sterilisation and disinfection control in prosthodontics

2. DISINFECTION IN PROSTHODONTICS

3. 3
Infection control (IC) is an essential part of dentistry
Potential for disease transmission in the dental clinic and lab is well
documented.
Potential pathogens can be transported to lab via orally soiled impressions,
dental prostheses/appliances.
Microorganisms can be transferred from contaminated impressions to
dental casts.
Oral bacteria can remain viable in set gypsum for up to 7 days.
INTRODUCTION

4. 4
Mechanism for transfer of infectious
material
1) Cross contamination
2) Direct contact transmission
3) Indirect contact transmission
4) Droplet infection
5) Air borne infections
6) Vehicle

5. 5
Requirements of infection control
• For ideal cross infection control procedures:-
– Should be simple,
– Easily reproduced,
– Economical,
– Should not involve a great deal of surgery time
– Should be easily understood by all staff
– Should not involve toxic substances.

6. 6
PRINCIPLES OF INFECTION CONTROL
PRINCIPLE 1- STAY HEALTHY
PRINCIPLE 2- AVOID CONTACT WITH BLOOD
PRINCIPLE 3- LIMIT THE SPREAD OF BLOOD
PRINCIPLE 4- MAKE OBJECTS SAFE FOR USE
PRINCIPLE 5- PATIENT SCREENING

7. 7
Disinfection & Sterilization
According to the CDC (CENTRE OF DISEASE
CONTROL), patient-care items (e.g., dental instruments,
devices, and equipment) are categorized as
Critical,
Semi critical, or
Noncritical,
based on the potential risk of transmitting infection if the
item becomes contaminated during use.

8. 8
Instruments that contact cut tissues or penetrate tissues
are considered to be critical items that require thorough
cleaning and sterilization for reuse.
Examples are
Forceps, periosteal elevators, cross bars Scalpels,
scissors, suture needles
Bone chisels
Surgical burs
Scaling instruments
Endodontic instruments
CRITICAL INSTRUMENTS

9. 9
Semi critical instruments
Semicritical items that touch mucosa are the
air/water syringe tip, suction tips, prophy angle, and
hand pieces

10. 10
• Non-critical instruments are those that come in
contact with intact skin.
• Risk of transmission of infection is minimum.
Examples :X-ray heads, pulse oximeter, BP cuff,
dental chair etc.

11. 11
• At the beginning of a routine treatment period, watches and jewellery
must be removed and hands must be washed with a suitable
cleanser.
• Hands must be lathered for at least 10 seconds, rubbing all surfaces
and rinsed.
• Clean brushes can be used to scrub under and around the nails.
• Must be repeated at least once to remove all soil.
• Disinfection is a less effective process than sterilization because it
does not kill bacterial endospores.
• Disinfectants are antimicrobial agents that are applied to non-living
objects to destroy microorganisms, the process of which is known as
disinfection.
DISINFECTION

12. 12
Criteria for an ideal disinfectant:-
Broad spectrum of activity
Acts rapidly
Non corrosive
Environment friendly
Is free of volatile organic compounds
Nontoxic, hypoallergenic & no staining
Good penetrating and cleaning ability,

13. 13
Alcohols
• Ethyl alcohol (ethanol) and isopropyl alcohol are
the most frequently used. They are used mainly as
skin antiseptics at a concentration of 60- 90% in
water.
• They act by denaturing bacterial proteins. They
have no action on spores
• Methyl alcohol is effective against fungal spores
and is used for cleaning cabinets and incubators.
• A pad moistened with methanol and a dish of
water (to ensure high humidity) are kept inside the
chamber which is left at working temperature for
several hours.

14. 14
Aldehydes
• Formaldehyde is active against the
amino group in the protein molecule. In
aqueous solutions it is markedly
bactericidal, sporicidal and virucidal.
• It is used to preserve anatomical
specimens, and for destroying anthrax
spores in hair and wool. 10% formalin
containing 0.5% sodium tetraborate is
used to sterilize clean metal instruments.
• Formaldehyde gas is used for sterilizing
instruments, heatsensitive catheters and for
fumigating wards, isolation rooms
and laboratories.

15. 15
Glutaraldehyde
• Has an action similar to that of formaldehyde.
• It is especially effective against the tubercle bacilli, fungi and viruses. It
has no deleterious effect on cement or lenses of instruments.
• Hence, it is used to sterilise cystoscopes, bronchoscopes, rubber
anaesthetic tubes, plastic endotracheal tubes and polythene tubing. It can
also be used for metal instruments.

16. 16
Orthophthalaldehyde
• Has bactericidal activity.
• It is used to cleanse
endoscopes between patients as
it is quick,effective and safe.48

17. 17
Halogens
• Iodine in an aqueous and alcoholic
solution has been widely used as a
skin disinfectant.
It is bactericidal, with moderate action
against spores. It is active against the
tubercle bacteria and viruses.
• Compounds of iodine with non-ionic
wetting or surface-active agents
known as iodophores have better
action than aqueous or alcoholic
solutions of iodine.

18. 18
• Chlorine and its compound hypochlorite
have been used as disinfectants over time.
They are markedly bactericidal and virucidal.
• Town water supplies, swimming pools, food
and dairy industries use chlorine for
disinfection. The organic chloramines are
used as antiseptics for dressing wounds.

19. 19
Phenols
• These compounds are obtained by distillation of
coal tar between temperatures of 170°C and 270°C.
• Bactericidal effect of phenols is due their capacity
to cause cell membrane damage, inactivation of
membrane-bound oxidases and dehydrogenases
leading to lysis and death of the microorganism.
Low concentrations of phenol precpitate proteins
• Phenols is widely used as disinfectants in hospital.
Commonly used compounds are Lysol and cresol
They are not readily inactivated by the presence of
organic matter; hence, they are good general
disinfectants
• Chlorhexidine (Hibitane) is a relatively non-toxic
skin antiseptic and wound dressing. They are active
against most Gram-positive organisms and fairly
effective against Gram-negative bacteria.

20. 20

21. 21
DISINFECTION IN PROSTHODONTIC
PRACTICE

22. 22
Methods Of Disinfecting Impressions
1. Spraying
2. Immersion

23. 23
Different Impressions
• Disinfection of Alginate Impressions can be done
with 0.5% sodium hypochlorite.
• Iodophores Immersion disinfection for prolonged
periods will cause distortion due to imbibition.
Beyerle, M.P., Hensley, D.M., Bradley Jr, D.V., Schwartz, R.S. and Hilton, T.J., . Immersion
disinfection of irreversible hydrocolloid impressions with sodium hypochlorite. Part I:
Microbiology. Int JProsthodont.2014, 7(3),234-8

24. 24
• Agar- Reversible Hydrocolloid: Found to be stable when
immersed in 1:10 dilution sodium hypochlorite or 1:2 iodophor.
• Recommended immersion time is 10 minutes.
Giblin, J., Podesta, R. and White, J., Dimensional stability of impression materials immersed in an iodophor disinfectant. Int J Prosthodont. 2010, 3(1). 72-7

25. 25
Zinc Oxide Eugenol Immersion
• It can be disinfected in 2% glutaraldehyde
Iodophores or Chlorine compounds.
• Adverse effect have been reported on ZOE
immersed for 16 hours in diluted
hypochlorite.
Olsson, S., Bergman, B. and Bergman,M., Zinc oxide-eugenol impression materials. Dimensional stability and surface detail
sharpness following treatment with disinfection solutions Swed
Dent J.2012, 6(4),177.

26. 26
Impression Compound
• Immersion in 1:10 dilution sodium
hypochlorite or iodophor for specified time
period has been found to be useful for
disinfecting impression compound
impressions.
Bhat, V.S., Shetty, M.S. and Shenoy, K.K., Infection control in the prosthodontic
laboratory. J Indian Prosthodont Soc 2007, 7(2),62.

27. 27
Elastomeric Impression Materials
• Polysulphide and Addition
Silicone: Glutaraldehyde, Iodophor,
0.5% sodium hypochlorite should be
used for its disinfection.
Thouati, A., Deveaux, E., Iost, A. and Behin, P., Dimensional stability of
seven elastomeric impression materials immersed in disinfectants. J
Prosthet Dent. 2016, 76(1),8-14.

28. 28
Polyether:
• Spraying in iodophor, 0.5% Sodium
hypochlorite should be used.
• Prolonged immersion causes distortion.
• Polyether shows dimensional changes on
immersion in 2% glutaraldehyde.
Drennon, D.G. and Johnson, G.H., The effect of immersion disinfection of elastomeric impressions
on the surface detail reproduction of improved gypsum
casts. J Prosthet Dent. 2012, 63(2),233-241.

29. 29
Disinfection Of Wax Bites & Wax
Rims
• Wax rims and wax bites should be disinfected by the
spray wipe spray method using an iodophor. Rinse &
spray may be more appropriate for wax bites.
• For adequate disinfection these should remain for
longer time in tuberculocidal disinfection.
• After the second spray, they can be enclosed in a
sealed plaster bag for the recommended time. These
items probably should be rinsed again after disinfection
to remove any residual disinfectant.

30. 30
Disinfection Of Bite
Registrations
• Bite registrations made of various materials or
compound can be handled in the same manner
as impressions of the same materials.
• These registrations also can be disinfected,
using the rinse spray rinse technique, with most
EPA registered hospital level tuberculocidal
disinfectants used as sprays (chlorine
compounds should not be applied to ZOE).
• After disinfection, the registration should be
rinsed again to remove residual disinfectant.

31. 31
Disinfection of Casts
• ADA recommends that stone casts be
disinfected by the spraying until wet or
immersing in a 1:10 dilution of
sodium hypochlorite or an iodophor.
• Casts to be disinfected should be fully set
(i.e. stored for at least 24 hours).
• Microwave irradiation of casts for 5 mins
at 900W gives high level disinfection of
the gypsum casts

32. 32
Disinfection Of Custom acrylic resin
impression trays
• Custom acrylic resin impression trays
should be disinfected by spraying with
surface disinfectants or immersing in
either 1:2 iodophor or 1:10 sodium
hypochlorite.
• They should be rinsed thoroughly to
remove any residual disinfectant and
allowed to dry fully before use. After use
in the mouth custom trays should be
discarded.

33. 33
Dental Prosthesis and
Appliances
• The ADA recommends disinfection by
immersion in iodophors or chlorine
compounds.
• Although both of these disinfectants are
somewhat corrosive, studies have shown little
effect on chrome cobalt alloy with short-term
exposure (10 minutes) to iodophors or 1:10
hypochlorite.

34. 34
• Cast partial dentures are
disinfected using iodophors
solution or 2% glutaraldehyde
solution for 10 minutes.
• Damage of heat cured denture
base resin has been shown to occur
after only 10 minutes of immersion
in glutaraldehyde.

35. 35
• Fixed metal/porcelain prosthesis may be
disinfected by immersion in glutaraldehyde's
for the time recommended for tuberculocidal
inactivation by the disinfectant manufacturer.
• In addition several clinical services have
confirmed that fixed prosthesis can be
disinfected by short immersion in diluted
hypochlorite without apparent harm to the
device.

36. 36
Disinfection of Dentures with Soft liners
• Disinfection of dentures with soft
liners can be done by soaking the
dentures in 2% alkalineglutaraldehyde
solution for 10minutes or by soaking in
5% sodium hypochlorite solution for
10 minutes.
• After disinfection is done the dentures
are washed with water before
re-inserting.

37. 37
Management of instruments after use:
• They should be cleaned and dried, lubricated if necessary and packaged before
loading into the autoclave.
• Cleaning involves an initial presoaking with detergent solution containing
disinfectants to soften organic debris and begin microbial kill. After cleaning the
instruments should be dried.
• Surfaces like unit handles, light handle, light switch, chair controls, head rest
knob, trolley handle, trolley and 3-way syringes cannot be disconnected and
sterilized and therefore need to be treated with disinfectants covered with a
protective barrier.

38. 38
• However instruments which enter oral cavity and are connected to some of the
equipment e.g.air rotor and surgical handpiece, ultrasonic inserts / tips, airwater
syringe tips and light cure probes / tips should be disconnected, sterilized and
rinsed.
• Disinfection of surfaces involves the cleaning of surfaces, after every patient
and application of a disinfectant chemical. These chemicals include alcohol
(spirit), iodophor products, synthetic phenols, glutaraldehyde, chlorines etc.
• The advantages of barriers include ease and speed of insertion, standard sizes
and the protection of equipment from damage by chemicals, blood and fluids.

39. 39
• Spittoons should be flushed with
water, scrubbed and disinfected.
• Waste buckets should be used
with disposable plastic bags as
liners to be changed wherever
necessary.

40. 40
Dental Unit Waterlines: Disinfection
and management
• Quality of water in dental unit waterlines
(DUWLs) attached to handpieces, ultrasonic
sealers and air/ water syringes has been debated
widely.
• The source of water to the dental unit is either
directly from municipal supply or via water
reservoir bottles usually filled with distilled
water or normal water.

41. 41
• After entering the unit, it passes through a
multichannel control box that distributes the water to
hoses (DUWLs) feeding various attachments such as
the high-speed handpiece, the air/water syringe and
the ultrasonic scaler.
• The main risk to dental staff and patient health from
DUWL contamination comes from opportunistic and
respiratory pathogens such as Legionella, non-
tuberculous mycobacteria (NTM) and Pseudomonas.
• These organisms can be amplified in the biofilm to
reachinfective concentrations, with the potential for
inhalationassociated respiratory infections or direct
contamination of surgical wounds.

42. 42
• All DUWLs should be flushed for 2 min at the beginning of each
day, prior to commencing treatment and at the end of the day.
• The DUWL should be flushed for 20–30 s between patients to
reduce temporarily the microbial count, as well as to clean the
waterline of materials that may have entered from the patient’s
mouth. This includes handpieces, ultrasonic scalers and air/water
syringes.
• All DUWLs should be fitted with non-retractable devices, to
prevent suck-back (backflow/backsiphon age) of material into the
municipal water supply.

43. 43
Maintenance of Wooden handle
spatulas, Blow-torches, Rubber
bowls & Shade- guides
• After manipulation chairside wooden handled
spatulas should be cleaned and disinfected.
• Other times such as Blow torches should be
disinfected after use, or the area to be touched
should be covered with a barrier such as plastic
wrap to prevent contamination.
• Rubber bowls should be cleaned and
disinfected after chairside use.

44. 44
• Items such as shade guides should be cleaned and disinfected to
avoid cross contamination.
• If iodophors are used on shade guides, they should be wiped with
water or alcohol after the exposure time to remove any residual.

45. STERILISATION IN
PROSTHODONTIC PRACTICE
45

46. 46
Sterilization of Diagnostic Instruments (Mouth mirror, Probe,
Explorer)
• Dry the diagnostic instrument with help of wipes. Only absolutely
dry instruments must be placed in the sterilizer, in order to avoid
calciferous deposits and/or water spots. Instruments are autoclaved
at 121° C.
• In order to prevent staining and corrosion, the steam must be free
of particles. When several instruments are sterilized, the maximum
capacity of the sterilizer must not be exceeded.
• After sterilization instruments must be stored and transported in
the rooms and containers designated by the practice. The
instruments should be processed as soon as possible after use.

47. 47
Sterilization of Impression Trays
• After the impression has been removed from the metallic impression trays the
trays are washed with running water and are made free from the particles
adhering to it.
• The trays are the properly dried and placed in autoclave for sterilization at
121° C.

48. 48
Sterilization of Handpiece
• Several ways to control the spread of contaminating matter between two
patients have been recommended.
• The most common methods of asepsis control are as follows:
Protection from any contact with the fluids present within the oral environment,
Chemical disinfection, Thermal sterilization, Disinfection using microwaves,
Disinfection via irrigation, Single use hand-pieces.
• Among the above techniques, moist heat using saturated water vapor's
(autoclave) offers the best results as regards the sterilization of handpieces in the
short time.

49. 49

50. 50

51. 51
Sterilization of Facebows & Bite forks
• Parts of facebow which are made of metal can be sterilized in autoclave.
• It is important to note that earpieces of facebow be removed before
sterilization.
• Before facebow and bite fork is kept in autoclave it is necessary to wipe it with
dry cloth.
• Facebow and bite fork can be autoclaved at 121 C.

52. 52
Sterilization of Dental Implants.
• The following products are delivered non sterile:
• Transfer Analogs, Drivers, Overdenture, Abutments, Transfer screws, Drill
Extension, Parallel Pin, Transfer Screws and plastic handle.
• It is recommended to sterilize the components and instruments prior to placing
in oral cavity.
• If modification has been made to the components and instruments clean prior
to sterilization.
• Dental implants and components are pre-cleaned prior to sterilization.

53. 53

54. 54

55. 55

56. 56
Sterilization of implant components
• Inspection: Before sterilization visual inspection for
cleanliness should be performed with magnifying glasses.
• Packaging of instruments: Place instruments in sterilization
pouches.
• Sterilization: Steam sterilize the device in a sterilization
pouch for 4 mins at 132 C.

57. 57
Fumigation of Operation Theatre/ Implant room
• To sterilize the operation theatre formaldehyde gas (bactericidal & sporicidal,
virucidal) is widely employed as it is cheaper for sterilization of huge areas like
operation theatres.
• Formaldehyde kills the microbes by alkylating the amino acids and sulfhydryl
group of proteins and purine bases.
• In spite of the gas being hazardous
continues to be used in several
developing countries.

58. 58
Procedure of Fumigation
• Thoroughly clean windows, doors, floor, walls and
All washable equipment's with soap and water.
• Close windows and ventilators tightly. If any
openings found seal it with cellophane tape or other
material.
• Switch off all lights, A/C and other electrical &
electronic items

59. 59
Personal care during fumigation
• Adequate care must be taken by wearing cap, mask, foot cover,
spectacle.
• Formaldehyde is irritant to eye & nose; and it has been
recognized as a potential carcinogen.
• So the fumigating employee must be provided with the personal
protective equipment's.

60. 60

61. 61
Modes of Occupational Exposure
• Patient to DHCP (Dental Health Care Personnel), including dentists, hygienists and
assistants.
• From DHCP to patient.
• From patient to patient.
Prevention Strategies (Universal Protection Protocol)
• The different prevention protocol includes the following:
1. Personal Protective Equipment's
2. Cubicle preparation
3. Gloves, masks, protective eye wears
4. Puncture resistant gloves and thimbles
5. Double gloves

62. 62
Barriers for Preventing Cross- Contamination of Infection
Gloves:
• After contact with each patient, gloves should be
removed, and hands should be washed and then regloved
before treating another patient.
• Exposure to disinfectants or other chemicals often
cause defect in gloves, thereby diminishing their
value
• Latex heavy rubber gloves, also called utility gloves
should be used in management of HIV patients.

63. 63
Protective clothing's such as gowns, clinic jackets or
similar outer protective garments which are disposable
should be used.
• Masks: Surgical masks or chin length plastic face
shields should be worn to protect the face and oral and
nasal mucosa when a discharge of body fluids is
anticipated

64. 64
• Handling of sharp instruments and needles:
If a patient requires multiple injection over time then the needle should be
recapped between each use to avoid needle stick injury.
• Disposable syringes, needles, scalpel blades, and other sharp items should be
discarded in puncture resistant biohazard container that are easily acceptable.

65. 65
Cubicle Preparation
1. Surface disinfection
2. Disinfecting counter tops
• Any item that cannot be autoclaved should be
disinfected with a fresh iodophor solution and
protective cover should be placed.
• Surfaces can be covered with plastic wrap,
aluminium foil or impervious backed absorbent
paper.
• Counter tops should also be disinfected with
appropriate disinfectants.

66. 66

67. 67

68. 68

69. 69

70. 70

71. 71

72. 72
Disposal of Contaminated Linen
• All linen from HIV seropositive and AIDS patients
must be treated as infected linen.
• Disposable plastic apron and gloves must be worn
when handling infected linen.
• Grossly contaminated heavily blood soaked linen
must be carried to the sluice area to be bagged
• It should be placed in the appropriate water-soluble
laundry bag at the bedside and sealed.
• This water-soluble bag is then placed in double
yellow bags and incinerated.

73. 73
Disposal, Disinfection & Sterilization Of Contaminated
Equipment
• Use disposable items whenever possible and dispose of as clinical
waste.
• Wear protective clothing when dealing with contaminated
equipment.
• Upon completion of procedure dispose of protective clothing as
clinical waste.

74. 74
Contaminated Instruments (Stainless steel & polypropylene instruments,
bowels, kidney dishes etc.)
• Clean the instruments with running water and dry.
• Place the instruments in surgical plate. Apply some amount of alcohol over the
instruments and burn it.
• Next place them in an autoclavable disposal bag.
• Secure the neck of the bag for transportation.
• Arrange transportation of contaminated items for decontamination and
sterilization.
• Incineration of some instruments is also carried out.

75. 75

76. 76
References
• Ananthanarayan And Panikers. Textbook Of Microbiology. 10th Edition. India:
Universal Press;2016.
• Baveja C.P. Textbook Of Microbiology. 11th Edition. India; ACP Publishers; 2011.
• Rai R, Anand V, Loushambam P. Disinfection Of Alginate Impression Materials
Using UvLights Coated With Candida Albicans. Global Journal For Research
Analysis. 2018 Oct30;7(10).
• Farrugia C, Cassar G, Valdramidis V, Camilleri J. Effect Of Sterilization
Techniques Prior To Antimicrobial Testing On Physical Properties Of Dental
Restorative Materials. Journal Of Dentistry. 2015 Jun 1;43(6):703-14.
• Bhat Vs, Shetty M, Shenoy K. Infection Control In The Prosthodontic Laboratory.
The JournalOf Indian Prosthodontic Society. 2017 Apr 1;7(2):62.

77. IN 2 OR 3 COLUMNS
Yellow
Is the color of gold,
butter and ripe lemons.
In the spectrum of
visible light, yellow is
found between green
and orange.
Blue
Is the colour of the
clear sky and the deep
sea. It is located
between violet and
green on the optical
spectrum.
Red
Is the color of blood,
and because of this it
has historically been
associated with
sacrifice, danger and
courage.
77

78. 78

79. USE CHARTS TO EXPLAIN YOUR
IDEAS
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80. AND TABLES TO COMPARE DATA
80
A B C
Yellow 10 20 7
Blue 30 15 10
Orange 5 24 16

81. MAPS
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82. 82
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83. 83
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85. LET’S REVIEW SOME
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Yellow
Is the color of gold, butter and
ripe lemons. In the spectrum of
visible light, yellow is found
between green and orange.
Yellow
Is the color of gold, butter and
ripe lemons. In the spectrum of
visible light, yellow is found
between green and orange.
Blue
Is the colour of the clear sky
and the deep sea. It is located
between violet and green on
the optical spectrum.
85
Red
Is the color of blood, and
because of this it has
historically been associated
with sacrifice, danger and
courage.
Blue
Is the colour of the clear sky
and the deep sea. It is located
between violet and green on
the optical spectrum.
Red
Is the color of blood, and
because of this it has
historically been associated
with sacrifice, danger and
courage.

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