Sterilization in Operative Dentistry

sterilization:Is a term referring to any process

that eliminates (removes) or kills all forms of microbial
life, including the resistant bacterial spores using
physical or chemical means. Sterilization in dentistry is a
very important and crucial aspect of providing
successful dental treatments. Since most instruments
contact mucosa and/or penetrate oral tissues, it is
essential that reused instruments be thoroughly cleaned
and sterilized by accepted methods that can be routinely
tested and monitored.
 
DISINFECTION:
A much lesser term of sterilization and indicate
procedure offering variable measures of control of
infection, in this way we not going to kill all living
microorganism may viruses kept survive.
Classification of sterilization
♦ PHYSICAL METHODS
♦ CHEMICAL METHODS
♦ COMBINATION OF BOTH
 
Methods of sterilization
There are five accepted methods of sterilization:
1. Steam pressure sterilization (autoclave)
2. Chemical vapor pressure sterilization (chemi-clave)
3. Dry heat sterilization (dryclave)
4. Ethylene oxide sterilization
5.Hydrogen Peroxide plasma
1. STEAM PRESSURE STERILIZATION (AUTOCLAVING)
_Sterilization with steam under pressure is performed in a
steam autoclave.

-For a light load of instruments, the time required at 250° F

(121° C) is a minimum of 15 minutes at 15 psi pressure.

-Time for wrapped instruments can be reduced to 3

minutes if the temperature is raised to approximately 273°F
(134° C) to give 20 psi of pressure.

-Time required for the sterilizer to reach the correct

temperature is not included.
Instruments which are sterilized by using autoclave
is
Handpieces, orthodontic pliers, impression trays, and
surgical instruments.
 Advantages Disadvantages
1- Autoclaving is the most 1- Items sensitive to the
rapid and effective method elevated temperature
for sterilizing cloth cannot be autoclaved.
surgical packs and towel 2- Autoclaving tends to
packs. rust carbon steel
2- Economical instruments and burs.
3- Good penetration on all 3- Steam appears to
surfaces. corrode the steel neck and
4- Short procedure time shank portions of some
5- Easily monitored diamond instruments and
carbide burs.
6.sterilize handle trays and
paper- baged instrument. 4- Dulling of unprotected
cutting edges.
2. CHEMICAL VAPOR PRESSURE STERILIZATION
(CHEMICLAVING)
● Sterilization by chemical vapor under pressure is
performed in a Chemiclave.
● Chemical vapor pressure sterilizers operate at 270° F (131°
C) and 20 lbs pressure.
● They are similar to steam sterilizers and have a cycle time
of about half an hour.
● Like ethylene oxide sterilizers,
they must be used with
aprescribed chemical by
the manufactur
 ● Instruments which are sterilized by using
chemiclave is:
❏Periodontal, restorative and endodontic instruments
❏ Carbon steel and other corrosion sensitive burs and
pliers
 Advantages Disadvantages
Carbon steel and other 1. items sensitive to the
corrosion-sensitive burs, elevated temperature will be
damaged.
instruments, and pliers
2.Instruments must be
are said to be sterilized
lightly packaged in bags
without rust or corrosion. obtained from the sterilizer
manufacturer.
3.Towels and heavy cloth
wrappings of surgical
instruments may not be
penetrated to provide
sterilization.
4. Vapor odor is offensive,
requires aeration.
 3-DRY HEAT STERILIZATION (hot air ovens)
-It is the most widely used method of sterilization by dry
heat.
-Dry heat sterilization is readily achieved at
temperatures above 320° F (160° C) for 1-2 hours.
-The oven is electrically heated and is fitted with a fan to
ensure adequate and even distribution of hot air in the
chamber.
-It is also fitted with a thermostat that maintains the
chamber air at a chosen temperature
-Packsof instruments must be placed at 1cm apart to
allow heated air tocirculate and must be perfectly dry.
Instruments which are sterilized by using hot air
oven are :
❏ Endodontic instruments
❏ Condensers
❏ Hand instruments
❏ Orthodontic pliers
❏ Surgical instruments
❏ Burs
 Advantages Disadvantages
1- High temperatures may
1- Carbon steel
damage more heat-sensitive
instruments and burs do
items, such as rubber or
not rust, corrode, or lose plastic goods.
their temper or cutting 2- Sterilization cycles are
edges if they are well dried prolonged at the lower
before processing. temperatures.
2- Economical. 3- Heavy loads of
3- Easily monitored. instruments, crowding of
packs, and heavy wrapping
easily defeat sterilization.
4-Hot air is bad conductor of
heat hence it has less
penetrating power.
4 - Ethylene Oxide sterilization
Ethylene oxide is a gas at a temperature below 100℃. It is
highly explosive and inflammable. It is highly
penetrative, non-corrosive agent with a bactericidal
action. It is used for the sterilization of towels, metal
and plastic instruments
 Advantage Disadvantage
a.Ethylene oxide sterilization a .potentially mutagenic
is the best method for and carcinogenic.
sterilizing complex, heat
sensitive instruments and b. Porous and plastic
delicate materials like rotary materials absorb the gas
handpiece. and require aeration for
b. Less expensive devices 24 hours or more before
operate overnight to produce it is safe for them to
sterilization at room remain in contact with
temperature. skin or tissues.
C .requires aeration
c . Units with large chamber chamber, cycle time lasts
sizes hold more instruments
hours.
or packs per cycle.
5.Hydrogen peroxide plama
a. this process is mostly used to sterilize temperature-
sensetive devices or materials.
b.the process operates in the range of 37_44C and has a
cycle time of 75 minutes.
c. No need for aeration because it is dry, non-thermal
process and the by products of the cycle are nontoxic.
NEW METHODS OF STERILIZATION
Various methods of sterilization are under
investigation and development
-Ozone
-Peroxide vapor
-Ultraviolet light
-Gamma radiation
LIQUID STERILANTS/HIGH-LEVEL DISINFECTANTS
_ Sterilants used for high-level disinfection of items for
reuse are glutaraldehydes at 2% to 3% concentrations; it
kills bactereial spores in 6-10 hours.
_ Greater dilutions are not encouraged for repeated use.
_ Placing wet items into disinfectant trays dilutes the
solution.
_ Glutaraldehydes are irritating, sensitizing to skin and
respiratory passages, and can be toxic as indicated in
manufacturers' safety data sheets.Keep trays tightly
covered in a well-vented area.
_ Do not use 2% glutaraldehyde solutions to wipe
counters or equipment [e.g., dental unit and chair]
 VACCINES FOR DENTAL HEALTH-CARE WORKERS
Although the possibility of transmission of blood
borne infections from dental workers to patients is
considered to be small, It is recommends that all dental
workers, who might be exposed to blood or blood-
contaminated substances in an occupational setting be
vaccinated for HBV also other vaccine-preventable
diseases; accordingly, vaccination against influenza
[H5N1 influenza virus' (bird flu virus), H1N1influanza
virus (swine flu virus) measles, mumps, rubella, and
tetanus..
HAND WASHING AND CARE OF HANDS DHCWS
should wash their hands before and after treating each
patient (i.e., before glove placement and after glove
removal) and after touching objects contaminated by
blood, saliva, or respiratory secretions.
DENTAL INSTRUMENTS CLASSIFICATION
STERILIZATION OR DISINFECTION OF INSTRUMENTS.
Methods of Sterilization or Disinfection of Dental
Instruments
• Before sterilization or high-level disinfection, instruments
should be cleaned thoroughly to remove debris.
• Persons involved in cleaning and reprocessing instruments
should wear heavy- duty(reusable utility) gloves to lessen the
risk of hand injuries.
•Placing instruments into a container of water or
disinfectant/detergent as soon a possible after use will
prevent drying of patient material and make cleaning easier
and more efficient.
• Cleaning may be accomplished by thorough scrubbing with
soap and water or a detergent solution.
• All critical and semi critical dental instruments that are
heat stable should be sterilized routinely between uses
by steam under pressure (autoclaving), dry heat, or
chemical vapor, following the instructions of the
manufacturers of the instruments and the sterilizers.
• Critical and semi critical instruments that will not be
used immediately should be packaged before
sterilization.
CLEANING AND DISINFECTION OF DENTAL UNIT AND
ENVIRONMENTAL SURFACES
• After treatment of each patient and at the completion of daily work
activities, countertops and dental unit surfaces that may have become
contaminated with patient material should be cleaned with disposable
toweling, using an appropriate cleaning agent and water as necessary.
. Surfaces then should be disinfected with a suitable chemical germicide.
Including:
phenolics, iodophors, and chlorine-containing compounds.
. A fresh solution of sodium hypochlorite (household bleach) prepared
daily is an inexpensive and effective intermediate-level germicide.
Concentration (1/4 cup of bleach to 1 gallon of water) is effective on
environmental surfaces that have been cleaned of visible contamination.
.Caution should be exercised, since chlorine solutions are corrosive to
metals, especially aluminum.
DISINFECTION AND THE DENTAL LABORATORY
• Laboratory materials and other items that have been
used in the mouth (e.g.,impressions, bite registrations,
fixed and removable prostheses, orthodontic
appliances)should be cleaned and disinfected before
being manipulated in the laboratory, whether an on-site
or remote location .
USE AND CARE OF HANDPIECES AND OTHER
INTRAORAL DENTAL DEVICES ATTACHED TO AIR
AND WATER LINES OF DENTAL unite
-Routine between-patient use of a heating process
capable of sterilization (i.e., steam under pressure
{autoclaving}, dry heat, or heat/chemical vapor) is
recommended for all high-speed dental hand pieces,
low-speed hand piece components used intra orally, and
reusable prophylaxis angles.
-Manufacturers' instructions for cleaning, lubrication,
and sterilization procedures should be followed closely
to ensure both the effectiveness of the sterilization
process and the longevity of these instruments.
- Other reusable intraoral instruments attached to, but
removable from, the dental unit airor water lines -- such
as ultrasonic scalar tips and component parts and
air/water syringe tips -- should be cleaned and sterilized
after treatment of each patient in the same manner as
hand pieces,
- Some dental instruments have components that are
heat sensitive or are permanently attached to dental unit
water lines. Some items may not enter the patient's oral
cavity, but are likely to become contaminated with oral
fluids during treatment procedures, including, for
example, handles or dental unit attachments of saliva
ejectors, high-speed air evacuators, and air/water
syringes. These components should be covered with
impervious barriers that are changed after each use or, if
the surface permits, carefully cleaned and then treated
with a chemical germicide having at least an
intermediate level of activity.
DISPOSAL OF WASTE MATERIALS
►Blood, suctioned fluids, or other liquid waste may be
poured carefully into a drain connected to a sanitary
sewer system.
►Disposable needles, scalpels, or other sharp items
should be placed intact into puncture-resistant
containers before disposal.
►Solid waste contaminated with blood or other body
fluids should be placed in sealed, sturdy impervious
bags to prevent leakage of the contained.
Thank you