Disinfection and Sterilization of

Dental Instruments
 Learning Objective
• Classification Categories
• Disinfection
• Instrument Processing
• Decontamination
• Cleaning
• Packaging
• Sterilization
• Sterility Assurance
• Storing
 Classification Categories
• Classification categories based on the risk of
transmitting infection (CDC):
Critical
instruments

Semi-critical
instruments

Non-critical
instruments
CDC: Centers for Disease Control
 Critical instruments
Penetrates soft tissues or
bone
Enter into or contact the
bloodstream or other
normally sterile tissue
Should be sterilized after
each use
Sterilization is achieved by
steam under pressure
(autoclaving), dry heat, or
heat/chemical vapor
Critical instruments
include forceps, scalpels,
bone chisels, scalers and
surgical burs
Semi-critical instruments Non-critical instruments
Do not penetrate soft Do not penetrate soft
tissues or bone tissue or bone
Contact mucous Come into contact only
membranes or non-intact with intact skin
skin
Should be sterilized after May be reprocessed
each use between patients
High-level disinfection is Intermediate-level or low-
appropriate level disinfection
Mirrors, reusable External components of x-
impression trays and ray heads, blood pressure
amalgam condensers cuffs and pulse oximeters
 Levels of Chemical Disinfection
Level Level Definition and Description
Low Kills most vegetative bacteria except M.tuberculosis and some fungi,
and inactivates some viruses
Hospital disinfectant or sanitizers
Intermediate Kills vegetative microorganisms, including M.tuberculosis, all fungi,
and inactivates most viruses
Disinfectant of laboratory benches and as a part of detergent
germicide
High Kills vegetative microorganisms and inactivates viruses, but not
necessarily high numbers of bacterial spores
For medical devices (10-30 minutes), not on environmental surfaces
Can be use in “cold sterilization” (6-10 hours)
Organisms Resistance to
Germicidal Chemicals
Bacterial Spores

Mycobacteria

Nonlipid Virus

Fungi

Vegetative Bacteria

Lipid Virus
 Activity Levels of
Selected Liquid Germicides

Procedure/ Product Aqueous Concentration Disinfection Activity Level

Glutaraldehyde Variable High to intermediate
Hydrogen peroxide 3-6% High to intermediate
Formaldehyde 1-8% High to low
Chlorine dioxide Variable High
Peracetic acid Variable High
Chlorine compound 1-10% household bleach Intermediate
Phenolic compounds 0.5-3% Intermediate to low
Alcohols 70% Intermediate
 Instrument Processing
• All critical and semicritical dental instruments
that are heat stable should be sterilized after
each use by steam under pressure
(autoclaving), dry heat, or chemical vapor.

Decontamination Cleaning Inspection Packaging Sterilization Storing

 Decontamination
Protect health care worker to perform following procedure

– Heavy-duty gloves should be worn

– Instruments should soak in disinfectant as soon as possible
after use to prevent drying of debris
 Cleaning
Before sterilization or high-level disinfection, instruments should be
cleaned so that any debris is removed

– Use enzymatic and non-enzymatic solutions

– Heavy-duty gloves should be worn
– Instrument cassettes and mechanical cleaning (e.g.,
ultrasonic cleaners) may be used to reduce direct handling
of contaminated instruments
– Rinse with good quality water to avoid staining

More effective,
cleaner, safer
 Inspection
• Each instrument should be inspected after
each cleaning for residual debris or damage
• Replace instrument as needed and never
sterilize dirty instruments
 Packaging

Packaging rinsed and dried instruments before

sterilization protects them from contamination
after they are removed from the sterilizer and
during transport

For quality assurance, include a

chemical indicator inside and outside
to verify the sterilization parameters
were met
 Packaging

Pouches Wrappers Perforated

• For small, • For dental Containers
lightweight trays • For dental
items surgery
intruments
Sterilization
Steam
Cycle : 121 C 30 minutes, 132 C 10
minutes, 135 C 4 minutes
Fast, inexpensive, efficient Allow packages
to dry in the
sterilizer before
Chemical Vapor
Cycle: 132 C, 20 minutes
they are
handled to
avoid
contamination
Dry Heat/ Rapid Heat
160 C for 1 to 2 hours
 Sterility Assurance
Physical Indicators

Chemical Indicators

Biological Indicators
 Physical Indicators
• Physical indicators:
– Time
– Temperature
– Pressure gauges

• Should be recorded every cycle

 Chemical Indicators
• Should be on the outside and inside of all
packages to visibly show they have been
processed
Biological Indicators
• Highest level of sterility
assurance
• Contain bacterial spore Bacillus
stearothermophilusincubate
check
• Sterilizer should be spore tested
at least weekly, and every load
that contain an implant
 Storing
• Sterile item should be
stored properly to
reduce contamination
• The self-life of sterile
packages is event
related and depends on
the quality of the
packaging material,
storage, and amount of
handling