Sterilisation /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078



The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Sterilisation /certified fixed orthodontic courses by Indian dental academy

  1. 1. www.indiandentalacademy.com
  2. 2. Sterilization in orthodontics  INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. CONTENTS            INTRODUCTION HISTORY BLOOD BORNE PATHOGENS AND DISEASE STATES PATHWAYS OF CROSS CONTAMINATION STERILIZATION AND DISINFECTION METHODS PRE STERILAZATION PROCEDURES POST STERILIZATION PROCEDURES METHODS OF STERILIZAION OF MATERIALS IN ORTHODONTIC OFFICE PERSONAL PROTECTION SURFACE ASEPSIS CONCLUSION. www.indiandentalacademy.com
  4. 4. INTRODUCTION  Sterilization is one of the most important priorities in the dental office so that the orthodontic experience for the patient can be both fulfilling and completely safe. While we may have fun in the office, we must take sterilization very seriously. www.indiandentalacademy.com
  5. 5. STERILISATION AND DISINFECTION Sterilization- is defined as the process by which an article, surface or medium is freed of all micro organisms either in vegetative or spore state. Sterilization- is defined as the destruction or removal of all forms of life, with particular reference to microbial spores Sterilization-refers to the complete destruction of all microbial life Disinfection-defined a s the destruction of pathogenic micro-organisms on inanimate surfaces www.indiandentalacademy.com
  6. 6. Goal of sterilization and infection control do us no Most microbes that we come in contact harm. Others colonize and become established as our commensal flora, yet others establish infection. Factors determining the development of infectious disease -virulence -dose -resistance Health or disease=virulence x dose ----------------------resistance Virulence of micro-organisms in their natural environments cant be changed Resistance to diseases can be enhanced by immunization but not for all diseases The only disease determinant we can effectively manage is the dose, and the management of the www.indiandentalacademy.com dose is called as infection control.
  7. 7. HISTORY     The science of microbiology has shed much light on the nature of disease. In the nineteenth century the work of Pasteur ,Lister and Koch did much to explain the role of bacteria in disease and to indicate possible methods of practicing safer medicine. LOUIS PASTEUR (1822-95) was the first scientist to show clearly that bacteria never generate spontaneously and that no growth of any kind occurs in the sterilized media One of his many achievements was the development of the technique of controlled heating known as ‘PASTEURISATION’ for the preservation of beverages and food stuffs. By his experimental studies on anthrax in 1876-77, for example, he was to prove that a certain type of infection invariably occurred when anumber of micro-organisms of a particular kind were introduced in to the body www.indiandentalacademy.com
  8. 8. Dr. Joseph Lister (1827-1912)  Discovered the effectiveness of 'carbolic acid,‘ which was used in controlling typhoid. Using carbolic acid, Lister was able to keep his hospital ward in Glasgow free of infection for nine months. Lister published the results of his experiments in The Lancet : 11 cases of compound fracture without any sepsis. www.indiandentalacademy.com
  9. 9. Carbolic acid spray being used at the time of a surgery www.indiandentalacademy.com
  10. 10.    Despite the fact that the germ theory of disease had been established in 1877, it was not universally accepted until 1882 when Koch presented his masterly paper on ‘The etiology to tuberculosis’ giving details of the isolation of the tubercle bacillus. In the following year he isolated the cholera vibrio. Robert Koch (1843-1910) was undoubtedly one of the greatest figures in the development of microbiology. He had immense skill in devising new bacteriological techniques. He was also the first to make photomicrographs of stained smears, and in addition he pioneered methods of growing bacteria on agar media. The ‘Golden era’ of medical microbiology which was opened by Pasteur, Lister and Koch was perhaps the greatest contribution ever to the theory and practice of medicine. www.indiandentalacademy.com
  11. 11. BLOODBORNE PATHOGENS AND OTHER DISEASE AGENTS : The patient’s mouth is the most important source of potentially pathogenic microorganisms in the dental office. Pathogenic agents may occur in the mouth as a result of four basic conditions: Blood borne diseases, Oral diseases, Systemic diseases with oral lesions, and Respiratory diseases . Systemic diseases with pathogens present in blood and other body fluids Disease Pathogen Hepatitis B Hepatitis B virus Hepatitis C Hepatitis C virus Hepatitis D Hepatitis D virus HIV-infection and AIDS www.indiandentalacademy.com Human immunodeficiency virus
  12. 12.   Blood borne pathogens may enter the mouth during dental procedures that induce bleeding. Thus contact with saliva during such procedures may result in exposure to these pathogens if present. Because it is very difficult to determine if blood is actually present in saliva, saliva from all dental patients should be considered as potentially infectious. www.indiandentalacademy.com
  13. 13. HEPATITIS B VIRUS Risk for the dental team : Risk for dental patients : Hepatitis B vaccine : •We are extremely fortunate that safe and effective vaccines for hepatitis B are available. •Because there is no successful medical treatment to cure this disease, prevention is of paramount importance. •The vaccine is strongly recommended for all members of the dental team. www.indiandentalacademy.com
  14. 14. HIV INFECTION AND AIDS Transmission : Intimate sexual contact (vaginal, anal, oral) involving contact or exchange of semen or vaginal secretions; •Exposure to blood, blood-contaminated body fluids, or blood products; •Perinatal contact (from infected mother to child • www.indiandentalacademy.com
  15. 15. Measures in dental office to prevent HIV transmission -All members of the dental team and other health-care workers must protect themselves from exposure to blood, saliva and other potentially infectious body fluids. - Contaminated sharps must be handled and disposed of properly. -Gloves, mask, and protective eyewear and clothing must be used during the care of all patients and in other instances to prevent direct or indirect contact with body fluids. - Also, all health-care workers must prevent their blood or body fluids from coming into contact with the patients being treated, and instruments and equipment used on more than one patient must be properly decontaminated before reuse. www.indiandentalacademy.com
  16. 16. ORAL DISEASES Diseases Pathogen Herpes infections Herpesvirus hominis (herpes simplex virus) Syphilis Treponema pallidum Hand-foot-mouth Coxsackievirus disease Herpangina Coxsackievirus Gonococcal pharyngitis Neisseria gonorrhoeae Candidiasis Candida albicans www.indiandentalacademy.com
  17. 17. I) - HERPES INFECTIONS : In this disease, vesicle-type lesions can occur in the mouth. -Vesicles during active herpes simplex infections at any site of the body contain the virus which may be spread to others by direct contact with these lesions. -Also, the herpes simplex virus may be present in saliva in those with oral or lip lesions and possibly in a small percent of those who are infected but have no active lesions. -In such instances, sprays or aeorosols of the saliva may result in spread of the virus to unprotected eyes of the dental team. www.indiandentalacademy.com
  18. 18. II) HERPANGINA AND HAND-FOOT-MOUTH DISEASE : Herpangina appears as vesicles on the soft palate or elsewhere in the posterior part of the mouth that break down to ulcers that last for about a week. -Fever, sore throat and headache frequently accompany the vesicular stage. -The lesions are caused by specific types of coxackie virus. www.indiandentalacademy.com
  19. 19. III) ORAL SYPHILIS . Treponema pallidum is a spirochete bacterium and is the causative agent of syphilis. -About 5-10% of the cases of syphilis first occur in the mouth in the form of a lesion called a primary chancre, an open ulcer frequently on the tongue or lips. -These lesions do contain the live spirochetes and may be spread by direct contact. - The possibility of the spirochete entering small cuts or breaks in the skin of unprotected hands of the dental team exists and has been documented in one instance causing syphilis of the finger. www.indiandentalacademy.com
  20. 20. IV) ORAL CANDIDIASIS : Candida albicans is a yeast that occurs in the mouth asymptomatically in about one third of adults. -Such circumstances that may result in oral disease called thrush or oral candidiasis might include conditions that disturb our body defense mechanisms such as the systemic diseases of HIV infection, and leukemia; -Spread of C. albicans from a patient’s mouth to the dental team is theoretically possible through direct contact with lesions or sprays or aerosols of infected saliva. www.indiandentalacademy.com
  21. 21. PATHWAYS FOR CROSSCONTAMINATION www.indiandentalacademy.com
  22. 22. A total office infection program is designed to prevent or at least reduce the spread of disease agents from:  Patient to dental team  Dental team to patient  Patient to patient  Dental office to community, including the dental team’s families www.indiandentalacademy.com
  23. 23. i) Patient to Dental Team: • Direct contact : with patient’s saliva or blood may lead to entrance of microbes through a non intact skin resulting from cuts, abrasions, or dermatitis. • Droplet infection: They occur as a result of sprays, spatter or aerosols from patients mouth. • Indirect contact: involves transfer of microorganisms from the source (e.g., the patient’s mouth) to an item or surface and subsequent contact with the contaminated item or surface. • Examples include cuts or punctures with contaminated sharps (e.g. instruments, needles, burs, files scalpel blades, wire) and entrance through non intact skin as a result of touching contaminated instruments, surfaces or other item. www.indiandentalacademy.com
  24. 24. ii) Dental Team to Patient : Spread of disease from the dental team to patients is indeed a rare event, but could happen if proper procedures are not followed. -If the hands of dental team member contain lesions or other non intact skin. - If the hands are injured while in the patient’s mouth, blood borne pathogens or other microbes could be transferred by direct contact with the patient’s mouth, and they may gain entrance through the patient’s mucous membrane. - If a member of the dental team bleeds on instruments or other items that are then used in the patient’s mouth, cross infection may result. www.indiandentalacademy.com
  25. 25. iii) Patient to patient : Disease agents might be transferred from patient to patient by indirect contact through improperly prepared instruments, hand-pieces and attachments or surfaces. www.indiandentalacademy.com
  26. 26. iv) Dental Office to Community : This pathway may occur if microorganisms from the patient contaminate items that are sent out or are transported away from the office. For example, contaminated impressions or appliances or equipment needing service may in turn indirectly contaminate personnel or surfaces in dental laboratories and repair centers. Dental laboratory technicians have been occupationally infected with hepatitis B virus (HBV). This pathway also may occur if members of the dental team transport microorganisms out of the office on contaminated clothing. In addition, if a member of the dental team acquires an infectious disease at work, the disease could be spread to personal contacts with others outside the office. Also, regulated waste that contains infectious agents and is transported from the office may contaminate waste haulers if it is not in proper containers. www.indiandentalacademy.com
  27. 27. ACCEPTED METHODS OF STERILIZATION IN ORTHODONTICS 1)Heat sterilization  Steam pressure sterilization  Dry heat sterilization  Chemical vapour sterilization 2)Gas or ethylene oxide sterilization 3)Liquid chemical sterilization and disinfection www.indiandentalacademy.com
  28. 28. HEAT STERILISAION Heat sterilization is the most common type of sterilization technique used in dentistry today Heat sterilization involves a) Steam sterilization b) Dry heat sterilization c) Unsaturated chemical vapour sterilization www.indiandentalacademy.com
  29. 29. (a) Steam sterilization    Steam under pressure has a higher temperature than 100 C To be effective against viruses and spore forming bacteria need to have steam in direct contact with material Autoclaves are highly effective and inexpensive www.indiandentalacademy.com
  30. 30. Characteristics :      Temperature : 121 C (250 F) Pressure : 15 psi Cycle time: 15-20 minutes Acceptable Materials: Paper, plastic, cloth, or paper peel pouches Unacceptable Materials: closed metal and glass containers Advantages: Short efficient cycle time Good penetration Ability to process a wide range of materials without destruction Disadvantages: Unsuitable for heat sensitive objects Corrosion of unprotected carbon steel instruments Dulling of unprotected cutting edges Possibility that packages may remain wet at end of cycle www.indiandentalacademy.com Possible deposits from use of hard wat
  31. 31. ( b) Dry heat sterilization Sterilization of instruments with dry heat is the least expensive form of heat sterilization. A complete cycle involves heating the oven to the appropriate temperature and maintaining that temperature for a proper interval. www.indiandentalacademy.com
  32. 32. Characteristics : Temperature : 160 C (320 F) Or 170 C (340 F) Cycle time : 2 hours Or 1 hour Requirements: Must not insulate items from heat Must not be destroyed by temperature used Acceptable Materials: Paper bags, aluminum foil, polyfilm plastic tubing Unacceptable Materials : plastic and paper bags that cannot withstand dry heat temperature www.indiandentalacademy.com
  33. 33. Advantages: -Is effective and safe for sterilization of metal instruments and mirrors . -Does not dull cutting edges . -Does not rust or corrode Disadvantages : -Requires long cycle for sterilization -Has poor penetration -May discolor and char fabric -Destroys heat-labile items -Cannot sterilize liquids -Is generally unsuitable for handpieces www.indiandentalacademy.com
  34. 34. (iii) RAPID HEAT TRANSFER STERILIZATION : Characteristics : Temperature : 190 C (375 F) Cycle time : 12 minutes for wrapped items ; 6 minutes for unwrapped items. Acceptable Materials: Paper bags, aluminum foil, polyfilm plastic tubing Unacceptable Materials : Plastic and paper bags that cannot withstand dry heat temperature Advantages: -It has a shorter cycle time than regular dry heat units. -Items are dry after cycle -It does not dull cutting edges Disadvantages: -Instrument must be dried before packaging and placement in chamber. -It destroys heat-labile items -It cannot sterilize liquids -It is generally unsuitable for dental handpieces -Unwrapped items become contaminated quickly after the cycle. www.indiandentalacademy.com
  35. 35. (c)Unsaturated chemical vapour sterilization       Depends on heat, water and chemical synergism for its efficacy A solution of alcohol, formaldehyde, ketone, acetone and water is used to produce a sterilizing vapour Characteristics: Temperature: 131 c pressure: 20 psi Cycle time: 20-40 mins Packaging material requirements : Vapors must be allowed to precipitate on contents Plastics should not contact the sides of sterilizer Acceptable materials: Perforated metal trays, paper or paper peel pouches Unacceptable materials :solid metal trays and sealed glass www.indiandentalacademy.com jars
  36. 36.  Advantages: -It has short cycle time -it does not rust or corrode metal instruments including carbon steels -it does not dull cutting edge -it is suitable for orthodontic stainless steel wires  Disadvantages: -Instruments must be dried completely before processing -A special chemical solution must be used -It will destroy heat sensitive plastics -There is a chemical odour in poorly ventilated areas -It can not steriize liquids: www.indiandentalacademy.com
  37. 37. GAS STERILIZATION www.indiandentalacademy.com
  38. 38. GAS STERILIZATION Ethylene oxide: The use of ETO is recognized by the American Dental association (ADA) and Centers for Disease control and prevention (CDC) . as an acceptable method of sterilization for the following items: i) those that can be damaged by heat and/ or moisture, and ii) those that can be cleaned and dried thoroughly.. This chemical is effective as a virucidal agent, is sporicidal, does not damage materials, and can evaporate without residue www.indiandentalacademy.com
  39. 39. CHARACTERISTICS Temperature : room temperature (250C/750F) Cycle time : 10-16 hours (depending on material) Acceptable materials : paper, plastic bags Unacceptable materials : sealed metal or glass containers Advantages : -High capacity for penetration -Does not damage heat-labile material -Evaporates without leaving a toxic residue -Suitable for materials that cannot be exposed to moisture Disadvantages: -Slow, requires long cycle time -Uses toxic/hazardous chemical -Items must be cleaned and dried thoroughly before exposure. -Causes tissue irritation if not well aerated www.indiandentalacademy.com
  40. 40. LIQUID CHEMICAL STERILIZATION AND DISINFCTION       Inexpensive and suitable for heat sensitive items Toxic and irritant 2% glutaraldehyde is most widely used Often used as disinfectants but can also sterilize instruments if used for prolonged periods liquid sporicidal chemical Most bacteria and viruses are killed within 10 minutes Spores can survive several hours www.indiandentalacademy.com
  41. 41. GLUTERALDEHYDE: 2.0 to 3.2% glutaraldehyde is used to sterilize and disinfect. At these concentrations, - glutaraldehydes can be effective against vegetative bacteria, including M. Tuberculosis, fungi and viruses, and can destroy microbial spores after a 10-hour immersion period.. - In fact, glutaraldehydes are useful in decontaminating certain types of dental impression materials. www.indiandentalacademy.com
  42. 42. Disadvantages : - Although glutaraldehyde formulations are effective as immersion steriliants/ disinfectants, they are also extremely toxic to tissues. - Irritation of hands and discoloration of cuticles are common sequelae when people do not wear appropriate utility gloves. - damage to respiratory and olfactory tissues and ocular injury www.indiandentalacademy.com
  43. 43. Alcohols: - Ethyl alcohol and isopropyl alcohol have been used extensively for many years as skin antiseptics and surface disinfectants. - Ethyl alcohol is relatively nontoxic, colorless, nearly odorless and tasteless, and readily evaporates without residue. Isopropyl alcohol is less corrosive than ethyl alcohol because it is not oxidized as rapidly to acetic acid and acetaldehyde. Disadvantages : -Not sporicidal - Damaging to certain materials, including rubber and plastics -Rapid evaporation rate with diminished activity against viruses in dried blood, saliva, and other secretions on surfaces www.indiandentalacademy.com
  44. 44. Iodine and Iodophors : • Iodine is one of the oldest antiseptics for application onto skin, mucous membranes, abrasions, and other wounds. • high reactivity of this halogen with its target substrate gives it potent germicidal effects. • It acts by iodination of proteins and subsequent formation of protein salts. • Tinctures of iodine are toxic for gram-positive and gram-negative bacteria, tubercle bacilli, spores, fungi, and most viruses. solubilizing agent or carrier. www.indiandentalacademy.com
  45. 45.   Their surfactant properties make them excellent cleaning agents before disinfection, and newer iodophor commercial formulations have shown EPAapproved tuberculocidal activity within 5 to 10 minutes of exposure. Iodophor antiseptics are useful in preparing the oral mucosa for local anesthesia and surgical procedures. www.indiandentalacademy.com
  46. 46. Phenols and Derivatives : . This phenolic solution was used as an all-purpose surgical instrument immersion steriliant, hand washing antiseptic, wound cleaner, and preparatory antimicrobial for surgical sites... • These agents act as cytoplasmic poisons by penetrating and disrupting microbial cells walls, leading to denaturation of intracellular proteins. • The intense penetration capability of phenols is probably the major factor associated with their anti microbial activity . • Thus, with the exception of the bisphenols, most phenolic derivatives are used primarily as disinfectants. www.indiandentalacademy.com
  47. 47. PRE STERILIZATION PROCEDURES • Holding (presoaking) • Pre cleaning • Corrosion Control, Drying, Lubrication • Packaging www.indiandentalacademy.com
  48. 48. I. HOLDING (PRESOAKING) If instruments cannot be cleaned soon after use, place them in a holding solution to prevent drying of the saliva and blood. • Extended presoaking for more than a few hours is not recommended, for this may enhance corrosion of some instruments. • The holding solution may be the same as that to be used for ultrasonic cleaning or it may be a germicidal solution (e.g., a glutaraldehyde) indicated for instrument immersion. • www.indiandentalacademy.com
  49. 49. II. PRECLEANING: Ultrasonic cleaning : Ultrasonic cleaning, compared with scrubbing instruments by hand, reduces direct handling of the contaminated instruments and the chances for cuts and punctures. •Exception is some high-speed hand pieces. •This time required ranges from about 5 to 15 minutes. • www.indiandentalacademy.com
  50. 50. Manual scrubbing of instruments : -Scrubbing contaminated instruments by hand is a very effective method of removing the debris if performed properly. -All surfaces of all instruments should be thoroughly brushed while the instruments are submerged in a cleaning solution to avoid spattering. -This is followed by thorough rinsing with a minimum of splashing. www.indiandentalacademy.com
  51. 51. III. CORROSION CONTROL, DRYING, AND LUBRICATION Instruments or portions of Instruments and burs made of carbon steel can rust during steam sterilization. • • the cutting surfaces of orthodontic pliers can rust by autoclaving rust inhibitors (e. g., sodium nitrite) that can be sprayed on the Instruments can reduce rusting of some of these items • • the best approach is not to process such items through steam. Instead, thoroughly dry the Instruments and use dry heat or unsaturated chemical vapor sterilization, which do not cause www.indiandentalacademy.com rusting. •
  52. 52. IV :Packaging: Packaging Instruments before processing through the sterilizer prevents them from becoming contaminated after sterilization during storage or when being distributed to chair side. Packaging involves organizing the Instruments in functional sets and wrapping them or placing them in sterilization pouches, bags, trays, or cassettes. Wrapping or Bagging : Functional sets of instruments can be placed on a small sterilizable tray and the entire tray wrapped with sterilization wrap grams the wrapping procedure. Seal the wrap with tape that will withstand the heat process. (e.g., “autoclave tape”). www.indiandentalacademy.com
  53. 53. Using Cassettes : Numerous styles of cassettes are available that contain functional sets of instruments during use at chairside and during the ultrasonic precleaning, rinsing, and sterilizing processes. - Using cassettes reduces the direct handling of contaminated instruments and keeps the instruments together through the entire processing. Unwrapped Instruments : Sterilizing unpackaged instruments is the least satisfactory approach to patient protection because it allows for unnecessary contamination before the Instruments are actually used on the next patient. www.indiandentalacademy.com
  54. 54. POST STERILIZATION PROCEDURES  Sterilization monitoring -biological monitoring -chemical monitoring - Physical monitoring  Handling of processed instruments www.indiandentalacademy.com
  55. 55. STERILIZATION MONITORING : -Heat sterilization failures result when direct contact between the sterilization agent and all surfaces of items being processed does not occur for the appropriate length of time. - In many instances, these failures will not be detected unless proper sterilization monitoring is performed. -There are three forms of sterilization monitoring, biological, chemical and physical monitoring. www.indiandentalacademy.com
  56. 56. i) Biological Monitoring  Biological monitoring provides the main guarantee of sterilization. It involves processing highly-resistant bacterial spores through the sterilizer and then culturing the spores to determine if they have been killed Types of biological indicators : 1)Bacillus stearothermophilus - steam or chemical vapor sterilization 2)Bacillus subtilis - dry heat or ethylene oxide gas sterilization.  www.indiandentalacademy.com
  57. 57. ii) Chemical Monitoring : Chemical monitoring involves the use of indicators that change color or physical form when exposed to certain temperatures such as autoclave tape, special markings on pouches and bags, chemical indicator strips, tabs or packets or tubes of colored liquid. Rapid-change indicator changes color rapidly after a certain temperature has been reached (e.g., autoclave tape and special markings on pouches and bags). Used as an external indicator on the outside of every pack • www.indiandentalacademy.com
  58. 58. Slow-change or integrated indicator: • - that changes color or form slowly, responding to a combination of time and temperature or temperature and the presence of steam. -Used on the inside of every pack, pouch or cassette to assess if the instruments have been exposed to sterilizing conditions. www.indiandentalacademy.com
  59. 59. iii) Physical Monitoring : Physical monitoring of the sterilization process involves observing the gauges and displays on the sterilizer and recording the sterilizing temperature, pressure and exposure time. -It must be remembered that sterilizer gauges and displays indicate the conditions in the sterilizer chamber rather than conditions within the packs, pouches or cassettes being processed. -Thus, physical monitoring may not detect problems resulting from overloading, improper packaging material or use of closed containers. www.indiandentalacademy.com
  60. 60. HANDLING PROCESSED INSTRUMENTS : Instrument sterility should be maintained until the sterilized packs, pouches or cassettes are opened for use at chairside. i) Drying and Cooling : Packs, pouches or cassettes processed through steam sterilizer may be wet and must be allowed to dry before handling www.indiandentalacademy.com
  61. 61. ii) Storage : Handling of sterile packages should be kept to a minimum , and those that are dropped on the floor, torn, compressed or become wet must be considered as contaminated -Store sterile packages in dry, enclosed, low-dust areas away from sinks and water pipes .This prevents packages from becoming wet with splashed water. -And store the packages away from heat sources that may make the packaging material brittle and more susceptible to tearing or puncture. iii) Distribution : Instruments from sterile packs or pouches can be placed on sterile, disposable, or at least cleaned and disinfected trays at chairside. -Sterilized instrument cassettes are distributed to and opened at chairside www.indiandentalacademy.com
  62. 62. RECOMMENDED STERILIZATION PROCEDURES FOR MATERIALS IN ORTHODONTICS         Impression trays Impressions wax bites and rims Acrylic appliances Orthodontic pliers Orthodontic bands and brackets Orthodontic wires Orthodontic marking pencils www.indiandentalacademy.com
  63. 63. Impression trays    Aluminium or chrome plated: heat or gas sterilization Custom acrylic trays: disinfect by NaOCl or iodophor; discard Plastic trays: ethylene oxide sterilization or disinfection by NaOCl or iodophor www.indiandentalacademy.com
  64. 64. Impressions   ADA council on dental impressions recommends (1991) disinfection by immersion in a suitable disinfectant. 2% gluteraldehyde is most commonly used. www.indiandentalacademy.com
  65. 65. Wax bites and wax rims  Disinfection by an iodophor Dental casts ADA recommends disinfection of stone casts by immersing in 1:10 NaOCl or an iodophor Dental prosthesis and appliances  ADA recommends sterilization by exposure to ethylene oxide or disinfection by immersion in iodophor or chlorine compounds www.indiandentalacademy.com
  66. 66. Orthodontic pliers     High quality stainless steel :dry heat, autoclave, chemical vapour, ethylene oxide Low quality stainless steel: dry heat, chemical vapour, ethylene oxide With plastic parts: ethylene oxide, chemical disinfection or sterilization. Effect of routine steam autoclaving on orthodontic pliers European Journal of Orthodontics www.indiandentalacademy.com
  67. 67. Orthodontic bands, brackets    Dry heat sterilization Autoclave Ethylene oxide www.indiandentalacademy.com
  68. 68. Orthodontic wires    Dry heat Autoclave Ethylene oxide Effect on tensile strength of TMA, stainless steel and NiTi wires Julie Ann Staggers, Dallas Margeson (The angle orthodontist 1993,vol 63) TMA wires: ethylene oxide autoclaving NiTi wires: ethylene oxide stainless steel wires: autoclave dry heat www.indiandentalacademy.com ethylene oxide
  69. 69. Orthodontic marking pencils Fernando ascencio et al (JCO 1998 VOL XXXII NO. 5) Orthodontic marking pencils are a potential source of cross contamination  Conventional orthodontic pencils can not be autoclaved  Gas sterilization  Alcohol containing permanent markers  Disinfectants  Disposable markers www.indiandentalacademy.com
  70. 70. PERSONAL PROTECTIVE EQUIPMENT AND BARRIER TECHNIQUES www.indiandentalacademy.com
  71. 71.   Oral health care providers and their patients may be exposed to a variety of microorganisms via blood or oral and respiratory secretions. Infections can be transmitted in the oral health care setting through - direct contact with blood saliva and other secretions - indirect contact with contaminated instruments equipment environmental surfaces operatory - Contact with air borne contaminants present in droplets spatter www.indiandentalacademy.com aerosols of oral and respiratory fluids
  72. 72. Gloves : . For the protection of oral health care personnel and the patient, medical gloves always must be worn when there is a potential for contacting blood, bloodcontaminated saliva, or mucous membranes. . www.indiandentalacademy.com
  73. 73. Masks : When a tooth is cut with a high-speed turbine handpiece or cleaned with an ultrasonic scaler, blood, saliva, and other debris are atomized and expelled from the mouth. -Masks that cover the mouth and nose reduce inhalation of potentially infectious aerosol particles. -They also protect the mucous membranes of the mouth and nose from direct contamination. - Masks should be worn whenever aerosols or spatter may be generated. www.indiandentalacademy.com
  74. 74. Protective eyeglasses : During dental procedures, large particles of debris and saliva can be ejected towards the oral health care provider’s face. - These particles can contain large concentrations of bacteria and can physically damage the eyes. -Protective eyewear is indicated, not only to prevent physical injury, but also to prevent infection. www.indiandentalacademy.com
  75. 75. IMMUNIZATION FOR ORAL HEALTH CARE PROVIDERS Health care workers are at particular risk of several vaccine-preventable diseases. www.indiandentalacademy.com
  76. 76. Recommended vaccines for Oral Health care Workers Generic name Primary schedule Boosters (s) and Hepatitis B recombinant DNA Two doses IM 4 weeks apart, 3rd dose 5 months after second Rubella live virus vaccine One dose SC, no booster Measles live virus vaccine 1 dose SC, no routine boosters Mumps live virus vaccine 1dose SC, no booster Influenza vaccine (inactivated whole- Annual vaccination with virus and split-virus vaccine) tetanus – current vaccine. Either whole diptheria toxoid or split virus vaccine may be used two doses IM 4 weeks apart, third dose 6to 12 months after second dose, booster every 10 years. Enhanced – potency inactivated E-IPV is preferred for poliovirus vaccine (E-IPV) live oral polio primary vaccination of adults, virus vaccine (OPV) two doses SC 4 to 8 weeks apart, a www.indiandentalacademy.comthird dose 6 to 12 months after the second.
  77. 77. Surface asepsis    Clean and disinfect surfaces Surface covers Use of disposables www.indiandentalacademy.com
  78. 78. Items Recommended covering Chair back (optional) Plastic Headrest (only if not covered along with chair back) Plastic Dental unit, including hose supports Plastic Side auxiliary support surfaces Plastic Air-water syringe handle Plastic High-volume evacuation control Plastic Saliva ejector control Plastic Lamp handles Foil, plastic wrap, or bag Light communication system Plastic www.indiandentalacademy.com Drawer handles Plastic
  79. 79. DISPOSAL OF WASTE MATERIALS :- Gloves, masks , wipes, paper drapes:Handled with gloves, discarded in impervious plastic bags. - Blood, disinfectants, steriliants:Carefully poured into a drain connected to a sanitary server system. - Sharp items, needles, blades, scalpels:Puncture- resistant containers marked with biohazard label. - Human tissue:- www.indiandentalacademy.com
  80. 80. INFECTION CONTROL CONSIDERATIONS IN DENTAL OFFICE DESIGN Considering that the clinical arena is the most affected by infection control, the following elements should be evaluated in regard to the overall health and safety of the person performing the task.  1)Office flow  2)Cabinetry.  3)Laminate, wall, and floor coverings  4)Ventilation. www.indiandentalacademy.com
  81. 81.      Office flow : The layout of the entire office should incorporate a smooth efficient operational flow. For example, patients have direct access to the treatment rooms and consultation areas from the reception area without having to pass through instrument processing areas. 2) Cabinetry : The number of drawers and their contents should be minimized to simplify cleanup procedures and reduce possible cross-contamination by the temptation to reach into the drawer during a procedure. -Treatment room cabinetry should be positioned on both sides of the patient’s chair. This will allow both the doctor and assistant access to essential side support areas and provide flexibility to both right and left-handed clinicians working in the same space. www.indiandentalacademy.com
  82. 82.     3)Laminates and wall and floor coverings : Although patient appeal and aesthetics continue to be a consideration, cabinetry surfaces and wall and floor coverings are a primary concern. Wood surfaces, heavily textured wall coverings, and fabrics for decoration should be eliminated. Smooth, seamless, nonporous materials will inhibit the collection of microbes and, therefore, also should be considered. 4) Ventilation : Work areas must have positive ventilation to control noxious vapors form various chemicals used in laboratory and sterilization areas. Additionally, considering that microbes inevitably are transported from one area to another via ventilation systems, these systems must be designed to prevent recirculation of contaminated air. www.indiandentalacademy.com
  83. 83. Compliance with infection control procedures among California orthodontists AJODO July 1992,Vol 102,5 www.indiandentalacademy.com
  84. 84. CONCLUSION IT IS OUR MOST IMPORTANT DUTY TO PRESERVE AND MAINTAIN THE HEALTH OF OUR PATIENTS AND OURSELVES. • WE AND OUR PATIENTS ARE AT ALARMINGLY HIGH RISK OF GETTING INFECTED BY DANGEROUS DISEASES LIKE Hepatitis-B, TB, Herpes, HIV ETC. • TO PREVENT ALL THESE DEADLY DISEASES AND TO PROTECT OURSELF WE SHOULD TAKE ATMOST PRECAUTION BY FOLLOWING STRICT STERILISATION AND DISINFECTION PROCEDURES. www.indiandentalacademy.com •
  85. 85. REFERENCES • Ascencio F, Langkamp H, Agarcoal S : Orthodontic marking pencils as a potential source of cross contamination. J Clin Orthod 1998; 32: 307-310. • Cash RG : Trends in sterilization and disinfection, procedures in orthodontic offices. Am J Orthod Dentofacial Orthop 1990; 98: 292-299. • Cohen KL, Helen G : Disease prevention and oral health promotion. • Compbell PM, Phenix N : Sterilization in orthodontic office. J Clin Orthod 1986; 20: 684-686. • Cottone AJ : Practical infection control in dentistry. • Council on Dental materials and council on dental therapeutics : Infection control in dental office. J Am Dental Assoc 1978; 97: 673-677. www.indiandentalacademy.com www.indiandentalacademy.com
  86. 86. • Dental Clinics of North America (1991) : Infection control and office safety • Dental Clinics of North America (1996) : Infectious diseases and dentistry. • Dental Clinics of North America (July 2003) : Infections and infectious diseases – Part I. Dental Clinics of North America (Oct 2003) : Infections and infectious diseases – Part II. Drake DL : Optimizing orthodontic sterilization techniques. J Clin Orthod 1997; 31: 491-498. Jones M, Pizarro K, Blunden R : Effect of routine steam autoclaving on orthodontic pliers. Eur J Orthod 1993; 15: 281-290. • • • • Matasa CG : Orthodontic recycling at crossroads. J Clin Orthod 2003; 37: 133139. • McCarthy GM, Mamandras AH, Mac Donald JK : Infection control in orthodontic office in Canada. Am J Orthod Dentofacial Orthop 1997; 112: 27581. www.indiandentalacademy.com
  87. 87. www.indiandentalacademy.com

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