and surgical burs) be classified as critical devices that should be sterilized after each use or discarded. Instruments not intended to penetrate oral soft tissues or bone (e.g., amalgam condensers, and air/water syringes) but that could contact oral tissues are classified as semicritical, but sterilization after each use is recommended if the instruments are heat-tolerant
… Heat-tolerant alternatives are available for most clinical dental applications and are preferred⁴³.

Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, page 21

8. Management of Equipment and Surfaces in Dentistry

a. In addition, after each use, sterilize dental instruments that are not intended to penetrate oral soft tissue or bone (e.g., amalgam condensers, air-water syringes) but that might contact oral tissues and are heat-tolerant, although classified as semicritical. Clean and, at a minimum, high-level disinfect heat-sensitive semicritical items. Category IA. ^{43, 209-211}

Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, page 91

Summary of Infection
Prevention Practices in
Dental Settings

BASIC EXPECTATIONS FOR SAFE CARE
Because the majority of semicritical items in dentistry are heat-tolerant, they should be sterilized using heat.
If a semicritical item is heat-sensitive, the DHCP should replace it with a heat-tolerant or disposable alternative

CDC SAFE CARE MODULES -MODULE 7 SLIDE 5

Special Considerations
Dental Handpieces and Other Devices Attached to Air and Waterlines

Heat methods can sterilize dental handpieces and other intraoral devices attached to air or waterlines ^{(246,275,356, 357,360)}. For processing any dental device that can be removed from the dental unit air or waterlines, neither surface disinfection nor immersion in chemical germicides is an acceptable method.

2003 MMWR, Guidelines for Infection Control in Dental Health-Care Settings — 2003 , page 30

Recommendations

CDC Guidelines, FDA, OSAP and ADA recommedations provided to help ensure the dental office is safe for its dental health care providers and patients. Our goal is to help reduce the chances of cross-contamination in the dental office.

USA
Recommendations

FDA

This is to notify you that the Food and Drug Administration (FDA) recommends that reusable dental handpieces and related instruments (such as air/water syringes and ultrasonic scalers) be heat sterilized between each patient use. Since 1989 CDC has recommended that those dental handpieces that cannot b e autoclaved only be used until the practitioner can replace them with a handpiece that can be autoclaved.
See Full Recommendation
CDC

Instruments not intended to penetrate oral soft tissues or bone (e.g., amalgam condensers, and air/water syringes) but that could contact oral tissues are classified as semicritical, but sterilization after each use is recommended.
See Full Recommendation
CDC

“Because the majority of semi critical items in dentistry are heat tolerant, they should be sterilized using heat. If a semi critical item is heat-sensitive, the DHCP should replace it with a heat-tolerant or disposable alternative. Therefore, handpieces and other intraoral instruments should be removed from the air and water lines of dental units, cleaned, and heat-sterilized between patients..."
See Full Recommendation
CDC

In addition, after each use, sterilize dental instruments that are not intended to penetrate oral soft tissue or bone (e.g., amalgam condensers, air-water syringes) but that might contact oral tissues and are heat-tolerant, although classified as semicritical.
See Full Recommendation
ADA

The ADA urges all practicing dentists, dental auxiliaries and dental laboratories to employ appropriate infection control procedures as described in the 2003 CDC Guidelines, and the 2016 CDC Summary and to keep up to date as scientific information leads to improvements in infection control...
See Full Recommendation
OSAP

All dental settings, regardless of the level of care provided, must make infection prevention a priority and should be equipped to observe Standard Precautions and other infection prevention recommendations contained in the CDC Guidelines for Infection Control in Dental Health-Care Settings - 2003..
See Full Recommendation
Joint Commission

Health care organizations and providers that use dental handpieces should be aware that studies have demonstrated how internal components of air-driven low- and high-speed dental handpieces may become contaminated with patient material during use, and that retained patient material may then be expelled intraorally during subsequent uses.
See Full Recommendation

Canada
Recommendations

College of Dental Surgeons of Alberta (CDSA)

Semi-Critical device is a medical device that comes into contact with mucous membranes or non-intact skin but does not penetrate them. Semi-Critical dental or medical devices that are compatible with heat and moisture shall be steam sterilized between each patient use.
See Full Recommendation
British Columbia College of Oral Health Professionals

Dental hand pieces and other intraoral devices that are attached to air or water lines should be sterilized after each patient use.
See Full Recommendation
New Brunswick Dental Society

The majority of semi-critical items used in dentistry are heat-tolerant and should always be heat-sterilized between uses. Dental handpieces and other intraoral devices that are atttached to air or waterlines must be sterilized after each patient use.
See Full Recommendation
Royal College of Dental Surgeons of Ontario

All critical and semi-critical instruments used in dentistry, including handpieces, are available in heat-tolerant and/or single-use (disposable) forms. All heat-tolerant resuable critical and semi-critical instruments must be heat-sterilized between uses.
See Full Recommendation
Provincial Dental Board of Nova Scotia

Semi-critical patient care items must be sterilized or considered as single-use items. The use of high-level disinfectants is not an appropriate sterilization method.
See Full Recommendation
Royal College of Dental Surgeons of Ontario

Several dental devices that contact mucous membranes are attached to the air or waterlines of the dental unit. These devices have the potential of retracting oral fluids into their internal compartments, which can then be expelled into the oral cavity of another patient during subsequent use.
See Full Recommendation

United Kingdom
Recommendations

Department of Health

Where instruments are difficult to clean, consideration should be given to replacing them with single-use instruments where possible. In dentistry this will include, but not limited to, instruments such as matrix bands, saliva ejectors, aspiration tips, and three-in-one tips...
See Full Recommendation
British Dental Association:

Equipment that cannot be safely decontaminated for re-use must be considered "single-use". Where instruments are difficult to clean, single-use alternatives (if available) should be considered - matrix bands, saliva ejectors, aspirator tips, three-in-one tips, for example.
See Full Recommendation

Australia
Recommendations

Australian Dental Association:

Semi-Critical items, where there is contact with intact non-sterile mucosa or non-intact skin. Instruments must be sterilized between patients where possible. When not possible, use thermal disinfection or instrument-level disinfection. Instruments should be 'single-use disposable' or sterilised after use.

See Full Recommendation

Research Studies

Learn more about the research studies pertaining to reusable versus disposable air water syringe tips and infection control studies of the air water syringe.

Air Water Syringe

Air/Water Syringe Tips

Aerosolization

Sterilization / Decontamination

Air Water Syringe - Other

Time to upgrade

The same air/water syringes that have been used for over 30 years are still being used today. The CDC, ADA, FDA and OSAP all recommend that this semi critical device should be removed between patients to be heat-sterilized. The problem is, once installed, current air/water syringes are never removed to be heat-sterilized. This makes the air/water syringe non-compliant with leading health authorities.

1988