Sir, the recent 'edict' from the Chief Dental Officer regarding single use for endodontic reamers and files is a poorly thought out 'knee jerk' reaction that smacks of politics rather than the application of evidence-based dentistry and is ridiculous to say the least. The facts are as follows:

  • The unpublished evidence for the presence of prions in dental tissues was carried out in mice using very high levels of the protein. However, to date, the prion has never been found in human dental pulp in patients with CJD1

  • The UK Department of Health (DoH) in 2003 concluded that there was little evidence for prion transmission within the dental clinic, mirroring our knowledge of Hep C and HIV and that the risk of transmission of vCJD in a single dental procedure from an infected patient would be one billion times less than for a tonsillectomy (also remote) and ten times less if infected dental pulp was involved2

  • In December 2001 the DoH withdrew its advice to surgeons regarding single use of tonsillectomy instruments due to the increased incidence of post operative complications. Evidently, complications were a more important consideration than the possibility of vCJD transmission

  • Even by loose association there is no real evidence of human to human transmission of CJD or vCJD following casual or intimate contact or blood transfusion, nor is there evidence of iatrogenic transmission of vCJD in a health care setting.3

Does the CDO know that the practice of endodontics involves more than files and reamers and that many more instruments are in contact with dental pulp during a single procedure? How about handpieces for access cavity preparation and rotary NiTi? Don't access cavity burs get contaminated? What about Gates Glidden drills, endodontic explorers, excavators and rubber dam clamps? When I look at these instruments after a procedure on a vital pulp they are covered in blood products. As everything we use in endodontics comes into contact with blood and pulpal tissue shouldn't everything be discarded after single use?

The cost of root canal instruments both hand and NiTi must be taken into consideration. Does the CDO really think that dentists in NHS practice can absorb the cost of single usage and still provide some sort of quality service? Is it his plan to undermine dentistry in the UK, reduce NHS costs and thus push more dentists into the private sector, or perhaps to push endodontics into the dark ages of the 1930s and 40s when many teeth were extracted due to the theory of 'focal infection'?

How on earth can he justify such draconian advice with so little evidence related to a disease whose incidence in the UK is so low – 158 deaths in the 12 years to 2006?4

Please Mr Cockcroft, this needs a rethink!!