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Sterilization

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 Content
 Introduction
 History
 Definitions
 Methods of sterilization
 Infection control
 Modalities of prevention
 Level of prevention for orthodontist

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 Introduction
 For protection of both the doctor and patient, infection
control is of utmost importance in preventing the spread of
infectious disease.

 This is of special significance in dentistry because more

microorganisms are found in the oral cavity than in any
other part of the body.

 The greatest danger for orthodontist and his staff is from

puncturing of the skin with contaminated instruments,
sharp edges of orthodontic appliance, as any cuts or
abrasions will allow micro-organisms to enter into the
body.

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 The microorganisms can also spread by direct contact
with a lesion, by indirect contact through
contaminated instruments or office equipments.

 As responsible clinicians, our goals should be to reduce

the number of pathogenic organisms to a level at
which our own body resistance may prevent infection
and to break the circle of infection by eliminating
cross-contamination.

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Definitions
 Sterilization:
Sterilization describes a process that destroys or
eliminates all forms of microbial life and is carried out
in health-care facilities by physical or chemical methods.

 Disinfection
It is the process of elimination of most pathogenic
microorganisms (excluding bacterial spores) on
inanimate objects.

Disinfection can be achieved by physical or chemical

methods. Chemicals used in disinfection are called
disinfectants.

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 Decontamination
It is the process of removal of contaminating
pathogenic microorganisms from the articles by a
process of sterilization or disinfection.

It is the use of physical or chemical means to remove,

inactivate, or destroy living organisms on a surface so
that the organisms are no longer infectious.

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 Sanitization
It is the process of chemical or mechanical
cleansing, applicable in public health systems.
Usually used by the food industry. It reduces microbes
on eating utensils to safe, acceptable levels for public
health.

 Asepsis
It is the employment of techniques (such as usage of
gloves, air filters, uv rays etc) to achieve microbe-free
environment.

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 Antisepsis
It is the use of chemicals (antiseptics) to make skin or
mucus membranes devoid of pathogenic microorganisms.

 Bacteriostasis
It is a condition where the multiplication of the bacteria is
inhibited without killing them.

 Bactericidal
It is that chemical that can kill or inactivate bacteria.
Such chemicals may be called variously depending
on the spectrum of activity, such as bactericidal, virucidal,
fungicidal, microbicidal, sporicidal, tuberculocidal or
germicidal.

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Physical methods of sterilization
Sunlight
 The microbial activity of sunlight is mainly due to the
presence of ultra violet rays in it.
 It is responsible for spontaneous sterilization in
natural conditions.
 In tropical countries, the sunlight is more effective in
killing germs due to combination of ultraviolet rays
and heat. By killing bacteria suspended in water,
sunlight provides natural method of disinfection of
water bodies such as tanks and lakes.
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

Solar clave used for sterilization

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Heat
Dry heat

 Red heat:
Articles such as bacteriological loops, straight wires,
tips of forceps and searing spatulas are sterilized by
holding them in Bunsen flame till they become red
hot.

This is a simple method for effective sterilization

of such articles, but is limited to those articles
that can be heated to redness in flame.
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Sterilizing the articles in red hot flame

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Flaming
This is a method of passing the article over a Bunsen flame,
but not heating it to redness.

Articles such as

 scalpels, mouth of test tubes, flasks, glass slides and cover slips
are passed through the flame a few times.

 Even though most vegetative cells are killed, there is no guarantee

that spores too would die on such short exposure.

 This method too is limited to those articles that can be exposed

to flame.
 Cracking of the glassware may occur.
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Flaming sterilization

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Incineration

 This is a method of destroying contaminated

material by burning them in incinerator.

 Articles such as
Soiled dressings, animal carcasses, pathological material
and bedding etc should be subjected to incineration.

This technique results in the loss of the article, hence is

suitable only for those articles that have to be disposed.
Burning of polystyrene materials emits dense smoke,
and hence they should not be incinerated

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Waste incinerator

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Hot air oven

 This method was introduced by Louis Pasteur. Articles

to be sterilized are exposed to high temperature 1600C
for duration of one hour in an electrically heated oven.

 Articles sterilized: Metallic instruments (like forceps,

scalpels, scissors), glass wares (such as petri-dishes,
pipettes,(flasks, all-glass syringes), swabs, oils, grease,
petroleum jelly and some pharmaceutical products.

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 Sterilization process: Articles to be sterilized must be
perfectly dry before placing them inside to avoid breakage.

 Articles must be placed at sufficient distance so as to allow

free circulation of air in between.

 Mouths of flasks, test tubes and both ends of pipettes must
be plugged with cotton wool.

 Articles such as petri dishes and pipettes may be arranged

inside metal canisters and then placed.

 Individual glass articles must be wrapped in kraft paper or

aluminum foils.

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HOT AIR OVEN

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Moist heat
 At temperature below 1000c

a) Pasteurization: used in sterilization of milk ,

It is of two type:

Holder method - At 63oC for 30 minutes

Flash method - At 72oC for 20 seconds
followed by quick cooling at 13oC

b) Vaccine bath : Bacterial vaccine are sterilized at temperature 600C

for one hour.
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c) Inspissation : Some serum or egg media , such as
loffler’s serum are rendered sterile by
heating at 80-85o C for 30 minutes daily for 3
consecutive days.

Vaccine bath Milk pasteurization plant

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 At temperature 1000 C

a) Boiling: Boling water for 10-30 minutes kills most of

vegetative form but spores with stand this
considerable time.

b) Tyndallisation : Steam at 100 o C for 3 days is

used. This is known as tyndallisation or
intermittent sterilization. The principle is that the first
exposure kills all the vegetative forms, in the intervals
between the heating the remaining spores germinate into
vegetative form gets killed on subsequent heating.

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 At temperature above 100o C

Autoclave
 Sterilization can be effectively achieved at a
temperature above 1000c using an autoclave.

Principle
 Steam above 100oc or saturated steam has better
killing power than dry heat .
 Bacteria are more susceptible to moist heat as
bacterial protein coagulates rapidly.
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 Saturated steam can penetrate porous material easily .

 When steam comes in contact with cooler surface it

condenses to water and librates its latent heat to the
surface.

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 In an autoclave the water is boiled in a closed chamber.

 At a pressure of 15 lbs inside the autoclave, the

temperature is said to be 1210c for 15 minutes .

 At pressure 20lbs/ sq inch , the temperature is 126oc for 10

minutes.

 At pressure 30lbs/sq inch , the temperature is 133oc for 3

minutes.

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 Exposure of articles to this temperature for 15 minutes
sterilizes them.

 To destroy the infective agents , higher temperatures or

longer times are used; 133oc or 121oc for at least one hour
are recommended.

Articles sterilized: culture media

rubber material
gowns , dresses, gloves etc.

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Autoclave

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 Radiation
Two types of radiations use for sterilization are:
 Ionizing radiation
 Non ionizing radiation

Ionizing radiation
 Ionizing radiations include gamma rays, x rays, and
cosmic rays .
 They have very high penetration power
 They damage DNA by various mechanism.
 Gamma rays are commercially used for sterilization of plastic
syringes, swab , cannulas , catheter etc .
 This method of sterilization is known as cold sterilization as
there is no change is temperature. 32
Non ionizing radiation
 Theses include infrared and ultraviolet radiations.

 Infrared is used for rapid mass sterilization of syringes and

catheters.

 Ultraviolet radiation with wavelength of 240-280 nm has marked

bactericidal activity.

 It acts by denaturation of bacterial protein.

 UV radiations is used for disinfection of bacteriological lab ,

laminar flow and operation theaters.

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Chemical methods of disinfection
 Disinfectants are those chemicals that destroy
pathogenic bacteria from inanimate surfaces.

 Some chemical have very narrow spectrum of activity

and some have very wide.

 Those chemicals that can sterilize are called

chemisterilants.

 Those chemicals that can be safely applied over skin and

mucus membranes are called antiseptics. 35
An ideal antiseptic or disinfectant should have following
Properties:

 Should have wide spectrum of activity

 Should be able to destroy microbes within practical period of

time

 Should be active in the presence of organic matter

 Should make effective contact and be wettable

 Should be active in any pH

 Should be stable
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 Should have long shelf life
 Should be speedy
 Should have high penetrating power
 Should be non-toxic, non-allergenic, non-irritative or non-
corrosive
 Should not have bad odour
 Should not leave non-volatile residue or stain
 Efficacy should not be lost on reasonable dilution
 Should not be expensive and must be available easily

The disinfectant which posses all the above criteria is yet to

be found.
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 Classification of disinfectant
 Based on consistency
a. Liquid (E.g., Alcohols, Phenols)
b. Gaseous (Formaldehyde vapor, Ethylene oxide)

 Based on spectrum of activity

a. High level
b. Intermediate level
c. Low level

 Based on mechanism of action

a. Action on membrane (E.g., Alcohol, detergent)
b. Denaturation of cellular proteins (E.g., Alcohol, Phenol) 38
Alcohols
Mode of action:
Alcohols dehydrate cells, disrupt membranes and cause
denaturation of protein.

Examples: Ethyl alcohol, isopropyl alcohol and methyl alcohol.

Application:
 70% aqueous solution is more effective at killing microbes than absolute
alcohols.

 70% ethyl alcohol (spirit) is used as antiseptic on skin. Isopropyl alcohol is

preferred to ethanol. It can also be used to disinfect surfaces.

 It is used to disinfect clinical thermometers.

 Methyl alcohol kills fungal spores, hence is useful in disinfecting inoculation

hoods.
Disadvantages: Skin irritant, volatile (evaporates rapidly), inflammable
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Aldehydes

Mode of action
It is markedly bactericidal, sporicidal and
Virucidal.

Application:
 Preservation of tissue for histological examination.
 To sterilize vaccine
 For killing of bacterial cultures and suspensions

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Phenols

Examples:
 5% phenol,
 1-5% Cresol,
 5% Lysol (a soponified cresol),
 Hexachlorophene,
 Chlorhexidine,
 Chloroxylenol(Dettol)
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Applications:

 Joseph Lister used it to prevent infection of surgical

wounds.

 Phenols are coal-tar derivatives.

 They act as disinfectants at high concentration and as

antiseptics at low concentrations.

 They are bactericidal, fungicidal but are inactive

against spores and most viruses.

 They are not readily inactivated by organic matter.

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 Chlorhexidine can be used in an isopropanol
solution for skin disinfection, or as an aqueous
solution for wound irrigation.

 It is often used as an antiseptic hand wash.

 20% Chlorhexidine gluconate solution is used for

pre-operative hand and skin preparation and for
general skin disinfection.

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 Primary goals of infection control
 To lower the risk of cross contamination by reducing the
levels of pathogens.

 To correct any break in aseptic technique.

 To use universal precautions with every patient (treat every

patient and instrument as potentially infectious).

 To protect patients and personnel from occupational

infections

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MODALITIES OF PROTECTION, PREVENTION AND
CONTROL
Primary level
 The protection level includes the protection of
orthodontist, personnel, and operator site with the
primary goal of infection control .

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Secondary level
 The prevention level includes prevention of
orthodontist and his personnel from all kinds of
infections while following all possible steps for
infection control.

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Tertiary level
 Tertiary level includes the control level sterilization of
armamentarium used during treatment as well as the
disposal of contaminated wastes for infection control.

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Primary level : The protection protocol
 Primary level includes the primary goals and the areas of
infection control.

 To protect patients and personnel from occupational

infections, to lower the risk of cross contamination by
reducing the levels of pathogens.

 To use universal precautions with every patient (treat every

patient and instrument as potentially infectious), and to
correct any break in aseptic technique should be the primary
goals.

 The areas of infection control are orthodontist and staff,

instruments, and the operator site.
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 Orthodontist and staff
 Good personal hygiene is the keystone of protection.

 The most important aspect of this is frequent hand washing.

 They should be washed at least for a minute in cold water

with germicidal soap.

 Cold water is suggested because hot water may cause pores to

open.

 Then, the use of a hand disinfectant is administered.

 As far as the orthodontist is concerned, a reasonably complete

medical history of his patient is important in determining who
all are more likely carrying pathogenic organisms 51
Instruments
 The orthodontist must decide for himself, which
instruments need to be sterilized.

Instruments can be of three categories according to

Spaulding system:

 Critical
 Semi critical
 Least critical

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a. Critical:- Instruments that penetrate the mucosa must be
sterilized.
example: Bands, band removers, ligature directors, orthodontic
mini-implant placement kit, band-forming pliers.

b. Semi Critical: Instruments that touches the mucosa should be

sterilized whenever possible or treated with
high-level disinfectants.
example: Most of the orthodontic instruments, mirrors,
retractors, dental handpieces.

c. Least Critical: Instruments that do not touch mucous

membrane.
example: Distal-end cutter, ligature cutter, torquing keys, arch
forming pliers, V-bend forming plier, bracket
positioning gauges should be disinfected. 53
Operator site
 We should have in mind that our chair, table, light handles,
spittoon, three way syringes etc. all become contaminated.

 It should be wiped frequently with 70% isopropyl alcohol.

 It is advisable to have straight tubing for the hand piece,

three-way syringe and hand pieces should be fitted with non
retraction valve.
 Minimize the number of tubing and wires which can
accumulate dust.

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Operator site protection

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Secondary Level: The Prevention Level

 This level includes all the steps necessary for infection

control which leads to the prevention of orthodontist
and personnel.

 It starts from patient screening and covers all aspect of

personal protection, the first line of defense, that
is, barrier method.

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Patient screening
 A regular informative medical history of the patient can
help to identify factors that assist in the diagnosis of oral
and systemic disorders.

 Many patients often fail to give the information.

 Every patient should be treated as potentially

infectious.

 This important fundamental application of infection

control is termed as UNIVERSAL PRECAUTIONS.
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Personal protection
 Repeated exposure to saliva and blood during the
dental treatment procedures may challenge the
dentist’s immune defense with a wide range of
microbial agents.

Immunological
protection
Personal
protection
Barrier
protection
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 Immunological Protection:
 For immunological protection the operator should be
vaccined with available vaccines of proven efficacy to
prevent the onset of clinical or sub-clinical infection.

 The occupational risk of contacting hepatitis B,

measles, rubella, influenza and certain other microbial
infections can be minimized by stimulating artificial
active immunity.

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Barrier Control:
 Barrier protection is against the range of potential
pathogens encountered during patient treatment.

The physical barriers like

 disposable gloves,
 face masks,
 protective eyewear,
 headcap
 and surgical gowns
during treatment procedure will minimize the
infectious exposure.

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Protection of body using barrier method
Certain points which should be kept in mind are

1. Gowns must be cleaned daily.

2. Short nails will avoid tears in gloves and decrease the

chance of patient discomfort. Hand jewelry and watches
also should be avoided.

3. Hands should be cleaned before wearing gloves

and should be washed after removing gloves also. Washing
is recommended if the procedure involved more than 15-
20 minutes. For routine OPD patients, use of hand scrub
in between patients is recommended. 61
4. Gloves should be changed after every patient and
should be changed if get torn or visibly soiled while
working on one patient.

5. Use disposable protective coverings, cover for dental

light, handle, tray, covers and tubing for hand pieces,
aspirator and air water syringe. For example, the inner
cover of sterile gloves can be wrapped around light handles
for light adjustments during the procedure.

6. Let the patient rinse with antimicrobial mouth wash

before treatment.

7. Avoid handling the chart, telephone, pen, pencil etc.

while attending patients.
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8. Use sensor lights instead of switches wherever
possible.

9. Use sensor controlled water filter / foot or elbow

operated water tap.

10. Disposable items should be burned immediately.

11. Impression should be disinfected immediately.

12. Protective eye-wear should be used in the lab.

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Washing and care of hands
Before gloving
To remove transient micro-organisms to suppress residual
micro-flora while wearing the gloves.

After glove removal

 To remove micro-organisms, which may have penetrated the
gloves through microscopic defects or tears to reduce any
residual micro-flora build up that may have occurred.

 Hand washing for routine dental procedures is described in .

 Hand washing should be performed for about 40-45 seconds for

performing routine orthodontic procedures .

 Hands should be dried with hot air or disposable paper towels,

and should be followed by the use of disposable gloves.
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Healthcare personnel hand washes
 These hand washes are non-irritating, anti-microbial
preparations designed for frequent use.

 Healthcare personnel hand washes have bacteriostatic

or germicidal ingredients which have been shown to be
active against residual skin micro flora, or
transient micro-organisms.

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Antiseptics used in hand washing
Chlorhexidine
 This is 2-4% chlorhexidine gluconate with 4% isopropyl
alcohol in a detergent solution with a pH of 5.0 to 6.5.
 More effective than povidone iodine or
parachlorometexylenol (PCMX).

Povidone Iodine
 These products contain 7.5% to 10% povidone iodine
providing 0.75% to 1.00% available iodine.
 Products containing emollients are available, for repeated
use as healthcare personnel hand washes.
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 Phenolic compounds
 Hexachlorophene Can be absorbed into the blood
stream through intact skin, although it is more readily
absorbed through abraded skin. It may be toxic if the
blood concentration rises with repeated exposure.
 Parachlorometexylenol (PCMX) is bactericidal and
fungicidal at 2% concentration. It is not toxic.

Alcohols
 Ethyl alcohol and isopropyl alcohol are widely used as
topical skin antiseptics, and have a potent bactericidal
effect, especially at 70% concentration.
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Gloves
Cuts and abrasions often found in fingers will serve as
roots of microbial entry into the system when ungloved
hands are placed in patient’s oral cavity –
WET FINGERED DENTISTRY.
Hand washing is not a substitute for use of gloves.

Four types of gloves can be identified for use in dentistry:

 Sterile surgical gloves
 Latex examination gloves
 Vinyl examination gloves
 Non disposable / heavy utility gloves
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 Sterile surgical gloves:
 Best fitting and expensive disposable glove.
 Used when maximum protection is required.
 Ensure practitioner proper fit of high quality latex glove.

Latex examination gloves:

 Most commonly used gloves.
 Occasional hypersensitivity to latex has been reported.
 Inadequate drying before gloving can cause dermatitis.
 In case of hypersensitivity opt for a glove without corn
starch or use vinyl or neoprene gloves or cotton glove liners
with latex gloves.
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Vinyl examination gloves:
 Wear over gloves.
 Used when intraoperative procedure is interrupted for
a brief time e.g. to attend telephone etc.

Non disposable gloves/Heavy utility gloves:

 Used when handling contaminated instruments or
supplies.
 They can be washed ,sterilized, disinfected and reused.
 Pin holes are present in all gloves.
 It can lead to penetration and multiplication of
microorganism.

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How to put the gloves

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How to remove the gloves

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Orthodontist’s gloves
 Orthodontists, repeatedly handle wire, bands, and
ligatures which increase the risk of glove puncture.

 The orthodontist can use puncture resistant gloves which

are thicker at the palm region, a high stress area for ligature
placement, and thinner material at the fingertips.

 Improper fitting gloves, reuse of gloves, and washing of

with antiseptics are not recommended.

 Washing gloves increase the size and number of pinholes.

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Protective eyewear
 Eyes are more susceptible to physical injury and microbial
attack because of their diminished immune capacities
and limited vascularity.

 Droplets containing microbial contaminants can result to

conjunctivitis.

 The operator should have a protective eyewear during working.

 If protection eyewear is available for patients, it is advisable

because handpieces, sharp instruments, archwires, etc. are
routinely passed over the patient’s face.

 Removing a patient’s glasses during dental treatment for the sake of

comfort can no longer be recommended.
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Protective eye ware to both patient and dentist
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Mask

 The best face masks can filter 95% of droplets of 3.0–

3.2 microns in diameter and protect the operator from
microbe laden aerosolized droplets.
 Mask should fit around the entire periphery of the
face, and it is advised to change the mask between
each patient.
 Mask should be removed immediately after finishing
by tearing it from the back and not left hanging
around the neck.

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Dentist with mouthmask

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Shoe cover and head cover
 A pair of smooth, slip-on shoes should be kept
exclusively for use in the clinics.
 These should be cleaned at the end of each clinical
session.
 Head covers provide an effective barrier.

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Proper clinical attire
 Appropriate dental clinic attire is a misunderstood area. Many
practitioners place too much emphasis on choice of attire and
not enough emphasis on correct protocol.

 Current recommendations state that clinical attire should

be changed at least once a day or when it becomes visibly
soiled.
 Studies have shown that clinical attire easily becomes
contaminated whenever a rotary instrument is used in the
mouth.

 For this reason, a disposable cover must be worn over the gown
when using rotary instruments.
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 OSHA statement indicates that all exposed skin surfaces should be covered, the
short sleeved uniform may be acceptable.

 Intact skin is an adequate barrier against blood borne pathogens.

 Gowns should be with fewer buckles and buttons.

 OSHA emphasizes that shoes and street clothes must not be worn
during patient treatment.

 Personnel should not wear clinic attire to and from the workplace.

 It is mandatory to use the aprons while examining patients or

while working in the laboratory.

 These procedures will sow microorganisms into the fabric of the apron.
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Proper clinical attire 82
Other barrier
 The use of an appropriate mouth wash prior to
treatment procedure will reduce the total number of
microbes in the oral cavity.

 Such a mouth rinse can reduce the number of oral

microbes over a period while dental procedures are
being performed.

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Tertiary Level: The Control Level
 After the damage has been done that is instruments or
other objects in dental clinics have been exposed to
infection - causing microorganisms, this level comes
into play.

 The prime goal is decontamination, disinfection, and

sterilization and disposal.

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Disinfection
Disinfection procedures are advised only for those
operatory surfaces and materials that cannot be
routinely sterilized, such as, the table, dental chair
and working surfaces, and for certain orthodontic
instruments.

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Surface disinfection
 Surfaces that are likely to be contaminated by the
handling or by the spatter or spill of oral contaminants
should be disinfected. Surfaces touched by the dental
surgeon are called touch surfaces.
Example : unit handles, various controls, light cure
unit, micromotor, ultrasonic handpiece,
three-way syringe.

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 The surfaces which are contaminated by contact with
soiled instruments are called transfer surfaces.
Example: instrument trays, tube and handpiece
holders.

 Surface disinfection can be done by scrubbing the

surface with the iodophor-soaked gauze pads and
allowed to dry.
 Then, 70% isopropyl alcohol should be used to remove
the residue.

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 Other materials such as sodium hypochlorite 5.25%
(1:10 dilution).

 Iodophors such as Biocide and combination

synthetics (Phenolics, Multicide, and Omni II
Vitaphine).

 0.25% glutaraldehyde can be used as surface

disinfectants.

 However, they should be used with care, as repeated

contact may damage the skin

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Instrument disinfection
Least critical instruments such as
 ligature tier ,
 distal-end cutter,
 orthodontic brackets,
 tying pliers,
 arch forming pliers,
 torquing keys,
 elastomeric rings should be disinfected.

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Disinfection of elastomeric ligatures
 Polyurethane elastomers are frequently used in
orthodontics as chain and ligature.
 The unused parts of elastomeric ligatures are generally
sterilized through cold sterilization since they
are not heat resistant.
 Disinfection of these materials in a 5% glutaraldehyde
solution for 10 min is recommended

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 Disinfection of orthodontic brackets
 Chlorhexidine is an efficient disinfectant to be used on
metal or ceramic brackets.

 0.01% chlorhexidine solution is used on metal and

ceramic brackets.

 It was found that chlorhexidine does not have a

significant effect on the metal bracket’s adhesion ability.

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 On the other hand, the attachment ability of ceramic
brackets is significantly affected by this disinfecting
solution, but the clinical effect does not reach levels
below.

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 Disinfection of removable acrylic
appliances
 When using removable appliances, there is an
excessive formation of a biofilm layer that is observed
on the retentive areas of springs and hooks, and on the
smooth acrylic surfaces of the appliance.

 Toothbrushes were not efficient enough to remove all

the microorganisms on the retentive areas of the
appliances

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 Soaking the appliance in a chemical solution could
cause decomposition of the acrylic resin molecules.

 Oral safe is a germicide deodorant that is harmless if

ingested.

 It was found to destroy 99% of microbes on removable

appliances during 10 min of submersion.

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Orthodontic Marking Pencils
 In practice, orthodontists focus their attention on
sterilization of pliers, handpieces, and other
instruments.
 Orthodontic marking pencils are usually not considered
as a possible link in the chain of infection.

Commonly used methods are:

 Wiping with a sterile gauze
 Soaking pencil tips in disinfectant.

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  A study by Ascencio et al.[5] showed that a single touch of a marking
pencil tip was sufficient to pick up and retain as many as 350,000
bacteria.

 This study also showed that conventional wiping of orthodontic marking

pencil is ineffective in eradicating infectious microorganisms.

 The only sure way to avoid potential cross -contamination is to use the
inexpensive, disposable markers.

Ascencio F, Langkamp HH, Agarwal S, Petrone JA, Piesco NP.Orthodontic marking pencils: A potential source
of cross-contamination.J Clin Orthod 1998;32:307-10. 97
Disinfecting the alginate impression
 Rinse the impression thoroughly under running tap water,
remove the excess water from the impression.

 Dip the impression in a 1:10 solution of sodium hypochlorite

for required amount of seconds to ensure maximum contact
of undercut with the disinfectant.

 Wrap the impression in gauze soaked in 1:10 sodium

hypochlorite and seal it in a plastic bag for 10 min.

 Remove the impression and rinse thoroughly under

running tap water
98
Disinfecting the alginate impression

99
Decontamination
 Work against all kinds of germs to reduce the
microbial source in amount for protection from
unexpected contamination and infection is called
decontamination.

100
Decontamination of orthodontic bands
 Preformed bands are first checked on the patient cast

 If in case they don't fit intraorally

 Then these tried bands are cleaned in ultrasonic

cleaner and disinfected with disinfectant solution for
recommended time as per manufacturer before placing
it back in the box.

101
Sterilization
Some of the most common ways that are followed in
orthodontic practice include:

 steam autoclave sterilization,

 dry heat sterilization (DHS),
 chemical vapor sterilization,
 and ethylene oxide sterilization.

102
Sterilization of orthodontic armamentarium
Orthodontic pliers

 Mazzocchi et al.[28] showed the effects of different methods

of sterilization of pliers.

 In autoclave units, the major problem is rusting and the

corrosion of the orthodontic plier’s joints and dulling of
instrument cutting edges.

 Chemiclave units cause less corrosion of cutting edge, and

it uses alcoholic solution with minimal water, but it emits
irritating fumes.
103
 Dry heat units require a higher temperature to operate,
for example : 320°F–340°F, slower than the other two
but they do not produce rust or fumes.

 The combination of higher grade stainless steel

instruments with the use of a sodium nitrate
solution dip can minimize the problems due to
corrosion as well as those related to dulling of cutting
edges.

104
  Vendrell et al.[29] showed that orthodontic
ligature-cutting pliers with stainless steel inserts
showed insignificant difference in mean wear whether
sterilized with a steam autoclave or dry heat.

 Steam autoclave sterilization can be used with no

deleterious effects on pliers with stainless steel inserts.

Vendrell RJ, Hayden CL, Taloumis LJ. Effect of steam versus dry-heat sterilization
on the wear of orthodontic ligature-cutting pliers 105
 Mazzocchi et al.[28] in their study found that surgical
stainless steel pliers are the most suitable for use in
clinics .

 Where instruments are recycled by steam autoclave

sterilization.

 The most important factor in maintaining the

longevity of instruments is to take care of them during
cleaning, lubrication, and sterilization process.

Mazzocchi A, Paganelli C, Marandini K. Effect of three types of sterilization on pliers. Am J Orthod

1997;3:281.
106
Sterilization of orthodontic wires
 Although Ni-Ti arch wires display low load deflection
and excellent resilience, their high cost has hampered
their universal appeal.

 As a consequence, both the retention and the cost

factor of elastic properties have led to reuse these
archwires.

 To minimize the potential health hazard to the

patient who gets a recycled wire, accepted techniques
of sterilization must be adopted.
107
 Pernier et al.[31] observed the sterilization of six
different arch wires by autoclaving them for 18 min in
134ºC through surface analysis techniques.

 No significant change was observed on the alloys

surface characteristics that would effect their
utilization.

Pernier C, Grosgogeat B, Ponsonnet L, Benay G, Lissac M. Influence of autoclave sterilization

on the surface parameters and mechanical properties of six orthodontic wires. Eur J Orthod
2005;27:72-81.
108
 Mayhew and Kusy[32] studied the effects of
sterilization on the surface topography and the
mechanical properties of 0.017″ × 0.025″ Nitinol
archwires.

 They concluded that neither multiple cycling

procedures nor the heat sterilization had a deleterious
effect on the elastic moduli, surface topography, or
tensile properties of Nitinol archwires.

Mayhew MJ, Kusy RP. Effects of sterilization on the mechanical properties and the surface
topography of nickel-titanium arch wires. Am J Orthod Dentofacial Orthop 1988;93:232-6.

109
  Kapila et al.[33] determined the effects of in vivo
recycling insinuated by DHS (together referred to as
clinical recycling [CR]) on the load-deflection
characteristics of nickel–titanium alloy wires (NiTi
and Nitinol).

 The results indicated that both CR and DHS, as well

as produced significant changes in the loading and
unloading characteristics of Nitinol and NiTi wires

Kapila S, Haugen JW, Watanabe LG. Load-deflection characteristics of nickel-titanium

alloy wires after clinical recycling and dry heat sterilization. Am J Orthod Dentofacial
Orthop 1992;102:120-6.
110
Rubber items and saliva ejectors
 The best method is to discard them after each use.

111
Method of sterilization Advantage Disadvantage

HOT AIR OVEN 1] no corrosion 1] longer sterilization time

2] Large capacity per cost 3]
Items are dry after
cycle
RAPID HEAT STERLIZER 1] no corrosion
2] Short cycle
3] Items are dry after cycle
AUTOCLAVE 1] good penetration
2] Time efficient
3] Sterilize water based
liquids
UNSATURAED Suitable method for
CHEMICAL VAPOUR orthodontic instruments
STERLIZER
ETHYLENE OXIDE Suited for large institutions
STERLIZER
2] Cannot sterilize liquids
3] May damage plastic and
rubber items
1] cannot sterilize liquids
2] May damage plastic and
rubber items
3] Small capacity per cost
1] non stainless items may
corrode
2] Closed containers cannot
be used
3] May damage plastic or
rubber items
Drawback of this is the odor,
even though not
toxic requires adequate
ventilation.
1] Slow procedure
2] costly 112
Sterilization on different instruments

113
Waste and sharps disposal system
 In dental health-care facilities, management of regulated
medical waste is done by use of color-coded or labeled
container .

 That prevents leakage (e.g., biohazard bag) to

contain nonsharp-regulated medical waste .

 Handling, segregation, mutilation, disinfection, storage,

transportation, and final disposal are vital steps for safe
and scientific management of biomedical waste in any
establishment.

114
115
Orthodontic waste management

116
117
Conclusion
 Always keep in mind that every patient is potentially infectious,
so all the safety measures must be taken during dental practice.

 All the three steps that are primary secondary and tertiary
should be employed.

 No method of sterilization is complete in itself, but we should at

least try to achieve as high levels of sterilization as possible along
with protection, prevention, and infection control.

 There is room for improvement in knowledge related to

sterilization procedures for both general dentist and
orthodontist

118
Refrences
1. Toroğlu MS, Haytaç MC, Köksal F. Evaluation of aerosol contamination
during debonding procedures. Angle Orthod 2001;71:299-306.

2. Starnbach H, Biddle P. A pragmatic approach to asepsis in the

orthodontic office. Angle Orthod 1980;50:63-6.

3. Mosley JW, White E. Viral hepatitis as an occupational hazard of

dentists. J Am Dent Assoc 1975;90:992-7.

4. Masunaga MI. Sterilization in orthodontics. Part 3. Corrosion of

instruments. J Clin Orthod 1987;21:331-2.

5. Smith GE. Glass bead sterilization of orthodontic bands. Am J Orthod

Dentofacial Orthop 1986;90:243-9.

.
119
6. Saniç A. Sterilization Applications and Problems in Turkey. Clinics Microbiol
Infec 2003;2:45-58.

7. Spaulding EH. Chemical disinfection of medical and surgical materials. In:

Lawrence C, Block SS, editors. Disinfection, Sterilization, and Preservation.
Philadelphia: Lea & Febiger; 1968. p. 517-31.

8. Mutlu S, Porter S, Scully C. Cross infection control in dentistry.Enfeksiyon

Kontrolü 1996;2:51-9

9. Moawad K, Longstaff C, Pollack R. Barrier controls in the orthodontic office. J

Clin Orthod 1988;22:89-91.

10. Miller CH. Infectious diseases and dentistry infection control. Dent ClinNorth
Am 1996;40:434-55.

11. Available from:

http://www.osha.gov/SLTC/dentistry/standards.
html. [Last accessed on 2017 Jan 14].

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