Prepared by : Umar Ali Hama

Garmyan Yawar

Group(D)
Dental Chair
Tumbler Holder
Saliva ejector
High Volume evacuator
Syringe
Curing Light
Bracket Table
Opaque glass plate/x-ray viewer
High speed & Low speed
adaptor
Dental chair control
Foot Control
• INTRODUCTION
• DENTAL CHAIR AND PATIENT POSTIONS

• OPERATOR POSITIONS
• OPERATING STOOLS
• GENERAL CONSIDERATIONS
 Proper positioning of the patient and
operator, illumination and retraction
for optimal visibility are fundamental
pre requisites to proper dental
treatment
Dental chair and patient
position
 For operative dental procedures , the patient may be
seated in one of the following positions:
1. Almost supine
2. Reclined 45 degrees
3. Upright position
1. ALMOST SUPINE POSITION:

 In this position the chair is tilted so that

the patient is almost in a lying down
posture
 The patient’s head ,knees and feet are
approximately at the same level
 The head should not be positioned
below the feet level as blood pressure
increases gradually
 2. RECLINED 45 DEGREE POSITION:

 In this position the chair is reclined at 45

degrees so that when the patient is seated,
the mandibular occlusal surfaces are
almost at 45 degrees to the floor
 Once the treatment is over the chair is
brought back to upright position so that the
patient can leave the chair easily
POSITONS OF THE OPERATOR

 Forearm parallel to the floor

 Thighs parallel to the floor
 Hip angle of 90 degrees
 Seat height positioned low
enough so that the heels of
your feet touch the floor
 When working from clock
positions 9-12:00, feet spread
apart so that your legs and the
chair base form a tripod which
creates a stable position
 Avoid positioning your legs
behind the patient’s chair
 Back of the operator should be
always straight
 Head erect and should not be
bent of drooping
 Operator position:
The main thing which we have
to consider is the Operator
Position

Correct positioning of the

operator is very important to
operator to have good visibility
and accessibility to oral cavity.
 FOR A RIGHT HANDED OPERATOR:

1. Right front or 7’o clock position

2. Right or 9’o clock position
3. Right rear or 11’o clock position
4. Direct rear or 12’oclock position

LEFT HANDED OPERATOR'S POSITIONS ,

1- 5 O'CLOCK
2- 3 O'CLOCK
3- 1 O'CLOCK
RIGHT FRONT POSITION (7 O'CLOCK) :

1. IT HELPS IN EXAMINATION OF THE PATIENT

2. WORKING AREAS INCLUDE:

a) MANDIBULAR ANTERIOR
b) MANDIBULAR POSTERIOR TEETH
(RIGHT SIDE)
c) MAXILLARY ANTERIOR TEETH

3. TO INCREASE THE EASE AND VISIBILITY,

THE PATIENT'S HEAD MAY BE TURNED
TOWARDS THE OPERATOR.
RIGHTPOSITION(9O'CLOCK):

1. IN THIS POSITION,DENTIST SITS

EXACTLY RIGHTTOTHEPATIENT

2. WORKING AREASINCLUDE:
a) FACIAL SURFACES OF
MAXILLARY RIGHT POSTERIOR
TEETH
b) FACIAL SURFACES OF
MANDIBULAR RIGHT
POSTERIOR TEETH
c) OCCLUSAL SURFACES OF
MANDIBULAR RIGHT
POSTERIOR TEETH.
RIGHT REAR POSITION (11 O'CLOCK):

1. IN THIS POSITION, DENTIST SITS BEHIND

AND SLIGHTLY TO THE RIGHT OF THE
PATIENT AND THE LEFT ARM IS
POSITIONED AROUND PATIENT'S HEAD

2. THIS IS PREFERRED POSITION FOR

MOST OF DENTAL PROCEDURES
3. MOST AREAS OF MOUTH ARE
ACCESSIBLE FROM THIS POSITION
EITHER USING DIRECT OR INDIRECT
VISION

4. WORKING AREAS INCLUDE:

a) PALATAL AND INCISAL
(OCCLUSAL) SURFACES OF
MAXILLARY TEETH
b) MANDIBULAR TEETH (DIRECT
VISION).
DIRECT REAR POSITION (12 O'CLOCK):

1. DENTIST SITS DIRECTLY BEHIND THE

PATIENT AND LOOKS DOWN OVER
THE PATIENT'S HEAD DURING
PROCEDURE.
2. WORKING AREAS ARE LINGUAL
SURFACES OF MANDIBULAR TEETH.
3. THIS POSITION HAS LIMITED
APPLICATION.
 SEQUENCE FOR ESTABLISHING POSITION
28

1 ME.
ASSUME THE CLOCK POSITION FOR THE TREATMENT AREA

2 MY PATIENT.
ESTABLISH PATIENT CHAIR AND HEAD POSITION.

MY EQUIPMENT.
3 ADJUST THE UNIT LIGHT. PAUSE AND SELF-CHECK THE
CLINICIAN, PATIENT, AND EQUIPMENT POSITION.

MY NONDOMINANT HAND.
4 PLACE THE FINGERTIPS OF MY NONDOMINANT HAND AS
SHOWN IN THE ILLUSTRATION FOR THE CLOCK POSITION.

MY DOMINANT HAND.
5 PLACE THE FINGERTIPS OF MY DOMINANT HAND AS
SHOWN IN THE ILLUSTRATION FOR THE CLOCK POSITION.
 POSITIONING TERMINOLOGY
• WHEN WORKING ON ANTERIOR 29
SEXTANTS, YOUR LEFT HAND (NON-
DOMINANT HAND) AND YOUR RIGHT
HAND (DOMINANT HAND) ARE
POSITIONED ON OPPOSITE SIDES OF THE
PATIENT’S MOUTH.

• ANTERIOR SURFACES TOWARD MY NON-

DOMINANT HAND—THE COLORED
ANTERIOR SURFACES IN THIS
ILLUSTRATION.

• ANTERIOR SURFACES AWAY FROM MY

NON-DOMINANT HAND—THE WHITE
ANTERIOR SURFACES IN THIS
ILLUSTRATION.
 POSITIONING TERMINOLOGY 30

POSTERIOR ASPECTS FACING TOWARD ME—

THE COLORED POSTERIOR SURFACES IN THIS
ILLUSTRATION.
• MAXILLARY RIGHT POSTERIOR SEXTANT,
FACIAL SURFACES
• MAXILLARY LEFT POSTERIOR SEXTANT,
LINGUAL SURFACES
• MANDIBULAR RIGHT POSTERIOR
SEXTANT, FACIAL SURFACES
• MANDIBULAR LEFT POSTERIOR
SEXTANT, LINGUAL SURFACES
POSITIONING TERMINOLOGY 31

POSTERIOR ASPECTS FACING AWAY FROM

ME—THE COLORED POSTERIOR SURFACES IN
THIS ILLUSTRATION.
• MAXILLARY LEFT POSTERIOR SEXTANT,
FACIAL SURFACES
• MAXILLARY RIGHT POSTERIOR SEXTANT,
LINGUAL SURFACES
• MANDIBULAR LEFT POSTERIOR
SEXTANT, FACIAL SURFACES
• MANDIBULAR RIGHT POSTERIOR
SEXTANT, LINGUAL SURFACES
 POSITION FOR THE RIGHT-HANDED
ARCH TREATMENT AREA CLOCK HEAD POSITION
POSITION 32
MANDIBULA ANTERIOR SURFACES TOWARD MY NON- 8–9 SLIGHTLY TOWARD,
R ARCH DOMINANT HAND CHIN DOWN
ANTERIOR SURFACES AWAY FROM MY 12 SLIGHTLY TOWARD,
NON-DOMINANT HAND CHIN DOWN
MAXILLARY ANTERIOR SURFACES TOWARD MY NON- 8–9 SLIGHTLY TOWARD,
ARCH DOMINANT HAND CHIN UP

ANTERIOR SURFACES AWAY FROM MY 12 SLIGHTLY TOWARD,

NON DOMINANT HAND CHIN UP

MANDIBULA POSTERIOR ASPECTS FACING TOWARD 9 SLIGHTLY AWAY,

R ARCH ME (RIGHT FACIAL AND LEFT LINGUAL) CHIN DOWN
POSTERIOR ASPECTS FACING AWAY 10–11 TOWARD, CHIN
FROM ME (RIGHT LINGUAL AND LEFT DOWN
FACIAL)
MAXILLARY POSTERIOR ASPECTS FACING AWAY 10–11 TOWARD, CHIN UP
ARCH FROM ME (RIGHT LINGUAL AND LEFT
FACIAL)
POSTERIOR ASPECTS FACING 9 SLIGHTLY AWAY,
TOWARD ME (RIGHT FACIAL AND LEFT CHIN UP
Operator stools:

 The design of the stool is important.

 It should be sturdy and well balanced
to prevent tipping/gliding away from
dental chair
 It should be well padded with cushion
edges and should be adjusted up and
down
 A well designed stool increases
operator comfort and reduces fatigue
LIGHTING;

 The operator should be well

illuminated either by natural or artificial
light.
 If the light is kept too close , it impairs
the physical movement of operator &
also increases patient discomfort due
to heat production.
 If the light is kept far away, it reduces
the illumination.
 As a rule for mandibular arch the light
is kept in a higher position & for
maxillary arch it is kept in a lower
position.
 general considerations:

 The patient’s head should be rotated according to need of

operator without hesitation
 During working maxillary occlusal surfaces should be
perpendicular to the floor and for mandibular occlusal surface
should be 45 degrees
 The operator should maintain space between the patient as
while reading a book
 There should be reduced contact with that of patient
a) The operator should never rest his hand on patient’s face
b) The chest of patient should never be used as trays to keep
instruments
 The left hand should be kept free to retract using the mouth
mirror
contents
 INTRODUCTION
 TRANSMISSION OF INFECTION
 MODE OF TRANSMISSION
 MODE OF INFECTION
CONTROL
 INFECTION CONCERN IN
DENTISTRY
 OBJECTIVES OF INFECTION
CONTROL
 PERSONAL BARRIER
PROTECTION
 OPERATORY ASEPSIS
 DISINFECTION
 INSTRUMENT HANDLING &
CLEANING
 STERILIZATION
 MONITORS OF STERILIZATON
 CLINICAL WASTE DISPOSAL
 STORAGE OF STERILIZED ITEMS
 HANDPIECE ASEPSIS
introduction
 Microorganisms are ubiquitous.
 Since pathogenic microorganisms cause
contamination, infection and decay, it becomes
necessary to remove or destroy them from materials
and areas.
 This is the objective of infection control and
sterilization.
definitions
 INFECTION CONTROL – Also called “exposure control plan”
by OSHA is a required office program that is designed to
protect personnel against risks of exposure to infection.
 STERILIZATION: Use of a physical or chemical procedure to
destroy all microorganisms including substantial numbers of
resistant bacterial spores.
 Sterilization means the destruction of all life forms. (Ronald
B Luftig)
 Sterilization is the process of killing or removing all viable
organisms. (MIMS – PLAYFAIR)
 STERILE: Free from all living microorganisms; usually described as a
probability (e.g., the probability of a surviving microorganism
being 1 in 1 million).
 DISINFECTION: Destruction of pathogenic and other kinds of
microorganisms by physical or chemical means. Disinfection is less
lethal than sterilization, because it destroys the majority of
recognized pathogenic microorganisms, but not necessarily all
microbial forms (e.g., bacterial spores).
 Disinfection is a process of removing or killing most, but not all,
viable organisms.
(MIMS-PLAYFAIR)
 Disinfection refers to the destruction of pathogenic organisms.
(Ronald B Luftig)
 DISINFECTANT: A chemical agent used on inanimate
objects to destroy virtually all recognized pathogenic
microorganisms, but not necessarily all microbial forms
(e.g., bacterial endospores).
 ASEPSIS: prevention of microbial contamination of living
tissues or sterile materials by excluding, removing or
killing microorganisms.
Transmission of infection
MODES OF TRANSMISSION:
Infectious
agent

Susceptible
Reservoirs
host

Chain of
infection

Portal of Portal of
entry exit

Means of
transmission

Six links in chain of transmission of infection

Be Aware of Cross-infection!!!
OBJECTIVES OF INFECTION
CONTROL
Reduce

Protect Implement

Simplify
STRATEGY TO ACHIEVE INFECTION CONTROL

Screening

PPE(personal
protection
equipment)

Aseptic techniques

Sterilization & disinfection

disposal

Laboratory asepsis
PREPROCEDURAL MOUTH RINSE

A commercial mouthrinse containing

0.05 percent CPC when used as a
preprocedural mouthrinse was equally
effective as CHX in reducing the levels
of spatter bacteria generated during
ultrasonic scaling.
HAND HYGIENE
 For routine dental examination procedures, hand washing
is achieved by using either a plain or antimicrobial soap
and water.
 The purpose of surgical hand antisepsis is to eliminate
transient flora and reduce resident flora to prevent
introduction of organisms in the operative wound, if gloves
become punctured or torn.
 At the beginning of a routine treatment period, watches
and jewelry 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.
PERSONAL BARRIER
PROTECTION
 Personal protective equipment (PPE), or barrier
precautions, are a major component of Standard
precautions.
 PPE is essential to protect the skin and the mucous
membranes of personnel from exposure to
infectious or potentially infectious materials.
 The various barriers are gloves, masks, protective
eye wear, surgical head cap & overgarments
gloves

 Types:
1. Latex gloves
Vinyl gloves
Nitrile gloves
Neoprene
General purpose utility
gloves
Steps in gloving
CONTACT DERMATITIS AND
LATEX HYPERSENSITIVITY
 Contact dermatitis is classified as
1. Irritant
2. Allergic.

 Latex hypersensitivity
PRECAUTIONS TAKEN FOR
LATEX ALLERGIC PATIENTS
 Be aware that latent allergens in the ambient air
can cause respiratory or anaphylactic symptoms
among persons with latex hypersensitivity.
 Patients with latex allergy can be scheduled for
the first appointment of the day to mini- mize their
inadvertent exposure to airborne latex particles.
 Have emergency treatment kits with latex free
products available at all times.
masks

 Types:
1. Surgical masks (required to have
fluid-resistant properties).
1. Procedure/isolation masks
 Made up from a melt blown placed between non-woven fabric
Layers of a Mask
1. an outer layer
2. a microfiber middle layer - filter large wearer-generated particles
3. a soft, absorbent inner layer - absorbs moisture.
 Available in 2 sizes: regular and petite.
N95 PARTICULATE
RESPIRATOR
 National Institute for Occupational Safety and
Health (NIOSH) introduced a rating system which
identifies the abilities of respirators to remove the
most difficult particles to filter, referred to as the
most penetrating particle size (MPPS), which is
0.3µm in size.
 The “N” means “Not resistant to oil”.
 N95: captures at least 95% of particles at MPPS.
 N99: captures 99% of particles at MPPS.
 N100: captures 99.97% of particles at MPPS.
Eye wear

 CAUSES OF EYE DAMAGE:

1. Aerosols and spatter may transmit infection
2. Sharp debris projected from mouth while using air
turbine handpiece, ultrasonic scaler may cause eye
injury.
3. Injuries to eyes of patients caused by sharp instruments
especially in supine position
Over garments
Gown type Situation and Rationale

Cotton/linen, reusable or disposable, long-sleeved Use if contamination of uniform or clothing is likely

isolation gowns or anticipated

Fluid resistant isolation gown or plastic apron over Use if contamination of uniform or clothing from
isolation gown significant volumes of blood or body fluids is likely or
anticipated (fluids may wick through non-fluid
resistant reusable or disposable isolation gowns)

Fluid impervious gowns e.g., Gortex® Use if extended contact or large volume exposure
(e.g., large volume blood loss during resuscitation of
MVA victim or surgical assist)
Footwear

 Most hospitals have their own policies regarding

footwear.
 Footwear with open heels and/or holes across the top
can increase the risk of harm to the person wearing
them due to more direct exposure to blood/body fluids
or of sharps being dropped for examples.
PRECAUTIONS TO AVOID
INJURY EXPOSURE
 Engineering controls are the primary method to reduce
exposures to blood from sharp instruments and needles
 Work-practice controls establish practices to protect
personnel whose responsibilities include handling, using,
or processing sharp devices.
 Sharp end of instruments must be pointed away from
the hand
 Avoid handling large number of sharp devices.
OPERATORY ASEPSIS

 In the dental operatory, environmental surfaces

(i.e., a surface or equipment that does not
contact patients directly) can become
contaminated during patient care. Certain
surfaces, especially ones touched frequently
(e.g., light handles, unit switches, and drawer
knobs) can serve as reservoirs of microbial
contamination, although they have not been
associated directly with transmission of infection
to either personnel or patients.
 Transfer of microorganisms from contaminated
environmental surfaces to patients occurs
primarily through personnel hand contact
CDC (center for Disease control) classification
Category Definition
Critical Penetrates soft tissue, contacts bone,
enters into or contacts the blood-
stream or other normally sterile tissue. burs
Semicritical Contacts mucous membranes or
nonintact skin; will not penetrate soft
tissue, contact bone, enter into or
contact the bloodstream or other
normally sterile tissue.
Noncritical Contacts intact skin.
Dental instrument or item
Surgical instruments, periodontal
scalers, scalpel blades, surgical dental
Dental mouth mirror, amalgam
condenser, reusable dental impression
trays, dental handpieces
Radiograph head/cone, blood pressure
cuff, facebow, pulse oximeter
DISINFECTION

 Disinfection is always at least a two-step

procedure:
 The initial step involves vigorous scrubbing of the
surfaces to be disinfected and wiping them
clean.
 The second step involves wetting the surface with
a disinfectant and leaving it wet for the time
prescribed by the manufacturer.
 The ideal disinfectant has the following properties:
1. Broad spectrum of activity
2. Acts rapidly
3. Non corrosive
4. Environment friendly
5. Is free of volatile organic compounds
6. Nontoxic & nonstaining
 High-level disinfection: Disinfection process that
inactivates vegetative bacteria, mycobacteria, fungi,
and viruses but not necessarily high numbers of
bacterial spores.
 Intermediate-level disinfection: Disinfection process that
inactivates vegetative bacteria, the majority of fungi,
mycobacteria, and the majority of viruses (particularly
enveloped viruses) but not bacterial spores.
 Low-level disinfectant: Liquid chemical germicide.
OSHA requires low-level hospital disinfectants also to
have a label claim for potency against HIV and HBV.
 Gigasept which contains succindialdehyde and
dimethoxytetrahydrofuran are used for disinfection of
plastic and rubber materials eg: dental chair
INSTRUMENT WASHER

 Instrument washers use high-velocity hot water

and a detergent to clean instruments.
 These devices require personnel to either place
instruments in a basket or to use instrument
cassettes during the cleaning and drying cycles.
 Types:
1. Counter top model
2. Resembles a kitchen dish washer
thermal disinfectors

 These devices may look like the instrument washers

described above; however, there is one important
difference.
 The high temperature of the water and chemical
additives in these devices cleans and disinfects the
instruments.
 Instruments can be more safely handled, and if the
dental healthcare professional were to sustain a
puncture injury, it would not require the follow-up that a
contaminated exposure requires
NEW SOLAR ENERGY TECHNOLOGY: KILLING
GERMS ON MEDICAL, DENTAL INSTRUMENTS

 “It is completely off-grid, uses sunlight as the

energy source, is not that large, kills disease-
causing microbes effectively and relatively
quickly and is easy to operate.
 Halas and colleagues have prototypes of two
solar steam machines.
1. The autoclave for sterilizing medical and dental
instruments.
2. Autoclave for disinfecting human and animal
wastes
INSTRUMENT PROCESSING
Selection of packaging
materials for sterilization
Steam sterilization Papers, cellulose, cotton/polyester cloths,
window packs, perforated rigid containers
with bacterial filters, glass containers for
liquids

Dry heat (hot air oven) Metal canisters and tubes of aluminium foil,
glass tubes, bottles

ETO Paper & Plastic, perforated rigid containers

with bacterial filters

Low temperature steam Paper, cloth

Radiation sterilization Polyethylene, PVC, polypropylene, foil.

STERILIZATION
 Stages for instrument sterilization:
1. Presoaking
2. Cleaning
3. Corrosion control and lubrication
4. Packaging
5. Sterilization
6. Handling sterile instruments
7. Storage
8. Distribution
 Agents used in sterilization
 Physical agents:  Chemical agents:
1. Sunlight 1. Alcohols: ethyl, isopropyl,
trichlorobutanol
2. Drying
2. Aldehydes: formaldehyde,
3. Dry heat: flaming, incineration,
glutaraldehyde
hot air
3. Dyes
4. Moist heat: pasteurization, boiling,
steam under pressure, steam 4. Halogens
under normal pressure.
5. Phenols
5. Filtration: candles asbestos pads,
membranes 6. Surface-active agents

6. Radiation 7. Metallic salts

7. Ultrasonic and sonic vibrations 8. Gases: ethylene oxide,

formaldehyde, beta
propiolactone.
The four accepted methods
of sterilization are :
 Steam pressure sterilization (autoclave)
 Chemical vapor pressure sterilization-
(chemiclave)
 Dry heat sterilization (dryclave)
 Ethylene oxide sterilization
STEAM PRESSURE STERILIZATION
(AUTOCLAVING)
 Advantages of Autoclaves.  Disadvantages of
Autoclaves.
1. Autoclaving is the most rapid
and effective method for 1. Items sensitive to the
sterilizing cloth surgical packs elevated temperature
and towel packs. cannot be autoclaved.
2. Is dependable and 2. Autoclaving tends to rust
economical carbon steel instruments and
burs.
3. Sterilization is verifiable.
3. Instruments must be air dried
at completion of cycle
 TRIPLE VACUUM AUTOCLAVE
 A triple vacuum autoclave is set up/function in a
similar fashion to a negative pressure
displacement.
 This is repeated three times, hence the name
"triple vacuum" autoclave. This type of autoclave
is suitable for all types of instruments and is very
versatile
CHEMICAL VAPOR PRESSURE
STERILIZATION (chemiclaving)
An unsaturated chemical vapor system , also called harvey
chemiclave.
 Advantages  Disadvantages

1. Carbon steel and other 1. Items sensitive to the

corrosion-sensitive
instruments are said to
be sterilized without rust.
2. Relatively quick
turnaround time for
instruments.
3. Load comes out dry.
4. Sterilization is verifiable.
elevated temperature
will be damaged. Vapor
odor is offensive, requires
aeration.
2. Heavy cloth wrappings
of surgical instruments
may not be penetrated
to provide sterilization.
DRY HEAT STERILIZATION

 Conventional Dry Heat Ovens

 Short-Cycle, High-Temperature
Dry Heat Ovens
 Advantages of Dry Heat
Sterilization
1. Carbon steel instruments and burs
do not rust, corrode, if they are
well dried before processing.
2. Industrial forced-draft hot air
ovens usually provide a larger
capacity at a reasonable price.
 Disadvantages of Dry Heat Sterilization
1. High temperatures may damage more
heat-sensitive items, such as- rubber or
plastic goods.
2. Sterilization cycles are prolonged at the
lower temperatures.
3. Must be calibrated and monitored

3. Rapid cycles are possible at high

temperatures.
4. Low initial cost and sterilization is
verifiable.
ETHYLENE OXIDE
STERILIZATION (ETO)

MOBILE FUMIGATOR
 Advantages:  Disadvantages:
1. Operates effectively at low 1. Potentially mutagenic and
temperatures carcinogenic.
2. Gas is extremely 2. Requires aeration chamber
penetrative ,cycle time lasts hours
3. Can be used for sensitive 3. Usually only hospital based.
equipment like handpieces.
4. Sterilization is verifiable
Gamma radiation
 The Nature of Gamma Radiation A form of pure energy that is generally
characterized by its deep penetration and low dose rates, Gamma
Radiation effectively kills microorganisms throughout.
 Benefits of Gamma Radiation include:
1. precise dosing
2. rapid processing
3. uniform dose distribution
4. system flexibility
5. dosimetric release–the immediate availability of product after processing.
 Penetrating Sterilization: Even with High-Density Products Gamma
Radiation is a penetrating sterilant.
 Substantial Decrease in Organism Survival: Gamma Radiation kills
microorganisms by attacking the DNA molecule.
 Uv radiation

 The wavelength of UV radiation ranges from 328 nm to 210 nm

(3280 A to 2100 A). Its maximum bactericidal effect occurs at
240–280 nm
 Inactivation of microorganisms results from destruction of nucleic
acid through induction of thymine dimers.
 UV radiation has been employed in the disinfection of drinking
water , air, titanium implants, and contact lenses.
 The application of UV radiation in the health-care environment
(i.e., operating rooms, isolation rooms, and biologic safety
cabinets) is limited to destruction of airborne organisms or
inactivation of microorganisms on surfaces
 Flash sterilization

 “Flash” steam sterilization was originally defined by Underwood

and Perkins as sterilization of an unwrapped object at 1320C for 3
minutes at 27-28 lbs. of pressure in a gravity displacement sterilizer.
 Currently, the time required for flash sterilization depends on the
type of sterilizer and the type of item (i.e., porous vs non-porous
items).
 Uses:
 Flash sterilization is considered acceptable for processing
cleaned patient-care items that cannot be packaged, sterilized,
and stored before use.
 It also is used when there is insufficient time to sterilize an item by
the preferred package method.
OTHER STERILIZATION
METHODS
 Glass Bead “Sterilizer”
 Vaporized Hydrogen
 Dry-Heat Sterilizers Peroxide

 Liquid Chemicals  Formaldehyde Steam

 Performic Acid  Gaseous Chlorine

Dioxide
 Filtration
 Vaporized Peracetic
 Microwave Acid
 Infrared radiation
NEW METHODS OF
STERILIZATION
 Various new methods of sterilization are under
investigation and development.
 Peroxide vapor sterilization - an aqueous
hydrogen peroxide solution boils in a heated
vaporizer and then flows as a vapor into a
sterilization chamber containing a load of
instruments at low pressure and low temperature
 Ultraviolet light - exposes the contaminants with a
lethal dose of energy in the form of light. The UV
light will alter the DNA of the pathogens. Not
effective against RNA viruses like HIV.
ozone
 Ozone sterilization is the newest low-temperature
sterilization method recently introduced in the US and is
suitable for many heat sensitive and moisture sensitive
or moisture stable medical devices
 Ozone sterilization is compatible with stainless steel
instruments.
 Ozone Parameters • The cycle time is approximately 4.5
hours, at a temperature of 850F – 940F.(nearly 23 C)
STORAGE AND CARE OF STERILE INSTRUMENTS

 Storage areas should be dust proof, dry, well ventilated and

easily accessible for routine dental use.
 Sterile materials should be stored atleast 8-10 inches from the
floor, atleast 18 inches from the ceiling, and atleast 2 inches
from the outside walls.
 Items should be positioned so that packaged items are not
crushed, bent, crushed, compressed or punctured.
 Items are not stored in any location where they can become
wet.
 Outside shipping containers and corrugated cartons should
not be used as containers in sterile storage areas.
 Ultra violet chambers and formalin chambers are now
commonly used for storage of instruments.
MONITORS OF STERILIZATION

 There are 3 methods of monitoring sterilization:

 Mechanical techniques
 Chemical indicators
1. Internal
2. External
 Biological indicators
 STERILIZATION METHOD SPORE TYPE INCUBATION TEMPERATURE

AUTOCLAVE Bacillus stearothemophilus 56°C

CHEMICAL VAPOR

DRY HEAT Bacillus subtilis 37°C

ETHYLENE OXIDE

Gamma radiation B. Pumilus E601 370C

 Sterilization monitoring has four components:

1. a sterilization indicator on the instrument bag, stamped with the date
it is sterilized,
2. daily color-change process-indicator strips,
3. weekly biologic spore test, and
4. documentation notebook.
HANDPIECE ASEPSIS

 Oral fluid contamination problems of rotary

equipment and especially the high-speed
handpiece involve:
 contamination of hand-piece external surfaces and
crevices,
 turbine chamber contamination that enters the
mouth,
 water spray retraction and aspiration of oral fluids
into the water lines of older dental units
 growth of environmental aquatic bacteria in water
lines
 exposure of personnel to spatter and aerosols
generated by intraoral use of rotary equipment.
HANDPIECE SURFACE
CONTAMINATION CONTROL
CLINICAL WASTE DISPOSAL
 Red: Anatomical waste
 Yellow: waste which requires disposal by incineration only
 Black: Domestic waste minimum treatment/disposal required is
landfill, municipal incineration.
 Blue: medicinal waste for incineration
 White: amalgam waste for recovery.
 REFERENCES:
 Sturdevent’s Art & Science of operative Dentistry.
 Clinical Operative dentistry- Ramya Raghu & Raghu Srinivasan
 Internet sources
 Pathways of the pulp, 9th edition, armamentarium & sterilization. Cohen
 Operative dentistry, infection control, 4th edition, sturdevent.
 Grossmans endodontic practice, 11th edition, instrument sterilization.
 Textbook of microbiology, sterilization and disinfection, 7th edition,
Ananthanarayan
 Textbook of clinical periodontology, Newman, Takei, Carranza, 11th edition.
• Introduction to sterilization disinfection & infection control, 2nd edition, Joan F
Gardner
• Sterilization and disinfection of dental instruments by ADA
• Disinfection & sterilization of dental instruments TB MED 266, 1995
• CDC, guidelines for disinfection & sterilization in health care facilities 2008.
• Infection prevention and control, college of respiratory therapists Ontario,
june 2011
• Effects of sterilization on periodontal instruments, JOP, vol 53, no:7, 1982.
• New CDC guidelines for selected infection control procedures, chris miller.
• CDC guidelines for infection control in dental health care settings, Dec19,
2003/vol.52.
• Sterilization of ultrasonic inserts.