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Department of

ORAL MEDICINE

Infection Control in
Dental Practice

By
Antony Sebastian Ullattil,
C.R.I.
Introduction
Objective
Patient perception and need for infection
control
Infection control in your dental office
OSHA regulation
Universal prevention
Methods of infection control
Disposal of wastes
Introduction
Why do we need to know about
infection control ?
The goal of infection control is to
eliminate or reduce the number of
microbes shared between people.
Implementing safe and realistic infection
control procedures requires the full
compliance of the whole dental team.
Patient perception and need for infection
control.
• It is the duty of every dental practitioner
to cure for all patients including those with
infections diseases.
• As a result of frequent medical coverage
the public is now aware of the need for
dentist to practice good infection control.
• Displaying an infection control
statement may be helpful to really patient
anxiety and gain their confidence.
Routine Procedures.

Through medical history

Asymptomatic carriers

Acceptance of patient

It is unethical to refuse dental care to


those patient with a potentially infections
disease on the grounds that it could
expose the dental clinician to personal
risk.
Confidentiality – Those with HIV
infection
Infected dental health care locker
most avoid exposure prone procedures.
Exposure risk and effect of infection on
dentistry.

Every health care specialty that


involves contact with mucosa blood or
blood contaminated body fluid is now
regulated.

The goal is to ensure compliance


with universal barriers and other
methods to minimize infection risks.
Environment of dental office
Ventilation – The recommended fresh
air supply rate of ventilation systems
should not fall below 5-8 liters per
second per occupant.
Recycling air conditioning systems
are not recommended.
Floor Covering
The floor covering should be
impervious and non slippery.
Carpet must be avoided.
Air borne contamination
High speed hand piece is capable of
creating air borne contaminants from
bacterial residents from saliva.
Aerosols
Particle size range from 50 um to
approximately 5 um. That can remain
suspended in the air and breathed for hrs.
Cross infections.
Patients infected usually are not
aware of the source of their infection.
Personal Vulnerability
Immunization - Hepatitis B infection
Anti – HBs levels must be measured
2-4 months after complete immunization
course.
HBS level > 100 M/U/ml will
provided adequate protection.
Single booster dose 5 years after
completion of primary course is
recommended for all health care workers.
Concept of Infection
The number of organisms required
to cause an infection is termed as “The
infective dose”.
Infections diseases of concern in dentistry.
Bacteria Viruses
N.Gonorrhoeae Hepatitis B,C,D
T. Pallidum H.I.V.
M. Tuberculosis Cytomegalo virus
Strep. Pyogenes Measles
Mumps
Rubella
Herpes
General Principles
Universal precautions – use of mouth
mask, head cap, protective eye were
gloves are recommended.
Hand washing and care of hands

Sir William Osler once


remarked that Soap and water
and common sense are the
best disinfectants.
Use of commonly available
antiseptic hand wash like
chlorhexidine is generally
enough.
OSHA (Occupational safety and Health
agency) regulation.
Exposure and control plan
Emergency and exposure incident plan
OSHA required records.
Methods of Infection control
Sterilization – Sterilization is the
destruction or complete removal of all
forms of micro organisms.
Disinfection – Disinfection is the
destruction of many microorganisms but
not usually the bacterial spores.
Choice of equipments
Choice of equipments depends
upon the requirement of the practioner.
Water supplies
The ADA council on scientific affairs
recommends to improved the design of
dental equipment of that water delivered
to patients during non surgical dental
procedures contains no more than 200
colony forming units / ml (cfu/ml) of
bacteria at any point of time in the
unfiltered output of dental unit.
Pre-Sterilization Cleaning
Bio-films of vegatitive form of bacterias
spores and the organic matter formed on
the surface of the instrument have to be
washed with the suitable disinfectant
before proceeding with the sterilization
process.
Physical agents S Chemical agents
Heat – Moist, Dry T Agents acting on cell
E membrane
R Surface acting agents,
Ionizing radiations
I Phenols, Organic solvents
X-rays, beta rays
L Agents that denature
gamma rays I proteins
Z Acids and alkalies
Ultraviolet rays A Agents acting on
T functional group of
I proteins
Filtration
O Heavy metals
N Oxidizing agents, Dyes,
Alkylating agents.
Steam Pressure Sterilization (Autoclaving)
Long cycle of 15 min – 121 degree Celsius
and 15 lbs pressure.
Short cycle of 7 min – 134 degree Celsius
and 30 lbs pressure.
Advantage of autoclaves - Most rapid and
effective methods for sterilization of
commonly used dental equipments.
Disadvantages of Autoclaves – Can cause
rusting of carbon steel instruments.
Dental burs can be autoclaved after dipping
it into 2 % sodium nitrite sol.
Dry Heat Sterilization – Hot air oven
Dry heat at 160 degree Celsius for
commonly used for this purpose. Microbial
inactivation by dry heat is primarily an
oxidation process.
Employed for sterilization of glassware,
glass syringes, oils and oily injection as
well as metal instruments.
Chemiclaving – Using ethylene oxide gas
131 degree celcius 20 pounds pressure is
use for this purpose. Heat sensitive plastic
instrument are sterilized by this method.
New methods of sterilization
Using - ultra violet light and gamma rays
Not effective against RNA viruses like
HIV and bacterial spores.
Ultrasonic sterilization.
Not commonly employed in dental
practice.
Glass bead sterilizer – used for
sterilization of endodontic files.
Types of instruments and sterilization
methods.
Hand piece – Should be well disinfected
before sterilization
Hot oil sterilization can be used for this.
Autoclaving is commonly carried out.
Sterilization of impression (Vinyl
Polysiloxane) or Rubber – Based
Impression. – These are sterilized by
dipping them in 2 % gluteraldehyde
solution for minimum of 2 hours.
These should be wrapped in sterile bag.
Disposal of waste / infected material
Waste material are first assorted as
infected or and non infected.
They are then accordingly disposed of into
color coated bags. – yellow, red, blue/white,
translucent, black.
Sharp objects like BP Blades are disposed
of into puncture proof metal boxes.
Needled are destroyed using needle
destroyer.
Use of disposable needled – syringes are
preferable.
Mercury containing amalgam wastes are
disposed of into sulphide solution.
Needle stick injury – one of the most
common hazard which dental professional
and other medical professional usually
come across.
The risk of transmission of HIV and
Hepatitis B is most dangerous.
For Hepatitis B – It is always better for
any health care worker to be well
vaccinated with HBs vaccine.
For HIV – as soon as one comes across
needle stick injury –
2. Hands should be washed thoroughly
with the available disinfectant.
3. The area of the injury should be
squeezed of for allowing blood to flow
out of it.
4. The patient can be ask for his HIV or
Hepatitis B status.
5. The senior medical incharge should be
informed about the accident.
1. HIV postexposure chemoprophylaxis for
health workers.
Basic (28 days) – Zidovudine + Lamivudine
Expanded (28 days) – As above + Indinavir
or nelfinavir or neviriapine
4. PCR – (polymerized chain reaction) can
detect the presence of HIV – p24 antigen
within 24 hrs of initial infection.
5. Check up with ELISA in every six
months.
6. The risk of HIV transmission by needle
stick injury is only 0.03 %
References :
Textbook of Oral and Maxillofacial
Surgery – Neelima Anil Malik

Sturdevants - Art & Science of Operative


Dentistry - Fourth edition

Medical problems in dentistry –


Shully and cowsan.