INFECTIONINFECTION
CONTROL INCONTROL IN
ORTHODONTICSORTHODONTICS
INDIAN DENTAL ACADEMY
Leader in continuing dental educati...
INDEXINDEX
1.1. INTRODUCTIONINTRODUCTION
2.2. HISTORYHISTORY
3.3. BLOOD BORNE PATHOGENS AND DISEASE STATESBLOOD BORNE PATH...
INTRODUCTION:
Dental care professionals are at an increased risk of
cross infection while treating patients.
• This occupa...
•Although there is common goal in infection control
,there are several approaches that may be used to
achieve the desired ...
DEFINITIONSDEFINITIONS
. STERILISATION:
The process by which an article surface or medium is freed of all
microorganisms, ...
HISTORYHISTORY
 The science of microbiology has shed much light on the nature ofThe science of microbiology has shed much...
““If I had the honour of being a surgeon, impressed as IIf I had the honour of being a surgeon, impressed as I
amam
with t...
Dr. Joseph ListerDr. Joseph Lister ((1827-1912)1827-1912)
 Discovered the effectiveness of 'carbolic acid,‘ which wasDisc...
Carbolic acid spray being used at the time of aCarbolic acid spray being used at the time of a
surgerysurgery
www.indiande...
Influx model carbolic spray, copper,Influx model carbolic spray, copper,
brass with wood handlebrass with wood handle

ww...
 Robert KochRobert Koch (1843-1910)(1843-1910) was undoubtedly one ofwas undoubtedly one of
the greatest figures in the d...
Antonie van Leeuwenhoek in 1683
was the first to describe microorganisms in human
mouth.
-His astute observation on scrapi...
Systemic diseases with pathogens present in blood and other bodySystemic diseases with pathogens present in blood and othe...
•Bloodborne pathogens may enter the mouth during
dental procedures that induce bleeding.
• Thus contact with saliva during...
A B C D E
Other name Infectious Serum Parenterally
transmitted
non-A, non-
B
Delta Enterically
transmitted
non-A, non-
B
M...
Risk for the dental team :
Risk for dental patients :
Hepatitis B vaccine :
•We are extremely fortunate that safe and effe...
HIV INFECTION AND AIDS
Oral manifestations of AIDS :
Early manifestations of AIDS occur as oral lesions.
•Oral manifestati...
Exposure to blood :
HIV INFECTION AND AIDS
www.indiandentalacademy.comwww.indiandentalacademy.com
Prevention :
Sexual contact :
HIV INFECTION AND AIDS
Recommendations for preventing the spread of HIV-1 through
sexual con...
-All members of the dental team and other health-care workers must
protect themselves from exposure to blood, saliva and o...
Diseases Pathogen
Herpes infections Herpesvirus hominis (herpes
simplex virus)
Syphilis Treponema pallidum
Hand-foot-mouth...
I) HERPES INFECTIONS :
Herpes simplex viruses may cause infections of the mouth, skin,
eyes and genitals.
-About 90% of ad...
II) HERPANGINA AND HAND-FOOT-MOUTH DISEASE :
Herpangina appears as vesicles on the soft palate or
elsewhere in the posteri...
III) ORAL SYPHILIS .
Treponema pallidum is a spirochete bacterium and is
the causative agent of syphilis.
-About 5-10% of ...
IV) ORAL CANDIDIASIS :
Candida albicans is a yeast that occurs in the mouth
asymptomatically in about one third of adults....
IMMUNIZATION FOR ORAL HEALTH CARE PROVIDERS
Health care workers are at particular risk of several
vaccine-preventable dise...
Generic name Primary schedule and Boosters (s)
Hepatitis B recombinant DNA Two doses IM 4 weeks apart, third dose 5
months...
PATHWAYS FOR CROSS-CONTAMINATION
A total office infection program is
designed to prevent or at least reduced
the spread of...
i) Patient to Dental Team:
• Direct contact : with patient’s saliva or blood may lead to entrance
of microbes through a no...
ii) Dental Team to Patient :
Spread of disease from the dental team to patients is
indeed a rare event, but could happen i...
iii) Patient to patient :
Disease agents might be transferred from
patient to patient by indirect contact through
improper...
iv) Dental Office to Community :
This pathway may occur if microorganisms from the patient
contaminate items that are sent...
After microbes enter the body, there are three basic factor that
determine if an infectious disease will develop:
•Virulen...
OPERATORY
PREPARATION
AND
INSTRUMENT
RECIRCULATION
www.indiandentalacademy.comwww.indiandentalacademy.com
OPERATORY PREPARATION
General:
All surfaces and items touched by and contaminated with saliva or
blood, initially should b...
Items Recommended covering
Chair back (optional) Plastic
Headrest (only if not covered along with chair back) Plastic
Dent...
INSTRUMENT PROCESSING
Instrument processing is the procedures that prepares
contaminated instruments for reuse. The proces...
I. HOLDING (PRESOAKING)
•If instruments cannot be cleaned soon after use, place them in a
holding solution to prevent dryi...
ii. PRECLEANING:
iii.Ultrasonic cleaning :
•Ultrasonic cleaning, compared with scrubbing instruments by hand, reduces
dire...
Manual scrubbing of instruments :
-Scrubbing contaminated instruments by hand is a very
effective method of removing the d...
III. CORROSION CONTROL, DRYING, AND
LUBRICATION
Instruments or portions of Instruments and burs made of carbon
steel will ...
IV :Packaging:
Packaging Instruments before processing through the sterilizer
prevents them from becoming contaminated aft...
Using Cassettes :
Numerous styles of cassettes are
available that contain functional sets of
instruments during use at cha...
STERILIZATION
1.Heat sterilization :Heat sterilization involving steam, dry
heat, and unsaturated chemical vapor is the mo...
Liquid chemical sterilization: Although the liquid chemical sterilant,
glutaraldehyde, can be shown to be sporicidal in co...
VI. STERILIZATION MONITORING :
-Heat sterilization failures result when direct contact
between the sterilization agent and...
 Biological monitoring provides the main guarantee of
sterilization. It involves processing highly-resistant
bacterial sp...
ii) Chemical Monitoring :
Chemical monitoring involves the use of indicators that change color or physical form
when expos...
Slow-change or integrated indicator:
- that changes color or form slowly, responding to a combination of time and
temperat...
iii) Physical Monitoring :
Physical monitoring of the sterilization process involves
observing the gauges and displays on ...
VII. HANDLING PROCESSED
INSTRUMENTS :
Instrument sterility should be maintained
until the sterilized packs, pouches or cas...
ii) Storage :
Handling of sterile packages should be kept to a minimum ,
and those that are dropped on the floor, torn, co...
INSTRUMENT PROTECTION:
Instrument processing can cause damage to instruments, but
several steps could be taken to keep thi...
STERILIZATION METHODS :
PHYSICAL METHODS OF STERILIZATION :
The use of heat has long been recognized as the most
efficient...
Characteristics :
 Temperature : 1210C (2500F)
 Pressure : 15 psi
 Cycle time : 15-20 minutes
 Acceptable Materials: P...
(ii) DRY HEAT :
Sterilization of instruments with dry heat is the least
expensive form of heat sterilization. A complete c...
Acceptable Materials: Paper bags, aluminum foil, polyfilm plastic tubing
Unacceptable Materials : plastic and paper bags t...
(iii) RAPID HEAT TRANSFER STERILIZATION :
Characteristics :
Temperature : 1900C (3750F)
Cycle time : 12 minutes for wrappe...
.
CHEMICAL STERILIZATION
Ethylene oxide: The use of ETO
is recognized by the American
Dental association (ADA) and
Centers...
Temperature : room temperature (250C/750F)
Cycle time : 10-16 hours (depending on material)
Acceptable materials : paper, ...
GLUTERALDIHYDE:
(1.5-Pentanedial) (C5H8O2) has two aldehyde units, one at
end of the carbon chain. The later two types use...
Disadvantages :
-Although glutaraldehyde formulations are
effective as immersion sterilants/ disinfectants, they
are also ...
Alcohols:
Ethyl alcohol and isopropyl alcohol have been used extensively for
many years as skin antiseptics and surface di...
Iodine and Iodophors :
• Iodine is one of the oldest antiseptics for application
onto skin, mucous membranes, abrasions, a...
Iodophor antiseptics are useful in
preparing the oral mucosa for local
anesthesia and surgical procedures.
. Their surfa...
Phenols and Derivatives :
• . This phenolic solution was used as an all-purpose surgical
instrument immersion sterilant, h...
PERSONAL PROTECTIVE EQUIPMENT AND BARRIER TECHNIQUES
Oral health care providers and their patients may be exposed to a
var...
Gloves : .
For the protection of oral health care personnel and the patient,
medical gloves always must be worn when there...
Masks :
When a tooth is cut with a high-speed turbine handpeice or
cleaned with an ultrasonic scaler, blood, saliva, and o...
Protective eyeglasses :
During dental procedures, large particles of debris and saliva
can be ejected towards the oral hea...
DISPOSAL OR WASTE MATERIALS:-
- Gloves, masks, wipes, paper drapes:-
Handled with gloves, discarded in impervious plastic ...
INFECTION CONTROL CONSIDERATIONS IN DENTAL OFFICE DESIGN
Additionally, the total square footage and layout of the entire
s...
1) Office flow :
The layout of the entire office should incorporate a smooth efficient operational
flow. For example, pati...
3)Laminates and wall and floor coverings :
Although patient appeal and aesthetics continue to be a consideration,
cabinetr...
CONCLUSIONCONCLUSION
• IT IS OUR MOST IMPORTANT DUTY TO PRESERVE AND
MAINTAIN THE HEALTH OF OUR PATIENTS AND HIM SELF.
• W...
• Bellavia De : Efficient and effective infection control. J Clin Orthod 1992; 26: 46-
54.
• Buckthal JE, Maynew MJ, Kusy ...
• Dental Clinics of North America (1991) : Infection control and office safety
• Dental Clinics of North America (1996) : ...
www.indiandentalacademy.comwww.indiandentalacademy.com
Thank youThank you
For more details please visitFor more details pl...
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Infection control in orthodontics /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
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Infection control in orthodontics /certified fixed orthodontic courses by Indian dental academy

  1. 1. INFECTIONINFECTION CONTROL INCONTROL IN ORTHODONTICSORTHODONTICS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. INDEXINDEX 1.1. INTRODUCTIONINTRODUCTION 2.2. HISTORYHISTORY 3.3. BLOOD BORNE PATHOGENS AND DISEASE STATESBLOOD BORNE PATHOGENS AND DISEASE STATES 4.4. IMMUNISATION FOR ORAL HEALTH CARE PROVIDERSIMMUNISATION FOR ORAL HEALTH CARE PROVIDERS 5.5. PATHWAYS OF CROSS CONTAMINATIONPATHWAYS OF CROSS CONTAMINATION 6.6. INSTRUMENT PROCESSINGINSTRUMENT PROCESSING 7.7. STERILISATION METHODSSTERILISATION METHODS 8.8. PERSONAL PROTECTIVE EQUIPMENT AND BARRIERPERSONAL PROTECTIVE EQUIPMENT AND BARRIER TECHNIQUETECHNIQUE 9.9. PROCEDURE FOR ORTHODONTIC INSTRUMENTSPROCEDURE FOR ORTHODONTIC INSTRUMENTS 10.10. DENTAL LAB INFECTION CONTROLDENTAL LAB INFECTION CONTROL 11.11. SURFACE ASEPSISSURFACE ASEPSIS 12.12. CONCLUSIONCONCLUSION 13.13. BIBLIOGRAPHYBIBLIOGRAPHY www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3. INTRODUCTION: Dental care professionals are at an increased risk of cross infection while treating patients. • This occupational potential for disease transmission become evident initially when one realises that most human microbial pathogens have been isolated from oral secretions. Because of repeated exposure to micro-organisms in blood and saliva, incidence of certain infectious diseases has been significantly higher among dental professionals than observed for general population. • Hepatitis-B, TB, Herpes simplex viral infections are well recognised and indicate need for increased understanding of modes of disease transmission and infection control procedures by dental care providers. www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4. •Although there is common goal in infection control ,there are several approaches that may be used to achieve the desired result.These approaches vary from office to office depending on type of dental procedure performed ,number and training employees,and type of equipment used. •Part of the problem lies in the fact that many practitioners and auxillaries previously failed to appreciate the infection potential presented by saliva and blood during treatment. •These dangers often we dismissed because much of spatter coming from patients mouth is not noticed readily. www.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5. DEFINITIONSDEFINITIONS . STERILISATION: The process by which an article surface or medium is freed of all microorganisms, either in the vegetative or spore state. DISINFECTION: The destruction of all pathogenic micro organisms or organisms capable of giving rise to infection. ANTISEPTICS: Chemical disinfectants, which can be safely applied to skin or mucous membrane surfaces and are used to prevent infection by inhibiting the growth of bacteria. BACTERICIDAL AGENTS: Agents able to kill bacteria. BACTERIOSTATIC: Agents preventing only the multiplication of bacteria, which may remain alive. www.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6. HISTORYHISTORY  The science of microbiology has shed much light on the nature ofThe science of microbiology has shed much light on the nature of disease. In the nineteenth century the work of Pasteur ,Lister anddisease. In the nineteenth century the work of Pasteur ,Lister and Koch did much to explain the role of bacteria in disease and toKoch did much to explain the role of bacteria in disease and to indicate possible methods of practicing safer medicine.indicate possible methods of practicing safer medicine.  LOUIS PASTEUR (1822-95) was the first scientist to show clearlyLOUIS PASTEUR (1822-95) was the first scientist to show clearly that bacteria never generate spontaneously and that no growth ofthat bacteria never generate spontaneously and that no growth of any kind occurs in the sterilized media.any kind occurs in the sterilized media.  One of his many achievements was the development of theOne of his many achievements was the development of the technique of controlled heating known as ‘PASTEURISATION’ fortechnique of controlled heating known as ‘PASTEURISATION’ for the preservation of beverages and food stuffs.the preservation of beverages and food stuffs.  By his experimental studies on anthrax in 1876-77, for example, heBy his experimental studies on anthrax in 1876-77, for example, he was to prove that a certain type of infection invariably occurredwas to prove that a certain type of infection invariably occurred when a number of micro-organisms of a particular kind werewhen a number of micro-organisms of a particular kind were introduced to the body..introduced to the body.. www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7. ““If I had the honour of being a surgeon, impressed as IIf I had the honour of being a surgeon, impressed as I amam with the dangers of exposure to the microbes scatteredwith the dangers of exposure to the microbes scattered of all objects, not only would I use perfectly cleanof all objects, not only would I use perfectly clean instruments,but after washing my hands with greatestinstruments,but after washing my hands with greatest carecare and submitting them to rapid flaming, I would useand submitting them to rapid flaming, I would use bandages,previously exposed in air at 130-150 degreebandages,previously exposed in air at 130-150 degree andand use water which has been submitted to a temp ofuse water which has been submitted to a temp of 120degree….this way I would have to fear only the120degree….this way I would have to fear only the germsgerms suspended in the air around the patients bed.”suspended in the air around the patients bed.” Louis Pasteur(1878)Louis Pasteur(1878) www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8. Dr. Joseph ListerDr. Joseph Lister ((1827-1912)1827-1912)  Discovered the effectiveness of 'carbolic acid,‘ which wasDiscovered the effectiveness of 'carbolic acid,‘ which was used in controlling typhoid.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.comwww.indiandentalacademy.com
  9. 9. Carbolic acid spray being used at the time of aCarbolic acid spray being used at the time of a surgerysurgery www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10. Influx model carbolic spray, copper,Influx model carbolic spray, copper, brass with wood handlebrass with wood handle  www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11.  Robert KochRobert Koch (1843-1910)(1843-1910) was undoubtedly one ofwas undoubtedly one of the greatest figures in the development of microbiology.the greatest figures in the development of microbiology. He had immense skill in devising new bacteriologicalHe had immense skill in devising new bacteriological techniques. He was also the first to maketechniques. He was also the first to make photomicrographs of stained smears, and in addition hephotomicrographs of stained smears, and in addition he pioneered methods of growing bacteria on agar media.pioneered methods of growing bacteria on agar media.  Despite the fact that the germ theory of disease hadDespite the fact that the germ theory of disease had been established in 1877, it was not universally acceptedbeen established in 1877, it was not universally accepted until 1882 when Koch presented his masterly paper onuntil 1882 when Koch presented his masterly paper on ‘The aetiology to tuberculosis’ giving details of the‘The aetiology to tuberculosis’ giving details of the isolation of the tubercle bacillus. In the following year heisolation of the tubercle bacillus. In the following year he isolated the cholera vibrio.isolated the cholera vibrio.  The ‘Golden era’ of medical microbiology which wasThe ‘Golden era’ of medical microbiology which was opened byopened by Pasteur, ListerPasteur, Lister andand KochKoch was perhaps thewas perhaps the greatest contribution ever to the theory and practice ofgreatest contribution ever to the theory and practice of medicine.medicine. www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12. Antonie van Leeuwenhoek in 1683 was the first to describe microorganisms in human mouth. -His astute observation on scrapings from carious cavities in teeth were made with the use of only a single-lens microscope. - But despite such limitations he was able to describe the principle shapes of bacteria that remains the basis for much of the classification of microorganisms today. Microbiology in Dentistry www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13. Systemic diseases with pathogens present in blood and other bodySystemic diseases with pathogens present in blood and other body fluidsfluids DiseaseDisease PathogenPathogen Hepatitis BHepatitis B Hepatitis B virusHepatitis B virus Hepatitis CHepatitis C Hepatitis C virusHepatitis C virus Hepatitis DHepatitis D Hepatitis D virusHepatitis D virus HIV-infection and AIDSHIV-infection and AIDS Human immunodeficiency virusHuman immunodeficiency virus 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: Bloodborne diseases, Oral diseases, Systemic diseases with oral lesions, and Respiratory diseases. www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. •Bloodborne 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.comwww.indiandentalacademy.com
  15. 15. A B C D E Other name Infectious Serum Parenterally transmitted non-A, non- B Delta Enterically transmitted non-A, non- B Major route of transmission Fecal-oral, water, food Parenteral, direct contact Parental, direct contact Parental, direct contact Fecal-oral, water, food Incubation 2-6 weeks 4-24 weeks 2-20 weeks 4-24 weeks Unknown Liver necrosis Rare Uncommon Uncommon Yes Unknown Chronicity No Yes (5-10%) Yes (50%) Yes No VIRAL HEPATITIS www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16. 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. HEPATITIS B VIRUS www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17. HIV INFECTION AND AIDS Oral manifestations of AIDS : Early manifestations of AIDS occur as oral lesions. •Oral manifestations include fungal diseases, such as candidiasis, histoplasmosis, geotrichosis, or cryptococcosis; •viral diseases such as warts, hairy leukoplakia, or herpes simplex infection; • bacterial diseases such as rapidly progressing periodontitis or gingivitis; • cancerous disease such as Kaposi’s sarcoma and non- Hodgkin’s lymphoma. 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.comwww.indiandentalacademy.com
  18. 18. Exposure to blood : HIV INFECTION AND AIDS www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. Prevention : Sexual contact : HIV INFECTION AND AIDS Recommendations for preventing the spread of HIV-1 through sexual contact includes abstinence or limiting sexual activities to one partner who is not infected and who does not have any other sex partners www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20. -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. - Injection drug abusers must not use blood-contaminated needles. Blood contact : www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21. Diseases Pathogen Herpes infections Herpesvirus hominis (herpes simplex virus) Syphilis Treponema pallidum Hand-foot-mouth disease Coxsackievirus Herpangina Coxsackievirus Gonococcal pharyngitis Neisseria gonorrhoeae Candidiasis Candida albicans ORAL DISEASES www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22. I) HERPES INFECTIONS : Herpes simplex viruses may cause infections of the mouth, skin, eyes and genitals. -About 90% of adults have been infected with herpes simplex virus type 1, but only 10% (usually children) experience the typical symptoms of oral herpes (primary herpetic gingivostomatitis). -In this disease, vesicle-type lesions 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.comwww.indiandentalacademy.com
  23. 23. 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.comwww.indiandentalacademy.com
  24. 24. 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.comwww.indiandentalacademy.com
  25. 25. 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.comwww.indiandentalacademy.com
  26. 26. IMMUNIZATION FOR ORAL HEALTH CARE PROVIDERS Health care workers are at particular risk of several vaccine-preventable diseases. www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27. Generic name Primary schedule and Boosters (s) Hepatitis B recombinant DNA Two doses IM 4 weeks apart, third dose 5 months after second Rubella live virus vaccine One dose SC, no booster Measles live virus vaccine One dose SC, no routine boosters Mumps live virus vaccine One dose SC, no booster Influenza vaccine (inactivated whole- virus and split-virus vaccine) tetanus – diptheria toxoid Annual vaccination with current vaccine. Either whole 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 poliovirus vaccine (E-IPV) live oral polio virus vaccine (OPV) E-IPV is preferred for primary vaccination of adults, two doses SC 4 to 8 weeks apart, a third dose 6 to 12 months after the second. For adults with a completed primary series and for whom a booster is indicated, either OPV or E-IPV can be given Recommended vaccines for Oral Health care Workers www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28. PATHWAYS FOR CROSS-CONTAMINATION A total office infection program is designed to prevent or at least reduced 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.comwww.indiandentalacademy.com
  29. 29. i) Patient to Dental Team: • Direct contact : with patient’s saliva or blood may lead to entrance of microbes through a nonintact 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 nonintact skin as a result of touching contaminated instruments, surfaces or other item. www.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30. 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 nonintact skin. - if the hands are injured while in the patient’s mouth, bloodborne 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.comwww.indiandentalacademy.com
  31. 31. 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.comwww.indiandentalacademy.com
  32. 32. 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.comwww.indiandentalacademy.com
  33. 33. After microbes enter the body, there are three basic factor that determine if an infectious disease will develop: •Virulence (pathogenic properties of the invading microorganism); •Dose (the number of microorganisms that invade the body); •Resistance (body defense mechanism of the host). These factors are called determinants of an infectious disease, and their Interaction determines the outcome of an infection as follows: Disease= Virulence x Dose Resistance GOAL OF INFECTION CONTROL www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34. OPERATORY PREPARATION AND INSTRUMENT RECIRCULATION www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35. OPERATORY PREPARATION General: All surfaces and items touched by and contaminated with saliva or blood, initially should be cleaned scrupulously and then disinfected with an Environmental protection Agency (EPA)- approved tuberculocidal agent before each patient is seated. -An alternative is to use protective disposable covers. -These barriers protect surfaces that directly or indirectly may come into contact with body fluids. www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36. 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 Drawer handles Plastic www.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37. INSTRUMENT PROCESSING Instrument processing is the procedures that prepares contaminated instruments for reuse. The processing must be performed carefully so that disease agents from a previous patient,or from a member of the dental team who handled the instruments, or from the environment will not be transferred by the instruments to the next patient. Processing also must be performed correctly to keep instrument damage to a minimum. Instrument processing steps 1.Holding (presoaking) 2.Precleaning. 3.Corrosion Control, Drying, Lubrication 4.Packaging 5.Sterilization 6.Sterilization monitoring 7.Handling Processed Instruments www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38. 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. •This can facilitate the actual cleaning. •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. • Place loose instruments in the ultrasonic cleaning basket and then place the basket in the holding solution. www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39. ii. PRECLEANING: iii.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.comwww.indiandentalacademy.com
  40. 40. 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.comwww.indiandentalacademy.com
  41. 41. III. CORROSION CONTROL, DRYING, AND LUBRICATION Instruments or portions of Instruments and burs made of carbon steel will rust during steam sterilization. •Examples might be nonstainless steel cutting or scraping Instruments such as scalers, hoes, and the cutting surfaces of orthodontic pliers. •Although rust inhibitors (e. g., sodium nitrite) that can be sprayed on the Instruments will 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 rusting. www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42. IV :Packaging: Packaging Instruments before processing through the sterilizer prevents them from becoming contaminated after sterilization during storage or when being distributed to chairside. 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.comwww.indiandentalacademy.com
  43. 43. 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.comwww.indiandentalacademy.com
  44. 44. STERILIZATION 1.Heat sterilization :Heat sterilization involving steam, dry heat, and unsaturated chemical vapor is the most common type of sterilization used in offices today. All the methods of heat sterilization can be routinely monitored for effectiveness using bacterial endospores There are three types of sterilization processes used in dentistry www.indiandentalacademy.comwww.indiandentalacademy.com
  45. 45. Liquid chemical sterilization: Although the liquid chemical sterilant, glutaraldehyde, can be shown to be sporicidal in controlled laboratory testing, Gas sterilization: Ethylene oxide gas sterilizers that operate at 720F to 1400F (much lower than heat sterilizers) also can be monitored with bacterial endospores, but this type of sterilization is not commonly used in dental offices because of the long exposure time required for sterilization. www.indiandentalacademy.comwww.indiandentalacademy.com
  46. 46. VI. 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.comwww.indiandentalacademy.com
  47. 47.  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 :  Bacillus stearothermophilus - steam or chemical vapor sterilization  Bacillus subtilis - dry heat or ethylene oxide gas sterilization. i) Biological Monitoring www.indiandentalacademy.comwww.indiandentalacademy.com
  48. 48. 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.comwww.indiandentalacademy.com
  49. 49. 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.comwww.indiandentalacademy.com
  50. 50. 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.comwww.indiandentalacademy.com
  51. 51. VII. 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.comwww.indiandentalacademy.com
  52. 52. 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.comwww.indiandentalacademy.com
  53. 53. INSTRUMENT PROTECTION: Instrument processing can cause damage to instruments, but several steps could be taken to keep this at a minimum. -Stainless-steel instruments are least effected by corrosion from moisture and heat, but some clinicians prefer instruments with carbon steel rather than stainless-steel cutting surfaces that may retain a sharp edge longer. - Unfortunately, carbon steel items corrode and lose sharpness during sterilisation. Carbon steel items are best sterilized in a non-corrosion producing environment such as dry heat or chemical vapor sterilizer. www.indiandentalacademy.comwww.indiandentalacademy.com
  54. 54. STERILIZATION METHODS : PHYSICAL METHODS OF STERILIZATION : The use of heat has long been recognized as the most efficient, reliable method of sterilization. (i) STEAM STERILIZATION : Efficient sterilization may be accomplished by the use of moist heat at higher temperatures in the form of saturated steam under pressure. This modality remains the oldest, most commonly used of the acceptable methods for instrument sterilization. www.indiandentalacademy.comwww.indiandentalacademy.com
  55. 55. Characteristics :  Temperature : 1210C (2500F)  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: Corrosion of unprotected carbon steel instruments Dulling of unprotected cutting edges Possibility that packages may remain wet at end of cycle Possible deposits from use of hard water Possible destruction of heat-sensitive materials www.indiandentalacademy.comwww.indiandentalacademy.com
  56. 56. (ii) DRY HEAT : 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. Characteristics : Temperature : 1600C (3200F) Or 1700C (3400F) Cycle time : 2 hours Or 1 hour Requirements: Must not insulate items from heat Must not be destroyed by temperature used www.indiandentalacademy.comwww.indiandentalacademy.com
  57. 57. Acceptable Materials: Paper bags, aluminum foil, polyfilm plastic tubing Unacceptable Materials : plastic and paper bags that cannot withstand dry heat temperature 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.comwww.indiandentalacademy.com
  58. 58. (iii) RAPID HEAT TRANSFER STERILIZATION : Characteristics : Temperature : 1900C (3750F) 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.comwww.indiandentalacademy.com
  59. 59. . CHEMICAL 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.comwww.indiandentalacademy.com
  60. 60. 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 CHARACTERISTICS www.indiandentalacademy.comwww.indiandentalacademy.com
  61. 61. GLUTERALDIHYDE: (1.5-Pentanedial) (C5H8O2) has two aldehyde units, one at end of the carbon chain. The later two types use an activator that brings the final 2.0 to 3.2% glutaraldehyde to the desired pH. 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.comwww.indiandentalacademy.com
  62. 62. Disadvantages : -Although glutaraldehyde formulations are effective as immersion sterilants/ 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. www.indiandentalacademy.comwww.indiandentalacademy.com
  63. 63. 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.comwww.indiandentalacademy.com
  64. 64. 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.comwww.indiandentalacademy.com
  65. 65. Iodophor antiseptics are useful in preparing the oral mucosa for local anesthesia and surgical procedures. . Their surfactant properties make them excellent cleaning agents before disinfection, and newer iodophor commercial formulations have shown EPA-approved tuberculocidal activity within 5 to 10 minutes of exposure. www.indiandentalacademy.comwww.indiandentalacademy.com
  66. 66. Phenols and Derivatives : • . This phenolic solution was used as an all-purpose surgical instrument immersion sterilant, 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.comwww.indiandentalacademy.com
  67. 67. PERSONAL PROTECTIVE EQUIPMENT AND BARRIER TECHNIQUES 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, operatory equipment, and environmental surfaces ; www.indiandentalacademy.comwww.indiandentalacademy.com
  68. 68. 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, blood-contaminated saliva, or mucous membranes. . www.indiandentalacademy.comwww.indiandentalacademy.com
  69. 69. Masks : When a tooth is cut with a high-speed turbine handpeice 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.comwww.indiandentalacademy.com
  70. 70. 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.comwww.indiandentalacademy.com
  71. 71. DISPOSAL OR WASTE MATERIALS:- - Gloves, masks, wipes, paper drapes:- Handled with gloves, discarded in impervious plastic bags. - Blood, disinfectants, sterilants:- 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:- Same as sharp items, but diff. containers. www.indiandentalacademy.comwww.indiandentalacademy.com
  72. 72. INFECTION CONTROL CONSIDERATIONS IN DENTAL OFFICE DESIGN Additionally, the total square footage and layout of the entire space should not be negotiated until each work area has been evaluated. 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.comwww.indiandentalacademy.com
  73. 73. 1) 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.comwww.indiandentalacademy.com
  74. 74. 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.comwww.indiandentalacademy.com
  75. 75. CONCLUSIONCONCLUSION • IT IS OUR MOST IMPORTANT DUTY TO PRESERVE AND MAINTAIN THE HEALTH OF OUR PATIENTS AND HIM SELF. • 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.comwww.indiandentalacademy.com
  76. 76. • Bellavia De : Efficient and effective infection control. J Clin Orthod 1992; 26: 46- 54. • Buckthal JE, Maynew MJ, Kusy RP : Survey of sterilization and disinfection procedures. J Clin Orthod 1986; 20: 759-765. • 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. • Ascencio F, Langkamp H, Agarcoal S : Orthodontic marking pencils as a potential source of cross contamination. J Clin Orthod 1998; 32: 307-310. www.indiandentalacademy.comwww.indiandentalacademy.com
  77. 77. • 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. • Lee SH, Chang Y : Effects of recycling on the mechanical properties and surface topography of nickel-titanium alloy wires. Am J Orthod Dentofacial Orthop 2001; 120: 654-663. • Matasa CG : Orthodontic recycling at crossroads. J Clin Orthod 2003; 37: 133- 139. • McCarthy GM, Mamandras AH, Mac Donald JK : Infection control in orthodontic office in Canada. Am J Orthod Dentofacial Orthop 1997; 112: 275- 81. www.indiandentalacademy.comwww.indiandentalacademy.com
  78. 78. www.indiandentalacademy.comwww.indiandentalacademy.com Thank youThank you For more details please visitFor more details please visit www.indiandentalacademy.comwww.indiandentalacademy.com

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