Infection Control in the Dental Office

Top Priority to Infection Control

There have always been concerns about infection control in dentistry, but in the last decade revolutionary changes have occurred in this area. Television and newspapers are filled with conflicting stories about the risks of dental care with respect to AIDS. Since building this office in 1989, I have given infection control top priority. I want you to know about the things that we do in this office.

First step: Infection Control Consciousness

The design of the office, the selection of the equipment and dental materials, and the staff procedures that I established are infection control driven. When you are examined, you will notice that the instruments, including the air-water spray syringe, are individually bagged and autoclave sterilized. So are all of our hand instruments for scaling, tooth preparation and filling, periodontal and oral surgery, etc.

Autoclaving -- What is it? How is it done?

For patients who are interested in the details of how we handle instruments, I will describe the procedure we follow. After use, each instrument and handpiece (drill) is cleaned in an ultrasonic cleaning bath and hand-scrubbed with Hibiclens (the same disinfection soap used for years in hospital operating rooms.) The instruments are placed in sterilization bags and autoclaved at 135^oC (275^oF) and 128 KPa [high pressure] for 30 minutes. This includes the air/water syringe, low- and high-speed handpieces (drill), the Kavo sonic cleaner (similar to, but less painful than the "Cavitron"), etc. Even the scrub brushes used to clean partial and complete dentures are autoclaved between patients in sterilization bags.

What about things that can't be autoclaved?

The burs (tiny drills) are disinfected and cleaned and then sterilized with dry heat. The rubber polishing wheels and plastic instruments are soaked overnight in an EPA-certified disinfectant sterilization solution. We also follow strict infection control procedures in our dental lab and the outside dental laboratory has the same commitment to quality and infection control.

What is done in the dental suite between patients?

The operatory is thoroughly wiped down with a disinfectant between each patient. Attention is paid to all equipment, drawers, light handles, hoses, counter tops and surfaces, etc. that may have been touched during the treatment session. Of course, a fresh cup, headrest cover and patient drape are used for each patient.

Disposable Supplies Used When Possible

Our office makes extensive use of disposables: patient drapes, water cups, matrix bands are all discarded after each use. Masks, gloves and safety glasses are used for patient care at all times. The gloves are often changed several times during treatment, to prevent cross-contamination or if a hole or tear occurs.

Unit-dose products help keep things new & fresh

We use unit-dose products whenever they are available. The composites, bonding agents, prophylaxis (cleaning/polishing) paste and rubber cup, cements, etc. are used in single patient dose units and disposed after use.

Equipment designed for infection control!

The American-made ADEC equipment is designed with non-retraction valves, so that the water spray tubes will not draw any saliva contamination back into the system. The hoses have a quick flush valve so that the lines are further flushed out after patients. The Kavo and other handpieces are all autoclaved after every patient, so that you are treated with an instrument that has been sterilized to hospital operating room standards. The connection to the ADEC dental unit is a quick connect coupler, which also minimizes contamination.

What About AIDS? What About Hepatitis?

With respect to catching AIDS from dental care, the record is clear. With proper infection control procedures, there is very little risk. In fact, the greater concern is with transmitting other diseases such as hepatitis, tuberculosis and herpes. The infection control procedures we follow are effective in protecting you against transmission of all communicable bacterial, viral and fungal infections. In addition, all of the staff members have been vaccinated against Hepatitis B.

What about the Water Lines and Biofilms?

You may have read in newspapers and magazines that there is a potential hazard of the water quality in dental equipment. The problem arises because of the thin tubing and the low volume of water that is needed for the water spray for both the air/water syringe and for the dental drill handpieces. This has been a controversial issue in dentistry and various government agencies and the ADA worked to formulate standards that will come into effect in the near future.

We have been proactive and all of our dental units are fit with DentaPure® DP365 water line systems that put a minute but adequate amount of iodine in the water to kill the biofilm bacteria for a full year.

The FDA indication allows them to claim that their system:

 “ Elutes 2-6 parts per million of iodine into the water in the dental water lines which reduces biofilms and leaves effluent water at less than 200 cfu. Iodine ingested by patients is less than the minimum adult daily requirement for iodine. Iodine used is I₂ which contains no allergenic proteins. “

The 200 colony forming units per cubic millimeter is the ADA standard that dental offices are supposed to meet. This system is certified for a full year and at considerable cost a new filter is installed each year.

What does all this Infection Control cost?

The cost of this high level of infection control is great. The autoclavable handpieces are more than twice the cost of non-autoclavable ones and they have to be factory repaired and replaced much more frequently. We also need many more of them due to the time for cleaning, bagging and autoclaving between patients. The sterilization bags and many disposables used are much more expensive than reusables. It takes considerable staff time to carry out this attention to detail. The separate system of handling medical wastes is another area of attention and cost that we carry. Between $16 and $35 per patient visit goes to infection control, not including the higher initial cost of the equipment and for its repair and maintenance.

The bottom line is that we are committed to giving you the best dental care possible and that includes doing infection control properly for your safety!