Armamentarium in Oral Surgery PDF

Armamentarium in Oral Surgery PPT Prepared By: Renelie P. San Jose, DMD  Incising Tissue Scalpel = Reusable Handle + Disposable, Sterile Blade most common handle : No. 3 handle most common blade for OS : #15 blade - used to make incisions around teeth and thr...

Armamentarium in Oral Surgery PPT Prepared By: Renelie P. San Jose, DMD  Incising Tissue Scalpel = Reusable Handle + Disposable, Sterile Blade most common handle : No. 3 handle most common blade for OS : #15 blade - used to make incisions around teeth and through soft tissue PPT Prepared By: Renelie P. San Jose, DMD  Incising Tissue #10 - for large skin incisions in other parts of the body #11 - sharp pointed blade, for making small stab incisions (i.e. abscess) #12 - hooked; for micogingival procedures on posterior aspects of teeth or on maxillary tuberosity PPT Prepared By: Renelie P. San Jose, DMD Incising Tissue PPT Prepared By: Renelie P. San Jose, DMD Incising Tissue PPT Prepared By: Renelie P. San Jose, DMD Incising Tissue PPT Prepared By: Renelie P. San Jose, DMD  Elevating the Mucoperiosteum No. 9 (Molt) Mucoperiosteal elevator has a sharp, pointed end, and a broader, rounded end pointed end - reflect the dental papilla from between teeth broad rounded end - continue the elevation of periosteum from bone PPT Prepared By: Renelie P. San Jose, DMD Elevating the Mucoperiosteum PPT Prepared By: Renelie P. San Jose, DMD  Elevating the Mucoperiosteum 3 Methods: 1. Pointed end is used in twisting, prying motion, to elevate soft tissue 2. Push stroke; pointed or broad end is slid underneath the periosteum 3. Pull stroke PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD  Retracting the Soft Tissue good access and vision cheek, tongue, mucoperiosteal flap protect soft tissue from sharp cutting instruments 2 most popular cheek retractors 1. Austin retractor 2.Minnesota retractor Seldin - for oral soft tissue mouth mirror - for tongue during routine exodontia PPT Prepared By: Renelie P. San Jose, DMD Retracting the Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD Retracting the Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD Retracting the Soft Tissue Henahan Seldin PPT Prepared By: Renelie P. San Jose, DMD Retracting the Soft Tissue Towel Clamp - hold the tongue; must be anesthetized, usually during tissue biopsy on the posterior portion PPT Prepared By: Renelie P. San Jose, DMD Retracting the Soft Tissue Weilder Retractor - retract the tongue; serrations are used to hold the tongue securely away from the surgical field PPT Prepared By: Renelie P. San Jose, DMD  Grasping the Soft Tissue Oral Procedures requiring tissue grasping: 1.to incise soft tissue 2.to stop bleeding 3.to pass a suture needle Adson Forceps (pick up) - with or without small teeth at the tips, to hold tissue gently and stabilize it Stillies Forceps - longer, 7-9in, for posterior parts of the mouth PPT Prepared By: Renelie P. San Jose, DMD Grasping the Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD  Grasping the Soft Tissue College, or Cotton, Forceps (cotton pliers) - angled, not for handling soft tissue, pick up loose tooth fragments or foreign material Allis Tissue Forceps - locking, for larger tissues (i.e. epulis fissurata) PPT Prepared By: Renelie P. San Jose, DMD Grasping the Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD  Controlling Hemorrhages Hemostat -long, delicate beaks, used to grasp tissue -has a locking handle that allows the surgeon to clamp the haemostat onto a vessel then let go -used also to remove granulation tissue, pick up small root tips, calculate deposits, amalgam, fragments etc. -NOT AN INSTRUMENT FOR SUTURING PPT Prepared By: Renelie P. San Jose, DMD Grasping the Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD Controlling Hemorrhages PPT Prepared By: Renelie P. San Jose, DMD Grasping the Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD  Removing Bone Rongeurs - has sharp blades that are squeezed together by the handles - cutting or pinching through bone - has a rebound mechanism, once released, it reopens 1. side cutting forceps 2. side- and end- cutting (Blumenthal Rongeurs) PPT Prepared By: Renelie P. San Jose, DMD  Removing Bone - must be only used to remove smaller amounts of bones in multiple bites - should not be used to remove teeth PPT Prepared By: Renelie P. San Jose, DMD  Removing Bone Bur and Handpiece - high speed, high torque handpiece - sharp, carbide burs ( #557, 703 fissure bur; #8 round) - handpiece must be completely sterilisable -must not exhaust air in the operator field (to prevent tissue emphysema) PPT Prepared By: Renelie P. San Jose, DMD Removing Bone PPT Prepared By: Renelie P. San Jose, DMD  Removing Bone Mallet and Chisel - for removing bony exostoses, lingual tori, sectioning teeth PPT Prepared By: Renelie P. San Jose, DMD  Removing Bone Bone File - double ended instrument with a small and larger end - for final smoothing of bone - pull stroke PPT Prepared By: Renelie P. San Jose, DMD Removing Soft Tissue from Bony Cavities Bone (Periapical) Curette - angled, double-ended to remove granulomas, small cysts from PA lesions -remove small amounts of granulation tissue debris from tooth socket PPT Prepared By: Renelie P. San Jose, DMD  Suturing Soft Tissue Needle Holder -with a locking handle and a short, blunt beak -for I/O, 6-inch needle holder is recommended -shorter and stronger beaks compared to hemostat -cross-hatched beak : for a positive grasp of a needle* PPT Prepared By: Renelie P. San Jose, DMD  Suturing Soft Tissue Needle Hemostat Holder PPT Prepared By: Renelie P. San Jose, DMD Suturing Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD  Suturing Soft Tissue Suture Needle -small half-circle or three eights-circle needle -curved, to allow it to pass through a limited space -tapered (round) or triangular tips (cutting) -held approximately 2/3 of distance between tip and base of the needle PPT Prepared By: Renelie P. San Jose, DMD Suturing Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD Suturing Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD Suturing Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD Suturing Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD Suturing Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD Suturing Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD Suturing Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD  Suturing Soft Tissue Suture Material -classified by Diameter, Resorbability, and whether they are Mono- or Polyfilament -size relates to its diameter -most common diameter : 3-0 (000) ; more 0s, the smaller the diameter* PPT Prepared By: Renelie P. San Jose, DMD  Suturing Soft Tissue -may be Resorbable (silk, nylon, vinyl, and SS) or Nonresorbable (made of gut i.e. catgut, chromic gut, polyglycolic acid, polylactic acid) -resorbable catgut stays for 3-5 days; chromic gut : 7-10 days PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD  Suturing Soft Tissue -Monofilament sutures are plain sutures i.e. chromic gut, nylon, and SS -Polyfilament sutures are braided sutures i.e. silk, polyglycolic acid, and polylactic acid -Polyfilament sutures tend to “wick” oral fluids along the suture to the underlying tissues due to multiple filaments -Monofilaments do not case wicking but are more difficult to tie and tend to come untied, cut ends are stiffer PPT Prepared By: Renelie P. San Jose, DMD  Suturing Soft Tissue -most commonly used suture material is : 3-0 black silk -more strength due to diameter, polyfilament makes it easy to tie with less stiff cut ends, color makes it easier to see when patient comes back for SR -sutures usually stay NO LONGER THAN 5-7 DAYS PPT Prepared By: Renelie P. San Jose, DMD Suturing Soft Tissue PPT Prepared By: Renelie P. San Jose, DMD  Suturing Soft Tissue Scissors A. Suture Scissors -have short cutting edges -sole purpose : cut sutures -most common : Dean Scissors : slightly curved handles and serrated blades -have long handles, and thumb and finer rings -held the same way as the needle holder PPT Prepared By: Renelie P. San Jose, DMD  Suturing Soft Tissue B. Tissue Scissors -straight or curved blades 1. Iris Scissors - small, sharp pointed, delicate tools for fine work 2. Metzenbaum Scissors - for undermining and cutting soft tissue; may either have sharp or blunt tips -should not be used for cutting sutures = dull* PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD  Holding the Mouth Open Bite Block - soft, rubberlike block on which the patient can rest his teeth PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD  Holding the Mouth Open Side-action Mouth Prop - for wider mouth opening PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD  Suctioning -to provide adequate visualization -blood, saliva, irrigating solution -has a smaller orifice compared to the one used in general dentistry Fraser suction -has a hole in the handle portion that can be covered with a fingertip as needed -hard tissue is being cut : cover* -soft tissue is being suctioned : do not cover PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD  Holding Towels and Drapes in Position Towel Clips -has a locking handle, and finger and thumb rings -sharp or blunt action ends PPT Prepared By: Renelie P. San Jose, DMD  Irrigating -steady stream of irrigating solution (sterile saline or sterile water) is necessary when cutting bone with handpiece and bur -cools the bur and prevents bone damaging heat build up -increases efficiency of bur by washing away bone chips, provides lubrication -Large Plastic syringe with a blunt 18-gauge* needle is commonly used PPT Prepared By: Renelie P. San Jose, DMD Irrigating PPT Prepared By: Renelie P. San Jose, DMD  Extracting Teeth Dental Elevators - used to luxate (loosen) teeth from surrounding bone prior to forcep adaptation - minimize the incidence of broken crowns, roots and bone - used to expand bone - used to remove broken or surgically sectioned roots from the sockets PPT Prepared By: Renelie P. San Jose, DMD  Extracting Teeth Dental Elevators - handle : straight, cross-bar or T-bar - shank : connects handle to the blade - blade : working tip, transmit force to toot, bone or both PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD Cross-Bar and T-Bar Handle PPT Prepared By: Renelie P. San Jose, DMD  Extracting Teeth 3 Basic Types of Elevators 1. Straight -blade has a concave surface one side that is place toward the tooth to be elevated - No. 301 : small, straight elevator most commonly used for beginning of luxation - larger : used to displace roots from their sockets, and to luxate teeth that are more widely spaced (No. 34S, 46, 77R) PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD  Extracting Teeth Straight -shape of the blades can be angled from the shank -used for more posterior aspects of the mouth -Miller and Potts elevators PPT Prepared By: Renelie P. San Jose, DMD  Miller Dental Tooth Elevator PPT Prepared By: Renelie P. San Jose, DMD Potts Dental Tooth Elevator PPT Prepared By: Renelie P. San Jose, DMD  Extracting Teeth 2. Triangular - provided in pairs : left and right (east and west) - used when a broken root remains in the tooth socket and the adjacent socket is empty - turned in a wheel-and-axle rotation, with the sharp tip engaging in the cementum of the tooth Cryer elevator : most common type PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD  Extracting Teeth 3. Pick Type - used to remove roots A.Crane Pick elevator : heavy version - used as a lever to elevate a broken tooth from the socket - usually necessary to drill a hole (purchase point) B. Root-Tip Pick elevator - used to tease small roots from the socket PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD  Extracting Teeth Periotomes - used to extract teeth while preserving the anatomy of the tooth’s socket - principle : sever the PDL of tooth to facilitate removal of tooth -pressure is applied in apical direction PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps - used for removing the tooth from alveolar bone - used to lift elevator-luxated teeth from their socket (not pulling) - also helps in expanding bone - handle, hinge, and beaks - handle : serrated surface for positive grip, and to prevent slippage (palm facing up for upper, palm facing down for lower) PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD For Extracting Maxillary Teeth PPT Prepared By: Renelie P. San Jose, DMD  For Extracting Mandibular Teeth PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps - Hinge : transfers and concentrates the force applied to the handles to the beaks 1. American type : horizontal hinge 2. English type : vertical hinge PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps -Beak : designed to adapt to the tooth root near the junction of the crown and the root A. Maxillary Forceps No. 150 - for Upper Central and Lateral Incisors, Canines, and Premolars No. 150A - for Upper Premolars No. 1 - for Upper Incisors and Canines PPT Prepared By: Renelie P. San Jose, DMD Forceps No. 150 PPT Prepared By: Renelie P. San Jose, DMD Forceps No. 150A PPT Prepared By: Renelie P. San Jose, DMD Forceps No. PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps No. 150S - for Upper Primary Anteriors PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps No. 18R - for Upper Right Molars No. 18L - for Upper Left Molars PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps No. 69 - for Upper Root Fragments No. 65 - for Upper Posterior Root Fragments PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps No. 210S - for Upper 2nd and 3rd Molars with conical roots PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps B. Mandibular Forceps No. 151 - for Lower Central and Lateral Incisors, Canines, and Premolars PPT Prepared By: Renelie P. San Jose, DMD PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps No. 151A - for Lower Premolars PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps No. 151S - for Lower Primary Anteriors PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps No. 17 - for Lower Molars with Bifurcation PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps No. 17 - for Lower Molars with Bifurcation PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps No. 16 - aka. Cowhorn forceps, for Lower Molars PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps No. 16 - aka. Cowhorn forceps, for Lower Molars PPT Prepared By: Renelie P. San Jose, DMD  Extraction Forceps No. 44 - Lower Root Fragments PPT Prepared By: Renelie P. San Jose, DMD PRINCIPLES OF ASEPSIS Dr. Amy P. Cabrera Oral Surgery Section  Infection Control Medical asepsis - refers to all procedures or practices used to prevent spread of any microorganisms that could cause disease - attempt to keep patients and health care staff and objects as free as possible of agents that cause infection  Surgical Asepsis – procedures done to prevent microbes from gaining access to surgically created wounds.  Definition of Terms 1. Infection – condition usually caused by microorganisms that invade the body and multiply. Invasion by most microorganisms begins when they adhere to cells in a person's body. 2. Nosocomial infection – (from two Greek words, "nosus" meaning "disease" & "komeion" meaning "to take care of“) - infection contracted by a patient while under medical care or one that occurred within 72 hours after admittance to the hospital, but was not present prior to.  Definition of Terms 3. Fomite - any inanimate object or substance capable of carrying infectious organisms (such as microorganisms or parasites) and hence transferring them from one individual to another. 4. Antiseptics – antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. 5. Antibiotics – antimicrobial substances transported through the lymphatic system that destroy bacteria within the body  Definition of Terms 6. Antibacterials – antiseptics that have the proven ability to act against bacteria especially if they target systems which kill only bacteria. 7. Bacteriocidal – refers to destroying and killing microbes, germicidal. 8. Bacteriostatic – only prevent or inhibit growth of bacteria. 9. Disinfectants – chemical compounds that destroy microorganisms found on non-living objects. 10. Pathogen: An agent of disease. A disease producer. Most commonly used to refer to infectious organisms which include bacteria (such as staph), viruses (such as HIV), and fungi. Less commonly, pathogen refers to a noninfectious agent of disease such as a chemical. 11. Sanitization – the reduction of the number of viable microorganisms to levels judged safe by public health standards 12. Sepsis – a serious bodywide response to bacteremia or another infection - breakdown of living tissue by the action of microorganisms usually accompanied by inflammation.  Definition of Terms 13. Fungicides – chemical compounds or biological organisms used to kill or inhibit fungi or fungal spores. 14. Viricides or antivirals – microbicides which kill virus particles 15. Sterilization – the complete elimination of all forms of microbial life.  Elements of Infection 1. Portal of entry 2. Virulence of the microorganism 3. Host resistance or susceptibility Communicable Pathogens  Infection Control I. Patient preparation II. Preparation of the surgeon and other members of the team III. OR preparation IV. Instrument preparation – sterilization V. Handling and disposal of sharps From Patient to Staff From One Patient to Another Methods of Reducing the Number of Micro-Organisms from a Surface I. Physical 1. Heat 2. Mechanical dislodgment 3. Radiation II. Chemical 1. Antiseptic 2. Disinfectant 3. Ethylene oxide glass Sterilization Methods and Equipments  Sterilization A process that destroy any form of microorganism (beneficial or harmful), viruses, bacteria (which could either be spore forming or non-spore forming) and fungi. Sterilization generally attains 100% kill compared to disinfection which usually achieves a 99+% kill.  Infection Control Procedures ◻ 1. Hand washing and gloving ◻ 2. Protection against aerosol and splatter ◻ 3. Instruments asepsis ◻ 4. Surface asepsis ◻ 5. Management of sharps and waste products ◻ 6. Aseptic technique  How to Prepare Instruments for STERILIZATION 1. Rinse the articles with cold water to remove organic materials. Hot water coagulates the protein of organic material and tends to make it adhere. Ex: organic material- pus and blood 2. Wash the articles in hot water and soap. ◻ The emulsifying action of soap reduces surface tension and facilitates the removal of dirt. 3. Use brush and/or bristle to clean the grooves and corners. Note: Scrubbing helps to dislodge foreign materials clinging to the instruments. 4. Rinse and dry the instruments/ articles. ❑ At this stage the articles are considered clean but not sterile. 5. Pack the instruments in a sterilization pouch and sterilize. Methods of Sterilization  Methods of Sterilization ❑ 1. Moist heat ❑ 2. Gas ❑ 3. Boiling water ❑ 4. Radiation  Moist heat (Steam) 2 ways of steam sterilization: Steam under pressure Free steam  Moist heat (Steam under Pressure) ❑ Saturated steam under pressure is the most widely used. ❑ Nontoxic, inexpensive, rapidly microbicidal, sporicidal, and rapidly heats and penetrates fabrics.  Moist heat (Steam under Pressure) Recognized minimum exposure periods for sterilization of wrapped healthcare supplies (U.S. CDC): 1. 30 minutes at 121 ° C (250 ° F) in a gravity displacement sterilizer 2. 4 minutes at 132 ° C (270 ° F) in a prevacuum sterilizer *Tucker, Hupp and Ellis. Contemporary in Oral and Maxillofacial Surgery.  Autoclave Machine The most effective method of sterilization.  Autoclave Makes use of the pressure cooker principle.  Free Steam 2. Free steam, 100 ° C (212 °F) is used to sterilize objects that would be destroyed at the higher temperature and pressure of the autoclave. Usually the article is steams for 30 minutes on 3 consecutive days Ex. bed pan flusher- is not sterilize rather flushed by free steam in less than 100 °C. Some of microorganism (hepatitis A virus) can survive this free steam application.  Free Steam 2. free steam or “flash" steam sterilization sterilization of an unwrapped object at 132 C for 3 minutes at 27-28 lbs. of pressure in a gravity displacement sterilizer (by Underwood and Perkins)  Gas Ethylene oxide gas destroys microorganism by interfering with their metabolic process. Also effective against spores Advantage - good penetration and effectiveness for heat-sensitive items  Ethylene Oxide The most common sterilization method, used for over 70% of total sterilizations and for 50% of all disposable medical devices Kills all known viruses, bacteria and fungi, including bacterial spores and is satisfactory for most medical materials, even with repeated use 39  Ethylene Oxide Sterilizer Disadvantages: Highly flammable and requires longer time to sterilize than any heat treatment Known as carcinogenic, requires a period of post-sterilization aeration to remove toxic residue. 40  Boiling Water The most practical and inexpensive method of sterilization. Disadvantage: spores and some viruses are not killed by this method The water temperature boils at 100 °C. A minimum of 15 minutes is advised for disinfection of articles in the home  Radiation (types) Non-ionizing has a disinfecting effect Ionizing is used to sterilize equipments E.g.: Ultraviolet light uses non-ionizing radiation, this is use for disinfection because it does not penetrate deeply Ionizing radiation is used effectively to sterilize foods, drugs and other things sensitive to heat, its disadvantage is that the equipment is the high cost.  UV Radiation - for sterilization of surfaces and some transparent objects. - routinely used to sterilize the interiors of biological safety cabinets between uses. - ineffective in shaded areas, including areas under dirt which may become polymerized after prolonged irradiation 43  Ionizing Radiation Uses radiation such as electron beams, gamma rays, or subatomic particles deeply penetrate Ex. Gamma rays - commonly used for sterilization of disposable medical equipment, such as syringes, needles, cannulas and IV sets.  Radiation Sterilization - requires bulky shielding for the safety of the operators. - continuously emits the gamma rays, therefore always presents a hazard in the area of the facility. 45 Other Methods of Sterilization Dry heat Glass beads sterilizer Flaming Tyndallization Chemical or Cold sterilization Chemiclave  Dry Heat Sterilization Baking process (hot air oven) At least two hours at 160 °C (320 °F) A rapid method heats air to 190 °C (374 ° F) for 6 minutes for unwrapped objects and 12 minutes for wrapped objects. * Kruger. Textbook in Oral Surgery *Tucker, Hupp and Ellis. Contemporary in Oral and Maxillofacial Surgery. Dry heat sterilizer Glass bead sterilizer  Tyndallization A lengthy process of sterilization, involves boiling, cooling, incubating for a day, and finally boiling again. Steaming or boiling for 3 successive days at 100°C to kill all organism in their vegetative forms and allowing the spores time to hatch in between the heating periods.  Cold Sterilization Or chemical sterilization Uses chemical agents that can disinfect but not sterilize Examples: 1. Alcohol like ethanol and isopropanol – ineffective against bacterial spores, volatile & flammable & damages some plastic or rubber. Chemical or Cold sterilization Examples: 2. Aldehyde – formaldehyde & gluteraldehyde Glutaraldehyde - Cidex Beta-propiolactone Some chemical solutions are volatile and toxic in skin contact and inhalation  Cold Sterilization Halogen compounds like Na hypochlorite (Chlorine bleach) Na Hypochlorite - for full sterilization, soak for 20 minutes - irritates the skin & mucosa - highly corrosive - decomposes over time when exposed to air, so fresh solutions should be made daily. 54 Chemical or Cold sterilization Chlorine partly reacts with proteinaceous liquids such as blood to form non-oxidizing N-chloro compounds, and thus higher concentrations must be used if disinfecting surfaces after blood spills. Produces carcinogen trihalimethane when hot water is hyperchlorinated Produces carcinogen bis(chloromethyl) ether in contact with formaldehyde  Surgical preparation Most commonly used antiseptics in dentistry 1. Iodophors – 1% polyvinylpyrrolidone-iodine (Betadine) 2. Chlorhexidine – 0.12% chlorhexidine gluconate (Orahex, Peridex) 3. Hexetidine – 0.1% solution (Bactidol) 56  Antiseptics in Dentistry Betadine (Povidone-iodine) an iodophor antiseptic solution (1% as mouthwash &10% as skin disinfectant) Its slow release of iodine within the formula reduces the sting and irritation produced by traditional iodine treatments.  Common Antiseptics in Dentistry Chlorhexidine - 0.12% chlorhexidine gluconate (Orahex, Peridex) more effective against gram + microorganisms, useful for maxillofacial surgery (*) Adjunct to oral hygiene in management of periodontal disease and dental implant surgery  Common Antiseptics in Dentistry Hexetidine – (Bactidol, Oraldene) a local anesthetic, antibacterial and anti-fungal agent against gingivitis, strep throat, tonsillitis, pharyngitis  Antiseptics in Dentistry Hexachlorophene – 1% Phisohex Higher concentrations were reported to cause brain damage  Other of Skin Disinfectants Benzalkonium Chloride – a quaternary ammonium compound that does not cause burnung sensation when applied to broken skin. Ex. Cutasept is an uncoloured, propanol-based benzalkonium Cl solution having a rapid and broad spectrum of effect.  Other of Skin Disinfectants Sterillium – ethanol-based rub-in disinfectant with broad spectrum coverage. Effectiveness: 1. Bactericidal 2. Yeasticidal 3. Tuberculocidal 4. Mycobactericidal 5. Viricidal (against HBV, HIV, HCV) Adeno-, polyoma- and retroviruses  Chemical or Cold sterilization ◻ Silver dihydrogen citrate(SDC)-A colorless, odorless, tasteless and non-caustic aqueous chemical compound - An additive or raw material which is an electrolytically generated source of stabilized ionic silver for inclusion in other antimicrobial products.  Chemiclave Sterilizer that uses a mixture of alcohol, ketones, acetones, formaldehyde and water in the temperature of 132° C for 20 minutes Chemiclave Sterilizer REVOX Sterilizer Uses peracetic acid in a chamber at room temp (18 - 30°C). Highly microbiocidal, with a wide range of compatibility with materials Temperature does not affect the material or packaging. Low/no residuals Safe to use for operators Short processing time  Exposure to higher conc of peracetic acid can cause irritation on the skin, eyes and respiratory system and higher or long-term exposure can cause permanent lung damage. Handling and Disposal of Sharps Proper Handling and Disposal of Sharps Preparation of the Surgery Team  Surgical Team 1. Surgeon 2. Assistant surgeon 3. Scrub nurse 4. Circulating nurse 5. Anesthesiologist 6. Medical consultant  OR Decorum Removal of all jewelries/accessories. Wearing personal protective equipment (PPE) /barrier 1. Hand scrubbing & gloving  Preparation of Surgeon 1. Perform hand scrubbing 2. Use barriers: Appropriate clothing Cap covering scalp hair and surgical mask Shoe covers Sterile gloves 74  INFECTION CONTROL PROTOCOL ❑ All surgical team members who will come in contact with the operative field during surgery must perform a surgical hand scrub prior to gowning and gloving.  INFECTION CONTROL PRACTICES: ❑ Fingernails must be free of any artificial nail enhancements to include but not limited to acrylics, bonding, wraps and tips. Nail polish must be free of cracks and chips. ❑ All rings, watches and bracelets must be removed prior to scrubbing. ❑ Cuticles, hands, and forearms should be free of open lesions and breaks in skin integrity. ❑ A counted brush-stroke method with a reliable antiseptic agent is effective. Agents include hexachlorophene, povidone-iodine and chlorhexidine. ❑ The hand must be kept higher than the elbow  Procedure for Surgical Hand Scrubbing 1. Turn on water and adjust to desired temperature. 2. Select and open a disposable scrub brush containing the antimicrobial agent of your choice. 3. Moisten hands and arms. Keep brush in palm of hand; and, under running water, clean subungual spaces with disposable nail stick.  4. Maintain hands above elbow level, holding hands and arms away from scrub attire and unsterile surfaces, such as faucets, sink, etc. 5. Perform the following counted stroke or timed hand scrub. Counted-Stroke Surgical Hand Scrubbing To perform counted-stroke hand scrub, proceed as follows: A) With scrub brush held in one hand, bristles perpendicular to nail tips, begin scrubbing across nails and fingertips using 30 strokes. One up-and-back motion counts as one stroke.  Hand Scrubbing Scrubbing of hands up to the elbows with antiseptic detergent solution. 82  Surgical Hand Scrubbing B) Next scrub fingers of the same hand, using 10 strokes to each side of fingers. Imagine fingers as having four surfaces (one on each side of each finger). Each surface gets 10 strokes. C) Give special attention to webbed spaces between fingers while scrubbing.  Surgical Hand Scrubbing D) Scrub hand next. Imagine hand as having four surfaces also (palmar, dorsal, medial, lateral) and give each surface 10 strokes. E) Repeat the above steps (a to d) on other hand. Add water to sponge as necessary to maintain a good lather.  Surgical Hand Scrubbing F) Next scrub arm surfaces from wrists to area 5 cm below the elbows. Again, envision the arms as having four surfaces and brush each surface with 10 strokes. To make stroke motion easier on length of arm, arm length should be divided in half, i.e. scrub from wrist to mid-arm on one arm, then the other. Continue from mid-arm to 5 cm below the elbow. Then do the same on the other arm.  G) At the completion of the surgical hand scrub: 1. Drop the scrub brush into a trash receptacle if available; otherwise drop the brush into the sink. 2. Rinse thoroughly by passing hands and arms under running water while maintaining the level of the hands above the elbow so that the scrub agent residue will not irritate the skin.  3. If you accidentally contaminate an area, you must rescrub it. If you are still holding your scrub brush, simply rescrub that area. If you have discarded your brush, you may ask someone to open another brush for you. If you must open a brush yourself, you must repeat scrub procedure from the beginning.  4. Turn off water. 5. Continuing to hold hands higher than elbows, allow excess water to drip into sink. 6. Using the back of your body, open the door of the operating room keeping hands and arms from becoming contaminated. 7. Proceed with drying hands and arms and don sterile surgical gown and gloves. Gloving  Gloving without an Assistant The first glove is donned on the left hand with the right hand holding the glove by the cuff Donning of 2nd glove in right hand. Left hand holds exterior of right glove, avoiding contact with skin of right hand 90 Donning of Gloves Only the gloved hand can hold the other glove.  Things to Remember Avoid contamination of sterile gloves. Do not touch the sterile outer side of the gloves with your bare hands. Gloved hands are always kept above waist level. A surgeon donned in his sterile surgical gown is considered sterile on the UPPER FRONT OF THE BODY from waist up The End