Sterilisation /certified fixed orthodontic courses by Indian dental academy

Sterilization in
orthodontics
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INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


CONTENTS
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INTRODUCTION
HISTORY
BLOOD BORNE PATHOGENS AND DISEASE STATES
PATHWAYS OF CROSS CONTAMINATION
STERILIZATION AND DISINFECTION METHODS
PRE STERILAZATION PROCEDURES
POST STERILIZATION PROCEDURES
METHODS OF STERILIZAION OF MATERIALS IN
ORTHODONTIC OFFICE
PERSONAL PROTECTION
SURFACE ASEPSIS
CONCLUSION.


INTRODUCTION


Sterilization is one of
the most important
priorities in the dental
office so that the
orthodontic experience
for the patient can be
both fulfilling and
completely safe.
While we may have fun in the office,
we must take sterilization very seriously.


STERILISATION AND DISINFECTION
Sterilization- is defined as the process by which an article,
surface or medium is freed of all micro organisms either in
vegetative or spore state.
Sterilization- is defined as the destruction or removal of
all forms of life, with particular reference to microbial
spores
Sterilization-refers to the complete destruction of all
microbial life
Disinfection-defined a s the destruction of pathogenic
micro-organisms on inanimate surfaces


Goal of sterilization and
infection control do us no
Most microbes that we come in contact

harm.
Others colonize and become established as our
commensal flora, yet others establish infection.
Factors determining the development of infectious
disease
-virulence
-dose
-resistance
Health or disease=virulence x dose
----------------------resistance
Virulence of micro-organisms in their natural
environments cant be changed
Resistance to diseases can be enhanced by
immunization but not for all diseases
The only disease determinant we can effectively
manage is the dose, and the management of the
dose is called as infection control.

HISTORY
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The science of microbiology has shed much light on the
nature of disease. In the nineteenth century the work of
Pasteur ,Lister and Koch did much to explain the role of
bacteria in disease and to indicate possible methods of
practicing safer medicine.
LOUIS PASTEUR (1822-95) was the first scientist to show
clearly that bacteria never generate spontaneously and that
no growth of any kind occurs in the sterilized media
One of his many achievements was the development of the
technique of controlled heating known as
‘PASTEURISATION’ for the preservation of beverages and
food stuffs.
By his experimental studies on anthrax in 1876-77, for
example, he was to prove that a certain type of infection
invariably occurred when anumber of micro-organisms of a
particular kind were introduced in to the body

Dr. Joseph Lister (1827-1912)


Discovered the effectiveness of 'carbolic
acid,‘ which was used in controlling typhoid.
Using carbolic acid, Lister was able to keep
his hospital ward in Glasgow free of
infection for nine months.
Lister published the results of his
experiments in The Lancet : 11 cases of
compound fracture without any sepsis.


Carbolic acid spray being used at the time of a
surgery


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Despite the fact that the germ theory of disease had
been established in 1877, it was not universally
accepted until 1882 when Koch presented his
masterly paper on ‘The etiology to tuberculosis’
giving details of the isolation of the tubercle bacillus.
In the following year he isolated the cholera vibrio.
Robert Koch (1843-1910) was undoubtedly one of
the greatest figures in the development of
microbiology. He had immense skill in devising new
bacteriological techniques. He was also the first to
make photomicrographs of stained smears, and in
addition he pioneered methods of growing bacteria on
agar media.
The ‘Golden era’ of medical microbiology which
was opened by Pasteur, Lister and Koch was perhaps
the greatest contribution ever to the theory and
practice of medicine.

BLOODBORNE PATHOGENS AND OTHER
DISEASE AGENTS :

The patient’s mouth is the most important source of
potentially pathogenic microorganisms in the dental
office. Pathogenic agents may occur in the mouth as a
result of four basic conditions:
Blood borne diseases, Oral diseases, Systemic diseases
with oral lesions, and Respiratory diseases .
Systemic diseases with pathogens present in blood and other body
fluids
Disease

Pathogen

Hepatitis B

Hepatitis B virus

Hepatitis C

Hepatitis C virus

Hepatitis D

Hepatitis D virus

HIV-infection and AIDS


Human immunodeficiency virus

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Blood borne pathogens may enter the mouth
during dental procedures that induce bleeding.
Thus contact with saliva during such
procedures may result in exposure to these
pathogens if present. Because it is very difficult
to determine if blood is actually present in
saliva, saliva from all dental patients should be
considered as potentially infectious.


HEPATITIS B VIRUS
Risk for the dental team :
Risk for dental patients :
Hepatitis B vaccine :
•We are extremely fortunate that safe and effective
vaccines
for hepatitis B are available.
•Because there is no successful medical treatment to cure
this disease, prevention is of paramount importance.
•The vaccine is strongly recommended for all members of
the dental team.


HIV INFECTION AND AIDS
Transmission :
Intimate sexual contact (vaginal, anal, oral)
involving contact or exchange of semen or vaginal
secretions;
•Exposure to blood, blood-contaminated body
fluids, or blood products;
•Perinatal contact (from infected mother to child
•


Measures in dental office to prevent HIV
transmission
-All members of the dental team and other
health-care workers must protect themselves
from exposure to blood, saliva and other
potentially infectious body fluids.
- Contaminated sharps must be handled and
disposed of properly.
-Gloves, mask, and protective eyewear and
clothing must be used during the care of all
patients and in other instances to prevent direct
or indirect contact with body fluids.
- Also, all health-care workers must prevent their
blood or body fluids from coming into contact
with the patients being treated, and instruments
and equipment used on more than one patient
must be properly decontaminated before reuse.

ORAL DISEASES

Diseases

Pathogen

Herpes infections Herpesvirus hominis (herpes
simplex virus)
Syphilis

Treponema pallidum

Hand-foot-mouth Coxsackievirus
disease
Herpangina

Coxsackievirus

Gonococcal
pharyngitis

Neisseria gonorrhoeae

Candidiasis

Candida albicans

I)

-

HERPES INFECTIONS :
In this disease, vesicle-type lesions can occur in the
mouth.

-Vesicles during active herpes simplex infections at any
site of the body contain the virus which may be spread
to others by direct contact with these lesions.
-Also, the herpes simplex virus may be present in saliva in
those with oral or lip lesions and possibly in a small
percent of those who are infected but have no active
lesions.
-In such instances, sprays or aeorosols of the saliva may
result in spread of the virus to unprotected eyes of the
dental team.

II) HERPANGINA AND HAND-FOOT-MOUTH
DISEASE :
Herpangina appears as vesicles on the soft
palate or elsewhere in the posterior part of the mouth
that break down to ulcers that last for about a week.
-Fever, sore throat and headache frequently accompany
the vesicular stage.
-The lesions are caused by specific types of coxackie
virus.


III) ORAL SYPHILIS .
Treponema pallidum is a spirochete
bacterium and is the causative agent of syphilis.
-About 5-10% of the cases of syphilis first occur in
the mouth in the form of a lesion called a primary
chancre, an open ulcer frequently on the tongue or
lips.
-These lesions do contain the live spirochetes and
may be spread by direct contact.
- The possibility of the spirochete entering small cuts
or breaks in the skin of unprotected hands of the
dental team exists and has been documented in
one instance causing syphilis of the finger.

IV) ORAL CANDIDIASIS :
Candida albicans is a yeast that occurs in the
mouth asymptomatically in about one third of adults.
-Such circumstances that may result in oral disease
called thrush or oral candidiasis might include
conditions that disturb our body defense mechanisms
such as the systemic diseases of HIV infection, and
leukemia;
-Spread of C. albicans from a patient’s mouth to the
dental team is theoretically possible through direct
contact with lesions or sprays or aerosols of infected
saliva.

PATHWAYS FOR CROSSCONTAMINATION


A total office infection program is designed
to prevent or at least reduce the spread of
disease agents from:
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Patient to dental team

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Dental team to patient

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Patient to patient

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Dental office to community, including the
dental team’s families


i) Patient to Dental Team:
•

Direct contact : with patient’s saliva or blood may lead to
entrance of microbes through a non intact skin resulting from
cuts, abrasions, or dermatitis.

•

Droplet infection: They occur as a result of sprays, spatter or
aerosols from patients mouth.

•

Indirect contact: involves transfer of microorganisms from the
source (e.g., the patient’s mouth) to an item or surface and
subsequent contact with the contaminated item or surface.

•

Examples include cuts or punctures with contaminated sharps
(e.g. instruments, needles, burs, files scalpel blades, wire) and
entrance through non intact skin as a result of touching
contaminated instruments, surfaces or other item.

ii) Dental Team to Patient :
Spread of disease from the dental team to patients is
indeed a rare event, but could happen if proper
procedures are not followed.
-If the hands of dental team member contain lesions or
other non intact skin.
- If the hands are injured while in the patient’s mouth,
blood borne pathogens or other microbes could be
transferred by direct contact with the patient’s mouth, and
they may gain entrance through the patient’s mucous
membrane.
- If a member of the dental team bleeds on instruments or
other items that are then used in the patient’s mouth,
cross infection may result.

iii) Patient to patient

:

Disease agents might be transferred
from patient to patient by indirect contact
through improperly prepared instruments,
hand-pieces and attachments or surfaces.


iv) Dental Office to Community :
This pathway may occur if microorganisms from the patient
contaminate items that are sent out or are transported away
from the office.
For example, contaminated impressions or appliances or
equipment needing service may in turn indirectly
contaminate personnel or surfaces in dental laboratories
and repair centers. Dental laboratory technicians have been
occupationally infected with hepatitis B virus (HBV).
This pathway also may occur if members of the dental team
transport microorganisms out of the office on contaminated
clothing. In addition, if a member of the dental team acquires
an infectious disease at work, the disease could be spread
to personal contacts with others outside the office.
Also, regulated waste that contains infectious agents and is
transported from the office may contaminate waste haulers
if it is not in proper containers.

ACCEPTED METHODS OF
STERILIZATION IN
ORTHODONTICS

1)Heat sterilization
 Steam pressure sterilization
 Dry heat sterilization
 Chemical vapour sterilization

2)Gas or ethylene oxide sterilization
3)Liquid chemical sterilization and disinfection


HEAT STERILISAION
Heat sterilization is the most common type of
sterilization technique used in dentistry
today
Heat sterilization involves
a) Steam sterilization
b) Dry heat sterilization
c) Unsaturated chemical vapour sterilization


(a) Steam sterilization
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Steam under
pressure has a
higher temperature
than 100 C
To be effective
against viruses and
spore forming
bacteria need to
have steam in direct
contact with
material
Autoclaves are
highly effective and
inexpensive

Characteristics :
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Temperature : 121 C (250 F)
Pressure : 15 psi
Cycle time: 15-20 minutes
Acceptable Materials: Paper, plastic, cloth, or paper peel
pouches
Unacceptable Materials: closed metal and glass
containers

Advantages:
Short efficient cycle time
Good penetration
Ability to process a wide range of materials without destruction
Disadvantages:
Unsuitable for heat sensitive objects
Corrosion of unprotected carbon steel instruments
Dulling of unprotected cutting edges
Possibility that packages may remain wet at end of cycle
Possible deposits from use of hard wat

( b) Dry heat sterilization
Sterilization of
instruments with dry heat is the
least expensive form of heat
sterilization. A complete cycle
involves heating the oven to the
appropriate temperature and
maintaining that temperature for
a proper interval.


Characteristics :
Temperature : 160 C (320 F) Or 170 C (340 F)
Cycle time : 2 hours Or 1 hour
Requirements:
Must not insulate items from heat
Must not be destroyed by temperature used

Acceptable Materials: Paper bags, aluminum foil, polyfilm
plastic tubing
Unacceptable Materials : plastic and paper bags that
cannot withstand dry heat temperature


Advantages:
-Is effective and safe for sterilization of metal instruments and
mirrors .
-Does not dull cutting edges .
-Does not rust or corrode

Disadvantages :
-Requires long cycle for sterilization
-Has poor penetration
-May discolor and char fabric
-Destroys heat-labile items
-Cannot sterilize liquids
-Is generally unsuitable for handpieces


(iii) RAPID HEAT TRANSFER STERILIZATION :
Characteristics :
Temperature : 190 C (375 F)
Cycle time
: 12 minutes for wrapped items ;
6 minutes for unwrapped items.
Acceptable Materials: Paper bags, aluminum foil, polyfilm plastic tubing
Unacceptable Materials : Plastic and paper bags that cannot withstand dry heat
temperature
Advantages:
-It has a shorter cycle time than regular dry heat units.
-Items are dry after cycle
-It does not dull cutting edges
Disadvantages:
-Instrument must be dried before packaging and placement in chamber.
-It destroys heat-labile items
-It cannot sterilize liquids
-It is generally unsuitable for dental handpieces
-Unwrapped items become contaminated quickly after the cycle.

(c)Unsaturated chemical vapour
sterilization
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Depends on heat, water and chemical synergism for its
efficacy
A solution of alcohol, formaldehyde, ketone, acetone and
water is used to produce a sterilizing vapour
Characteristics:
Temperature: 131 c
pressure: 20 psi
Cycle time: 20-40 mins
Packaging material requirements :
Vapors must be allowed to precipitate on contents
Plastics should not contact the sides of sterilizer
Acceptable materials: Perforated metal trays, paper or
paper peel pouches
Unacceptable materials :solid metal trays and sealed glass
jars

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Advantages:
-It has short cycle time
-it does not rust or corrode metal instruments including carbon
steels
-it does not dull cutting edge
-it is suitable for orthodontic stainless steel wires

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Disadvantages:
-Instruments must be dried completely before
processing
-A special chemical solution must be used
-It will destroy heat sensitive plastics
-There is a chemical odour in poorly ventilated areas
-It can not steriize liquids:

GAS STERILIZATION


GAS STERILIZATION
Ethylene oxide: The use of ETO is
recognized by the American Dental
association (ADA) and Centers for
Disease control and prevention (CDC)
.
as an acceptable method of sterilization
for the following items:
i) those that can be damaged by
heat and/ or moisture, and
ii) those that can be cleaned and
dried thoroughly..
This chemical is effective as a
virucidal agent, is sporicidal, does
not damage materials, and can
evaporate without residue


CHARACTERISTICS
Temperature : room temperature (250C/750F)
Cycle time : 10-16 hours (depending on material)
Acceptable materials : paper, plastic bags
Unacceptable materials : sealed metal or glass containers
Advantages :
-High capacity for penetration
-Does not damage heat-labile material
-Evaporates without leaving a toxic residue
-Suitable for materials that cannot be exposed to moisture

Disadvantages:
-Slow, requires long cycle time
-Uses toxic/hazardous chemical
-Items must be cleaned and dried thoroughly before exposure.
-Causes tissue irritation if not well aerated

LIQUID CHEMICAL STERILIZATION
AND DISINFCTION
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Inexpensive and suitable for heat sensitive
items
Toxic and irritant
2% glutaraldehyde is most widely used
Often used as disinfectants but can also
sterilize instruments if used for prolonged
periods
liquid sporicidal chemical
Most bacteria and viruses are killed within
10 minutes
Spores can survive several hours

GLUTERALDEHYDE:
2.0 to 3.2% glutaraldehyde is used to sterilize and
disinfect. At these concentrations,
- glutaraldehydes can be effective against vegetative
bacteria, including M. Tuberculosis, fungi and viruses,
and can destroy microbial spores after a 10-hour
immersion period..
- In fact, glutaraldehydes are useful in decontaminating
certain types of dental impression materials.


Disadvantages :
- Although glutaraldehyde formulations are effective as
immersion steriliants/ disinfectants, they are also extremely
toxic to tissues.
- Irritation of hands and discoloration of cuticles are
common sequelae when people do not wear appropriate
utility gloves.
- damage to respiratory and olfactory tissues and ocular
injury


Alcohols:
- Ethyl alcohol and isopropyl alcohol have been used

extensively for many years as skin antiseptics and
surface disinfectants.
- Ethyl alcohol is relatively nontoxic, colorless, nearly
odorless and tasteless, and readily evaporates without
residue.
Isopropyl alcohol is less corrosive than ethyl alcohol
because it is not oxidized as rapidly to acetic acid and
acetaldehyde.

Disadvantages :
-Not sporicidal
- Damaging to certain materials, including rubber and
plastics
-Rapid evaporation rate with diminished activity against
viruses in dried blood, saliva, and other secretions on
surfaces

Iodine and Iodophors :
•

Iodine is one of the oldest antiseptics for
application onto skin, mucous membranes,
abrasions, and other wounds.

•

high reactivity of this halogen with its target
substrate gives it potent germicidal effects.

•

It acts by iodination of proteins and subsequent
formation of protein salts.

•

Tinctures of iodine are toxic for gram-positive
and gram-negative bacteria, tubercle bacilli,
spores, fungi, and most viruses. solubilizing
agent or carrier.

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Their surfactant properties make them
excellent cleaning agents before
disinfection, and newer iodophor
commercial formulations have shown EPAapproved tuberculocidal activity within 5 to
10 minutes of exposure.
Iodophor antiseptics are useful in preparing
the oral mucosa for local anesthesia and
surgical procedures.


Phenols and Derivatives

:

. This phenolic solution was used as an all-purpose surgical
instrument immersion steriliant, hand washing antiseptic, wound
cleaner, and preparatory antimicrobial for surgical sites...
•

These agents act as cytoplasmic poisons by penetrating and
disrupting microbial cells walls, leading to denaturation of
intracellular proteins.

•

The intense penetration capability of phenols is probably the
major factor associated with their anti microbial activity .

•

Thus, with the exception of the bisphenols, most phenolic
derivatives are used primarily as disinfectants.


PRE STERILIZATION
PROCEDURES
•

Holding (presoaking)

•

Pre cleaning

•

Corrosion Control, Drying, Lubrication

•

Packaging


I. HOLDING (PRESOAKING)
If instruments cannot be cleaned soon after use,
place them in a holding solution to prevent drying of
the saliva and blood.
•

Extended presoaking for more than a few hours is
not recommended, for this may enhance corrosion of
some instruments.
•

The holding solution may be the same as that to be
used for ultrasonic cleaning or it may be a germicidal
solution (e.g., a glutaraldehyde) indicated for
instrument immersion.
•


II. PRECLEANING:
Ultrasonic cleaning :
Ultrasonic cleaning, compared with scrubbing instruments by
hand, reduces direct handling of the contaminated instruments
and the chances for cuts and punctures.
•Exception is some high-speed hand pieces.
•This time required ranges from about 5 to 15 minutes.
•


Manual scrubbing of instruments :
-Scrubbing contaminated instruments by hand is a very
effective method of removing the debris if performed
properly.
-All surfaces of all instruments should be thoroughly brushed
while the instruments are submerged in a cleaning solution to
avoid spattering.
-This is followed by thorough rinsing with a minimum of
splashing.


III. CORROSION CONTROL, DRYING, AND
LUBRICATION
Instruments or portions of Instruments and burs made of carbon
steel can rust during steam sterilization.
•

•

the cutting surfaces of orthodontic pliers can rust by autoclaving

rust inhibitors (e. g., sodium nitrite) that can be sprayed on the
Instruments can reduce rusting of some of these items
•

•

the best approach is not to process such items through steam.

Instead, thoroughly dry the Instruments and use dry heat or
unsaturated chemical vapor sterilization, which do not cause
rusting.
•

IV :Packaging:
Packaging Instruments before processing through the sterilizer
prevents them from becoming contaminated after sterilization during storage or
when being distributed to chair side. Packaging involves organizing the
Instruments in functional sets and wrapping them or placing them in sterilization
pouches, bags, trays, or cassettes.

Wrapping or Bagging :
Functional sets of instruments can be placed on a small sterilizable tray and the
entire tray wrapped with sterilization wrap grams the wrapping procedure. Seal
the wrap with tape that will withstand the heat process. (e.g., “autoclave tape”).


Using Cassettes :
Numerous styles of cassettes are
available that contain functional sets of
instruments during use at chairside and
during the ultrasonic precleaning,
rinsing, and sterilizing processes.
- Using cassettes reduces the direct
handling of contaminated instruments
and keeps the instruments together
through the entire processing.

Unwrapped Instruments :
Sterilizing unpackaged instruments is
the least satisfactory approach to
patient protection because it allows for
unnecessary contamination before the
Instruments are actually used on the
next patient.


POST STERILIZATION
PROCEDURES
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Sterilization monitoring
-biological monitoring
-chemical monitoring
- Physical monitoring

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Handling of processed instruments


STERILIZATION MONITORING :
-Heat sterilization failures result when direct contact
between the sterilization agent and all surfaces of
items being processed does not occur for the
appropriate length of time.
- In many instances, these failures will not be
detected unless proper sterilization monitoring is
performed.
-There are three forms of sterilization monitoring,
biological, chemical and physical monitoring.


i) Biological Monitoring


Biological monitoring provides the main
guarantee of sterilization. It involves processing
highly-resistant bacterial spores through the
sterilizer and then culturing the spores to
determine if they have been killed

Types of biological indicators :
1)Bacillus stearothermophilus - steam or chemical
vapor sterilization
2)Bacillus subtilis - dry heat or ethylene oxide gas
sterilization.




ii) Chemical Monitoring :
Chemical monitoring involves the use of indicators that change color or physical
form when exposed to certain temperatures such as autoclave tape, special
markings on pouches and bags, chemical indicator strips, tabs or packets or
tubes of colored liquid.
Rapid-change indicator
changes color rapidly after a certain temperature has been reached (e.g.,
autoclave tape and special markings on pouches and bags). Used as an
external indicator on the outside of every pack
•


Slow-change or integrated indicator:

•

- that changes color or form slowly, responding to a combination of time and
temperature or temperature and the presence of steam.
-Used on the inside of every pack, pouch or cassette to assess if the
instruments have been exposed to sterilizing conditions.


iii) Physical Monitoring :
Physical monitoring of the sterilization process involves
observing the gauges and displays on the sterilizer and recording
the sterilizing temperature, pressure and exposure time.
-It must be remembered that sterilizer gauges and displays
indicate the conditions in the sterilizer chamber rather than
conditions within the packs, pouches or cassettes being
processed.
-Thus, physical monitoring may not detect problems resulting
from overloading, improper packaging material or use of closed
containers.


HANDLING PROCESSED INSTRUMENTS :
Instrument sterility should be maintained until
the sterilized packs, pouches or cassettes are
opened for use at chairside.

i) Drying and Cooling :
Packs, pouches or cassettes processed
through steam sterilizer may be wet and must be
allowed to dry before handling


ii) Storage :
Handling of sterile packages should be kept to a minimum ,
and those that are dropped on the floor, torn, compressed or
become wet must be considered as contaminated
-Store sterile packages in dry, enclosed, low-dust areas away
from sinks and water pipes .This prevents packages from
becoming wet with splashed water.
-And store the packages away from heat sources that may make
the packaging material brittle and more susceptible to tearing or
puncture.
iii) Distribution :
Instruments from sterile packs or pouches can be placed
on sterile, disposable, or at least cleaned and disinfected trays at
chairside.
-Sterilized instrument cassettes are distributed to and opened at
chairside

RECOMMENDED STERILIZATION
PROCEDURES FOR MATERIALS IN
ORTHODONTICS
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Impression trays
Impressions
wax bites and rims
Acrylic appliances
Orthodontic pliers
Orthodontic bands and brackets
Orthodontic wires
Orthodontic marking pencils


Impression trays
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Aluminium or chrome plated: heat or gas
sterilization
Custom acrylic trays: disinfect by NaOCl or
iodophor; discard
Plastic trays: ethylene oxide sterilization or
disinfection by NaOCl or iodophor


Impressions
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ADA council on dental impressions recommends
(1991) disinfection by immersion in a suitable
disinfectant.
2% gluteraldehyde is most commonly used.


Wax bites and wax rims



Disinfection by an iodophor

Dental casts

ADA recommends disinfection of stone casts
by immersing in 1:10 NaOCl or an iodophor

Dental prosthesis and appliances


ADA recommends sterilization by
exposure to ethylene oxide or disinfection
by immersion in iodophor or chlorine
compounds

Orthodontic pliers
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High quality stainless steel :dry heat, autoclave, chemical
vapour, ethylene oxide
Low quality stainless steel: dry heat, chemical vapour,
ethylene oxide
With plastic parts: ethylene oxide, chemical disinfection or
sterilization.

Effect of routine steam autoclaving on orthodontic
pliers
European Journal of Orthodontics

Orthodontic bands, brackets
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Dry heat sterilization
Autoclave
Ethylene oxide


Orthodontic wires
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Dry heat
Autoclave
Ethylene oxide

Effect on tensile strength of TMA, stainless steel and NiTi
wires
Julie Ann Staggers, Dallas Margeson
(The angle orthodontist 1993,vol 63)
TMA wires: ethylene oxide
autoclaving
NiTi wires: ethylene oxide
stainless steel wires: autoclave
dry heat
ethylene oxide

Orthodontic marking pencils
Fernando ascencio et al
(JCO 1998 VOL XXXII NO. 5)
Orthodontic marking pencils are a potential source
of cross contamination
 Conventional orthodontic pencils can not be
autoclaved
 Gas sterilization
 Alcohol containing permanent markers
 Disinfectants
 Disposable markers

PERSONAL PROTECTIVE
EQUIPMENT AND BARRIER
TECHNIQUES






Oral health care providers and their patients
may be exposed to a variety of microorganisms
via blood or oral and respiratory secretions.
Infections can be transmitted in the oral
health care setting through
- direct contact with
blood
saliva and
other secretions
- indirect contact with
contaminated instruments
equipment
environmental surfaces

operatory

- Contact with air borne contaminants present in
droplets
spatter
aerosols of oral and respiratory fluids

Gloves : .

For the protection of oral health care
personnel and the patient, medical gloves
always must be worn when there is a
potential for contacting blood, bloodcontaminated saliva, or mucous
membranes.
.


Masks

:

When a tooth is cut with a high-speed turbine
handpiece or cleaned with an ultrasonic scaler,
blood, saliva, and other debris are atomized and
expelled from the mouth.
-Masks that cover the mouth and nose reduce
inhalation of potentially infectious aerosol
particles.
-They also protect the mucous membranes of
the mouth and nose from direct
contamination.
- Masks should be worn whenever aerosols or
spatter may be generated.


Protective eyeglasses :
During dental procedures, large particles of debris
and saliva can be ejected towards the oral health
care provider’s face.
- These particles can contain large
concentrations of bacteria and can physically
damage the eyes.
-Protective eyewear is indicated, not only to
prevent physical injury, but also to prevent
infection.


IMMUNIZATION FOR ORAL HEALTH
CARE PROVIDERS
Health care workers are at particular
risk of several vaccine-preventable
diseases.


Recommended vaccines for Oral Health care Workers
Generic name

Primary
schedule
Boosters (s)

and

Hepatitis B recombinant DNA

Two doses IM 4 weeks apart,
3rd dose 5 months after second

Rubella live virus vaccine

One dose SC, no booster

Measles live virus vaccine

1 dose SC, no routine boosters

Mumps live virus vaccine

1dose SC, no booster

Influenza vaccine (inactivated whole- Annual
vaccination
with
virus and split-virus vaccine) tetanus – current vaccine. Either whole
diptheria toxoid
or split virus vaccine may be
used two doses IM 4 weeks
apart, third dose 6to 12
months after second dose,
booster every 10 years.
Enhanced
–
potency
inactivated E-IPV is preferred for
poliovirus vaccine (E-IPV) live oral polio primary vaccination of adults,
virus vaccine (OPV)
two doses SC 4 to 8 weeks
apart, a
www.indiandentalacademy.comthird dose 6 to 12
months after the second.

Surface asepsis





Clean and disinfect
surfaces
Surface covers
Use of disposables


Items

Recommended
covering

Chair back (optional)

Plastic

Headrest (only if not covered along
with chair back)

Plastic

Dental unit, including hose supports

Plastic

Side auxiliary support surfaces

Plastic

Air-water syringe handle

Plastic

High-volume evacuation control

Plastic

Saliva ejector control

Plastic

Lamp handles

Foil, plastic wrap, or
bag

Light communication system

Plastic


Drawer handles

Plastic

DISPOSAL OF WASTE
MATERIALS :- Gloves,

masks , wipes, paper drapes:Handled with gloves, discarded in impervious
plastic bags.
- Blood, disinfectants, steriliants:Carefully poured into a drain connected to a
sanitary server system.
- Sharp items, needles, blades, scalpels:Puncture- resistant containers marked with
biohazard label.
- Human tissue:-


INFECTION CONTROL CONSIDERATIONS IN
DENTAL OFFICE DESIGN
Considering that the clinical arena is the
most affected by infection control, the
following elements should be evaluated in
regard to the overall health and safety of
the person performing the task.
 1)Office flow
 2)Cabinetry.
 3)Laminate, wall, and floor coverings
 4)Ventilation.









Office flow :
The layout of the entire office should incorporate a smooth
efficient operational flow. For example, patients have direct
access to the treatment rooms and consultation areas from
the reception area without having to pass through
instrument processing areas.
2) Cabinetry :
The number of drawers and their contents should be
minimized to simplify cleanup procedures and reduce
possible cross-contamination by the temptation to reach
into the drawer during a procedure.
-Treatment room cabinetry should be positioned on both
sides of the patient’s chair. This will allow both the doctor
and assistant access to essential side support areas and
provide flexibility to both right and left-handed clinicians
working in the same space.







3)Laminates and wall and floor coverings :
Although patient appeal and aesthetics continue to be a
consideration, cabinetry surfaces and wall and floor
coverings are a primary concern. Wood surfaces, heavily
textured wall coverings, and fabrics for decoration should
be eliminated. Smooth, seamless, nonporous materials will
inhibit the collection of microbes and, therefore, also should
be considered.
4) Ventilation :
Work areas must have positive ventilation to control
noxious vapors form various chemicals used in laboratory
and sterilization areas. Additionally, considering that
microbes inevitably are transported from one area to
another via ventilation systems, these systems must be
designed to prevent recirculation of contaminated air.


Compliance with infection control
procedures among California orthodontists
AJODO July 1992,Vol 102,5


CONCLUSION
IT IS OUR MOST IMPORTANT DUTY TO
PRESERVE AND MAINTAIN THE HEALTH OF OUR
PATIENTS AND OURSELVES.
•

WE AND OUR PATIENTS ARE AT ALARMINGLY
HIGH RISK OF GETTING INFECTED BY
DANGEROUS DISEASES LIKE Hepatitis-B, TB,
Herpes, HIV ETC.
•

TO PREVENT ALL THESE DEADLY DISEASES AND
TO PROTECT OURSELF WE SHOULD TAKE ATMOST
PRECAUTION BY FOLLOWING STRICT
STERILISATION AND DISINFECTION
PROCEDURES.
•

REFERENCES
•

Ascencio F, Langkamp H, Agarcoal S : Orthodontic marking pencils as a
potential source of cross contamination. J Clin Orthod 1998; 32: 307-310.

•

Cash RG : Trends in sterilization and disinfection, procedures in orthodontic
offices. Am J Orthod Dentofacial Orthop 1990; 98: 292-299.

•

Cohen KL, Helen G : Disease prevention and oral health promotion.

•

Compbell PM, Phenix N : Sterilization in orthodontic office. J Clin Orthod 1986;
20: 684-686.

•

Cottone AJ : Practical infection control in dentistry.

•

Council on Dental materials and council on dental therapeutics : Infection
control in dental office. J Am Dental Assoc 1978; 97: 673-677.

•

Dental Clinics of North America (1991) : Infection control and office safety

•

Dental Clinics of North America (1996) : Infectious diseases and dentistry.

•

Dental Clinics of North America (July 2003) : Infections and infectious
diseases – Part I.
Dental Clinics of North America (Oct 2003) : Infections and infectious
diseases – Part II.
Drake DL : Optimizing orthodontic sterilization techniques. J Clin Orthod 1997;
31: 491-498.
Jones M, Pizarro K, Blunden R : Effect of routine steam autoclaving on
orthodontic pliers. Eur J Orthod 1993; 15: 281-290.

•

•

•

•

Matasa CG : Orthodontic recycling at crossroads. J Clin Orthod 2003; 37: 133139.

•

McCarthy GM, Mamandras AH, Mac Donald JK : Infection control in
orthodontic office in Canada. Am J Orthod Dentofacial Orthop 1997; 112: 27581.


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