BIOSAFETY IN DENTAL CARE by Dr.T.V.Rao MD

1. BIOSAFETY IN
DENTAL CARE
Dr.T.V.Rao MD
12/30/2018 Dr.T.V.Rao MD @ Safe dental practices 1

2. EVERY ONE NEEDS A
DENTAL CARE
HOW SAFE WE ARE ?
• Every person at some stage
in their lives will have
entered a dentists
attention, and treatment
Most people will see the
dentist on a regular basis to
ensure a planned
preventative dental
inspection of their teeth is
in place to identify at an
early stage for any dental
problems.
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3. INFECTION
PREVENTION A
EMERGING TOPIC OF
IMPORTANCE
• Infection prevention in dentistry
is an important topic that has
gained more interest in recent
years and guidelines for the
prevention of cross-transmission
are common practice in many
countries. However, little is
known about the real risks of
cross-transmission, specifically in
the dental healthcare setting.
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4. Break the Chain of Infection
Spread
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5. The Patients at risk from
the following Infections
in Dental care
• Facts from the literature
on HSV, VZV, HIV,
Hepatitis B, C and D
viruses, Mycobacterium
spp., Pseudomonas spp.,
Legionella spp. and multi-
resistant bacteria are
presented.12/30/2018 Dr.T.V.Rao MD @ Safe dental practices 5

6. Source and Spread of Infections in
Dental Procedures
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7. The Dental patients at greater
Risk from Hepatitis B Infections
• There is evidence that Hepatitis B
virus is a real threat for cross-
infection in dentistry. Data for the
transmission of, and infection with,
other viruses or bacteria in dental
practice are scarce. However, a
number of cases are probably
not acknowledged by patients,
healthcare workers and
authorities.
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8. 12/30/2018 Dr.T.V.Rao MD @ Safe dental practices 8

9. Dentists too at great risk
from patients
Following Universal
Precautions is the true
choice
• Every patient should be
treated as potentially
infectious. The dental
team should be
acquainted with the
biological principles
behind these procedures.
The cross-infection control
regulations should
undergo regular
monitoring and need to be
subjected to revision
whenever necessary
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10. HOW SAFE WE
ARE ?
• Behind the scenes, the dental
team are responsible for
ensuring a safe environment
covering health and safety
legislation and infection
control best practice.
•Many countries have no
safe regulations ???
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11. What exactly is
Infection Control?
• Infection Control is a way to
minimize the transmission of
microbes in the dental office.
Potentially, diseases could be
transmitted in a dental setting
in three ways - from patient
to dental-care provider,
from patient to patient,
and from dental-care
provider to patient.
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12. INFECTION
CONTROL MATTERS
MOST
• Infection control
procedures arrests
transmission of diseases
by using different
methods such as -
physical barriers,
chemical agents, and
heat.
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14. Infection control
policy
• Infection control is an equally
important aspect of this
working environment. As a
starting point, all dental
practices should have an
infection control policy in
place which must be
managed, implemented and
reviewed on a regular basis.
Infection control needs to
include all aspects of the
running of a dental practice.
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15. Universal Precautions
• Because the dental team cannot
identify all patients who harbor
disease-causing microbes, a system
called universal precaution is used.
Universal precautions simply
means that all patients are
treated with the same type of
precautions. It assures that even if a
patient does not know that he or she
is infectious, protection for the dental
team and other patients is assured.
Universal precautions dramatically
reduces the spread of potential
harmful diseases in the dental setting.
• Protecting oneself from HIV
HBV and HCV a priority
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16. Health and safety
in a dental practice
• A dental practice is a
working environment
and health and safety
legislation relevant to
this workplace is to
be managed and
implemented.
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17. Dental care In
India
• Much of the dental care in
India is delivered by the
qualified Dental surgeons,
at majority of the
geographical locations
however quackery in dental
care is less when compared
with Medical services
rendered.12/30/2018 Dr.T.V.Rao MD @ Safe dental practices 17

18. Poor documentation
is common
emerging problems
even by the
qualified Dentists
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19. •Does the
dental team
use personal
protective
equipment for
you and for
them?
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20. Sterilization of Dental
Instruments
• Patient-care items (e.g.,
dental instruments,
devices, and equipment)
are categorized as critical,
semi critical, or noncritical,
depending on the
potential risk for infection
associated with their
intended use.
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21. 12/30/2018 Dr.T.V.Rao MD @ Safe dental practices 21

22. 12/30/2018 Dr.T.V.Rao MD @ Safe dental practices 22

23. Sterilization of Semi critical
Instruments
• Semi critical items (e.g.,
mouth mirrors, amalgam
condensers, reusable dental
impression trays) are those
that come in contact with
mucous membranes or non-
intact skin (e.g., exposed skin
that is chapped, abraded, or
has dermatitis). These items
have a lower risk of
transmission. Because the
majority of semi critical
items in dentistry are heat-
tolerant, they should also be
sterilized using heat
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24. Safe practices in Dentistry
• Note: Dental handpieces and associated attachments,
including low-speed motors and reusable prophylaxis
angles, should always be heat sterilized between patients
and not high-level or surface disinfected. Although these
devices are considered semi critical, studies have shown
that their internal surfaces can become contaminated with
patient materials during use. If these devices are not
properly cleaned and heat sterilized, the next patient may
be exposed to potentially infectious materials.
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25. Follow Food and Drug
Administration (FDA)-cleared
barrier to reduce contamination
• Digital radiography sensors
are also considered semi
critical and should be
protected with a Food and
Drug Administration (FDA)-
cleared barrier to reduce
contamination during use,
followed by cleaning and
heat-sterilization or high-
level disinfection between
patients. If the item cannot
tolerate these procedures
then, at a minimum, protect
with an FDA-cleared barrier.
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26. Does the dental team wash their hands?
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27. 12/30/2018 Dr.T.V.Rao MD @ Safe dental practices 27

28. Caring the Non Invasive
Instruments
• Noncritical patient-care items
(e.g., radiograph head / cone,
blood pressure cuff, face bow)
are those that only contact
intact skin. These items pose
the least risk of transmission of
infection. In the majority of
cases, cleaning, or if visibly
soiled, cleaning followed by
disinfection with an EPA-
registered hospital disinfectant
is adequate
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29. Sterilization of Non
critical instruments
• Noncritical patient-care items
(e.g., radiograph head / cone,
blood pressure cuff, face bow) are
those that only contact intact
skin. These items pose the least
risk of transmission of infection.
In the majority of cases, cleaning,
or if visibly soiled, cleaning
followed by disinfection with an
EPA-registered hospital
disinfectant is adequate
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30. Many New Technologies
are shaping the
Disinfection Practices
• The disinfection or sterilization
process. Automated cleaning
equipment (e.g., ultrasonic
cleaner, washer disinfector)
should be used to remove debris
to improve cleaning
effectiveness and decrease
worker exposure to blood. After
cleaning, dried instruments
should be inspected, wrapped,
packaged, or placed into
container systems before heat
sterilization
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31. Sterilization of Critical Instruments
•Critical items, such as
surgical instruments and
periodontal scalers, are
those used to penetrate
soft tissue or bone. They
have the greatest risk of
transmitting infection
and should always be
sterilized using heat.
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32. Decontamination of instruments
• Decontamination is the process
by which reusable items are
made safe to use again and is
required to minimise the risk
of cross-infection between
dental staff and those being
treated. It is a process of
different stages that involves
cleaning, disinfection,
inspection and sterilization.
The dental practice should
ensure safe contamination
practices and procedures are
implemented.
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33. Maintenance and
Biosafety of Dental
Instruments
• A planned preventative
maintenance regime
should be managed and
implemented in the dental
practice. All
decontamination
equipment should be
subjected to maintenance
and servicing as
recommended by the
manufacturer. Details of
inspection and
maintenance are found in
the operating manual that
is supplied with the
equipment.
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34. Need for quality Check
of Dental Instruments
• Before using any equipment
staff should visually check all
dental instruments prior to
use for any obvious
deterioration. This includes
also any equipment that was
delivered and sealed as a
product could potentially
deteriorate with time if left in
storage. If there is any doubt
about the integrity of an
instrument then it must not be
used. All records of
maintenance should be
retained within the business.
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35. In case of Biosafety and Instrumentation
issues contact the Manufacturers
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36. Documented
records
• All dental equipment and
instruments should have a
record of the date of
decontamination and also
an expiry date. The user of
the instrument must check
this date before using it.
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37. Maintenance of
equipment
3
7
• A planned preventative
maintenance regime should be
managed and implemented in
the dental practice. All
decontamination equipment
should be subjected to
maintenance and servicing as
recommended by the
manufacturer. Details of
inspection and maintenance are
found in the operating manual
that is supplied with the
equipment.
12/30/2018
Dr.T.V.Rao MD @ Safe dental practices

38. Checking the Dental
Instruments for
effective services
• Before using any
equipment staff should
visually check all dental
instruments prior to
use for any obvious
deterioration. This
includes also any
equipment that was
delivered and sealed as
a product could
potentially deteriorate
with time if left in
storage.
Dr.T.V.Rao MD @ Safe dental practices 12/30/2018 38

39. Regular Check of
Instruments for Physical
and Biosafety ?
Dr.T.V.Rao MD @ Safe dental practices
• If there is any
doubt about the
integrity of an
instrument then
it must not be
used. All records
of maintenance
should be
retained within
the business.
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40. Some facts in caring
in reducing the
infections
Does the dental
team inform you
of their
procedures
around prevention
of infection?
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41. Keeping the standards in
procedural room is
priority
• How clean is the
entire office? A
practice of being
clean extends from
the nearest
counter to the
farthest corners.
What do you
observe?
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42. Optimal sterilization
Practices reduce the
spread of Infections
•If you ask to see
the sterilization
area, do they
show it to you?
Is it clean,
uncluttered,
neat?
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43. The disease transmission is
Underreported in developing
countries
• Therefore,
healthcare-
associated infections
are under-reported
in literature from the
developed world .
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44. Poor Hygienic Practices and lack of
aseptic protocols increases
morbidity and Mortality
• In developing countries the
risk of transmission of
several microorganisms, for
instance the blood borne
viruses, is high since a large
section of the population is
infected. However, literature
on the subject from these
countries is scarce.
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45. Patient too demand better Aseptic
practices in Dental care –
Are we Prepared ???
• Ask about their sterilization
practices – how do they test
and monitor their sterilizers?
It should be at least weekly.
• What visible signs of
infection prevention do you
see? For example, are the
instruments individually
packaged?
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46. Creating Standard Operating procedures
and training the health care personal a
Priority
• Are there infection
prevention
procedures, for
example protocols for
cleaning and
disinfecting
treatment rooms,
and instrument
cleaning and
sterilization.
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47. Are You using Safe and effective
disinfectants
Does the office cleaning crew use appropriate products for cleaning and disinfection.
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48. References and Resources
• Healthcare-associated viral and bacterial infections in dentistry
A.M.G.A. Laheij,1,* et al Journal ListJ Oral
Microbiolv.4;2012PMC337511
• Web resources on improving dental care in Developing reousces
• Google images in dental medicine
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49. •Program File Created by Dr.T.V.Rao MD for
benefit of Dental, Medical and Nurses to raise
the awryness on safe dental practices
• Email
• doctortvrao@gmail.com
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