Professional Documents
Culture Documents
Single Use Endo Files
Single Use Endo Files
Journal of
Infection
Original Article
Prevention
Abstract
Background: The concept of single-use of endodontic files remains controversial in the published literature. The extent
and attitudes concerning the single-use of endodontic hand files is currently unknown in many countries.
Aim: The prevalence and perceptions regarding the single-use of endodontic files was investigated in this descriptive
observational study.
Methods: A questionnaire regarding the perceptions and usage protocols of endodontic files was developed. Twenty-
seven South African dental practices were included in this study. Participation was voluntary.
Results: None of the respondents reported single-use of endodontic hand files. Several decontamination methods were
used by the respondents for reprocessing endodontic files.
Discussion: Financial constraints were reported as the primary reason for the reuse of endodontic files. As no stan-
dardised method of reprocessing these instruments exists for South Africa, written guidelines on this subject should be
developed.
Keywords
Single-use, endodontic files, decontamination, reuse, infection control guidelines
•• Difficulty in adequately cleaning endodontic files Department of Odontology, School of Dentistry, University of Pretoria,
(Walker et al., 2007); Pretoria, South Africa
•• The risk of transmission of infectious diseases
Corresponding author:
(Laheij et al., 2001); Glynn Dale Buchanan, Oral and Dental Hospital, 4th level, 31 Bophelo
•• The potential transmission of prion disease (Kirby Road, Prinshof Campus, Riviera, Pretoria, 0002, South Africa.
et al., 2012; Walker et al., 2007); Email: glynn.buchanan@up.ac.za
Buchanan and Warren 33
•• Laboratory trials have demonstrated the ability to •• Decontamination methods used for endodontic hand
remove 100% of stained debris from the surfaces of files;
endodontic files (Messer et al., 2003; Parashos et al., •• Quality control measures for assessing file cleanliness;
2004b); •• Reasons for multiple use;
•• The accepted reuse of the other stainless-steel dental •• Attitudes regarding the concept of single-use
instruments that contact the dental pulp, in some ter- protocols.
ritories (Messer et al., 2003);
•• The absence of prion proteins in the dental pulps of All statistical analyses were performed using the SAS soft-
individuals diagnosed with Creutzfeldt-Jakob dis- ware suite, Release 9.4 (SAS Institute Inc., NC, USA).
ease (Head et al., 2003); Simple descriptive statistical analysis was conducted. The
•• The increased cost incurred in implementing single- data obtained were expressed as simple percentages.
use protocols (Letters et al., 2005; Messer et al., The research protocol for this study was approved by
2003; Parashos et al., 2004b); both the Research Committee of the School of Dentistry,
•• Cleaning and sterilising procedures do not appear to Faculty of Health Sciences, University of Pretoria and the
be an important factor of the fracture resistance of Ethics Committee of the Faculty of Health Sciences,
nickel-titanium files (Hülsmann et al., 2005). University of Pretoria.
Table 1. Singular decontamination methods used. Table 2. Combined decontamination methods used.
Manual cleaning (brushes and detergent) 29.6 Manual and ultrasonic cleaning 29.6
Gauze/sponge soaked in alcohol 7.4 Manual, ultrasonic cleaning with washer 7.4
disinfector
Washer disinfector 14.8
Manual cleaning with washer disinfector 3.7
Total 51.8
Total 39.7
device manufacturers must provide to users for reprocess- Just over one-quarter of the participants responded that
ing instruments in order for them to be safe to use, espe- the single-use of endodontic files would increase patient
cially if instruments are labelled as single-use items. The and personnel safety. This finding indicates that a signifi-
absence of guidelines for reprocessing endodontic files in cant proportion of the respondents felt that the single-use of
South Africa leaves the decisions regarding reprocessing files was probably better clinical practice than reusing
and reuse of these instruments with the individual dentist. them.
Single-use of endodontic hand files significantly Despite the controversy surrounding the concept of sin-
increases the number of instruments that must be purchased gle-use endodontic files in the published literature, dentists
by a practice, increasing the overheads associated with the have a moral and ethical responsibility towards their
provision of endodontic treatment and decreasing the profit patients to practise infection control procedures to a high
margin of providing such services. Some of the participants standard (Scarlett and Grant, 2015). Inadequate infection
from this study attributed the trend of multiple use of endo- control practices may lead to violation of these ethical prin-
dontic hand files to the cost of the instruments. Such finan- ciples. Currently, in some territories, the decision to imple-
cial considerations may deter not only private dental ment single or multiple use of endodontic instruments rests
practitioners, but also public and academic dental hospitals with the individual practitioner.
from implementing the single-use of endodontic files as The single-use of endodontic hand files is currently not
policy (Messer et al., 2003). While previous research has in place in private dental practices surveyed in Pretoria,
suggested financial reasons as a factor for not implement- South Africa. Furthermore, files are reprocessed and reused
ing single-use policies in dental practice (Messer et al., on multiple clinical cases. There is no standard decontami-
2003), the results of this survey confirm that this is indeed nation method used to reprocess files in South Africa and
the case. No data are available on the cost of reprocessing written guidelines should be developed for reprocessing
dental instruments in South Africa; therefore, a direct com- these instruments. The primary reason for the reuse of these
parison between reprocessing these instruments versus instruments are concerns surrounding the financial implica-
single-use is not possible. Future research should aim to tions of introducing single-use protocols.
address this gap in knowledge and a cost–benefit analysis
may be conducted to provide clarity. Declaration of conflicting interests
Great variation in the methods for decontamination of The author(s) declared no potential conflicts of interest with
endodontic files was found among the respondents to this respect to the research, authorship, and/or publication of this
survey. This finding indicates a lack of a standardised pro- article.
cedure for the reprocessing of these instruments and is
likely due the lack of written guidelines on the subject in Funding
South Africa. It has previously been demonstrated that den- The author(s) received no financial support for the research,
tal instruments may not be effectively cleaned and steri- authorship, and/or publication of this article.
lised to an acceptable standard within the South African
context (De Kock and van Wyk, 2001; Mehtar et al., 2007; Peer review statement
Oosthuysen et al., 2010; Yengopal et al., 2001). Previous Not commissioned; blind peer-reviewed.
research from other territories has, however, demonstrated
the unreliability of cleaning endodontic files, regardless of ORCID iD
the reprocessing method used (Letters et al., 2005). Glynn Dale Buchanan https://orcid.org/0000-0003-2957-166X
The finding that some respondents used magnification
aids for instrument inspection before reuse is encouraging References
and demonstrates an increase in acceptance of this quality-
Aasim SA, Mellor AC and Qualtrough AJE. (2006) The effect of pre-soak-
control method. Whether this method of inspection resulted ing and time in the ultrasonic cleaner on the cleanliness of sterilized
in better detection of remaining debris on endodontic files endodontic files. International Endodontic Journal 39(2): 143–149.
after reprocessing is not clear. Further investigation into the Carrotte P. (2004) Endodontics: Part 5 Basic instruments and materials for
use of magnifying aids to detect the failure of decontamina- root canal treatment. British Dental Journal 197(8): 455–464.
De Kock K and van Wyk CW. (2001) Infection control in South African
tion should be conducted.
oral hygiene practice. Journal of the South African Dental Association
A small number of respondents stated that complete 56(12): 584–587.
decontamination of previously used endodontic files was Head MW, Ritchie D, McLoughlin V and Ironside JW. (2003) Investigation
possible. This finding is confounding, considering all the of PrPres in dental tissues in variant CJD. British Dental Journal
respondents implemented multiple-use protocols and 95(6): 339–343.
Hülsmann M, Peters OA and Dummer PM. (2005) Mechanical prepara-
reused their endodontic files. It is clear from the responses
tion of root canals: shaping goals, techniques and means. Endodontic
to this question that the attitudes of dental practitioners and Topics 10(1): 30–76.
their staff regarding infection control procedures may not Kirby E, Dickinson J, Vassey M, Dennis M, Cornwall M, McLeod N,
necessarily be aligned with their beliefs. Smith A, Marsh PD, Walker JT, Sutton JM and Raven ND. (2012)
36 Journal of Infection Prevention 20(1)
Bioassay studies support the potential for iatrogenic transmission of Oosthuysen J, Potgieter E and Blignaut E. (2010) Compliance with infec-
variant Creutzfeldt Jakob Disease through dental procedures. PLoS tion control recommendations in South African dental practices: a
One 7(11): E49850. review of studies published between 1990 and 2007. International
Laheij AMGA, Kistler JO, Belibasakis GN, Valimaa H, de Soet JJ and Dental Journal 60(3): 181–189.
European Oral Microbiology Workshop (EOMW) 2011. (2012) Parashos P, Gordon I and Messer HH. (2004a) Factors influencing defects
Healthcare-associated viral and bacterial infections in dentistry. of rotary nickel-titanium endodontic instruments after clinical use.
Journal of Oral Microbiology 4(1): 17659. Journal of Endodontics 30(10): 722–725.
Letters S, Smith AJ, McHugh S and Bagg J. (2005) A study of visual and Parashos P, Linsuwanont P and Messer HH. (2004b) A cleaning protocol
blood contamination on reprocessed endodontic files from general for rotary nickel-titanium endodontic instruments. Australian Dental
dental practice. British Dental Journal 199(8): 522–525. Journal 49(1): 20–27.
Medpages. (2017) Available at: https://www.medpages.co.za/sf/index. Scarlett MI and Grant LE. (2015) Ethical oral health care and infection
php?page=servicetown&servicecode=129&localityid=25 (accessed control. Journal of Dental Education 79(5 Suppl): S45–47.
5 December 2017). Strachan B, Zabow T and Van der Spuy ZM. (2011) More doctors and
Mehtar S, Shisana O, Mosala T and Dunbar R. (2007) Infection con- dentists are needed in South Africa. South African Medical Journal
trol practices in public dental care services: findings from one 101(8): 523–528.
South African Province. Journal of Hospital Infection 66(1): Walker JT, Dickinson J, Sutton JM, Raven ND and Marsh PD. (2007)
65–70. Cleanability of dental instruments–implications of residual protein
Messer H, Parashos P and Moule A. (2003) Should endodontic files be and risks from Creutzfeldt-Jakob disease. British Dental Journal
single-use only? Australian Endodontic Journal 29(3): 143–145. 203(7): 395–401.
Morrison A and Conrod S. (2009) Dental burs and endodontic files: are Yengopal V, Naidoo S and Chikte UM. (2001) Infection control among
routine sterilization procedures effective? Journal of the Canadian dentists in private practice in Durban. Journal of the South African
Dental Association 75(1): 39. Dental Association 56(12): 580–584.