On January 1st, 2019, all individuals licensed to practice dentistry in California will be required to follow the new standards for infection control (AB-1277) and unethical conduct (SB-1491).
According to the text in AB-1277, “This bill would require the board to amend 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.” Read the full bill here.
AS OF SEPTEMBER, 2018…
…a new bill has been introduced that alleviates the immediate need for the dental board to amend the minimum standards for infection control by the end of the calendar year 2018. SB-1491, “requires the Dental Board of California to amend, consistent with the federal Centers for Disease Control and Prevention recommendations for water quality, the 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.” Read the full bill here.
Essentially, the requirements of AB-1277 have been satisfied by or deferred to SB-1491, allowing the Dental Board of California (DBC) to amend the minimum standards for infection control under the formal rule making process rather than under emergency conditions.
THE PURPOSE BEHIND THIS BILL
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. Find out more on the Children’s Dental outbreak
WHAT INFECTION CONTROL PRACTICES ARE CHANGING?
As of right now, relevant changes for licensed dental professionals will be following the verbiage in SB 1491.
Effective January 1st, 2019 it will be considered unprofessional conduct under SB 1491, section 1680, if you are “Using water, or other methods used for irrigation, that are not sterile or that do not contain recognized disinfecting or antibacterial properties when performing dental procedures on exposed dental pulp.”
LOOKING TO THE FUTURE
Amending the minimum standards for infection control is ongoing with the start of the formal rulemaking process to begin sometime in early 2019. A list of proposed amendments can be found on pg. 407-408 of the CDB May meeting packet.
The following amendments to the minimum standards for infection control have been proposed to the dental board:
Water or other methods used for irrigation shall be sterile or contain recognized disinfecting or antibacterial properties when performing procedures that expose dental pulp.
Dental unit water lines shall be anti-retractive. At the beginning of each workday, dental unit lines and devices shall be purged with air or flushed with water for at least two (2) minutes prior to attaching handpieces, scalers, air water syringe tips, or other devices. The dental unit lines and devices shall be flushed between each patient for a minimum of twenty (20) seconds.
Dental unit water lines shall be monitored following the instructions for use from the manufacturer of the dental unit or the dental unit waterline treatment product.
THE NEW STANDARD OF CARE
Clearly, dental water is now in the spotlight, and there are no signs the lettered regulatory agencies have intentions of loosening requirements for water quality used in any procedural capacity. Currently, there is no specific verbiage in either of these bills referencing coolants used in restorative procedures. This is in no way suggesting that the DBC will not adopt a more comprehensive approach to waterline treatment down the road.
In a recent press release, California Dental Association (CDA) Regulatory Compliance Analyst Teresa Pichay asserted 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.” Pichay continued by saying “it is a dentist’s responsibility to prevent the introduction of pathogens into the pulpal tissue…” Statements like this reinforce the notion that waterline treatment is now incorporated into the standard of care for restorative procedures. Avoiding treatment may no longer be an option.
HOW STERISIL CAN HELP
If you’re not doing anything to mitigate microbial contamination in your waterlines, you may be courting disaster. As a practitioner, accounting for the unexpected is part of your responsibility. Adhering to CDC standards for water quality only when pulp is exposed is a gamble and may leave you and your practice at risk. Why worry about accidentally infecting a patient? Continuous treatment with Sterisil’s patented residual silver ions is clinically proven to maintain your waterlines to ≤10 CFU/ml. That’s 50 times lower than the CDC’s recommendation of 500 CFU/ml. What are you waiting for? Request your complimentary Citrisil™ trial today and stop worrying about waterline compliance now!