STERILIZATION AND

INFECTION CONTROL

[Link] YADAV
PG FIRST YEAR
DEPT OF CONSERVATIVE DENTISTRY AND
1
ENDODONTICS
Contents
1. INTRODUCTION
2. MICROBIAL EXPOSURES IN OPERATORY FIELD
3. OSHA GUIDELINES
4. UNIVERSAL PROTECTION FOR DENTISTS
5. PERSONAL BARRIER TECHNIQUE
6. CLASSIFICATION OF INSTRUMENTS
7. DECONTAMINATION CYCLE
8. METHODS OF STERILIZATION
9. DENTAL CHAIR AND WATERLINE DISINFECTION
10. FUMIGATION OF DENTAL CLINIC
11. STERILIZATION IN OPERATIVE AND ENDODONTICS
12. BIOMEDICAL WASTE MANAGEMENT
13. RECENT ADVANCES
14. CONCLUSION
15. REFERENCES
2
INTRODUCTION
1. Sepsis: The presence of pathogens in blood or other tissues.

2. Asepsis: The prevention of contact with pathogens. In dentistry it is

achieved through barrier protection, sterilization and disinfection.

3. Sterilization: Process by which an article, surface or medium is made

free off all living microorganisms either in vegetative or spore form.

4. Disinfection: Destruction or removal of all pathogenic organisms, or

organisms capable of giving rise to infection.(excluding spores)

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Decontamination: Refers to the process of
rendering an article or area free of danger from
contaminants which include microbial, chemical,
radioactive etc.,

Antiseptics: Agents that prevent the growth

or action of microorganisms on living tissues.

 Disinfectants: chemicals capable of killing

pathogenic organism when applied on inanimate
objects.
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 MICROBIAL
EXPOSURE IN
DENTAL OPERATORY

AIR-BORN INDIRECT
CONTAMINATION DIRECT CONTAMINATION
CONTAMINATION

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CROSS INFECTIONS

Cross infection and infection

control concepts has been derived
from data collected from hospitals.

 Evidence of oral or systemic cross infections

in dentistry is difficult to obtain because
patients may have contacted infections
elsewhere before or after having a dental
treatment

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 FEDERAL AND STATE REGULATIONS TO
RECDUCE EXPOSURE RISKS FROM PATHOGENS
IN BLOOD AND OTHER SOURCES OF INFECTION

 The federal occupational safety and health act (OSHA)

uses exposure control programmes to protect personnel
against risks of exposure to patient.

 The OSHA defines EXPOSURE as specific eye, mouth,

other mucous membrane, non intact skin, or parenteral
contact with blood or other potentially infectious
materials that results from performance of an
employee’s duties.

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OSHA GUIDELINES

 Employers must provide HBV immunization to employees without

charging within 10 days of employment.

 Employers must require standard precautions to be observed to prevent

contact with blood and other potentially infectious materials. Saliva is
considered a blood contaminated body fluid in relation to dental
treatments

 Employers must implement work practice precautions to minimize

splashing, spatter, or contact of bare hands with contaminated surfaces.

 Employers must be provided with facilities and instruction for washing

hands after removing gloves, and for washing other skin immediately or
as soon as feasible after contact with blood or potentially infectious
materials.
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 Employers must prohibit eating, drinking, handling
contact lenses, and application (but not wearing) of
facial cosmetics in contaminated environments such as
operatories and cleanup areas.
 Employers must prescribe safe handling of needles and
other sharp items. Needles must not be bent or cut.

• Ensure that employees correctly use and discard

personal protective equipment( PPE )or properly prepare
it for reuse. Provide adequate facilities to discard gowns
or laundry in the location where they are used

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10
 HANDWASHING:
Before any treatment the operator must wash his hands with
a suitable cleanser containing a mild antiseptic such as 3%, p-
chlorometaxylenol (PCMX) or 4% chlorhexidine gluconate.
This can control transient pathogens.

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Hand washing
technique

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 Personal barrier techniques in the
dental clinic
Since there are many sources for potential infection in the dental
office, certain protective barriers are mandatory to prevent both the
dentist and the patient from contacting infectious or hazardous
materials. These includes:
GLOVES:
• The clinician must wear gloves during all treatment procedures as there are
chances of contacting the patient’s blood, saliva or mucous membrane which
may transmit infection from the patient to the dentist.
• Fresh gloves should be used for every patient.

PROTECTIVE EYEWEAR, MASK AND HAIR PROTECTION:

• The operator must protect his eyes from spatter by wearing protective glasses
with solid side shields. These can be disinfected between patients.
• Face shields are required when there is heavy spatter such as during crown and
bridge preparation, scaling etc. 13
PROTECTIVE EYE
WEAR

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• Mouth masks are a must to protect the dentist
oral and nasal mucosa from aerosols and spatter
of blood and saliva. Rectangular mask with folds
have the highest filtration rate. Mask must be
changed when they become moist or visibly
soiled.

• The operators hair has to be kept away from the

treatment field by means of a surgical cap.

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OVERGLOVES:
 These are made up of light weight, inexpensive clear
plastic.
 They are put over treatment gloves while handling
cabinets, answering the phone, making entries in
dental chart etc so that treatment gloves are not
contaminated.

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PROTECTIVE OVER GARMENTS:

A cotton or synthetic fiber over garment worn

over the dentist cloth provides protection
against spatter from routine work.

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NEEDLE DISPOSAL

 Dispose off needles in a hard-walled, leak proof, and sealable

container, which has the OSHA biohazard label.

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NEEDLE SYRINGE
DESTROYER
 It is designed to cut the disposable syringe nozzle
& destroy the used disposable syringe.
 USE & APPLICATION: Clinical ,Hospital
 Color: White
 Material: Plastic
 Driven Type: Electric
 Warrantly: 1 year
 Type: Automatic
 Certification: ISI Certified

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 Extreme care should be taken during
recapping of needles in order to prevent
needle stick injuries.

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CLASSIFICATION OF INSTRUMENTS

Dental instruments are classified into three categories

depending on the risk of transmitting infection (CDC):

1. Critical instruments
2. Semi-critical instruments
3. Noncritical instruments

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Category Definition Example Method of
handling
Critical Instrument that Surgical Heat sterilised
enters or penetrate instruments,
into sterile tissue, forceps, burs,
cavity or blood periodontal knives
stream

Semi – Instruments that Dental hand piece, High Level

come in contact mouth mirror, disinfectant
critical with mucous plastic instruments
membrane
Heat sterilisation

Non- critical Patient care Radiograph Intermediate or

items that come head/cone, low level of
blood pressure
in contact with cuff, facebow,
disinfectant.
intact skin pulse oximeter
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 Decontamination cycle:
 Decontamination is a combination of processes,
including cleaning, disinfection, inspection, packaging,
sterilization, storage and use.

 The effective decontamination of reusable instruments

is essential in reducing the risk of transmission of
infectious agents.

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DECONTAMINATION
CYCLE

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 Procedure before sterilization
 All contaminated instruments should be soaked and then
cleaned before being sterilized.

PRESOAKING OF INSTRUMENTS
 Contaminated instruments are kept soaked in a chemical
disinfectant like glutaraldehyde or synthetic phenol for 30
min.
 This will prevent blood and saliva from drying on the
instruments thus facilitating cleaning.

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PRESTERILIZATION IN CLEANING
OF INSTRUMENTS
 After soaking the contaminated instruments for some time,
they must be thoroughly cleaned before sterilization in order
to remove gross organic debris, blood and saliva.

 Cleaning can be done by:

MANUAL CLEANERS:
Wearing protective utility gloves the instruments may be
cleaned using a hard brush with stiff bristles along with a
detergents solution or using soap and water.
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ULTRASONIC CLEANING
 The mechanical method is considered preferable as it is more
effective than manual cleaning. Washer disinfectors are more
efficient at pre-sterilization cleaning than ultrasonic cleaners. Hand
cleaning must not be used as a substitute for sterilization
procedures.
 This operates at 40̊ C and 35 KHz and is filled with detergent
solution. Instruments are kept in this bath for 5 min .

ULTRASONIC CLEANERS WASHER DISINFECTORS 27

Procedure
 Ultrasonic cleaners employ piezoelectric oscillators situated
underneath stainless steel enclosures to create oscillations in a
fluid-filled tank. The cavitation effect produces microscopic
bubbles that effectively clean in accessible areas on
instrument surfaces.

 After cleaning, the instruments are rinsed under running

water to remove any residual detergent and dried thoroughly
before sterilization.

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Inspection
 Inspection should be performed before sterilization in order to
ensure that appropriate safety levels are being maintained. These
items should be examined to ensure they are clean with no sign of
debris remaining and there is no evidence of damage.

 Sub-standard instruments should be removed from the cycle

immediately. If dirty, they should be re-cleaned. If damaged, they
should be sterilized before repair work is carried out. Alternatively,
they should be destroyed if repair is not an option .

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 Packaging
 Packaging is required for items which are to be stored for later
use. Packed items should only be processed in a vaccum
autoclave.
 Some commonly used packaging materials are: Woven textile
fabrics (muslin or linen), Non woven fabrics, Papers (crepe
paper), Plastic (spun bounded polypropylene wrappers)

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31
PHYSICAL AGENTS

Heat
 Most reliable method of sterilization.
 Killing effect of dry heat is due to protein denaturation,
oxidative damage and the toxic effect of elevated levels of
electrolytes.
 The lethal effect of moist heat is due to the denaturation and
coagulation of proteins.

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 Materials which get damaged can be sterilized at low
temperature for longer period or by repeated cycles
 It depends on different factors
 Nature of heat(moist or dry)
 Temperature and time
 Number of microorganisms present
 Organism characteristics
 Type of material from which it had to be eradicated

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 Dry Heat Sterilization

The following procedures are used for sterilization by

dry heat-

i. RED HEAT
ii. FLAMING
iii. HOT AIR OVEN

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• Red heat: Inoculating loops or wires, tip of forceps and
spatulas are held in a bunsen flame till they are red hot.

• Flaming: Glass slides, scalpels are passed through

bunsen flame without allowing them to become red hot.

• Most widely used method of dry heat sterilization.

• Dry heat is used to sterilize materials that do not get damaged
by high temperatures, and moist heat such as laboratory
glassware, burs and certain orthodontic instruments.
• Not used for sterilization of other items, which may melt or
burn.

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Dry heat sterilizers used in dentistry include static-air and
forced-air types.

The static-air type is commonly called an oven-type sterilizer.

The forced-air type is also known as a rapid heat transfer

sterilizer. Heated air is circulated through the chamber at a
high velocity, permitting more rapid transfer of energy from
the air to the instruments, thereby reducing the time needed
for sterilization compared to the oven-type sterilizer

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 Materials should be wrapped lightly in aluminium foil or
special nylon bags & arranged at least 1cm apart to allow
free circulation of heated air between the objects.

 Total time required also depends on the efficiency of the oven

for its size, the size of the load, and how instruments are
packaged.
Sterilization Temperature
Time
10-15 min 185-190

25-30 min 175-180

60-90 min 165-175
2 hrs 160-165
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USES:

 Used for the sterilization of:

 Glassware like glass syringes, petridishes, flasks

pipettes and test tubes.
 Surgical instruments like scalpels, scissors,
forceps.
 Chemicals such as liquid paraffin, fats,
sulphonamide powders.
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PRECAUTIONS

 It should not be overloaded

 The material should be arranged in a manner which
allows free circulation of air
 Materials to be sterilized should be perfectly dry
 Test tubes, flasks etc should be fitted with cotton
plugs
 Peri dishes and pippetes should be wrapped in a
paper
 Rubber materials(except silicone rubber) or any other
inflammable material should not be kept inside the oven
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 Disadvantages of dry heat
sterilization
Usually requires longer processing
times than do steam sterilization or
unsaturated chemical
vapour .Damages some plastics.
Requires careful loading. High
temperatures may prohibit use with
some materials and may melt or
destroy some metal or solder joints.
Advantages of dry heat
sterilization
Is very reliable.
Rust and corrosion are not a
problem, provided that items
are dry prior to sterilization. Is
easy to use and requires little
maintenance.
Can be readily monitored for
effectiveness.

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 Moist Heat Sterilization

 Kills microorganisms by denaturation & coagulation of proteins.

CARRIED OUT BY FOLLOWING METHODS-

1. Temperature at 100oC: Boiling

2. Temperature above 100oC: Steam under pressure: Autoclave.

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Steam Pressure Sterilization
AUTOCLAVE

Sterilization with steam under pressure is performed in a

steam autoclave.
It works on the principle that water boils when its vapour
pressure is equal to that of the surrounding pressure

For a light load of instruments, the time required at 250 oF

(121° C) is a minimum of 15 minutes at 15 lbs of pressure.

Time for wrapped instruments can be reduced to 7

minutes if the temperature is raised to approximately 273°
F (134° C) to give 30 pounds of pressure. 42
PRINICPLE OF AUTOCLAVE
 Steam above 100 degree Celsius or saturated
steam has a better killing power than dry heat
saturated steam ,It penetrates the porous
material easily. Bacterial protein coagulates
easily as they are more susceptible to moist
heat. When steam comes in contact with a
cooler surface it condenses to water and
liberates its latent heat to that surface.
Condensed water produces moist conditions for
killing the microbes present.

Steam pressure sterilizer

(Autoclave) 43
CLASS N AND CLASS B
AUTOCLAVE
 The class B autoclave is defined by a pre sterilization
vacuum cycle. The class B is considered to be the
highest class of autoclave and can be used to sterilize
all loads including solids, type A hollow instruments,
type B hollow instruments porous loads and wrapped
instruments
 Post sterilization vacuum drying ensures complete
drying of all loads after the sterilization process is
complete.
 In N autoclaves do not feature a vacuum cycle and are
suitable for sterilizing unwrapped solid instruments
and liquids

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STERLIZATION CYCLE FOR AUTOCLAVE

 Both high and low-speed handpieces are best autoclaved.

 Stainless steel instruments and mirrors used for operative, endodontic, or dental
hygiene procedures can be sterilized.

 Towels and towel packs of instruments needed for surgery are best sterilized by
autoclaving.

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 Disadvantages of steam heat
sterilization

May cause rust and corrosion

(corrosion inhibitors such as
sodium nitrite are available
that may reduce this problem).
May damage plastics.
May blunt certain sharp items.
Advantages of steam
sterilization
Is quick and easy to use.
Allows loads to be packed,
making it easier to maintain
items in a sterile state.
Penetrates fabric and paper
wrappings.
Can be readily monitored for
effectiveness.

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Chemical vapour pressure Sterilization
(chemiclaving).

 Sterilizationby chemical vapour under pressure is

performed in a chemiclave.

A Chemiclave chemical vapour sterilizer uses a

solution of 72% ethanol and 0.23% formaldehyde in
place of water in its autoclave.

 Chemical vapour pressure sterilizers operate at 270° F

(131° C) at 20 pounds of pressure for 20 minutes. 47
 They are similar to steam sterilizers and have a cycle time
of approximately half an hour.

Procedure
 When the solution is heated under pressure it forms a gas
that sterilizes instruments. The chemical vapours kills
microorganisms by destroying vital protein systems.
 Instruments are packed in paper, muslin or steam-
permeable plastic. The sterilizer must be pre heated before
use.

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 Requires good ventilation owing to
fumes. Won't penetrate fabric-
wrapped packs. Damages some
plastics.
Requires replacement of special
solution, increasing cost.
Requires hazardous waste disposal of
the sterilizing solution.
Advantages of chemical
Items sensitive to thevapour
elevated
sterilization
temperature will be damaged.
Is relatively quick.
.
Does not rust or corrode metal items.
Carbon steel and other corrosion-
sensitive burs, instruments, and pliers
are sterilized without rust or corrosion
.
Can be used with packaged items
(paper packaging only).
Can be monitored for effectiveness.
49
 FILTRATION

 It is useful for substances which get damaged by heat

process examples: serum , sugars ,antibiotic solutions.

 As viruses pass through ordinary filters, filtration can be

used to obtain bacteria free filtrates of chemical samples for
viruses isolation.

 Bacterial toxins can be obtained by passing cultures through

filters.

50
TYPES OF FILTERS

 CANDLE FILTERS-These are

manufactured in different grades of
porosity and have been used widely for
purification of water for industrial and
drinking purposes

 ASBESTOS FILTERS-disposable, single

use discs. They have high absorbing
capacity and tends to alkalinize filtered
liquids . Carcinogenic potential of
asbestos have discouraged their use

51
 SINTERED GLASS FILTERS- Prepared by
heat fusing finely powdered glass
particles of graded sizes. They have low
absorptive property and can be cleaned
easily but are brittle and expensive

 MEMBERANE FILTERS- Made up of

cellulose esters or other polymers have
largely replaced other types of filters .
They are routinely used in water
purification and analysis , sterilization
and sterility testing and for the
preparation of solutions for parenteral
use

52
 ETHYLENE OXIDE
STERILIZATION:

 This method uses automatic devices filled with ethylene

oxide gas at temperatures below 100̊c to sterilize
complex and delicate materials.

 Ethylene oxide is highly penetrable and kills

microorganisms by chemically reacting with nucleic
acids. The sterilization cycle takes several hours and
once over, aeration for 24 hours or more is needed
before the instruments can be used.
53
 It has a potential toxicity to human beings , including
mutagenicity and carcinogenicity. It is highly inflammable.

 It is specially used for sterilizing plastic and rubber

articles, heart lung machines, sutures , dental equipments
and clothing.

 Commercially used for sterilization disposable syringes

and other disposable items.

 It is unsuitable for fumigation of rooms as it is explosive in

nature .

54
ADVANTAGES

 Most gentle for sensitive equipments like handpieces.

 Operate effectively at low temperature.

DISADVANTAGES

 High cost.
 Prolonged time.
 Best for hospitals, not practical for dental clinics.
 Ethylene oxide gas is potentially mutagenic and carcinogenic.

55
Instruments Methods of sterilization

[Link] steel [Link]

instruments

[Link] [Link]
instruments

[Link] hand- [Link]

piece
[Link] heat oven or chemiclave
[Link] steel
instruments [Link] heat oven or chemiclave

[Link] burs
and adhesive

56
 Irradiation
 Gamma rays are used to sterilize suture materials, syringes,
disposable needles and other heat sensitive items.

 Ultra-voilet light is used to purify the air in the dental

operatory but it is not effective against HIV and bacterial
spores. Its limitations are poor penetration of oil and
incomplete exposure of all surfaces.

 Ultraviolet chambers are used for storage of sterilized

instruments.

57
 Chemical Sterilization
Instruments and other items can be
sterilized by soaking in a chemical
solution followed by rinsing in sterile
water.
The immersion time to achieve
sterilization or sporicidal activity is
specific for each type of chemical
steriliant.
The chemical sterilants must only be
used according to manufacturer's
instructions and for those applications
indicated on their label. Misapplications
include use as an environmental surface
disinfectant or instrument holding
solution. 58
Chemical Agents:
 Alcohols: Ethyl (50-80%) & isopropyl alcohol
 Aldehydes: formaldehyde & glutaraldehyde
 Phenols: chloroxylenol
 Surface-active agents- Quaternary ammonium
compounds
 Halogens- chlorine & iodine

59
 ALCOHOL
Ethyl alcohol and isopropyl alcohol are the
most frequently used.
They act by denaturing bacterial proteins.
They rapidly kill bacteria including
Tubercle bacilli but they have no sporicidal
or virucidal activity.
They are used mainly as skin antiseptics.
To be effective , they should be used at a
concentration of 60-70% in water.

Methyl alcohol is effective

against fungal spores and is USES: Alcohols are not
used for treating cabinets recommended for
affected by them. sterilizing medical and
surgical materials
Microbicidal activity: principally because they
Methyl alcohol (methanol) lack sporicidal action and
has the weakest they cannot penetrate
bactericidal action of the protein-rich materials.
alcohols and thus seldom
used in healthcare.
60
ALDEHYDE

Formaldehyde
Formaldehyde is used as
a disinfectant and
steriliant in both its liquid
and gaseous states. Uses:
10% aqueous solution is Preservation of tissue for
a bactericide, histological examination.
tuberculocide, fungicide, To sterilise bacterial
virucide and sporicide. vaccines.
To prepare toxoid from
toxin.
For killing of bacterial
cultures and suspensions. 61
 GLUTRALDEHYDE

It is specially effective against

[Link], fungi, and viruses.
It is less toxic and irritant to the eyes
and skin than formaldehyde.
It is used as 2% buffered solution.
It is available commercially as cidex.
It can be used for delicate instruments
having lenses.

For sterilisation of
cystoscopes,
To sterilise plastic endoscopes and
endotracheal tubes, bronchoscope.
face masks,
corrugated rubber
anaesthetic tubes and
metal instruments.
62
 PHENOLS
 Phenols are produced by distillation of coal-tar between
temperatures of 170 ̊C and 270 C .
 The lethal effect of phenols is due to cell membrane damage,
thus releasing cell contents and causing lysis.
 Phenol (1%) has bacteridical action.
 Certain phenol derivatives like cresol, chloroxylenol(principal
ingredient in Dettol) and hexachlorophene are commonly used
as antiseptics.

63
HALOGENS

 Chlorine and iodine are two commonly used disinfectants.

 Chlorine is used in water supplies, swimming pools, food and

dairy industries.

 Chlorine compounds in the form of bleaching powder, sodium

hypochlorite are used.

 The disinfection action of all the chlorine compounds is due to

release of free chlorine.

64
 When hypochlorite is added to water, the chlorine reacts with
water to form hypochlorous acid which is a strong oxidising
agent and effective disinfectant.

 Bleaching powder or hypochlorite solution is the most widely

used disinfectant for human immunodeficiency virus (HIV)
infected material.

 The hypochlorites have a bactericidal, fungicidal, virucidal

and sporicidal action.

65
 Iodine in alcoholic and aqueous solutions is used as a skin
disinfectant. It is actively bactericidal with moderate action
against spores.

 It is active against [Link] and viruses.

 Compounds of iodine with surface active agents known as

iodophores are claimed to be more active than the aqueous
or alcoholic solutions of iodine.

 Betadine is one example of commonly used iodophores.

66
Monitoring sterilization

 There are 2 methods of verifying sterilization:

 Process indicators.
 Biological indicators.

 1) PROCESS INDICATORS
 This are strips, tapes or paper marked with
special ink that changes colour on exposure to
heat, steam or chemical vapour when the
specific time, temperature and pressure is
reached. However, they do not guarantee
complete sterilization.

67
2) BIOLOGICAL INDICATORS

 These are non-pathogenic bacterial spores

attached to a paper strip within a
biologically protected packets. If the
sterilization method destroy spores then it is
effective against all other organisms.

 After sterilization, the spores strip is

cultured for a specific time. If there is no
growth then the sterilization is successful.

 The organism used are spores of Bacillus

stearothermophilus or Bacillus subtilis.

 Biological indicators are the most accurate

test for verifying sterilizer efficacy. Periodic
biological monitoring is recommended to
check sterilizer functioning.
68
 LOW –TEMPERATURE
STERILIZATION
Ethylene oxide (ETO)
ETO has been widely used as a low-
temperature steriliant since the 1950s.

Two types of ETO sterilizers are available,

Mixed gas and 100% ETO.

The microbicidal activity of ETO is

considered to be the result of alkylation of
protein, DNA, and RNA.

69
Advantages:
It can sterilize heat or moisture-sensitive medical equipment
without deleterious effects on the material used in the medical
devices.

Disadvantages:
lengthy cycle time, the cost, and its potential hazards to patients
and staff.

Uses:
ETO is used in healthcare facilities to sterilize critical items
(and sometimes semicritical items) that are moisture or heat
sensitive and cannot be sterilized by steam sterilization. 70
 LOW TEMPERATURE PLASMA STERILIZER

 The production of free radicals within a plasma field are

capable of interacting with essential cell components (e.g.,
enzymes, nucleic acids) and thereby disrupt the metabolism of
microorganisms.

 This process has the ability to inactivate a broad range of

microorganisms, including resistant bacterial spores.

Uses:
 Materials and devices that cannot tolerate high temperatures
and humidity, such as some plastics, and corrosion-susceptible
metal alloys, can be sterilized by hydrogen peroxide gas plasma. 71
Dental chair and
water line
contamination and
biofilm & disinfection

72
73
 Dental water

line
Dental unit water lines may be contaminated by biofilms.
Biofilms is the colonization and proliferation of microorganisms on
surfaces bathed by fluids.

Disinfectants such as iodophor as or diluted sodium hypochlorite is used to

clean the system must be flushed out on the system with clean, boiled, or
sterile water before use. Handpiece should always be removed before
disinfecting the system with 0.5% NaOCl2 as it would damage the high
speed hand piece and other metal products

Filters and anti-retraction valves may be installed in the waterline as close

as possible to the point of use. They can prevent the retraction of fluids
back into the tubing.

Use of sterile water delivery systems can also reduce the risk of
transferring potentially infective organisms
74
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81
Sterilization in operative
and endodontics
Sterilization of hand piece

The internal surfaces of handpieces become

contaminated with blood and debris, but
limited access to internal surfaces limits its
cleaning & disinfection thus, surface
disinfection is not adequate. Hand piece must
be first cleaned and then sterilize after each
patient cleaning can be done by using water
and detergent or wiping the handpiece using a
suitable disinfectant like alcohol. Lubricate the
handpiece prior to sterilization.
82
Sterilization of dental burs

 Burs can be protected by keeping them submerged in a small

amount of 2% sodium nitrite solution

 Prepare fresh sodium nitrite solution by adding 20grams of crystal

to 1 litre of water and place it in a perforated beaker containing
burs

 After ultrasonic cleaning, burs are rinsed and placed into any
small metal or glass beaker with a perforated lid and filled with
sufficient fresh nitrite solution, then placed in the sterilizer and
operated at normal sterilization cycle.

83
 Sterilization of endodontic instruments
Glass bead sterilizer
It consists of hot salt or glass beads as a medium for dry heat sterilization.
The temperature range employed is between 425 degree Fahrenheit and
475 degree Fahrenheit. However these are no longer in use

Proper steam autoclaving reliably produced completely sterile instruments

Salt sterilization and glutaraldehyde solutions may not be adequate

sterilization methods for endodontic hand files and should not be relied on
to provide completely sterile instruments

Files sterilized by autoclave and lasers were completely sterile. Those

sterilized by glass bead were 90% sterile and those with glutaraldehyde
were 80% sterile

84
Individual instruments can be
sterilized in the following ways
 Glass slab by swabbing with tincture of thimerosal,
followed by a double cleaning with alcohol
 Gutta percha cones may be kept in sterile screw
capped vials containing alcohol
 to sterilize gutta percha cone freshly removed from
the box immerse in 5.2% sodium hypochlorite
for 1 minute then rinse with hydrogen peroxide
and dry between 2 layers of sterile gauze.
 Silver cones are sterilized by passing them
through a flame 3-4 times or by immersion in hot
salt sterilizer for 5 seconds

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 Rubber dam clamps, frame, forecep are sterilized by
autoclave and punches are sterilized by hot air oven

 Carbon steel instruments and burs are best sterilized by dry

heat or chemiclave

 Sterilization dental cements, calcium sulphate is done by

“WHATEVER IS TOUCHED IS CONTAMINATED”

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Disposal of waste
 All clinical waste materials like contaminated disposables
(masks , gloves) blood/saliva-soaked cotton rolls etc. must be
carefully discarded in sealed plastic bags to minimize human
contact

 Sharp items like needle, scalpel blades etc must be stored in

puncture-resistant container before disposal in plastic bags.

 Local environmental protection or control agencies regulate

the disposal of blood contaminated wastes.

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RECENT ADVANCES:

 OZONE

 HYDROGEN PEROXIDE PLASMA

 HYDROCLAVE

 SUPER OXIDISED WATER

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Ozone
 Sterilization process, which uses ozone as the sterilant, for
processing reusable medical devices.

 Duration of the sterilization cycle is about 4 h and 15 m, at

30-35oC.

 Ozone is generated within the sterilizer using only oxygen

and water. On completion of the sterilization cycle, ozone is
exhausted through a catalytic converter where it is
converted back into the raw materials of oxygen and water.
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 Ozone is produced when O2 is energized and split into two
monatomic (O) molecules. The monoatomic oxygen molecules
then collide with O2 molecules to form ozone, which is O3.

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Advantages:
 No handling of the steriliant,
 No toxic emissions,
 No residue to aerate,
 Low operating temperature means there is no danger of an
accidental burn.

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Hydrogen Peroxide Gas Plasma.

 This process inactivates microorganisms primarily by the

combined use of hydrogen peroxide gas and the generation of free
radicals (hydroxyl and hydroperoxyl free radicals) during the
plasma phase of the cycle.

 Gas plasmas are generated in an enclosed chamber under deep

vacuum using radio frequency or microwave energy to excite the
gas molecules and produce charged particles, many of which are
in the form of free radicals.

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 HYDROCLAVE

 Newer regulations (Environmental and

Medical Waste Regulations) require a
non-incineration technology, which is easy
and safe to operate & has no harmful
emissions & also sterilizes at low cost.

 Hydroclave offers a remarkably simple,

affordable, patented, proven
medical/Infectious waste treatment
process which achieves the highest waste
sterility, at an incredibly low treatment
cost.

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 Hydroclave Autoclave

 Low operating cost by  Higher operating cost,

recycling steam. no steam recycling.

 No special bags  High temp/ bags

required. required.

 Treats wet or liquid loads  Cannot treat wet or

easily. liquid loads .

 Consistent high sterility  Spotty sterility

SUPEROXIDIZED WATER:

 Concept of electrolyzing saline to create a disinfectant or

antiseptics, The main products of this water are hypochlorous acid
and chlorine.

 The antimicrobial activity of superoxidized water is strongly

affected by the concentration of the active ingredient (available
free chlorine).

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 Super-oxidized water indicated a
remarkable and similar bactericidal effect
to that of traditional NaOCl against E.
faecalis biofilms. In terms of successful
endodontic treatment approaches, super-
oxidized water may be used as an effective
irrigation solution in clinics.

Zan R, Alacam T, Hubbezoglu I, Tunc T, Sumer Z, Alici

O. Antibacterial Efficacy of Super-Oxidized Water
on Enterococcus faecalis Biofilms in Root Canal. 99
Jundishapur J Microbiol. 2016 Aug 31;9(9):e30000.
U V CHAMBER
 It is used to store sterilized dental instruments thus, it eliminates
the possibility of surface deterioration
 Ultraviolet germicidal irradiation is a disinfection method that
uses short wavelength ultraviolet(UV C) light to kill or inactivate
micro-organisms by destroying nucleic acids and disrupting their
DNA, leaving them unable to perform vital cellular functions
 U v chamber is rust proof made up of stainless steel bright mirror
finish sheet which reflects UV rays to pass uniformly through
entire work surface area within the cabinet
 Magnetic gasket seals the chamber and door switch interlocks
immediately cut out the UV source when the door is opened,
preventing accidental UV exposure

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CONCLUSION:

 Knowing and understanding the

scientific basis, principles and various
sterilization methods and their proper
applications, as well as the monitoring
and record keeping requirements can
help Health professional to ensure
effective sterilization, patient safety, and
cost-effectiveness.
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REFERENCES:
 Sturdvent’s art and science of operative
dentistry (5th edition)

 Ananthanarayan and paniker's textbook of

microbiology (7th edition)

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THANK YOU

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