Sterilization in Operative Dentistry PDF

Sterilization in Operative Dentistry Done by: Dr. Ali Alkhawaja Master in Esthetic and Restorative dentistry Islamic University- college of dentistry Stage: third Time: 2 hours...

Sterilization in Operative Dentistry Done by: Dr. Ali Alkhawaja Master in Esthetic and Restorative dentistry Islamic University- college of dentistry Stage: third Time: 2 hours 2024-2025 Let: 3 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. DISINFECTI ON 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 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  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. 1.STEAM PRESSURE STERILIZATION (AUTOCLAVING) 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 of autoclaves 1.It is the most rapid and effective method for sterilizing cloth surgical packs and towel packs. 2.Economical 3. Good penetration on all surfaces. 4- Short procedure time 5- Easily monitored  Disadvantages of autoclaves Items sensitive to the elevated temperature cannot be autoclaved. Disadvantages of autoclaves Items sensitive to the elevated temperature cannot be autoclaved.  Disadvantages of autoclaves Autoclaving tends to rust carbon steel instruments and burs. Disadvantages of autoclaves Steam appears to corrode the steel neck and shank portions of some diamond instruments and carbide burs.  Disadvantages of autoclaves Dulling of unprotected cutting edges. 2.CHEMICAL VAPOR PRESSURE STERILIZATION (CHEMICLAVING) Sterilization by chemical vapor under pressure is performed in a Chemiclave  2.CHEMICAL VAPOR PRESSURE STERILIZATION (CHEMICLAVING) Chemical vapor pressure sterilizers operate at 270° F (131° C) and 20 lbs pressure. 2.CHEMICAL VAPOR PRESSURE STERILIZATION (CHEMICLAVING) They are similar to steam sterilizers and have a cycle time of about half an hour.  2.CHEMICAL VAPOR PRESSURE STERILIZATION (CHEMICLAVING) Like ethylene oxide sterilizers, they must be used with a prescribed chemical by the manufacture. Instruments which are sterilized by using chemiclave is: ❏Periodontal, restorative and endodontic instruments ❏ Carbon steel and other corrosion sensitive burs and pliers  Advantages of Chemiclaves Carbon steel and other corrosion-sensitive burs, instruments, and pliers are said to be sterilized without rust or corrosion. Disadvantages of Chemiclaves Items sensitive to the elevated temperature will be damaged.  Disadvantages of Chemiclaves Items sensitive to the elevated temperature will be damaged. Disadvantages of Chemiclaves Instruments must be lightly packaged in bags obtained from the sterilizer manufacturer.  Disadvantages of Chemiclaves Towels and heavy cloth wrappings of surgical instruments may not be penetrated to provide sterilization. Disadvantages of Chemiclaves Towels and heavy cloth wrappings of surgical instruments may not be penetrated to provide sterilization.  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. 3. DRY HEAT STERILIZATION (hot air ovens) The oven is electrically heated and is fitted with a fan to ensure adequate and even distribution of hat air in the chamber. It is also fitted with a thermostat that maintains the chamber air at a chosen temperature. Instruments which are sterilized by using hot air oven are : ❏ Endodontic instruments ❏ Condensers ❏ Hand instruments ❏ Orthodontic pliers ❏ Surgical instruments ❏ Burs Advantages of dry heat 1. Carbon steel instruments and burs do not rust, corrode, or lose their temper or cutting edges if they are well dried before processing. 2. Economical. 3. Easily monitored.  Disadvantages of dry heat 1- High temperatures may damage more heat-sensitive items, such as rubber or plastic goods. Disadvantages of dry heat 2- Sterilization cycles are prolonged at the lower temperatures.  Disadvantages of dry heat 3- Hot air is bad conductor of heat hence it has less penetrating power. 4 - Ethylene Oxide sterilization Ethylene oxide sterilization is the best method for sterilizing complex, heat sensitive instruments and delicate materials like rotary handpiece.  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. 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. LIQUID STERILANTS/HIGH-LEVEL DISINFECTANTS Greater dilutions are not encouraged for repeated use. LIQUID STERILANTS/HIGH-LEVEL DISINFECTANTS Placing wet items into disinfectant trays dilutes the solution.  LIQUID STERILANTS/HIGH-LEVEL DISINFECTANTS 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. LIQUID STERILANTS/HIGH-LEVEL DISINFECTANTS Do not use 2% glutaraldehyde solutions to wipe counters or equipment (e.g., dental unit and chair). Infection control program in minimum dental office 1.Sterilization of instruments 2.Comprehensive medical history 3.Hepatitis B vaccine to prevent any cross infection 4. Antiseptic and mouthwash 5. Disposal mask and gloves 6.Protective eye glass 7. Rubber dam 8. Surface cleaning and cover tray 9. Needle and sharp instrument safety Infection control program in minimum dental office 1.Sterilization of instruments Infection control program in minimum dental office 2.Comprehensive medical history Infection control program in minimum dental office 3. Hepatitis B vaccine to prevent any cross infection Infection control program in minimum dental office 4. Antiseptic and mouthwash Infection control program in minimum dental office 5. Disposal mask and gloves Infection control program in minimum dental office 6. Protective eye glass Infection control program in minimum dental office 7. Rubber dam Infection control program in minimum dental office 8. Surface cleaning and cover tray Infection control program in minimum dental office 9. Needle and sharp instrument safety  DENTAL INSTRUMENTS CLASSIFICATION based on risk of transmission and need of sterilization -CRITICAL -SEMI-CRITICAL -NON-CRITICAL  Stages for instrument sterilization Presoaking - Placing the instrument in a presoak solution until time is available for full cleaning prevents drying and begins to dissolve or soften the debris. Presoak solutions used are detergents  Stages for instrument sterilization Cleaning - Clean instruments in an ultrasonic cleaner (preferred), instrument washer, or by hand while wearing proper protection. Ultrasonic cleaners are safest and most efficient ways to clean instruments, ultrasonic cleaning is 9 times more effective than hand cleaning ,it provides fast and thorough cleaning without damage to instruments. Stages for instrument sterilization Packaging - Place instruments in a sealed package or pouch, unless you're going to use them immediately after sterilization.  Stages for instrument sterilization Sterilization- Sterilize instruments using steam autoclaving, dry-heat, or chemical vapor machines. Stages for instrument sterilization Drying or cooling- Store Instruments in a Dry, Protected Area CLEANING AND DISINFECTION OF DENTAL UNIT AND ENVIRONMENTAL SURFACES 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 OF 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 and after being manipulated in the laboratory, before placement in the patient's mouth. STERILISATION OF After each patient use, HANDPIECES run any handpiece that is connected to the dental air/water system, to discharge water and/or air for at least 30 seconds  STERILISATION OF Leave the burHANDPIECES in place while you clean the outside of the handpiece with detergent and warm water. STERILISATION OF HANDPIECES If recommended by the manufacturer, lubricate the handpiece with pressurized oil until clean oil appears from handpiece.  STERILISATION OF HANDPIECES Sterilize in an autoclave. 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 disposable covers 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.  DISPOSAL OF WASTE MATERIALS Disposable needles, scalpels, or other sharp items should be placed intact into puncture-resistant containers before disposal. DISPOSAL OF WASTE MATERIALS Solid waste contaminated with blood or other body fluids should be placed in sealed, sturdy impervious bags to prevent leakage of the contained