For many years, infection control studies have shown that reusable dental handpieces can be a source of cross-contamination if proper sterilization protocols are not observed. Components of dental handpieces can become contaminated with patient material during use, which can spread into the air or mouths of other patients during consecutive use.
As a result, infection prevention and control guidelines by the Centers for Disease Control and Prevention (CDC) state that dental health-care providers (DHCPs) must adhere to CDC cleaning and heat sterilization requirements for dental handpieces and other intraoral devices in between use on patients.1
Portable dental handpieces
In addition to dental handpieces that are attached to our dental units and driven by air, there is now a cordless, portable slow-speed handpiece. The US Food and Drug Administration (FDA) regulates dental handpieces, including devices that are independent of air- and waterlines. This applies to cordless, portable dental handpieces that hygienists can use outside the dental setting, such as during visits to schools or nursing homes. While they are convenient, use of portable handpieces has raised the question of how we should properly maintain and sanitize this type of equipment. To reprocess (clean, lubricate, and/or sterilize) these devices, the CDC recommends adhering to current FDA regulations, using FDA-cleared devices, and following verified manufacturer’s instructions for use (IFU).
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In 2015, the FDA issued updated advice for reprocessing medical devices, providing recommendations to manufacturers of reusable medical devices on how to write and scientifically evaluate reprocessing instructions. Manufacturers are responsible for offering detailed information on how to prepare equipment for use on subsequent patients.
This means dental providers should take note when using reusable devices made before 2015, as they may not fulfill current FDA reprocessing guidelines on ensuring equipment is appropriately cleaned, disinfected, and sterilized. Furthermore, the CDC strongly recommends that dental professionals refrain from using handpieces that cannot be sterilized with heat, are not meant for patient use (i.e., lab-only usage), and do not have verified FDA clearance with reprocessing instructions.
No handpiece should be used on more than one patient without being properly reprocessed according to the manufacturer’s IFU. This could mean that the entire device is barrier wrapped and then wiped down with EPA-registered disinfectants. Or the handpiece may have an outer metal sleeve that must be removed between patients and properly sterilized. Each device will be different and the IFU should be a consideration when deciding which portable device is right for the practice.
Should the validity of the manufacturer’s reprocessing instructions be challenged, or if there is cause to believe that the instructions do not align with basic infection prevention and control principles, DHCPs can request FDA-approved documentation clearance for the device in question from the manufacturer. If the information provided still does not satisfy, dentists can contact the FDA’s Office of Compliance for further guidance.
Critical and semicritical items
As a reminder, reusable medical devices—such as surgical forceps, scalpels, endoscopes, and scalers—are tools that DHCPs can reprocess and reuse on patients. All reusable medical devices fall into one of three groups based on the risk of infection associated with their use.2 It is important to know which category the portable device or its parts falls into so DHCPs can ensure they are properly reprocessing the devices according to CDC guidelines:
Critical instruments: These are classified as such because their use penetrates soft tissue or bone and comes into contact with blood. These instruments include forceps, scalpels, scalers, and bone chisels, which require thorough cleaning and heat sterilization after each use.
Semicritical instruments: Tools such as mirrors and amalgam condensers should also undergo sterilization between patients, as they come into contact with mucous membrane and oral tissues.
Noncritical instruments: Items such as x-ray heads have a relatively low risk of infection transmission as they only come into contact with intact skin. Even so, proper disinfection protocols must be strictly followed.
Things to keep in mind when purchasing a new handpiece
Although the life expectancy of a corded dental handpiece reduces with each sterilization cycle, studies have shown that with adequate care and maintenance, you can expect approximately 500 sterilization cycles without a substantial loss in performance.3 This equates to about a year of use per handpiece. The next time you purchase a new portable handpiece, consider its maintenance and reprocessing requirements. Verify if the equipment is autoclavable, if it has nooks or pockets that can trap debris or bacteria, and if it is designed with the right material to withstand multiple sterilizations or disinfection over a long period of time. This can help you to develop a more streamlined sterilization process.
Instrument sterilization is an effective, low-cost, evidence-based approach to improving patient safety in dental clinics. Nevertheless, compliance among DHCPs continues to remain a serious barrier. We must read and adhere to the instructions on all medical equipment that we use, including how to properly sterilize and reprocess reusable tools to inhibit the spread of contaminants. If you are considering purchasing a portable dental handpiece, you must also consider other factors such as its maintenance and sterilization requirements. We all want tools that will make our jobs easier and keep our patients safe by adhering to infection control and prevention protocols. Choose wisely!
Editor's note: This article originally appeared in the March 2022 print edition of RDH. Hygienists in North America are eligible for a complimentary print subscription. Sign up here.
References
- CDC Statement on Reprocessing Dental Handpieces. Centers for Disease Control and Prevention. April 11, 2018. Accessed January 6, 2022. https://www.cdc.gov/oralhealth/infectioncontrol/statement-on-reprocessing-dental-handpieces.htm
- Sterilization or disinfection of dental instruments. J Am Dent Assoc. 2001;132(6):785. doi:https://doi.org/10.1016/S0002-8177(14)61746-3
- Leonard DL, Charlton DG. Performance of high-speed dental handpieces subjected to simulated clinical use and sterilization. Comparative study. J Am Dent Assoc. 1999;130(9):1301-1311. doi:https://pubmed.ncbi.nlm.nih.gov/10492537/
