Infection Control in a Dental Office

With the rise of Covid-19, infection control is necessary for public and private spaces.

However, healthcare facilities have been taking steps to prevent the spread of infection for a long time.

Patients with different diseases and infections visit hospitals and dental clinics frequently.

Among which are viral and bacterial infections that can spread from one patient to another even if they never met.

Meeting the same doctor and using the same equipment can cause these issues.

Therefore, you will notice that healthcare settings are almost always clean.

But how do you ensure that your dental clinic is controlling infection too?

Keep reading this article to know how your frequent dental clinic controls infections and prevents you from several infectious diseases.

Infection Control Through Instrument and Equipment Sterilization

In a dental office, there is a risk of both airborne and blood-borne diseases.

Due to which the Centers for Disease Control and Prevention (CDC) launched policies and guidelines for dental offices to abide by to ensure disease control.

The CDC Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care highlights the measures dentists should take to ensure that their facility is safe for patients.

It consists of an assessment checklist and recommendations to follow.

These recommendations are on sterilizing equipment, office cleanliness, using Personal Protection Equipment (PPE) and much more. More on that below!

Firstly, dental handpieces need sterilization.

Heat sterilization is ideal for dental handpieces and other intraoral equipment.

This includes both the low-speed and high-speed instruments that are removable from the air lines and waterlines of dental units.

Though, there are also handpieces that do not attach to waterlines or air lines.

In that case, use only the devices cleared by FDA.

Moreover, follow along with the instructions by the manufacturer to reprocess them.

Those that do not have clearance from FDA and lack instructions on reprocessing are better not to be used.

Basically, if you cannot dispose of the equipment after one use, clean, sterilize and disinfect them.

The dental instruments are divided into three categories that are at critical, semi-critical, and non-critical levels of spreading infection.

Hence, these instruments need sterilization after they are used on a patient.

Critical, Semi Critical and Non-Critical Instruments

Critical instruments are those that come in contact with the blood but mostly get in bone and soft tissue.

Scalers, forceps, bone chisels, and scalpels all come under this category.

It is mandatory to sterilize them after each use, hence the name critical.

The methods of sterilizing them include autoclaving.

It uses a specific sterilization machine.

Similarly, using dry chemical vapor, heat vapor or dry heat can also sterilize it well.

• Semi Critical

These do not penetrate the bone or tissue but rather come in contact with the mucous membrane or skin that isn’t dry.

This includes the mirrors that dentists use to see inside your mouth.

Moreover, the amalgam condensers and impressions trays that you can reuse.

These can come in contact with the inside of your cheeks and also saliva.

Sterilize them using dry heat thoroughly following each use.

• Non-critical

These instruments only come in contact with our skin.

Blood pressure cuffs, pulse oximeters, and X-ray heads come in this category.

Since they do not get inside your mouth or any other body part you can reuse them.

However, in dental offices and health care facilities, even these will get infected.

They will get intermediate-level disinfection.

That uses a hospital disinfectant which prevents the spread of tuberculosis.

It also kills other bacteria and viruses that may spread from one patient to another.

Furthermore, now dentists use List N disinfectants that also provide protection from the spread of the Coronavirus disease.

Sterilizer Monitoring

Your dentist and their staff not only sterilize the equipment but also check if the sterilizer is working properly.

The sterilizing process can result in errors, which can pose a threat to infection.

Such as overloading with many pieces of equipment or mechanical errors that cause it to become dysfunctional.

Such procedural errors can render sterilization useless.

Hence, doctors need to constantly monitor the sterilization process.

Thye can do so using chemical, biological, and mechanical indicators.

Chemical Indicators

Your dentist may use indicator tapes with every instrument.

This chemical indicator changes color when the instruments receive proper sterilization.

However, if they do not change color then that shows a lack of a proper sterilization environment.

This indicates improper pressure or temperature.

Therefore, you will have to sterilize the instrument load again so that they are free of bacteria and viruses.

Moreover, you can only use tape indicators for what they are specific to.

Steam sterilizer indicators cannot be used on chemical vapor sterilizers.

Though important, the chemical indicators are not replacements for biological ones.

You may want to know why is that so?

Keep reading below to find out!

Biological and Mechanical Indicators

Bacterial endospores can measure how effectively sterilization kills microbes.

Therefore, you need to monitor using biological indicators at least once a week.

This monitoring includes:

• Mail in-spore monitoring program

This is monitoring by a third-party service.

The results come in about a week.

They are more accurate than the second form of biological indicators which are in-house.

• In-office incubator

This includes a spore monitoring strip.

You can receive results within a day or two.

If the spore test result is positive then that shows how infection control did not work in the sterilization process.

Immediately stop using the sterilizer.

First, begin by looking for procedural errors such as the overloading of instruments.

Then retest it using biological also chemical and mechanical indicators.

If there are constant negative results then it is suitable to use again.

Mechanical Indicators

The temperature, pressure, and cycle time for every instrument load are the mechanical indicators.

You should record them to know at what temperature and pressure all instruments disinfect.

If the results continuously show positive results after correcting procedural errors then your dentist will not use the sterilizer.

Even if they correct any mechanical error, it should only return to service when there are three negative biological indicators.

These spore tests will be empty chamber sterilization cycles.

After you are sure that the spore test is negative, re-sterilize the instruments in use inside.

It is important to remember that sterilization only applies to nondisposable dental tools.

Disposable needles and other dental tools are thrown after one use. 

Using Other Protective Measures for Infection Control

Hand Washing and Cleanliness

If there’s one thing Covid-19 taught us, it’s this…

Hand washing and hand hygiene prevent a lot of diseases and infections.

Therefore, it is crucial for your dentist to keep their hands clean while treating different patients.

While it is fine for people to use a hand sanitizer with 60 percent alcohol, your dentist should wash their hands.

That too thoroughly with an antibacterial soap.

They can additionally use a hand sanitizer in between patients as well.

Though, it is crucial to wash hands properly before and after treating patients.

Your dentist will be mindful of cleaning them before they put on gloves and as soon as they remove them.

Additionally, they will wash their hands if they touched a piece of equipment with saliva or blood with their bare hands.

Therefore, their hands will remain clean throughout your procedure.

Preventing Surface Contact and Contamination 

You may have noticed that your dentist’s office is always squeaky clean.

This is because you and your doctor can get infections from not only instruments or hands but also surfaces.

Housekeeping surfaces are part of their dental office.

These are the walls, floors, sinks and chairs.

They need cleaning on a daily basis.

Moreover, floors and sinks are periodically getting clean throughout the day.

The other is clinical contact surfaces.

These consist of the dentist’s chair, faucet handle, light handles, countertops and drawers.

Notice any difference between the two?

The housekeeping surfaces only come in contact with the patient and dentist, however, the clinical contact surfaces come in contact during the procedure.

Your dentist may touch them as they are carrying out your procedure.

Use protective barriers like plastic sheets and wrap.

Moreover, disinfect and clean them daily with a disinfectant.

Using Gloves, PPE and Other Protection

Your dentist should wear:

• Personal Protective Equipment
• Surgical Mask
• Face Shield
• Sterile Gloves
• Goggles
• Gown

While dentists do wear gloves, masks and gowns, they should also not skip the rest.

There is very close contact between the patient and dentist in dentistry.

This can prevent the spread of infectious disease from either of two to each other.

Furthermore, there is respiratory hygiene and cough etiquette for both dentists and their patients.

They can attach posters in their office guiding over hand hygiene and cough etiquette while also giving masks.

If you happen to visit a dentist during a viral outbreak for a tooth fillings, cavity or then you will follow some SOPs.

• They will take your temperature before stepping in for treatment
• They will also advise you to sanitize your hands and wear mask
• Your dentist and other dental staff will wear N-95 masks
• They will also follow proper hand hygiene to prevent disease transmission.

This will help protect your dental hygiene, oral health and overall physical health.

Dentists also provide training to their staff to ensure that there is no infection transmission.

Final Takeaway 

Since the contact between the dentist and patient is close there is a crucial need of infection control.

You should choose a dentist that knows this quite well and maintains cleanliness in their office.

Hence, your dentist goes to length to ensure that there is proper infection control and no risk of disease transmission among patients and from the dentist.