PREVENTION OF COMMUNICABLE
DISEASES IN DENTAL PRACTICE
INFECTION
CONTROL
STRATEGIES
Control of Microorganisms:
Dental staff are exposed to a wide variety of
infectious microorganisms.
The most important communicable diseases
of concern to dentists are:
Viral Diseases:
1. Upper respiratory tract infection.
[Link] - Rubella - Measles.
[Link] virus
[Link] virus
[Link] immunodeficiency virus (HIV)
(AIDS).
6. Swine Flu.
Bacterial Diseases:
As : Tuberculosis, syphillis, Diphteria ... etc.
Fungal Diseases: As Candida infections
I-Before patient treatment.
1- Careful medical history
2-Disposable coverings of countertops and surfaces
3-Disinfect prostheses and appliances
4-Hand scrubbing and washing
5-Protective barriers
6-Reducing spread of microorganism
II-After patient treatment
A- Preparing instruments for sterilization
A- Decontaminating Instruments With An Ultrasonic Cleanser
2- Wrapping instruments
3- Instrument transfer
B-Sterilization:
1- heat sterilization
Moist heat sterilization Dry heat sterilization
2- Cold sterilization
I-Before patient treatment.
1- Careful medical history:
Careful attention should be given to infectious
diseases as AIDS, hepatitis, T.B. syphilis, pharyngitis.
Also Special attention for high risk groups as
patients undergoing renal dialysis, patients treated
with frequent blood transfusion, drug abusers and
homosexuals.
2-Disposable coverings of countertops and
surfaces:
Impervious-backed paper, foil, or clear plastic
wrap may be used as disposable covers for the
dental unit, light switch and handles of bracket
tables, receptables for handpecies, air syringe,
control switches, saliva ejector, chair arms.
3-Disinfect prostheses and appliances
Dental prostheses and orthodontic appliances
received from the dental laboratory should be washed
with detergent, disinfected and rinsed before it is
placed in the patient's mouth.
4-Hand scrubbing and washing:
There is transient bacteria under the finger nails and
around the nails. special brush used to clean
thoroughly under the nails.
The washing should continue to all sides of the
fingers, hands, Wrists and lower arms for 6 minutes,
this is followed by the use of an antiseptic solution.
Face Shield
5-Protective barriers:
1-Face masks protect the dentist from inhalation
or ingestion of aerosols carrying bacteria and viruses.
It remove up to 99% of bacteria in dental aerosols.
N.B. viral hepatitis may become an airborne infection
during dental treatment.
2-Protective Eye-glasses:
should be worn to prevent physical injuries
(accidental dropping of an instrument or filling
materials) and infection (aerosol or splatter) of the
eyes.
3-Full Face Shield
It is plastic or Acrylic Full Face coverage used to
protect all face against physical injuries and infection.
4- Disposable gloves:
Hands should always be washed after removing the
gloves.
5-Gowns, laboratory coats, or uniforms should be
worn and should be changed daily or when visibly
soiled with blood, using hot water and laundry
detergent.
6-Reducing spread of microorganism
1- Placing Of A Rubber Dam should be used to
isolate the working area from the rest of mouth.
2- A High-Suction evacuation system. The aspirator
tip should be placed close to the working area for the
greatest efficiency.
3- Rinsing The Work Area With Water Followed
By Air rather than use of water spray to create less
splatter of blood and saliva.
4- avoiding the use of brushes for polishing and
prophylaxis. use of Rubber polishing point and
prophylaxis cups minimize the creation of droplets and
aerosols.
5-Avoid injuries from sharp instruments:
The following precautions should be followed:
*Point the sharp ends away from yourself and you’re
assistant.
*Avoid picking up sharp instruments by the handful.
*Keep fingers out of the way of rotating Instruments.
*Dispose of used needles and other sharp Items
securely.
* Never try to recap or bend disposable needles.
Sharps container with biohazard
label warning.
Reusable dental safety syringe
with disposable needle.
Disposable dental safety syringe.
Disposable scalpet with blade.
Safety scalpel with retractable blade.
Needle destroyer
Risk from needle stick injuries
• A survey conducted in Egypt revealed
that almost 70% of all HCP have been
exposed over their lifetime to needle
stick injuries.
• Studies from other countries reveal an
overall needle stick & sharps injuries
(NSSI) rate of 33 per 1000 HCP. The
highest proportion of exposures was
to nurses.
II-After patient treatment
Preparing instruments for sterilization
A- Decontaminating Instruments With An
Ultrasonic Cleanser Prior To Sterilization
It is the mechanical and chemical cleaning.
Any instrument that is to be sterilized must be
prepared by thorough immersion in a disinfecting
solution (avoid drying of organic material and trapping
germs) cleaning (washed in a soapy water, using a
brush with a handle) rinsing and drying.
N.B. 1-The disinfecting solution should be changed
every day and for every patient set.
2-The operator should wear heavy rubber gloves and
handle sharp Instruments carefully.
3-Ultrasonic cleaner can be used for mechanical
cleaning and processing prior to sterilization.
2- Wrapping instruments:
Unless an instrument will be used immediately
after sterilization it should be wrapped in a paper or
plastic bag that can withstand the condition of
sterilization.
3- Instrument transfer
To maintain a chain of asepsis in preparing the tray
for treatment, sterile supplies should be transferred to
the bracket table by means of transfer forceps rather
than with fingers (to avoid pathogenic bacteria
transmittable by the hands)
Sterilization
All items used intraoral should be sterilized
routinely using a acceptable means of sterilization.
Methods of sterilization:
It could be classified into :
1- heat sterilization
Moist heat sterilization (autoclave & chemoclve).
Dry heat sterilization (hot oven, rapid heat transfer
type and glass bead sterilization ).
2- Cold sterilization
(chemicals disinfectants, ethylene oxide gas &
gamma radiation).
The autoclave
(steam under pressure)
It is used at a temperature of 121°C and pressure of
15 to 20 psi for 15 to 20 minutes.
Advantages:
The most reliable, quick and efficient method for
sterilization of wide variety of materials.
Disadvantages:
a) can not be used for oils, greases, powders and
heat sensitive materials.
b) May rust metal instruments if precautions (use
of anti rust solutions as 1 % sodium nitrite or by
commercial oil-water antirust agent) are not taken.
c) May dull cutting edges.
2-Chemoclave
As autoclave but Use Alcohol,
formaldehyde & Ketone (chemical vapor)
instead of water at 127° C and 20 psi for 20
minutes.
3-Dry heat oven:
Used at 1600 C – 1700 C for 1-2 hour.
Advantage:
[Link] capacity
[Link] not dull cutting edges.
[Link] methods for sterilization of oils greases and
powder.
[Link] not corrode metals.
[Link] to operate.
Disadvantage:
•Requires longer time for sterilization.
•Can not be used on some heat sensitive materials.
4-Rapid heat transfer type
sterilization at 1900C for 8-15 min.
Not cause corrosion, short cycle
may cause damage soldering and heat sensitive
instruments
5- Steel balls/ Glass beads sterilization
Heating steel balls or glass beads at 210-2300C for
10-30 sec. in small chamber container contain
small steel balls & glasses pieces (useful for burs,
root canal instruments & small instruments.
Cold sterilizations
6-Ethylene oxide gas:
It is used at 60 0C for 2 - 3 hours or at room
temperature for 12 hours. Most dental supplies and
instruments can be sterilized by ethylene oxide gas.
Advantage:
a)Sterilization of hand pieces that can not be
autoclaved.
b) Sterilization of heat sensitive items.
Disadvantage:
[Link] to eye and nose.
[Link] sterilization time.
[Link] equipments.
[Link] materials must be exposed to air several
hours to rid them of the toxic gas.
7-Gammma radiation
Used In manufactures for specially for heat & moist
sensitive materials as rubber, powder,… but expensive
and need special equipments and precaution.
8-Disinfection
Many materials cannot be exposed to high heat so
should be disinfected and sterilized using chemical
disinfectant.
They may produce high and intermediate-level of
disinfection, depending on the length of immersion.
Chemical disinfectants
1-Chlorine solutions
2- Formaldehyde
3-Glutaraldehyde
4- lodophors
1-Chlorine solutions
such as sodium hypochlorite (household bleach) usually
contain 5.25 % hypochlorite solution.
It is used for disinfection of surfaces ranges from I part
bleach: 10 parts water to I part bleach : 100 parts water
depending on the degree of contamination.
A dilution of I: 10 is recommended for prosthesis.
Immersion time ranges from 10-30 min., not more
because of the instability of sodium hypochlorite.
Solution must be freshly prepared and discarded after
use.
One major disadvantage is that it is highly corrosive to
some metals.
Mechanism of action of chlorine:
When chlorine is added to water it forms hydrochloric
acid and hypochlorus acid.
Hydrochloric acid is neutralized by alkalinity of water.
Hypochlorus acid is mainly responsible for
disinfection of water.
When pH exceeds 8.5, hypochlorus acid gets ionized
into hypochlorite ions which are weak disinfectants
than hypochlorus acid.
So chlorine acts as best disinfectant when pH of water
is around seven because of high concentration of
hypochlorus acid.
2- Formaldehyde
It is a colorless, flammable gas that has a suffocating
odor.
It kills microorganisms by chemically damaging the
proteins and nucleic acid of the organism.
High level of disinfection can be obtained with 8%
solution in water or in 70% alcohol, while a 3% solution
in water gives an intermediate level of disinfection in 30
minutes.
disadvantages:
a-Suffocating odor.
b-irritating to skin, eyes, and oral and respiratory
tissues.
c-Incompatibility with some materials.
3-Glutaraldehyde
kills microorganisms by damaging their
proteins and nucleic acids.
The disinfectant comes in two containers and it is
activated when the prescribed amounts of each are
mixed.
Activated solutions have a shelf life of 14 to 30 days
to 3 years depending on the formulation.
It can disinfect in 10 minutes at room temperature and
sterilization can be achieved after 7 hours to 10 hours,
depending on the formulation.
Disadvantage:
1. Long immersion time.
2. Destruction of hepatitis virus is probable but not
proven.
3. May corrode carbon steel after 24 hours of
immersion
4. It is irritant to skin and eyes.
5. Extensive use on exposed surfaces releases irritant
gas.
4- lodophors:
These are detergents to which iodine quickly
binds and is slowly released.
Iodine produces intermediate level of
disinfection in about 10 to 30 minutes.
A convenient method is to use pads saturated
with diluted iodophor to wipe a specific area. The
liquid is allowed to dry and any residue is removed
with a pad wetted with70% alcohol.
On using a disinfectant, consider the following:
1. The heavily contaminated instruments or materials
should not be disinfected without pre-cleaning.
2. Use heavy duty gloves Protection of hands during
cleaning.
3. Use of ultrasonic cleaners is important in this
regard.
4. All surfaces should be pre-cleaned before
disinfection.
5. Not to use a solution for too long time.
6. Followed the manufacturer's instructions.
7. Disinfectants should not be mixed together with
other cleaning agents.