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AFRAID?
We better be-
Let us explore this world of heat, light, chemical, gases etc. under the
following subheadings:
INTRODUCTION
DEFINITIONS
HISTORY
PRELIMINARIES
STERILIZATION
DISINFECTION
CONCLUSION
BIBLIOGRAPHY
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INTRODUCTION:
also the age of medical challenges. From the “back with a vengeance”
is omnipresent and ever threatening. Into this scenario comes the dental
professional being the center of a health care delivery system, dentists are
not only at risk themselves but also pose a pathway of infection to their
implement all those practices and procedures that will result in minimizing
state.
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DISINFECTION: It means the killing, removal of or destruction of
inanimate objects.
zenith.
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Microbiostasis agents are substances or conditions that do not immediately
HISTORY:
Zaccharis Jannsen, in 1590 and Robert Hooks in 1660 opened the world of
Further process effort of Louis Pasteur added new direction to the field of
sterilization.
Input by various researchers like John Lyndall, Robert Koch etc. further
accelerated the progress, when finally in the 1890’s the advent of stear
sponges engaged.
were stated by the CDC in 1973 and specific dental infection control
guidelines and the ADA is 1878 revised in 1985, and 1988 also defined in
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administration). Comprehensive guidelines for infection control come into
effect in Dec. 1991 and continually being ungraded to incorporate the mind
sterilize:
The basic answer lies in the fact that we sterilize to minimize and eliminate
alarming results.
aerolization.
Herculean the task is and what risk dentists themselves face-as do their
Doesn’t look all that small does if. Also mention AIDS, hepatitis, TB, viral,
bacterial etc.
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Thus infection control involves:
The preliminaries:
care.
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2. identifying infection or high risk that may be important to a clinical
aseptic dentistry.
1. Hand washing.
2. Gloves
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3. Gowns
4. Masks
5. Protective eye wear
6. Rubber dam
7. Pre procedural mouth rinse.
Hand washing : Hands must always be washed at the start of each day
before gloving, after removal of gloves and after touching inanimate
objects likely to be contaminated by patients saliva or blood . Hand
washing with plain soap and water appears to be adequate for routine
examination and non surgical procedures. For surgical procedures an
antimicrobial surgical hand scrub should be used. Hand washing procedure
begins with a thorough initial scrubbing of all surfaces of the nails, fingers,
hands and lower arms with an antimicrobial preparation. Drying should be
done with a clean paper towel.
Gloves : Gloves are required in dentistry when the dentist has to come in
contact with potentially infectious secretions or for contact with oral
mucous membrane. Four types of gloves are identified for use in dentistry.
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iii. Vinyl examination gloves.
iv. Utility gloves.
Surgical gloves : Best fitting and generally the most expensive disposable
gloves is the sterile surgical glove. Used when maximum protection is
indicated. They are made of high quality latex.
Latex examination gloves : These are the most commonly used gloves in
dentistry. Available in a variety of sizes designated as S,M,L.
Heavy utility gloves : These are non disposable gloves. They should be
worn when handling contaminated instruments, when using chemical
sterilants and during general cleaning of the treatment area. These gloves
can be washed, sterilized, disinfected and reused and are puncture resistant.
Gowns, Aprons or lab coats must be worn when the skin or clothing
is likely to come in contact with saliva or blood. They should be changed
when visibly soiled. These garments should be limited to the dental office
and not be worn out side.
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Masks :
Masks protect the face, oral mucosa and nasal mucosa of the dentist
from splatter of blood or saliva from the use of high speed hand piece with
water coolant.
It also protects both the dentist and the patients from aerosol
contamination by potential from the respiratory tract.
- Fit comfortably.
- Not leak out air
- Fit around the entire periphery of the face.
- Not irritate skin.
- Provide breathability.
- Not cause fogging of protective eyewear.
- Not have an objectionable odour.
- Not touch lips or nostrils.
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Protective eye wear
The eyes due to limited vascularity and lower immense abilities are
susceptible to macroscopic and microscopic injury.
Rubber dam :
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Pre procedural mouth rinse
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A) Mechanical is further classified into:
Under mechanical:
kill bacteria while viruses are more resistant. However, the method
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is highly unreliable, spores are unaffected by drying and can remain
3. Next we come to heat: This is the most popular, widely used and
A) Dry heat means the use of heat without any moisture content. It
spatulas are held in a Bunsen flame till they become red hot for
sterilization.
Scalpel, needles, mouth of culture tubes, glass slides, cover stips etc
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3) Conventional dry heat hot air ovens: This is the more commonly
and a 2 hour holding period at 160°C or/ how at 170°C is used with
at 150°C for 1 hour while among rubbers only silicon rubbers can
Another innovation are the short cycle, high temperature dry heat ovens.
mechanical connection oven with a fan or blow for air circulation) reduces
type used must be properly calibrated and approved. The main precaution
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is that the sterilization is done after the temperature reaches the required
setting.
burs. Rapid cycles can be used at high temperatures and cutting edges are
nontoxigenic Clostridia tetani spores or Browne’s tube green spot test. Also
used.
transfer devices.
practitioner as they encompass the glass bead and salt media sterilizers.
Glass beads, molten metal and salt are media often used. It essentially
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consist of a metal cup in which table salt or glass beads are kept at a
used with the unit of temperature indication devices are not incorporated.
105. It does not affect the temperature of instruments in any way. The hot
salt sterilizer has superseded the molten metal and glass bead sterilizer
because metal or glass beads could accidentally cling to the instrument and
get lodged in root canals, clogging them. Salt eliminates this risk and usual
fusion is used. Salt should be changed weekly. Glass beads are often used
and their size should be less than 1cm. The hottest part of this apparatus is
along the outer rim at the bottom most layer and lowest in the center of the
Going further, we now come to the most widely used form of heat
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The lethal effect is due to denaturation and coagulation of protein and its
sterilized at 56°C for 1 hour for several successive days. Media such
2) Temperatures at 100°C:
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include rapidity, economy, no elaborate equipment, good penetration
process.
temperatures. The principle is that the 1st exposure kills all vegetative
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sterilization and has been the standard method for many years. It is
pounds of pressure.
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The advantages include excellent penetration, short cycle time, relative
This system depends on heat, water and chemical synergism for its efficacy
and has the major advantage of greatly reducing corrosion of metal items
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pounds pressure with a cycle lie of 20-40 minutes. Medial instruments used
dry instruments at the end of the cycle and automatic preset cycle timing.
Since it has 8-9% vapor content, much less than the 15% minimum for
Hot oil bath have been used to sterilize metallic instruments. Oil can reach
difficult to remove.
sterility.
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4) Radiation – Radiation can be ionizing, non-ionizing and lasers:
rays gama rays, particulate radiations, cosmic rays and are highly
water. Though more used individually, medically they are used for
operation theatres.
Various types like CO2, Argon, Nd:YAG etc are used. Hoob and
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magnetostrictive oscillation or piezoelectric crystals. Though
various forms. This is the method of choice for heat labile liquids
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2. Asbestos filters: Disposable, single use discs, they have high
Common pare sizes are 0.22 to 10µ but filters are produced
nonvisual microbes while that 0.005µ can strain out even the
smaller viruses.
10µm poly carbonate film with etched holes and pare sizes of
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After the physical agents, we shall now see the chemical agents used in
Firstly,
the only time chemical sterilant while the others are considered merely as
mixtures contain 12% ETO and 88% CFC or ETO and CO2 to reduce
hours is the norm with variable time periods for degassing to prevent
adverse effect with the gas. Items should be clean and dry and specially
and relative humidity of 40% reduce time to 4 hours. Varying these factors
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Advantages include high penetration, no damage to heat sensitive and
degassing required.
protein. For best results, a relative humidity of about 70% and temperature
of 22°C are required. It has low penetrability and high toxicity, being
and sterilize clean metal instruments. The gas is used for sterilizing
active against tubercle bacilli, fungi and viruses. It is less toxic and irritant
organic matter and do not harm rubber and plastic hence being indicated
Their shelf life, use and reuse life should be noted. Their main
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disadvantages are their toxicity and irritation and physical contact with
and formaldehyde with a boiling point of 163°C 0.2%. BPL is used for
too. It is also used to sterilize vaccines, graft tissues and other delicate
biological material.
antiseptics:
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evaporation, dehydration, corrosion and ineffectiveness
organic media.
are:
detergents.
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chloride is most commonly used. Primarily active
used as such:
sparingly now.
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toxic. The lethal effect is due to a reaction with acid group in
the cell.
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c. Cresols – Alkyl derivatives of phenol composed of
asepsis.
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7. Heavy metal compounds: All metal ions inhibit microbes in
asepsis.
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compounds are hypochloride solution and chlorine dioxide
complexes and have a broad antimicrobial spectrum but are less irritating,
non staining and have stained activity, common carries used are polyvinyl
as well as are surface acting agents improving penetrability. They are also
200ppm. Solutions are unstable and should be diluted with distilled water.
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Monitoring of sterilization and disinfectants:
sterilization progress.
Chemically treated tapes and other heat sensitive indications that change
been reached. However, these are not perfectly reliable as they change
color much earlier too with autoclave tapes being notoriously unreliable.
Heat sensitive indications consist of paper strips, labels and steam patterns
bacterial spores more resistant to heat thus viruses and vegetative bacteria
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Thus a combination of the 2 should be used for clinical needs. Evaluation
control, use dilution test, inactivation tests and specific filter testing for
monitored.
dentistry:
Firstly,
The dental chair and delivery system. The chair should be smooth and
between patients.
controlled. Cart tops should be smooth and preferably separate. The entire
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Also included are the task seating surfaces and foot controls. The dental
Next come the X-ray unit – an integral part of all practices it is subject to
spread. Also disinfectants can be used on the surfaces. Film holders, bite
blocks and the processing unit which are all subject to high contamination
Also, cabinets and work surfaces should be kept to a minimum and should
Tubings and hoses including suction and delivery hose can harbor
infection. All surfaces should be smooth and without crevices. Ideally they
closed with water and disinfectant while hand piece and air water syringe
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connector assembly should be washed with detergents and disinfected by
immersion.
After this we shall have a look at handpiece sterilization and asepsis. The
speed, need size, chuck, hose and connector and handpiece lighting should
sterilization.
and oral fluid retraction, water line contamination and spatter and aerosol
generation.
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through knowledge of them mechanics should go into their purchase.
Common brands like KaVo, Midwest, Star etc use specified lubricants and
Next come the water system asepsis – water line asepsis should be a
factor considered in the clinic firstly water and oral fluid fraction should be
solutions, filters, and dedicated water systems for infection control are
recommended.
Now lets see infection control for impression and related registration –
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follow decontamination procedures hardly materials as biohazardous and
can be heat sterilized. Various other items are shown in the table. Also note,
numerous items are recommended for disposable use in a single use and
feasible. Also barrier methods and plastic or other disposable covers should
be used for complex devices or straight surfaces like light are units to
sterilized, do it.
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mandatory. Special considerations should be made in use of HIV and
Barrier techniques the double gloving etc should be used. Sharps should be
performed. Stringent sterile precautions are called for while dealing with
CONCLUSION:
sterilization will help ensure safety from the invisible but deadly world of
microbial pathosis and assist the practitioner in delivering holistic care with
physicians themselves.
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