Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.

1. CONTENTS
• INTRODUCTION
• PAST CONCERN
• DEFNITION
• CLASSIFICATION OF INSTRUMENTS TO BE STERILIZED
• BEFORE STERILIZATION
• RATE OF KILLING
• PRINCIPLES OF STERILIZATION
• AFTER STERILIZATION
• DISINFECTION
• IN ENDODONTIC PRACTICE
• ADVANCES
• REFERENCES
• CONCLUSION
I. INTRODUCTION :

2. Microorganisms are present all around us may be in active.
Suppressive from since they cause contamination, infection and decay. H
became necessary to remove or destroy them from the materials or the
related areas. So this is the main objective of sterilization.
In our daily routine practice we are paying very less attention towards
sterilization and disinfection as a result of which treatment provided to the
patient can be a failure.
So in a country like India with a huge population and demand for
health service it is important to follow strict sterilization and disinfection
procedures in dentistry to prevent spread of infections.
II. DEFINITION :
Sterilization is a process by which actives surface or medium are
freed of all microorganisms of both in vegetative or spore state.
Disinfection : Destruction of pathogenic organism but not necessarily
resistant spores.
Antiseptic : Chemical disinfectant which are safely applied to the skin or
mucous membrane and used to prevent infection.
Disinfectant : Reserved – Gr. germicides which are too corrosive or toxic to
be applied on tissues but which are suitable for application on objects or
articles by inhibitions the growth.
III. CLASSIFICATION OF INSTRUMENTS TO BE STERILIZED :

3. A) CRITICAL :
• Surgical and other instruments used to penetrate soft tissue and bone.
eg: Surgical burs, elevators forceps, scalpel scaling instruments
sutures, needles.
B) SEMI CRITICAL :
• Instruments that do not penetrate soft tissue or bone but contact
oral tissue. Eg: mirror, amalgam carries, plastic instruments tweezer.
C) NON CRITICAL :
• Do not come in contact with body fluids. Eg: medicament tars, cavity
liners, restorative material light switches, drawer pulls on cabinets.
IV. PROCEDURE BEFORE STERILIZATION :
1) Grouping and presoaking of contaminated instruments.
2) Pre sterilization cleaning.
3) Packing and sealing of instruments.
• Grouping and presoaking of contaminated instruments.
Instruments should be grouped according to their use, (eg: amalgam
set, composite set) banded together and presoaked together.
Presoaking prevents blood to adverse into instrument surface and easily
removed by cleaning process.
• Pre sterilization cleaning
- After soaking, instruments should be cleaned.
Cleaning is performed by scrubbing with soap and H2O or ultrasonic
cleaning.

4. • Packing and sealing of instruments.
Instruments should be properly packed and before sterilization
packing protects the instruments after sterilization and before use at chair
side. Packing materials used are sealing paper, plastic pouches, bags and
tubing.
Selection of packaging materials for various sterilization methods :
Packaging material
Moist heat Paper, plastic pouches paper thin cloth, nylon type
Dry heat Nylon plastic tubes some sterilization paper.
Chemiclave Plastic pouches of some sterilization paper.
V. Rate of killing of microorganisms :
Rate of killing is defined by relationship.
N  no. of survivors is inversely proportional to the conc. and time of the
sterilizing agent.
CT  referred as dose.
Relationship is usually stated in turns of survivors because they are
reassured by colony formation.
VI. Classification :
A) Moist heat sterilization.
B) Dry heat sterilization
C) Chemical sterilization.
Sterilization is also classified as
N α
1
CT
Chemical agents
Alcohols
Aldehydes
Malogens
Phenols
Gases
Ethylene oxide
BPL beta propio
lactone
Physical agents
Sunlight
Drying
Dry heat (flaming,
incineration hot air oven)
Moist heat (pasteurization,
boiling, steam under normal
pressure, steam under
pressure)
Filtration (candles, asbestos
filters membranes)
Radiation
Ultrasonic and sonic
vibrations.

5. Sunlight :
• Bactericidal activity.
• Germicidal activity because of U V rays + heat.
Studies have shown that in India, typed bacilli exposed to sun on pieces of
white drill cloth were killed in 2 hours where as controls kept in dark room
were still alive after 6 days.
Drying :
• Moisture is essential for the growth of bacteria 4/5th
by wt of bacterial
cell consists of H2O drying in air is ∴deleterious effects on many
bacteria.
• Un reliable method.
• Spores are unaffected by drying.
Heat :
• Dry
• Moist

6. • Heat is the most reliable method of sterilization and should be method
of choice unless contraindicated.
Killing by dry heat is due to
• Protein denaturation
• Oxidative damage
• Toxic effects of elevated of electrolytes.
Dry heat (Flaming) :
Inoculated loops wires point of forceps and scaring spatulas are held
in Bunsen flame till they become red hot in order to be sterilized.
• If the loops contain infective proteinacious material they should be
first dipped in chemical disinfectant before flaming to prevent
spattering.
• Scalpel, needles, mouth of cultures tubes, glass slides cover slips etc
are passel few times over the flame without allowing them to become
red hot.
• Bacteria are destroyed by this method.
Incineration : Excellent method for destroying materials such as soiled
dressings, animal carcasses, bedding and pathological material.
Hot air oven : Dry heat sterilization at 1600
C.
• Have heated members that allows air to circulate by gravity flow.
• Hot air is bad conductor of heat and penetrating power is low.
Individual instrument must be heated at 1600
C for 1 hour for effective
sterilization.
Time reavised depends upon 
o Oven size
o Size of load

7. o How instruments are packed.
• Instruments packets must be placed atleast 1 cm apart to allow heated
air to circulate. If packed together without spacing  ineffective
sterilization.
Disadvantage :
• Time consuming procedure.
• High temp may damage rubber and plastic goods.
• Heavy load, crowding of packs can easily defect sterilization.
Advantages : Carbon steel instruments and burs do not rust, collude, or lose
their tamper or witting edge if they are died before procedure.
To over come this lengthy time procedure, RHTS Cox manufacturing
has introduced rapid heat transfer sterilizer (short cyclic high temp dry heat
over).
Operated at 1900
C  packed instruments 12min un wrapped
instruments 6min.
MOIST HEAT :
Action is by
• Protein denaturation.
• Coagulation of protein.
Advantage of steam lies in the blatant heat liberated when it
condenses on a cooler surface raising the temp of that surfaces.
• In cases of spores  steam condenses on the spores and kill them by
hydrolysis and breakdown of bacterial protein.
Temp below 1000
C :

8. Pasteurization  630
C for 30min (holder method) or 720
C for 15-20 sec
(flash forces) following by cooling quickly to 130
C by this process all non
spacing pathogens such as mycobacterium brucella and salmonella are
destroyed.
Vaccine bath  bacterial vaccine  are sterilized at 600
C for 1 hour.
Inspissator  80 – 850
C for 30min Iowenstein Jensens and coeffies serum
are rendered sterile for 3 successive days in an inspissator.
Most heat resistant cells are the spore of clostridium botulinum –
require 1200
C for 4min.
Temperature at 1000
C (Boiling)  (10 – 30 min)
• Vegetative bacteria are killed almost at 900
C – 1000
C but sporing
bacteria require considerable periods of boiling.
• Boiling is not recommended for surgical instruments.
• Hard water should not be used
Hard water soft water
• Lid should not be opened during this period.
Steam at atmospheric pressure 1000
C :
• Used for sterilize culture media which may decompose if subjected to
increase temperature.
• Koch or Arnol steamer is usually used.
Steam at normal atmosphericpressure
1000
C  90 min.
For media containing sugar or gelatin on exposure of 1000
C for 20
min for 3 successive days is used – this is known as.
Tyndallization or intermittent sterilization :
adding
2% NaH CO3

9. The principle is first exposure kills all gram –ve bacteria and spares
present will germinate in favourable medium and are killed in subsequent
occasion.
STEAM UNDER PRESSURE (AUTOCLAVE) :
Temp. 12,0c.
Pressure - 15-16 per square, inch.
Time - 15 – 20 min
Disadvantage :
• Carbon steel instruments cannot be sterilized results in rusting
corrodes or dulling.
• Certain plastics and rubber are sensitive to heat and moisture cannot
be placed in autoclave.
• Steam appears to corrode steel neck and shank portion of diamond
instruments and carbide burs.
Advantages : Most rapid and effective method for sterilizing cloth surgical
packs and towel packs.
Sterilization of burs in autoclaves :
For autoclave sterilization burs can be protected by keeping them
submerged in a small amount of 2% sodium nitrite 50% preparation –
Rotagerm of sodium nitrite crystals to 1 litre of H2O).
After ultrasonic cleaning burs can be rinsed and placed in metal or
glass beaker with a perforated lid. Fill the beaker with sufficient fresh nitrite
sol. to have it above the burs approx. 1cm place the container of burs and
fluid into the sterilizer and operate a normal sterilization cycle. Then discord
the fluid from the container through perforated lid. Use store forcep to place

10. the burs into bur holder. Store the burs dry. Any nitrite residue can be wiped
or rinsed off with clean or sterile H2O if desired.
Advantages of moist heat over dry heat :
• Moist heat kills organisms and spores at lower temp and lower time.
• Penetrating power is more for moist heat than dry heat.
Filtration : Useful for antibiotic solutions, sera, carbohydrate solution,etc.
Draw back: viruses and mycoplasma may pass through
Types used:
• Earthen-ware candles, ex: berkfeld, chamberland.
• Asbestos disc filter, ex: seitz.
• Sintered glass filters.
• Collodion or membranous filter.
RADIATION :
• Ionizing radiation (x-rays, x-rays cosmic rays).
• Non – ionizing radiation (infra red, U.V rays).
Ionizing rays :
• Lethal to DNA high penetration power.
• Used to sterilize plastic syringes latherers rubbers.
Nonionizing :
• Infra red rapid moss sterilization of syringes.
• UV-rays  Operation rooms entry way virus laboratories hospital
wards.
ULTRASONIC AND SONIC VIBRATION :

11. • Results are not good because microorganisms still survive after the
ultrasonic and sonic vibration sterilization procedures.
CHEMICAL VAPOUR STERILIZATION (CHEMICLAVE ):
This method is based on the factors of heat, water and chemical
synergism.
• Chemicals include alcohols, formaldehyde.
• The water content is below the 15% level, above which rust,
corrosion dullness of metal occur.
Composition of heat + chemicals is much kinder to metal surfaces
than other tech.
Temperature 1310
C and 20 pounds pressure for 20min.
Advantages : Carbon steel and corrosion sensitive burs, instruments, and
pliers are sterilized.
Disadvantages : Odor is released when chemical are heated.
Periodontal,
Restorative and
Endodontic
Instruments
Carbon steel
Instruments and
Burs
VII. STERILIZATION MONITORING :
Autoclave
(OR)
Chemical vapor
pressure sterilizer
Dry heat (OR)
Chemical vapor pressure

12. A) Physical monitoring : Refers to periodic observation of displays or
gauges on the sterilizer during cycle o ensure sterilization process.
A) Chemical monitoring
B) Biologic monitoring
Chemical monitoring  Heat sensitive chemical indicators (those that
change color after exposure to heat). Two types of chemical used.
Biologic monitoring  is the only dependent method to determine sterility.
Those monitors are composed of strips of paper with live, resistant spore
which should be killed if properly sterilized.
• Should be done weekly.
• Spore types used for evaluating sterilization
spore type used.
Autoclave
Chemical vapor
Dry heat
Etox
IX. PROCEDURE AFTER STERILIZATION :
Process indicator
paper
T.S, T strips
(time, steam
temp.)
Bacillus
Staerothermophilus
Bacillus Subtilis

13. Drying and cooling of instrument :
Instrument sterilized by moist heat are allowed to dry before
handling.
Cooling of warm packages must be done slowly and warm packs
should not be transferred to cool surfaces or placed under air conditioning
units.
• Use of fans to cool down the warm instrument is not recommended
because it can cause undue circulation of potentially contaminated air
around the packs.
Storage :
After sterilization – they should be kept in a cool dry protected area,
above the floor a few inches away from walls and ceilings , away from sinks
and heat sources.
X. DISINFECTION :
It is a lethal process to kill disease producing microorganisms but not
bacterial spores.
• Process of disinfecting instruments, equipments by using a liquid
chemical germicides is called cold sterilization. Time period
according to environmental protection agency (EPA) is 10 hours.
• After immuring the instruments for a holding period than they should
be rinsed with sterile water and thin drying should be done.
Mechanism of action :
• Protoplasmic poision.
• Damages the microbial cell membrane resulting in loss of vital cell
constituents.
• Glutaraldehyde and formaldehyde appear to seal or fix cell membrane
and thereby block the progress of cellular component thus killing of
organisms.

14. • Halogens by oxidizing agents.
Ideal properties :
- Should have wide spectrum of action.
- Speedy action
- High penetrating power should be stable.
- Not corrode metals.
- Not to toxic if absorbed in the circulating system.
- Not to interfere with healing.
Alcohols : Not accepted by ADA for disinfection of instruments.
Aldehydes :
Disinfection occurs in 10-30min various types of preparations are
capable of sterilization.
2% acidic  600
C for 1 hour.
2% alkaline  room temp for 10 hours.
2% alkaline with phenolic buffer  room temp for 6.7 5 hours.
2% neutral  room temp for 10 hours.
Glutasaldehydes are generally not recommended for sterilization because of
instability of activated solutions.
Disadvantage by the use of glutaraldehyde
• Vaportoxicity
• Hand and eye irritation
• Expense
Chlorinedioxide :
• Used to disinfect instruments and operatory surfaces in 1-3 min.

15. • Solution reavires no rinsing and leaves no reside after use.
• Solution can sterilize items in 6 hours at rooms temp.
Advantages  non toxic disadvantages – corrosion
non sensitive
non irritating
NaOCl :
• Suitable surface disinfection other than instrument sterilization.
Divtions 1:1 to 1:5 are recommended disinfection time 3-3.0 minutes
• Virucidal, bactericidal, tubercolocidal.
Disadvantage, corrosive un pleasant older
Iodophors : broad spectrum disinfectant including HBV, M tuberculosis,
Poliovirus, Herpes Simplex virus.
Advantage : slow release of elemental iodine to enhance bactericidal
activity.
• Hard H2O inactivates iodophor.
• Biocidal activity occurs within 30 min. when iodophor solution is
fresh it will be amber color as age of solution advances it changes to
light yellow indicating loss of lodophor molecule.
• Iodophor solely disinfectant
Sporicidal capabilities absent.
Disinfection techniques :
A) Immersion disinfection
B) Surface disinfection
C) Decontamination of dental unit –
Check values have been recommended to fervent aspiration of
infective materials into hand pieces of H2O lines.
• The center for disease control recommends that hand pieces be
flushed 20 – 30 sec. Between patient and several minutes at the

16. beginning of each day to redvice and over night bacterial accumulation
in the units.
GASES :
Formaldehyde gases :
• Used for fumigation of operation theaters after sealing the windows
and other outlets formaldehyde gas is generated by adding 150 gm of
kmno4 to 280 ml of formation.
The reaction produces heat. There heat resistant vessels should be used.
• After fumigation door are left unopened for 48 hours.
• Surfaces which have been disinfected by this agent may release on
irritant vapor for sometime after disinfection and this can be nullified by
exposure to NH3 vapor after disinfection.
Ethylene oxide :
Colorless liquid, boiling point 1070
C
• At normal temp and pressure it is highly penetrating pas with sweet
small.
• Highly inflammable and explosive so other gases are added CO2 or N2
• Used for disinfection of heart lung machines respirators. Sutures,
books and clothing.
INFECTION CONTROL FOR IMPRESSIONS AND RELATED
REGISTRATIONS :
Concepts for transporting impressions and associated registrations to
a remote laboratory.
• Potentially infectious material shall be placed in a container which
prevents leakage during collection, handlings, processing, transport.

17. Controversy regarding transport of potentially infectious item.
i) Sent it cleaned (rinsed) and undisinfected in a biohazard-
labeled, heat-sealed, plastic bag or
ii) Debride, clean (rinse) and adequately disinfect it place
sealed transport bag.
In either case most laboratories will disinfect the item to ensure
protection of lab. Personal disinfecting twice is time wasted and multiple
exposure to disinfectant should be avoided. The simplest and best approach
is 1st
one.
Procedures for handing and transporting poly vinyl siloxane or rubber
based impression material and any associated registrations to a remote
laboratory :
I.C. procedures regarding nanaqueous rubber impression and any
associated registration are as follows :
1) Before the patient appointment, prepare one or more clean, strong,
clear, heat sealable, bionazard labeled plastic bags of appropriate size.
One for containing the scheduled impression and a separate one for any
inter occlusal registration. Place bag into an open canister of suitable size
so that the bags open end extends above the rim of the canister, allowing
a slight folding downward outward of the bags open edge. This helps
keep it open and also prevents contamination of the bags outer surface
during insertion of item.
2) Remove impression from mouth were still wearing gloves. Remove
any attached debris and rinse the item well with running tap H2O for 15
sec. to remove saliva and blood.
3) After rinsing and while still wearing barriers place impression into
bag without touching the bags outer surface.

18. 4) Now remove gloves because they are contamina with clean hands,
close the bag while touching only. The bags clean outer surface and heat
seal it.
5) Tape the prescription to bag
6) Attach a note appropriately lettered to alert the laboratory that the
item in the bag was debrided and rinsed but not disinfected send the bag
to remote lab.
Procedures for handling and transporting items for an aqueous
impression material tech usually irreversible, reversible hydrocolloids
and poly ether impressions :
1) Thoroughly rinse the impression under top H2O (15 sec) to remove
any saliva or blood.
2) Disinfect the impression by spraying unit thoroughly soaked with a
hospital level disinfectant. The product with the shortest time allows
less distortion.
3) With clean hands thoroughly rinse the disinfected impression under
top H2O to avoid prolonged exposure to the disinfectant % any
residual disinfectant can adversely affect surface hardness or stone
cast.
4) Shake excess H2O from impression and pour cast immediately.
One reversible hydrocolloid manufactures [VANR] offers two alternatives
to immediate pouring of impression after disinfection.
i) Submerge impression into 2% potassium sulfate solution for
20 min and then remove shake off excess and pour the impression.
ii) Place the impression into a humidor for upto 4 hours with
no temp change remove and submerge into 2% potassium sulfate 50%
for 20 min remove, shake of excess and pour the impression.
5) The cast from a disinfected impression does not need to disinfected,

19. 6) Pack the cast for shipment to remote lab.
Irreversible hydrocolloid  Chlorine compounds or lodophors
Poly sulfide silicone  Glutaraldehyde chlorine
compounds lodophors phenolies
Polyether  Chlorine compounds iodophors
Reversible hydrocolloid  2% potassium sulfate
XII. Handpiece surface contamination control and sterilization :
Blood and saliva contaminate the surfaces of handpieces during
various dental treatments irregular surfaces and especially crevices around
the bur chuck are difficult to clean and disinfect.
• Submersion of high speed handpiece in a high level disinfectant has
not been an option by manufuact.
• Scrubbing and applying disinfectant will reduce the no of bacteria
but did not completely eliminate them. Only sterilization can completely
bring infection control of handpiece surface.
• Handpieces are semicritical instruments.
• Autoclave sterilization of handpiece is one of the most rapid method.
• Fiber optic dim with repeated heat sterilization apparently due to oil
residue and debris baked on the ends of optical fibers. Cleaning with
detergent sol and wiping ends of optics with alcohol will prolong use.
Procedures for handpiece with a metal bearing turbine :
• Scrub metal bearing high speed handpieces and sheath or cone of low
speed handpiece at the sink with running water and detergent.
• Because the handpiece and autoclave them.
Procedure for handpiece with a lube free ceramic bearing turbine :
• For this type of handpiece avoid using chemicals because they
damage internal parts.
• Fiber optics are cleaned by isopropyl alcohols.

20. • Bag and autoclave the handpiece.
Chemical vapor pressure sterilization recommended for ceramic bearing
handpieces.
Ex: ETOX (ethylene oxide) gas is used.
• Oil left in handpiece can impair sterilization in some ETOX sterilizers
gas appears to penetrate high speed handpieces.
Dry heat sterilization of handpiece is generally not recommended.
XIII. STERILIZATION IN ENDODONTICS :
• Rubber dam sterilized by – 2% benzalkonivm chloride in 50%
isoprophylalcohol (OR) swabbing with H2O2 followed by tincture of
iodine.
• Cold sterilization of instruments is not recommended for 2 reasons.
i) Process is ineffective against all variety of
microorganitions.
ii) Lengthy procedure.
Cold sterilizing 50% is sporicidin – composition
Phenol – 7.05%
Sodium tetraborate
Glutaraldehyde
Sodium phenate
• Absorbent points, broaches, files and other root canal instruments –
sterilized in Hot salt sterilizer. It consists of metal cup in which table salt
is kept at temp 4250
F and 4750
F silver cones broaches, reamer, files  5
sec.
Absorbent point and cotton pellets  10 sec.
Bring disinfection in 10min at
room temp and sterilization in
6.75 hours

21. Hot salt sterilizer has superseded glass bead sterilizer and molten – metal
sterilizer because metal and glass beads occasionally clung to a wet
instrument, escaped detection and then clogged the root canal as instrument
was instated.
Advantages of Hot salt sterilizers is
1) Use of ordinary table salt.
2) Eliminates the risk of clogging the canal.
Usual commercial table salt, contains a small amount (1%) of sod.
Silicoaluminate, magnesium, carbonate, sod carbonate.
Pure NaCl should not be used without these additives because high
heat may cause fusion of the granules of salt.
Glass beads may be effectively substituted for a salt in a hot salt
sterilizer provided the beads are less than 1mm in diameter.
Larger beads are not so effective in transfer of heat to endo
instruments because larger air spaces between the beads reduce the efficacy
of sterilizer.
Operating temperature 4200
F to 4750
F
• Hottest part of salt bath in sterilizer is along its outer rim, starting at
the bottom layer of salt.
Temperature is lowest in the center of the surface layer of salt.
To sterilize on instrument one should immerse it at least a greater
inch below the salt surface and in peripheral area of the sterilizer.
Root canal instruments are immersed in not salt or gloss bead
sterilized for 5 sec. (Recovers, files breaches) and for 10 sec. (absorbent
points and cotton pellets).
• Dappen dishes  sterilized by swabbing with tincture of thimersol
followed by alcohol.

22. • Long handle instruments, tips of cotton plier blades of scissors 
sterilized by dipping the working point in alcohol and flaming twice.
• Root canal instruments may be sterilized by autoclave – 15,6 pressure
at 120
C for 15 min.
• Dry heat autoclave  may ie. Used to sterilize root canal instruments
but this is time consuming because it requires an elapsed time
of 2 hours for sterilization at 3200
F
1 hours for sterilization at 3400
F
30 min for sterilization at 3800
F
Gutta-percha sterilized by immersion it in 5.25% NaOCl for 1min
than rinse the cone with H2O2 and dry it between 2 layers of sterile gauge.
• Silver cones  passing them over bunsen flame for 3 – 4 times.
 Also sterilized by hot salt sterilizer 5 sec.
• Pyrex glass ware  can with stand high temperature can be sterilized
by autoclave or dry heat sterilization.
XIV. ADVANCES IN STERILIZATION :
Lasers : Sterilization of root canal by CO2, Nd:YAG, XeCl, Er:YAG is
being tried.
Nd:YAG is more popular because thin fiber optic delivery system is
available for entering narrow root canal.
• Sterilization time – 2 sec.
• Lasers have bactericidal effect.
MGP Gutta-percha : Medicated gutta-percha has been developed by
martin and martin.
• Iodoform is centrally located within gutta-percha and takes about 24
hours to leach to the surface.
• Iodoform inhibit microbial growth.

23. • Iodoform remains inert until it comes in contact with tissue fluids that
activates the free iodine.
REFERENCES
1. EFFICACY OF CHEMICAL STERILIATION AND STORAGE
CONDITIONS OF GUTTA PERCHA CONES.
a. ( IEJ,34;6;SEP:2001.)
2. THE STERILIZATION OF ENDODONTIC HAND FILES.
a. (JOE ;22;6;JUNE 1996.)
3. HEPATITIS B IN DENTISTRY : THE CURRENT POSITION
(BRIT.DENT,1981,150,89-91.)
CONCLUSION :
As the saying stich oin time….saves nine goes, it is better to follow
sterilization procedures and aseptic tecniques rather than to suffer from
diseases or cross infection.
“CLEANLYNESS IS NEXT TO GODLYNESS”