INFECTION CONTROL IN

RESTORATIVE DENTISTRY
 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).
• ASEPSIS: prevention of microbial contamination of living
tissues or sterile materials by excluding, removing or killing
microorganisms.

• 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).
 MODES OF DISEASES TRANSMISSION
• Direct contact with blood or body fluids
• Indirect contact with a contaminated instrument or surface.
• Contact of mucosa of the eyes, nose, or mouth with droplets or spatter.
• Inhalation of airborne microorganisms.

There is always the potential for contamination and transmission in dentistry.

Saliva is a potentially infectious fluid and has transmitted Hepatitis B, Herpes and
many other infections.
• The most serious infections in dentistry are transmitted by blood to blood
contact through accidental sharps injuries.
Diseases Transmission in Dental Office:
The dental office should have an infection control program to
prevent the transmission of disease from the following :
- Patient to dental team
- Dental team to patient
- Patient to patient
- Dental office to community ( include dental team’s family)
- Community to dental office to patient Diseases Transmission in
Dental Office
The most effective ways to prevent the transmission of diseases
includes :
1) Hand washing
2) Gloves
3) Face masks
4) Protective eye wear
5) Protective clothing
6) Instrument sterilization and disinfection
 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

2. VINYL GLOVES

3. NITRILE GLOVES

4. NEOPRENE

5. GENERAL PURPOSE UTILITY GLOVES

6. STEPS IN GLOVING
 MASKS
Types:
1. Surgical masks (required to have fluid-resistant properties).
2. 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).
 95 PARTICULATE
RESPIRATOR

95 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
 PROTECTIVE
CLOTHING
The clothing must protect the skin.
•the protective cloth must be changed whenever becoming moist or
visibly soiled.
• Used protective clothing that require a minimum handling and
must be laundered easily.
• Wearing the protective clothing at home or out of the clinical area
should not occur.
 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.
 METHOD OF
STERILIZATION
1. Physical method
2. Chemical method
3. Combination of both
Physical sterilization
1. Boiling water: widely used, easy and economic.
Disadvantages
• Rusting of the instruments.
• The instruments are going to be dull under 100c for 30 min. to minimized
rusting we added sodium bicarbonate which inhibits the rusting.
2. Dry heat: hot air oven is widely used in dentistry because it's
efficient than boiling water and economic. Two points should
put in consideration ((temperature &time))
The recommended temp.150 c˚ for 1-1.5 hours
Advantages:
1. If we use it under 150 c we can use it for sterilization of
paper points, cotton roll, and dressing.
2. Some kinds of hand pieces don’t contain plastic part in them,
we can sterilize them by this method after they clean and should
be oiled.
3. Materials to be sterilized can be sealed before sterilization in
metal boxes, will remain sterilized for long period of time.
4. The cost is less than 1/2 of that of portable autoclave.
Disadvantages:
1. High temp. required will affect the sharpness
of the instrument, it will break the mirror and
will melt the plastic handle of the reamers
2. The process is slow
3. It is easy for the dentist to interfere with the
process any time, so never guarantee the
sterilization
3. Autoclave: the most efficient method in dentistry
(heat under pressure) for 15 min., 170 c under pressure
20 pounds/inch, so we destroy most organisms '' viruses,
fungi and spores in relatively short time.
Disadvantages:
1. rusting of the instruments, so to minimize this we
added sodium nitrate 1%.
2. this method is effective for (reamer, file and
hypodermic syringe)
* The most widely used methods is (dry heat) The most
effective method is (autoclave).
4. Hot-oil method: mainly used for hand pieces, the sterilization for 15 min. under 150c temp.
5. Ultrasonic vibration method: used especially for reamer, file and burs.
Advantages:
16 times more effective than hand scarping
Erosion of the instrument is less.
Decrease puncturing wound by the contaminating instrument; we consider this method as cleaning
more than sterilizing.
6. Radiation: using U.V. light, Gamma, and beta rays. It is expensive but effective method. We use it
especially for disposable needles and drugs.
7. Gas method: ethylene oxide used which is highly bacterocidal. Hand piece sterilize by this method.
 Chemical sterilization :
All chemicals are poor alternative to physical ways. Disinfection
antiseptics don’t kill all spores.
They act:
• Reacting with cell portion of the bacteria.
• Reacting with enzyme system of the bacteria.
• Cause destruction of the cell wall of the bacteria.
Properties of ideal antiseptics:
• Destroy the microorganism
• Should penetrate deeply through the bacterial cells
• Rapid in action
• Return its potency
• Soluble in water
• Not corrosive
• Don’t stain the instruments
• Don’t damage materials or living tissue when come in contact.
Important points for disinfection
• Concentration: we should follow the instruction of each agent, if
we ↑concentration →↓ time
• Time of exposure: not all organisms are killed immediately, so we
need longer time especially in the presence of organic material.
• Temperature: when increase temperature we get efficient
sterilization.
• PH: each agent has special PH act perfectly on it.  The
presences of contaminated m.o. take more time.
Combination method: (Temperature +pressure+ chemicals)
• This method used vapor created by heating alcohol formaldehyde under
pressure. The temp. 130c, time 20-25 min., pressure20 pounds/ inch we can
gain a very good sterilization, but it is very expensive, so we use it in big
operation.
Advantages:
1. Short time
2. No rusting
3. Availability of immediate dryness
4. Useable of instrument with no delay for airing
 INFECTION CONTROL DURING
THE PRETREATMENT PERIOD
• The process of infection control begins during the period of
preparation for clinical treatment.
• Paying attention to infection control at this time has several payoffs.
• In addition to reducing the risk of transmission of infectious agents
during patient care, thinking ahead will make the treatment session
more efficient and will also make the post treatment infection control
process easier and more effective.
1. Remove unnecessary items from the dental procedure area : The dental procedure
area should be arranged to facilitate a thorough cleaning following each patient.

2. Preplan the materials needed during treatment. - Set out all instruments,
medications, impression materials, and other items that are needed for a
procedure. - Thinking ahead minimizes the need to search for additional items or
to enter cabinets and drawers once gloves have become contaminated.

3. Utilize disposable items whenever possible: The use of disposable items saves
time during cleanup and decontamination and solves the problem of proper
reprocessing.
4. Use prearranged tray set-ups for routine or frequently performed procedures.
–Helps to eliminate the need to go into cabinets once you have started a
procedure.

5. Use individualized, sterilized bur blocks for each procedure, Using

individualized bur blocks containing only the burs required for that procedure
helps to eliminate the contamination of other, unneeded burs and to make
clean-up easier.

6. If indicated, have the rubber dam setup on the tray. When a rubber dam will
be used during a clinical procedure, it also should be included on the tray setup.
In addition, include those items needed for high-velocity evacuation.
Surface barriers :
Surface barriers are used to prevent contamination on the
surface underneath.

All the surface barriers should be resistant to fluids in order

to prevent microorganisms in saliva, blood, and other liquids
from soaking through the barrier and reach the surface
underneath.
 INFECTION CONTROL DURING THE
TREATMENT PERIOD

The infection control procedures described in the

previous period will help you to reduce the risk of
transmission of infectious agents. During treatment there
are additional precautions that can be taken to further
reduce infection risks.
1. Use care when receiving, handling, or passing sharp
instruments
2. Take special precautions with syringes and needles.
3. Use a rubber dam whenever possible
4. Avoid touching unprotected switches, handles and
other equipment once gloves have been
contaminated.
5. Avoid entering cabinets once gloves have been
contaminated.
 INFECTION CONTROL DURING THE
POST- TREATMENT PERIOD
• continue to wear personal protective equipment during clean-up:
After patient care is completed, begin the cleaning and disinfection
process by removing contaminated gloves used during treatment,
wash your hands and use the utility gloves before beginning the
clean up.
• Continue to wear protective eyewear, mask, and gown
• Remove all disposable barriers : All of the barriers placed before
treatment, including light handle covers and countertop barriers,
should be removed.
• Clean and disinfect all items not protected by barriers.
 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.