California Dental Board Approved: Infection Control (2 Units)

Special Considerations

Dental Handpieces 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.

Saliva Ejectors

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 use.

Dental Radiology

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 cross-contamination.
  • Avoid contamination of developing equipment.

Parenteral Medications

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 infection transmission.

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 single-patient, disposable.

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 patient.

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 syringes.

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

Extracted teeth that are being discarded are considered infectious and should be treated as regulated medical waste.

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.

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