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CDC recommends using a sterile syringe or bulb syringe with sterile water for irrigating. Under what circumstances is sterile water required? All procedures involving sub gingival procedures?

The CDC maintains an infection control FAQ webpage pertaining to Oral Surgical Procedures which can be accessed at:
https://www.cdc.gov/oralhealth/infectioncontrol/faqs/oral-surgical-procedures.html ¹

This webpage states in part:

Oral surgical procedures involve the incision, excision, or reflection of tissue that exposes the normally sterile areas of the oral cavity. Examples are biopsy, periodontal surgery, apical surgery, implant surgery, and surgical extractions of teeth (removal of erupted or nonerupted tooth requiring elevation of mucoperiosteal flap, removal of bone or section of tooth, and suturing if needed).

And,

Oral surgical procedures raise the risk of local or systemic infection because microorganisms from inside or outside the mouth can enter the vascular system and other normally sterile areas of the oral cavity (e.g., bone or subcutaneous tissue). These procedures require a higher level of infection prevention than routine procedures, including the following:

• Surgical hand antisepsis using an antimicrobial agent that is fast-acting, has a broad spectrum of activity, and has a persistent effect (see Hand Hygiene)
• Use of sterile surgeon’s gloves
• Use of sterile irrigating solutions and devices designed for delivering sterile irrigating fluids such as a sterile bulb syringe, sterile single-use disposable products, or sterilizable tubing (see Dental Unit Water Quality) ¹

Recommendations and requirements may also vary by state. You may wish to contact your state dental board for further information on this matter.

Resources

1) U.S. Centers for Disease Control and Prevention. Oral Surgical Procedures. https://www.cdc.gov/oralhealth/infectioncontrol/faqs/oral-surgical-procedures.html Accessed on December 4, 2020.

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