and Other Devices Attached to Air and Waterlines
Any removable device that is attached to
the air or waterlines should be heat sterilized to ensure
that internal components have been sterilized.
It is very important to follow the manufacturer's
instructions for cleaning and lubrication. These protocols
can ensure the effectiveness of the process and contribute
to the life of the device.
Surface disinfection or liquid chemical germicide
immersion are not acceptable. In addition, the use of ethylene
oxide is not recommended because it cannot reliably penetrate
the internal components.
Components of Devices
Permanently Attached to Air and Waterlines
Some parts of dental instruments are permanently
attached to dental unit waterlines. These items do not enter
the patient's mouth but are likely to become contaminated
with oral fluids during treatment procedures. Some examples
include handles or dental unit attachments of saliva ejectors,
high-volume evacuators, and air/water syringes.
These components should be covered with waterproof
barriers and changed after each use.
If the item becomes visibly contaminated
during use, clean and disinfect with an EPA-registered hospital
disinfectant with a tuberculocidal claim (intermediate-level
disinfectant) before using it with the next patient.
Backflow, meaning reverse flow, can occur
when there is more negative pressure in the patient's mouth
than in the evacuator tubing, for example, when the patient
uses the saliva ejector as a straw. When this happens, material
from the mouth of a previous patient might remain in the vacuum
line of the saliva ejector and be aspirated into the mouth
of the next patient being treated.
Although there have been no reports of any
adverse health issues, patients should not be instructed to
close their lips tightly around the saliva ejector tip during
When taking or processing radiographs:
- Wear gloves and other appropriate personal protective
equipment as necessary.
- Heat sterilize heat-tolerant radiographic accessories.
- Transport and handle exposed radiographs so as to prevent
- Avoid contamination of developing equipment.
Parenteral medications are medications that are injected
into the body.
Cases of disease transmission following improper administration
of parenteral medications have been reported in medical settings.
For this reason it is critical that DHCP handle parenteral
medications safely and use special precautions to prevent
Precautions to prevent disease transmission associated with
the use of parenteral medications include:
- Treat fluid infusion and administration sets, including
IV tubings, bags, connections, needles, and syringes as
Regarding single-dose vials:
- Do not administer to multiple patients even if the needle
on the syringe is changed.
- Use single-dose instead of multidose vials whenever possible.
- Do not combine leftover contents for later use.
Single-Use (Disposable) Devices
A single-use device, also referred to as a disposable device,
is intended for use on one patient. It was never intended
to be cleaned, disinfected, or sterilized and used on another
Single-use devices used in dentistry are usually not heat
tolerant and cannot be reliably cleaned. Examples of such
items include syringe needles, prophylaxis cups and brushes,
and plastic orthodontic brackets.
Preprocedural Mouth Rinses
Preprocedural mouth rinsing is the use of an antimicrobial
mouth rinse by the patient prior to a dental procedure. These
mouth rinses can contain, for example, chlorhexidine gluconate,
essential oils, and povidine-iodine.
Studies have shown that preprocedural mouth rinses can reduce
the number of aerosolized bacteria, and in some cases, the
number of bacteria introduced into the bloodstream. However,
there is no scientific evidence that this practice can prevent
clinical infections among patients or DHCP.
Although there is no harm in using preprocedural mouth rinses
because of the lack of evidence that clinical infections are
prevented, no recommendation is made.
Oral Surgical Procedures
The oral cavity is colonized by many types and large numbers
of microorganisms. Surgical procedures present an opportunity
for these microorganisms to enter the bloodstream and other
normally sterile areas of the mouth. Entry of microorganisms
into bone and subcutaneous tissue may increase the potential
for localized or systemic infection.
CDC recommendations define oral surgical procedures as those
that "involve the incision, excision, or reflection of tissue
that exposes normally sterile areas of the oral cavity."
Examples include biopsy, periodontal surgery, implant surgery,
apical surgery, and surgical extractions of teeth, defined
as the removal of erupted or nonerupted teeth requiring elevation
of mucoperiosteal flap, removal of bone, or sectioning of
teeth and suturing if needed.
A higher level of infection control is warranted when performing
surgical procedures and includes the following:
- Surgical handscrub using an antimicrobial agent.
- Use of sterile surgeon's gloves.
- Use of sterile irrigating solutions.
- The latter includes delivery systems that bypass the
dental unit, such as sterile bulb syringes or sterile injection
Handling Biopsy Specimens
To protect the people handling and transporting biopsy specimens,
each specimen must be placed in a sturdy, leakproof container
with a secure lid to prevent leakage during transport.
Care should be taken when collecting the specimen to avoid
contaminating the outside of the container. If the outside
of the container becomes visibly contaminated, it should be
cleaned and disinfected or placed in a leakproof bag.
The container also must be labeled with a biohazard symbol.
Extracted teeth that are being discarded are
considered infectious and should be treated as regulated medical
Extracted teeth containing amalgam should not
be placed in a medical waste container that uses an incinerator
for final disposal. State and local regulations should be
consulted regarding disposal of amalgam.
Extracted teeth used for shade comparison should
be cleaned and the surface disinfected with an intermediate-level
EPA-registered hospital grade disinfectant before sending
to the laboratory.
If patients request their own extracted teeth,
the tooth fairy wins: OSHA regulations no longer apply once
the tooth has been returned to the patient. However, for the
safety of others who may come into contact with the tooth,
it should be cleaned and disinfected before it is returned
to the patient.
Extracted teeth are occasionally collected and
used for preclinical educational training.
- Extracted teeth should be cleaned of visible blood and
debris and kept hydrated in tap water or saline. Be sure
to use a sturdy, leakproof container if transporting and
label the container with a biohazard symbol.
- Using teeth without amalgam is preferred because teeth
can be safely autoclaved. If extracted teeth that contain
amalgam must be used, DO NOT heat sterilize since this will
produce harmful mercury vapors. Instead, immerse in 10%
formalin for 2 weeks before use.
- Even though the inside of the pulp chamber is now safe
to touch, CDC suggests that students use Standard Precautions,
because preclinical exercises should simulate clinical practice.
Continue on to Special Considerations,