NFPA Journal - January/February 2018 - 82
Comfortably
NUMB
on data from Texas, since many states fail to track data on
patient morbidity and mortality in dental offices.
DIGGING
INTO DENTAL
Five things accomplished
by NFPA 99's new chapter
on dental gas and vacuum
systems
Establishes clearly defined categories
for dental gas and vacuum systems
Category 1 systems are in facilities performing deep sedation and general anesthesia; category 2 systems are in facilities
performing moderate or minimal sedation
using only oxygen and nitrous oxide;
and category 3 systems are in facilities
performing minimal or no sedation with
no medical gases.
Provides distinctions between medical
air and dental air
Dental air is defined to be used to drive
dental tools and not for respiration,
unlike medical air. Dental air equipment is
therefore allowed to be simplex, meaning
it doesn't need redundant components
so the system can operate if one fails,
and dental facilities don't need to develop
their emergency plans to deal with the
loss of dental air.
Provides rigorous performance,
testing, and maintenance criteria for
category 1 dental gas, vacuum, and
WAGD systems
Criteria for category 1 gas, vacuum, and
waste anesthetic gas disposal systems in
dental facilities must comply with Chapter 5: Gas and Vacuum Systems, which is
what would be followed in an ambulatory
surgical center or hospital.
Provides rules on nitrous oxide (N2O)
scavenging, or the collection and
removal of N2O
For instance, in category 1 systems for
dental facilities, N2O scavenging inlets
cannot be interchangeable with any other
vacuum inlets.
Indicates the materials acceptable
for piping in dental gas and vacuum
systems
Piping for dental compressed air systems
must be annealed temper copper tube,
for example, while piping for dental
vacuum and scavenging systems can be
copper, PVC, or CPVC plastic.
82 | NFPA JOURNAL * J A N U A R Y / F E B R U A R Y 2 0 1 8
NFPA 99 and dentistry
Safety advocates stress that one of the best ways to prevent
dental injuries and death is the use of NFPA 99. The code,
however, does not have a long history of being correctly
applied or even used at all in dentistry.
NFPA's inclusion of medical gas systems in its codes and
standards dates back to the 1920s, said Jon Hart, a principal fire protection engineer at NFPA and staff liaison to
NFPA 99. Back then, the concern was primarily on flammable gases being used for sedation, such as ether. Over
the years, as the U.S. phased out flammable anesthetics,
NFPA's involvement in medical gas and vacuum systems
remained, and were addressed by NFPA 99, which was created as a compilation of numerous health care documents
in the early 1980s. Today, commonly used medical and
dental gases like oxygen can propagate a fire-there's a case
from the 1990s of a dental patient whose mustache rapidly
caught fire after a spark created by drilling a cavity landed
inside an oxygen-filled nasal mask-but they're not flammable. Therefore, the chief concerns NFPA has for these
systems, which are addressed by NFPA 99, are things like
the crossed gas lines that caused brain damage to Kansas
high schooler Austin Stone in 2009; vacuum pumps that
might not be strong enough to stop an unconscious patient
from choking to death; or systems that don't automatically
switch over to full gas tanks when the levels in existing
tanks become too low.
For years, NFPA tried to fit regulations for dental gas and
vacuum systems with the regulations for medical systems,
but it simply didn't work, according to Hart. There were
inconsistencies with terminology, and it was difficult to
determine how dental facilities should be classified using the
same category or level system as hospitals and other medical
facilities. The result over time has been less scrutiny given
to dental gas and vacuum systems used for sedation than
what's been typically given to their medical counterparts.
"A normal building safety checklist that happens with
hospital facilities or ambulatory surgery centers is the NFPA
99 med gas system checklist and verification, and that's not
happening in these dental offices," Wong said. He remembers
being told for years by medical professionals, enforcers, and
others that the code didn't even apply to dentistry.
The hope is that the new chapter can change things. For
dental facilities requiring category 1 systems, which are
defined as those that perform deep sedation and general
anesthesia, the chapter says they must follow the same
requirements as medical facilities that do the same when it
comes to gas and vacuum systems. Valves, outlets and inlets,
and piping for category 1 dental systems, for instance, must
comply with sections of the general Gas and Vacuum Systems chapter, which facilities like hospitals follow.
The changes reflect what some experts have preached
for years. "What I tell people is, the minute you take somebody across the line of consciousness, your entire office now
Table of Contents for the Digital Edition of NFPA Journal - January/February 2018
Contents
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NFPA Journal - January/February 2018 - 1
NFPA Journal - January/February 2018 - Contents
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