The document discusses infection control in dentistry. It begins by explaining why infection control is important given that the oral cavity harbors many bacteria and viruses. It then outlines the contents which will be covered, including transmission of infections, the chain of infection, standard precautions, immunizations, sterilization, disinfection, and waste management. The introduction provides more context around the oral cavity environment and a dentist's duty to protect patients and staff from cross-infection. The document goes on to discuss various aspects of infection control in dentistry in detail, such as questions to consider, the chain of infection, standard precautions like hand hygiene and personal protective equipment, sterilization methods including steam and radiation, and disinfection

1. INFECTION CONTROL IN
DENTISTRY
Dr.Anirudh Singh Chauhan
PG 1st year
Department of Periodontics
JAIPUR DENTAL COLLEGE

2. WHY INFECTION CONTROL ??

3. CONTENTS
• INTRODUCTION
• QUESTIONS TO THINK ABOUT….
• TRANSMISSION OF INFECTIONS
• CHAIN OF INFECTION
• STANDARD PRECAUTIONS
• IMMUNIZATION FOR DENTAL PROFESSIONALS
• PROTECTION OF THE DENTIST
• STERILIZATION
• DISINFECTION OF DENTAL SETUP
• DENTAL WASTE MANAGEMENT
• CONCLUSION

4. INTRODUCTION
• The oral cavity is an environment in itself which provides
a nutritive medium for bacterial growth. The mouth
harbors bacteria and viruses from the nose, throat and
respiratory tract as well.
• Any dental procedure that has the potential to aerosolize
saliva will cause airborne contamination with organisms
from some or all of these sources.
• Dentists have a duty to take appropriate precautions to
protect their patients , their staff and more importantly
THEMSELVES from the risk of cross-infection.

5. HISTORY
• Zaccharias Jansen in 1590 and Robert Hooke in 1660 opened
the world of microbes to mankind by their inventions of
microscopes
• It was Anthony Van Levenhook who first described
microorganisms
• Joseph Lister between 1865 to 1891 delineated the
principles of wound infection and asepsis
• Further pioneering efforts of Louis Pastuer added new
dimensions to the field of sterilisation

6. • Input by various researchers like John Tyndall, Robert Koch
etc further accelerated the progress, when finally in 1890’s
the advent of steam sterilizers, sterile gowns, drapes and
gloves emerged
• The modern infection control prevention and sterilization
guidelines were stated by the CDC (Centre for Disease
Control) in 1973 and specific dental infection control
guidelines by the ADA and OSHA in 1978 revised in 1985 and
1988

7. Thus infection control involves-
1. Reduction of pathogen concentration to allow normal host
resistant mechanisms to prevent infection
2. Break the cycle of infection and eliminate cross infection
3. Treat every patient and instrument as potentially
infectious and therefore employ universal safety
precautions
4. Protect patients and personnel from occupational
infection

8. Questions to think about…..
• How can you “break the chain” of infection in your office
today?
• Are there areas of your daily practice where cross-
contamination could be happening?
• How can you make changes that will prevent cross-
contamination in your daily practice?

9. What factors influence the development of
infection?
• The number of microorganisms and
duration of exposure (how many and for how long?)
• Virulence of organisms (ability to cause disease;
pathogenic properties)
• Immune status of the host (body defenses)

10. • The goal of an infection control program
is to “break the chain” of infection by
consistently practicing protocols which
would prevent the infectious agent from
moving to one host to another and
preventing cross-contamination.
**Application to Practice**

11. How are diseases transmitted in
the dental setting?
 From the patient to the dental worker
 From the dental worker to the patient
 From one patient to another
 From the dental office to the community

12. Transmission can be…
1) Direct Contact with blood, oral fluids, or other
patient materials;
2) Indirect Contact with contaminated objects
(e.g., instruments, equipment, or environmental
surfaces);
3) Droplets - (e.g., by coughing, sneezing or talking)
4) inhalation of airborne microorganisms that can
remain suspended in the air for long periods

13. The Infectious Process
“Chain of Infection”
Infectious agent
Port of Exit
Transmission
Port of Entry
Susceptible host
Reservoir

14. The chain of infection example
Hepatitis B
The bloodstream
Bleeding wound
Direct via needle stick
Puncture wound
Unvaccinated
Dental worker
Infectious agent
Port of Exit
Transmission
Port of Entry
Susceptible host
Reservoir

15. STANDARD PRECAUTIONS
• Standard precautions integrate and expand the elements of
universal precautions into a standard of care designed to
protect HCP and patients from pathogens that can be spread
by blood or any other body fluid, excretion, or secretion
Centre for Disease Control and
Prevention, USA
1996

17. IMMUNIZATION FOR DENTAL
PROFESSIONALS
• Dental Professionals are at very high risk of acquiring
infection through CROSS CONTIMINATION in a dental setup
during dental procedures.
• Thus there is a need for
Dental professionals to get the
Vaccinations done on time.

18. WHY SHOULD PATIENT HAVE ALL THE
NEEDLES !!!

19. Preventing Blood borne Transmission
of Pathogens
A. HBV VACCINATION
• We all MUST get HBV vaccination series as we have the
potential occupational exposure to blood or other potentially
infectious material

20. Hepatitis B Vaccine
• PRE-EXPOSURE
Hepatitis B (HB) recombinant vaccine – 2 doses
IM, 4 weeks apart and the third dose should be
administered 5 months after the second dose. Booster
doses not necessary.
• POST-EXPOSURE
Hepatitis B immuno globulin (HBIG) – 0.06mL/kg
IM as soon as possible after the exposure. A second dose
of HBIG should be administered if the HB vaccine series
has not been started.

21. Other Recommended Vaccines…
• Flu (Influenza) – to be taken annually
• MMR (Measles, Mumps & Rubella) – 2 doses with a gap of
28 days
• Varicella (Chicken pox) – 2 doses, 1 month apart (if u have not
had chicken pox or vaccinated earlier)
• Tdap (Tetanus, Diphtheria, Pertusis) – one time dose and
booster dose every 10 years (Pregnant HCWs need to get a dose of
Tdap during each pregnancy)
Advisory committee for Immunization Practices
(ACIP) 2011

22. HAND HYGIENE

23. Hand hygiene is a general term applying to processes aiming
to reduce the number of microorganisms on hands.

24. • This includes either the application
– Alcohol-based hand rub (ABHR)
– The use of soap/solution (plain or antimicrobial)
– Water, followed by patting dry with single use
towels.

25. HAND CARE
• Hands must be well cared for, because intact skin is a first line
defense mechanism against infection.
• Lacerated, chafed or cracked skin can allow entry of
microorganisms, any cuts or open wounds need to be covered
with a waterproof dressing.

26. • All hand & wrist jewellery should be removed prior to
putting on gloves as its presence compromises the fit and
integrity of gloves and also promotes significant growth of
skin microorganisms.
• All fingernails must be kept short to prevent glove tears and to
allow thorough cleaning of the hands.

27. PERSONAL PROTECTIVE
EQUIPMENT

28. • The wearing of protective personal clothing and equipment
where aerosols are likely to be generated is an important way
to reduce the risk of transmission of infectious agents.
• Barrier protection including gloves, mask, eyewear and gown
must be removed before leaving the work area (e.g. dental
surgery, instrument processing or laboratory areas).

29. GLOVES
• Dental practitioners and clinical support staff must wear
gloves whenever there is risk of exposure to blood, saliva or
other body secretions or when hands will come in contact
with mucous membranes.
• Wearing gloves does not replace the need for hand hygiene
because hands may still become contaminated.

30. • Gloves must be removed or overgloves worn before touching
any environmental surface without a barrier or before
accessing clean areas.
• If the dental practitioner, clinical support staff member or
patient has a proven or suspected allergy to latex, alternatives
such as neoprene or nitrile gloves must be used.

31. MASKS
• In the dental surgery environment, the most common causes
of airborne aerosols are the high speed air rotor handpiece,
the ultrasonic scaler and the triplex syringe.
• The aerosols produced may be
contaminated with bacteria and fungi from
the oral cavity (from saliva and dental
biofilms), as well as viruses from the
patient’s blood.

32. • Because masks protect the mucous membranes of the nose
and mouth, they must be worn wherever there is a potential
for splashing, splattering or spraying of blood, saliva or body
substances, or where there is a probability of the inhalation of
aerosols with a potential for transmission of airborne
pathogens.
• The filtration abilities of a mask begin to
decline with moisture on the inner and outer
surfaces of the mask after approximately 20
minutes.

33. • MASKS MUST - cover both the nose and
mouth, and where possible be folded out fully
to cover the chin and upper neck; and be
removed by touching the strings and loops only
MASKS MUST NOT - be worn
loosely around the neck while the dental
practitioner or clinical support staff
member walks around the premises, but
be removed and discarded as soon as
possible after use.

34. EYE PROTECTION
• Dental practitioners and clinical support staff must wear
protective eyewear where there is the potential for
penetrating injury or exposure to aerosols, splattering or
spraying with blood, saliva or body substances.
• Protection from projectiles is
particularly important during scaling,
when using rotary instruments,
when cutting wires and when
cleaning instruments and equipment.

35. • Eyewear must be optically clear, anti-fog, distortion-free,
close-fitting and should be shielded at the sides.
• All patients must be offered protective eyewear. If patients
refuse to wear the protective glasses, the risks should be
explained and the refusal noted in their dental records.
• With regard to cleaning, eyewear for
patients may be either single use or
can be reused after cleaning with
detergent and water.

36. PROTECTIVE CLOTHING
• Protective clothing (e.g. reusable or disposable gown,
laboratory coat or uniform) should be worn while treating
patients when aerosols or splatter are likely to be generated
or when contamination with blood or saliva is possible.
• Items of protective clothing must be changed as soon as
possible when they become visibly soiled or after repeated
exposure to contaminated aerosols.

37. FOOTWEAR
• Dental practitioners and clinical support staff should wear
enclosed footwear that will protect them from injury or
contact with sharp objects (e.g. accidentally dropped sharps
or spilt chemicals).

38. PATIENT PREPARATION
• Betadine preparation of patient before any
surgical procedure to be performed.

39. • PRERINSE- Rinsing of mouth with 0.2%
Chlorhexidine prior to treatment reduces the
aerosols contents in the oral cavity.

40. STERILIZATION
• PHYSICAL
• CHEMICAL

41. • Physical is classified into
1. Sunlight
2. Drying
3. Dry heat : FLAMING, INCINERATION, HOT AIR
4. Moist heat : PASTEURATION, BOILING, STEAM UNDER
NORMALPRESSURE, STEAM UNDER PRESSURE
5. Filtration : CANDLES, ASBESTOS PAD, MEMBRANES
6. Radiation : MICROWAVE, X-RAYS, UV Rays
7. Ultrasonic and sonic vibrations

42. 1. ALCOHOLS: ETHYL, ISOPROPYL, TRICHLOROBUTANAL
2. ALDEHYDES: FORMALDEHYDE, GLUTERALDEHYDE
3. DYES
4. HALOGENS
5. PHENOLS
6. SURFACE ACTIVE AGENTS
7. METALLIC SALTS
8. GASES: ETHYLENE OXIDE, FORMALDEHYDE, BETAPROPIOLACTONE
9. HYDROGEN PEROXIDE PLASMA / VAPORS
Chemical is classified into :

43. A. Open flaming:
B. Hot air oven
The temperature cycles for dry heat sterilization are as
follows: Temprature Time
121˚ C 6-12 hours
140˚ C 3 hours
150˚ C 2 & ½ hours
160˚ C 2 hours
170˚C 1 hour
190˚- 204˚ C 15 minutes

44. C.GLASS BEAD AND HOT SALT STERILISER
• The glass bead sterilizer uses a metal cup with glass beads of
1 mm diameter in it
• The hot salt container uses ordinary table salt
• The temperature range for both varies from 425oF TO 475oF
• Both are used to sterilize endodontic instruments and scaler
tips.
• The hot salt sterilizer is better than the glass bead sterilizer
because the glass beads stick to the instruments and clog
the root canal.
• Also the material used in the hot salt sterilizer is ordinary
table salt which is readily available

45. Electric glass bead steriliser

46. D. Steam under pressure
• Moist heat in the form of pressurized steam is regarded as
the most dependable method for destruction of all forms of
bacterial life including spores.
• This method is incorporated into a device called the
AUTOCLAVE.
• Over a hundred years ago, French & German microbiologists
developed the autoclave.
• The basic principle is that when the pressure of a gas
increases the temperature increases

47. • As the water molecules in steam become more energized,
their penetration also increases
• Same principle is used in home
pressure cooker.
• It is important to note that sterilizing
agent is moist heat not the pressure.
• Pressure Temp. Time
15 psi 121 C 20 min.
20 psi 134 C 3 – 5 min.
(Flash method)

48. E. Autoclave

49. Radiation
• Visible light is a type of radiant energy detected by the
sensitive cells of eye. Wavelength is 400-800 nm.
• Radiation may have sufficient energy to remove an electron
completely from an atom and produce an electrical change
(ionization), or to raise electron to high energy state
(excitation).

50. NON IONISING RADIATION
• This include infrared rays and ultraviolet rays
• Infra red are used for mass sterilization of syringes

51. ULTRAVIOLET LIGHT
• Ultraviolet germicidal radiation (UVGI) is a disinfection method
that uses ultraviolet (UV) light at sufficiently short wavelength
to kill microorganisms
• UV light is used to limit airborne or surface contamination in a
hospital room, pharmacy food service operation.
• UV light does not penetrate liquids or solids and it may cause
damage to the human skin.
• used primarily in medical sanitation
and sterile work facilities

52. IONIZING RADIATION
• X-rays and gamma rays have wave length shorter than UV
light
• Can be used for syringe sterilization, suture materials,
dressing materials etc.

53. MICROWAVE
• Microwaves have a wavelength longer than UV light.
• In a microwave oven waves are absorbed by water
molecules.
• The molecules are set into a high speed motion, and the
heat of friction is transmitted , which become hot rapidly.

54. LASER
• LASER – Light Amplification by Stimulated Emission of
Radiation
• Recent experiments indicate that laser beams can be used to
sterilize instruments & the air in operating rooms, as well as
for a wound surface.
• Various types include CO2 , Argon ,Nd-YAG etc

55. Ultrasonic vibrations
• They are high frequency sound waves beyond the range of human
ear.
• When propagated in fluids ultrasonic vibrations cause formation of
microscopic bubbles or cavities and the water appears to boil.
• Some observers call this cold boiling.
• The cavities rapidly collapse & send out shock waves. The formation
and implosion of the cavities is known as cavitation.
Microorganisms in the fluid are quickly disintegrated by the external
pressures.
• The current trend is to use ultrasonic as a cleaning agent to follow
the process by sterilization in an autoclave.

57. FUMIGATION
• The operating room is fumigated with the help of 40%
formaldehyde (350 ml) added with KMnO4 (174 Gms) for a
room measuring 1000 cubic Ft.
• This mixture produces an exothermic reaction and should be
kept in a stainless steel bowl in the Operatory Room
• The fumes rapidly spread in the OR and kill the
microorganisms.
• The OR should be closed in an air tight manner and sealed to
prevent leakage of fumes.
• Fumigation is done weekly and gates should be kept closed for
24 hours

58. DISINFECTION OF DENTAL UNIT AND
ENVIRONMENTAL SURFACES

59. DENTAL UNIT
•Cleaned by DISPOSABLE TOWELING
•EPA-ENVIRONMENTAL PROTECTIVE AGENCY
•use an EPA registered hospital disinfectant
•Cleaning Agents Like
PHENOLICS, IODOPHORS, CHLORINE CONTAINING compounds

60. ENVIRONMENTAL SURFACES
• CLINICAL CONTACT SURFACES
–High potential for DIRECT
CONTAMINATION from spray or spatter or
by contact with gloved hand.
• HOUSEKEEPING SURFACES
–Do not come into contact with patients or
devices
–LIMITED RISK of disease transmission

61. CLINICAL CONTACT
SURFACES

62. CLEANING CLINICAL CONTACT
SURFACES
• Risk of transmitting infections greater than for
housekeeping surfaces.
• Surface barriers can be used and changed
between patients.
OR
• Clean then disinfect using an EPA-registered low-
(HIV/HBV claim) to intermediate-level
(tuberculocidal claim) hospital disinfectant.

63. HOUSEKEEPING SURFACES

64. Cleaning Housekeeping Surfaces
• Routinely clean with SOAP AND WATER or an EPA-
REGISTERED DETERGENT/HOSPITAL DISINFECTANT
routinely
• Clean MOPS AND CLOTHS and allow to dry thoroughly before
re-using.
• Prepare FRESH CLEANING AND DISINFECTING
SOLUTIONS daily and per manufacturer recommendations.

65. DISINFECTION AND THE DENTAL
LABORATORY

66. BASICS OF LABORATORY
• Need COORDINATION between DENTAL OFFICE
AND LAB
• Use of proper methods/materials for handling
and decontaminating soiled incoming items
• All contaminated INCOMING ITEMS should be
cleaned and DISINFECTED before being
HANDLED BY LAB PERSONNEL, and before
being returned to the patient

67. • Rinse under running tap
water to remove blood/saliva
• Disinfect as appropriate
• Rinse thoroughly with tap
water to remove residual
disinfectant
• No single disinfectant is ideal
or compatible with all items
INCOMING ITEMS

68. OUTGOING ITEMS
• Clean and disinfect before delivery
to patient
• After disinfection: rinse and place
in plastic bag with diluted
mouthwash until insertion
• Do not store in disinfectant before
insertion
• Label the plastic bag: “This case
shipment has been disinfected
with ______ for _____ minutes”

69. MANAGEMENT OF MEDICAL WASTE
‘Bio-medical waste’ means any solid and/or liquid
waste, including its container and any intermediate
product, which is generated during the diagnosis,
treatment or immunization of human beings or
animals or in research

71. • Inappropriate handling of sharps, both during and after
treatment, is the major cause of penetrating injuries which
involve potential exposure to blood borne diseases in the
dental surgery.
• Sharp instruments such as scalpels and scalers must never be
passed by hand between dental staff members and must be
placed in a puncture-resistant tray or bowl after each use.

72. • Do not recap used needles by using both hands or any other
technique that involves directing the point of a needle toward
any part of the body.
• Use either a one-handed scoop technique or a mechanical
device designed for holding the needle cap when recapping
needles

73. MANAGEMENT OF DENTAL WASTE

74. • Use a color-coded or labeled container that prevents leakage
(e.g., biohazard bag) to contain non sharp regulated medical
waste.
• Used disposable needle syringe combinations, empty or
partially used cartridges of local anaesthetic solution, burs,
needles, scalpel blades, orthodontic bands, endodontic files
and other single use sharp items must be discarded in clearly
labelled , puncture and leak proof containers.
• Pour blood, suctioned fluids or other liquid waste carefully
into a drain connected to a sanitary sewer system.

75. • Sharps containers must be placed in a safe position within the
treatment room to avoid accidental tipping over and must be
out of the reach of small children.
• Sharps containers must be sealed when they have been filled
to the line marked on the container, and then collected by
licensed waste contractors for disposal according to local
waste management regulations.

76. Environmental Infection Control
• Clean spills of blood and decontaminate surface with an EPA-
registered hospital disinfectant with low - to intermediate-
level activity, depending on size of spill and surface porosity
• Avoid using carpeting and cloth-upholstered furnishings in
dental operatories, laboratories, and instrument processing
areas

77. SPECIAL CONSIDERATIONS
• Do not surface-disinfect, use liquid chemical sterilants, or
ethylene oxide on handpieces and other intraoral
instruments
• Wear gloves when exposing radiographs and handling
contaminated film packets.
• Do not administer medication from a syringe to multiple
patients, even if the needle on the syringe is changed
• Do not combine the leftover contents of single-use vials
for later use

78. • During transport, place biopsy specimens in a sturdy,
leakproof container labeled with the biohazard symbol
• Clean and place extracted teeth in a leakproof container,
labeled with a biohazard symbol
• Dispose of extracted teeth as regulated medical waste unless
returned to the patient
• Do not dispose of extracted teeth containing amalgam in
regulated medical waste intended for incineration

79. CONCLUSION
• “PREVENTION IS BETTER THAN CURE”- a
proverb well suited to sterilization.
• Promotion of a safety climate is the cornerstone of prevention
of transmission of pathogens in the health care.
• Provision of adequate staff and supplies, together with
leadership and education of health workers, patients and
visitors, is critical for an enhanced safety climate in health-
care settings.
• Standard precautions should be the minimum level of
precautions used while providing care for all patients

80. Reference
• Guidelines for Infection control in Dental Health care
settings (2003)–Dr.William G.Kohn et al, Division of Oral Health,
National Centre for Chronic Disease Prevention and Health Promotion,
CDC
• Guidelines for Infection Control in Dental Health Care
Settings (2012)- Australian dental Association
• Cohen’s Pathways of the Pulp, Tenth Edition
• Fundamentals of microbiology- Frobisher 9th Edition Saunders
• Gupta DS, Borle RM. Operation theatre discipline. J Indian Dent Assoc.
1983 Nov;55(11):437-40.
• Reinhardt PA, Gordon IG. Infectious and medical waste management.
Chelsea, MI: Lewis Publishers, 1991.

81. THANK
YOU!!