The Department of Health has conducted an interesting study on the risks of Creutzfeldt Jakob Disease (CJD) transmission; through the use of dental and orthodontic instruments.  Based on a pre-existing model for surgical instruments, the analysis shows a number of uncertainties in the realm of dentistry.

If a patient is recognized as high risk for CJD disease (has CJD symptoms), instruments used on the individual must be selected with special care.  These instruments should always be sterilized, quarantined, and if absolutely necessary, destroyed.  The issue with instruments stems from the idea that they might unknowingly be used on someone carrying the disease, or a CJD variant.  If this were to happen, two potential infection routes exist.

1.  The possibility on transmitting the Jakob Creutzfeldt Disease infection through abrasions, typically of the patient’s lingual tonsils.   This route has been studied and applied in humans.  CDJ infectivity can also occur in other tissues (dental pulp, for example).  This type of transmission, though not yet studied in humans, has proven efficient in animal studies.

2.  Some instruments used in oral surgeries, such as reamers and files, can sometimes carry significant material residues – even after washing.  Transmission risks would most certainly be present if any remaining residue carries CJD disease.

While there are definite risks to patient, the chance of Creutzfeldt Jakob Disease transmission through tonsil invasion is fairly minimal.  However, if tissues such as dental pulp were to be infected, the risk of transmitting the disease would increase significantly.  The risk to the public in general, of course, would depend critically on the initial prevalence of CJD disease and the number of invasive dental procedures carried out in a given period.  The ratios at this point are not yet clear, but, we can conclude that transmission through dental tools is much less likely than infection through surgical instruments.

Reducing the risk of vCJD spread starts with dental and orthodontic instrument decontamination.  Though most current methods cannot remove the threat completely, they will greatly decrease the amount of risk posed.  Other simple ways to reduce risk of infection include the utilization of single-use instruments and medical grade disinfectants.

The qualifications of this study are based on a couple of factors.  For one, the decontamination and disinfectant procedures of standard dental offices isn’t much less effective than the researchers assumed (the assumptions are provided as fairly conservative estimates for CDJ infectivity).  Second, is the area of uncertainty, since we are still not completely certain which types of tissues carry the disease, and what tools and instruments carry the highest risk of infection.  Therefore, it remains extremely important to monitor decontamination practices, and, to use a medical grade disinfectant spray whenever possible to decrease the risk of infection.  As a side not, the information contained in this study was tabulated by the UK Department of Health.