Infection Control in Prosthodontics Review

Volume 2 Issue1 February 2011

Infection Control In Prosthodontics

Reader,

Prof. & Head,

Senior lecturer, Dept of Prosthodontics, Sri

Siddhartha Dental College, Tumkur, Karnataka.

Abstract: Dental professionals in the are exposed and saliva to of a the wide variety of

microorganisms

blood

patients.

These

microorganisms may cause infectious diseases. The use of effective infection control procedures and universal precautions in the dental office and the dental laboratory will prevent cross contamination that could extend to dentists, dental office staff, dental techinicians and patients. This review of literature has attempted to appraise the different protocols designed to protect the dentist and laboratory technician from potential infection as well as to protect the patients from cross contamination. Key words: Dental infection, Dental Clinical, Dental Laboratory,

Disinfectant, Sterilization.
Journal of Dental Sciences & Research 2:1: Pages 93-107

Introduction: Infection control is as old as disease control in health care

practice universal precautions in the form of personal barrier

techniques. Recently, dental materials have been disinfected using effective techniques. Hence, this literature review is undertaken to upgrade our

modalities. The dental profession has developed an increased

appreciation of the potential for disease transmission in the dental clinic and laboratory. The most efficient method of implementing conscientious infection control for our collective protection is to

knowledge on the pros and cons of all the available procedures and techniques in the field of

93 Journal of Dental Sciences and Research

Infection Control in Prosthodontics infection control in dental office and laboratory. For convenience, the literature was reviewed under following only patient

Volume 2 Issue1 February 2011 Patient evaluation Any treatment is performed after a comprehensive This is

evaluation.

groups, Infection control in

achieved by a medical history specially patients in particularly designed who to are identify either to

dental office. Infection control

susceptible

dental laboratories. Infection office: Prosthodontic patients are a high-risk group relative to their potential to transmit infectious diseases as to well as their them. must control in dental

infection or who are at risk of transmitting infection, known as carriers of disease or by being in a high-risk category.
(5)

Personal protection Dentist can best manage patients infected with HepatitisB viruses (HBV) and protect

susceptibility The dental

acquire

profession

assume that every patient treated is a risk of cross infection and to adopt appropriate control measure.(5) The cycle of cross contamination

themselves, and in turn other patients, by being vaccinated with HBV vaccine. Clare Connors
(5)

report has shown that the vaccine is safe and highly efficacious, protection with a

affording

success rate of more than 95%. In June 1982, the council on dental therapeutics adopted a

resolution recommending that all dental personnel having patient contact including dentists, dental students personnel, 94 Journal of Dental Sciences and Research and dental all auxiliary dental

and

Infection Control in Prosthodontics laboratory personnel receive the Hepatitis B vaccine.

Volume 2 Issue1 February 2011 Instrument and equipment

decontamination It is generally recognized that disposable equipment should be used whenever possible. All other instruments that have been used in the oral cavity should be cleaned ultrasonic thoroughly bath before
(2)

The vaccination programme must certainly be considered the most effective cross infection

control measure to protect dental personnel disease.(5,12) A longsleeved, highand in turn their

patients, from a potentially fatal

in

an being

sterilized in an autoclave.

necked clinical coat, eye shields, facemasks and rubber gloves

Disinfectants must be used to decontaminate non-sterilable apparatus (e.g. Shade & mould guides, mixing spatula, wax

must be considered essential to reduce cross contamination with in prosthodontic practice . Dental personnel should wear eye shields and a facemask covering the nose and mouth to when there is and

knifes, occiusal plane indicators, articulators, face bows, and other maxillo mandibular
(22)

registration

apparatus). R.R. Runnels basic in 1988, six control

exposure

aerosols

splatter(5,6,23) For maximum protection,

infections

procedures as mandatory for the control of infectious disease in dental practice. These commonly recommended procedures are as follows
(6,22).

cuts and abrasions on the skin should be covered with adhesive dressings Pregloving beneath the gloves. confers

disinfection

strong antimicrobial properties on the internal surfaces of the

* All dental treatment personnel should wear latex examination

gloves. Hands should be washed using a disinfectant hand wash agents such as povidone-iodine or chlorhexdine.
(6)

gloves during patient treatment. * All dental treatment personnel should wear masks covering the

95 Journal of Dental Sciences and Research

Infection Control in Prosthodontics nose and mouth during patient treatment. * All dental treatment personnel should wear protective eyewear during patient treatment. * All items used in the oral cavity should be sterilized in a heat or heat pressure sterilizer whenever possible. * All touch & splash surface should be disinfected with an EPA registered. ADA accepted disinfectant is not silicone, polyvinyl immersing

Volume 2 Issue1 February 2011 polysulfide siloxane, in a and two after 2%

glutaraldehyde solution and (b) the effect on acrylic resin after sterilizing by immersion when

acrylic resin trays with impression were used in clinical practice. Their results indicated that the polyether was affected

dimensionally by immersing in the disinfectant (as they shrunk when dry and swelled when in

solutions.) The dimensions of two silicon - tray resin assemblies were not greatly changed and the adhesive used was not degraded by disinfectant. S. A. Belt et al
(2)

whenever possible.

sterilization Presently

available

chemicals meeting these criteria include glutaraldehyde, iodophor sodium and

studied the

hypochlorite,

biocidal effectiveness of chlorine dioxide and to 5.25% kill sodium

synthetic phenolic compounds. * Contaminated material should be disposed it off in carefully a by

hypochiorite

pathogenic

organisms on denture base acrylic resin strips in the presence of 10% horse serum organic

placing

sealed,
(21)

appropriately marked containers. Roger E. Johansen et al in

material in 1989. They concluded that, the chlorine dioxide achieved complete

1987 conducted a study (a) to measure and compare the linear dimensional changes of five

disinfection of all three organisms within 2 minutes. achieved Sodium complete

representative rubber elastomers including polyether, condensation

hypochlorite

96 Journal of Dental Sciences and Research

Infection Control in Prosthodontics disinfection of all the three

Volume 2 Issue1 February 2011 immersion for inactivation of the virus.

organisms within 4 minutes. Disinfectants applied by spray

Rhonda F.K.J et al determined autoclaving that

in 1991 steam linear

atomization was examined by D. G. Drennon et al(7) in 1989 for possible dimensional distortion of elastomeric impression materials namely polyether, polysulfide and addition silicone. Chlorophenol, a 0.25% acid glutaraldehyde, an iodophor, a phenyl phenol and a phenol sodium phenate used.It spray was

the

causes

dimensional change or decreased strength in heat processed poly (methylmethacrylate) material. Two types of methylmethacrylate cranial implants were tested, heat heatimplant

chemically

activated The

and

disinfectants

were

polymerized.

also shown that the disinfectants applied by spray atomization were effective on the surface of an elastomeric impression material contaminated with selected test organisms. In 1990, J. 0. Look et at
(13)

polymerized resin was tested and processed, following autoclaving. It was compared to an

autopolymerising methylmethacrylate strength. They concluded that, there was no significant change in strength between processed and non-sterilize methyl heatfor impact

studied the biocidal

action of germicides against an enveloped virus on an irreversible hydrocolloid surface.The that dipping authors or impression concluded is

methacrylate

autoclaved

heat-processed

immersion

methyl methacrylate. The heatprocessed significantly specimens stronger were than

strongly preferred to spraying, to avoid inhalation of an aldehyde. The 0.5% sodium hypochlorite

autopolymerising methylmethacrylate cranioplasty. A significant linear distortion of 1.211% was measured between

spray was effective in 3 to 10 minutes required range 3 to and 10 iodophor minutes

97 Journal of Dental Sciences and Research

Infection Control in Prosthodontics the heat methylmethaciylate autoclaved and non-sterile processed was found

Volume 2 Issue1 February 2011 Full strength sodium hypochlorite was the most effective

disinfectant over all and required the shortest contact

but was not considered clinically significant. In 1992, H. S. Harold et al

time

(1

minute). Brace & Plummer demonstrated in 1993 dental

determined the efficacy of eight disinfectant solutions viz sodium hypochloride (undiluted), sodium hypochloride (diluted), Alcide

that

prostheses could be easily and effectively disinfected with a

chlorine dioxide procedure. In 1994, R. S. Schwartz et al(20) evaluated the effectiveness of four disinfectants i.e., 0.525% sodium hypochlorite, OMC 11,

L.D., OMC II, Biocide, Sporicidin, Lysol, Impresept and sterile water (control) when used as for

immersion and a spray against three microorganisms (S. aureus, M. Phlei and Bacillus subtilis) and normal mixed oral flora on the surface of irreversible

Alcide L.D and lodofive, against five different microorganisms S.choleraesuis, M.bovis or

(S.aureus, P.aeruginosa,

hydrocolloid impressions. This study concluded that, Alcide L.D., Lysol spray, OMC II and Biocide were relatively ineffective against the three microorganisms tested and on mixed oral flora. Full strength sodium hypochlorite and Impresept were essentially equal in effectiveness against S. Aureus, M. phlei and mixed oral flora. sodium Sporicidin and diluted were

B.subtilis) and mixed oral flora on irreversible impressions. The hydrocolloid impressions

were cultured after immersion in one of the disinfectanta This study concluded that Alcide L.D achieved greater reduction of all test organisms, 0.525% sodium was

hypochlorite

effective against S. aureus, S. choleraesuis, P. aeruginosa and mixed oral flora. lodofive and

hypochlorite

effective only against S. aureus.

OMC 11 were ineffective against

98 Journal of Dental Sciences and Research

Infection Control in Prosthodontics all organisms tested including The

Volume 2 Issue1 February 2011 results of that, this study sodium

mixed oral flora. In 1996, M. Dellinges and D. Curtis

concluded

hypochloride solution proved a more effective method than

evaluated the accuracy

of the new mechanical torque wrench system and for implant the

exposure to microwave energy, which in turn was more effective than leaving the lining material dry overnight. Because sodium hypochioride some use, solution in presents clinical soaking

restorations

tested

effects of steam autoclaving or chemiclave sterilization

procedures on the accuracy of the wrenches. The results that of this study wrench will

disadvantages including a

long

period, bleaching and corrosive effects energy on metals, microwave can be and

concluded system

torque

before

sterilization

disinfections an

result in recordings close to target values. Autoclave and chemiclave sterilization increased the range of torque values as compared with values recorded before

considered

effective
(15)

simpler alternative. Furukawa K. H. et al evaluated both the (1998) of

effectiveness and

spray

immersion

sterilization. produced

Autoclaving statistically higher

disinfection of Coe Soft and Coe Comfort denture liners by using chlorine dioxide. Specimens made of soft denture liners attached to acrylic resin bases with E were coli, S

torque values for the 10 Ncm Dyna Torque wrench. The effectiveness of microwave energy in the disinfection of

contaminated

Molloplast-B long-term soft lining material contaminated with

aureus and Candida albicans. They dioxide concluded was that, chlorine against steel

Candida albicans or S.aureas was studied by A. Baysan et al(1) (1998).

effective stainless

nonporous

specimens but was inadequate for denture liners at the

99 Journal of Dental Sciences and Research

Infection Control in Prosthodontics recommended 3 minutes time of disinfection. technique was The more immersion effective

Volume 2 Issue1 February 2011 genera of fungi present in used dental laboratory pumice. In 1988 M. .J. McGowan et al
(17)

than the spray technique, but the difference was not significant.

studied the effects of 0.5%,

1%, 2%, 3%, 4%, and 5.25% concentrations hypochlorite on of sodium and

They recommended that coe soft and coe comfort denture liners be removed before entering the

Ticonium

Vitallium alloys. The result of this study indicated that the short term exposure of both Ticonium and Vitallium alloys to either a 2% sodium

laboratory. These materials, even adhering to proper disinfection procedures still contain sufficient microorganisms contamination laboratory. In the year 2000, T. Larsen et al
(26)

to of the

cause clean

hypochlorite solution for a period of 5 minutes or a 5.25% sodium hypochlorite solution for a period of 3 minutes will produce no harmful effects on these metals. C. Shen et al(3) in 1989, studied the effect of two alkaline

examined the effect of UV.

radiation for the disinfection of dental impressions and occlusal records. The results in this study

glutaraldehyde base disinfectants, (one alkaline and the other an alkaline with a phenolic buffer,) on a heat cured denture base resin. From this study they concluded that, phenolic-buffered

concluded that the UV radiation delivered by the device did not produce a sufficient bacterial

reduction for the disinfection of dental impressions and occlusal records. Infection control in dental

disinfectants should not be used as a disinfecting to be agent. used on A a

laboratories. Henry N. Williams et al

in

disinfectant

1986 determined the number and

denture base resin should not contain chemicals that may cause

100 Journal of Dental Sciences and Research

Infection Control in Prosthodontics dissolution, swelling, pitting or crazing of the resin. The effects of a 2% concentration of ID 210 solution on impression compound, impression plaster

Volume 2 Issue1 February 2011 J. M. Stanley et al

in 1991

studied the effects of chemical disinfecting agents like Sodium hypochlorite, Exspor, Cidex and Wescodyne-D, on color stability of denture acrylic resins. The tested resins were CH Lucitone, Triad VLC and Trulinear. This study concluded that, both 1% sodium hypochlorite and 2% Cidex disinfectant produced the least color change in the samples tested. Polyzois Yannikakis G.L,
(9)

and zinc oxide eugenol impression material Wafter was investigated & by P.

S.D.

G.Fong(8)(1990). This laboratory study evaluated the dimensional stability, surface detail reproduction and assessed the penetration of the disinfectant into the impression materials and the transfer of the disinfectant from impressions to stone casts. 1% aqueous toluidine blue dye was chosen for assessment of the penetration of disinfectant. The results of a this study

Zissis

and

(1995), evaluated

the effect of the glutaraldehyde and method microwave on the disinfection dimensional

stability, hardness and flexural properties of a heat polymerized denture base acrylic resin. The results showed exhibited that all

concluded

that,

20-minute

immersion in 2% ID 210 solution had no adverse effects on the dimensional stability or surface detail reproduction of the rigid impression materials. The dyed disinfectant impression penetrated plaster and into also

specimens

linear

changes and small microhardness differences during disinfection

procedures. These changes were clinically Flexural not significant. The

properties

remained

diffused into stone casts poured against such impressions.

unaffected during all disinfectant procedures. They concluded that microwave method is a useful

101 Journal of Dental Sciences and Research

Infection Control in Prosthodontics alternative disinfection. Jurgen setz et al

Volume 2 Issue1 February 2011 and water. The addition of an antiseptic product that contained

to

immersion

(1996)

Octenidine as active agent to conventional pumice reduced the number of microorganisms by 99.999%. The mix of steribim with water reduced the number of bacteria by 99%.

studied the number of microorganisms in two different combinations of pumice and disinfectant and compared with a conventional mixture of pumice

In the light of the current knowledge disinfection protocol can be summerised as:Burs - carbon, steel, diamond points. Dapen dishes Glass slabs Dry heat oven-ie 60C for 1 hour, Chemical vapour-20 minutes at 270 F. Ethylene oxide-450-800 mg/l. Steam autoclave-121C for 15 to 20 minutes at 15 lb pressure/square inch, Ethylene oxide-450-800 mg/l. Steam autoclave- 121C for 15 to 20 minutes at 15 lb pressure/square inch, Dry heat oven-160C for 1 hour, Chemical vapour-20 minutes at 270 F. Ethylene oxide-450-800 mg/l. Dry heat oven-l60C for 1 hour, Chemical vapour-20 minutes at 270 F. Ethylene oxide450-800 mgJl. Steam autoclave- 121C for 15 to 20 minutes at 15 lb pressure/square inch, Dry heat oven-I 60C for 1 hour, Chemical vapour-20 minutes at 2700 F. Ethylene oxide-450-800 mg/l. According to manufactures recommendation. Ethylene oxide-450-800 mg/I. Steam autoclave- 121C for 15 to 20 minutes at 15 lb pressure/square inch.

Hand instruments Carbon steel

Stainless steel

Hand pieces

Impression trays, Aluminum metal tray, Chrome plated tray, Custom acrylic

Steam autoclave- 121C for 15 to 20 minutes at 15 lb pressure/square inch, Chemical vapour-20 minutes at 270 F. Ethylene oxide-450-800 mg/l.

102 Journal of Dental Sciences and Research

Infection Control in Prosthodontics resin tray, Plastic tray, Irreversible hydrocolloid Reversible hydrocolloid

Volume 2 Issue1 February 2011

Mirrors (mouth & face) Needle Orthodontic pliers

Tissue retraction Pluggers Polishing wheels and disks Saliva evacuators, Ejectors Stones

Ethylene oxide-450-800 mg Dry heat oven Chemical vapour-20 minutes at 270 F. Ethylene oxide450-800 mg/I. Discard; do not reuse Dry heat oven-160C for 1 hour, Chemical vapour-20 minutes at 2700 F. Ethylene oxide-450-800 mg/l. Steam autoclave- 121C for 15 to 20 minutes at 15 lb pressure/square inch, Dry heat over-160C for 1 hour, Chemical vapour-20 minutes at 270 F. Ethylene oxide-450-800 mg/I. Ethylene oxide-450-800 mg/I. Ethylene oxide-450-800 mg/l. Chemical vapour-20 minutes at 270 F. Steam autoclave- 121C for 15 to 20 minutes at 15 lb pressure/square inch, Dry heat oven-l60C for 1 hour, Chemical vapour-20 minutes at 270 F. Ethylene oxide-450-800 mg/I Ethylene oxide-450-800 mg/I, According to manufacture recommendation. Immersed in 2% ID 210 solution for 20 minutes Immersed for 10 minutes in 2% glutaraldehyde. Spray with sodium hypochlorite, rinse, spray again and stand under damp gauze or in sealed bag for 10 minutes. Immersed in 2% glutaraldehyde for 10 minutes Spray with sodium hypochlorite, rinse, spray again and stand under damp gauze for 10 minutes Rinsed for 45 seconds with water and immerse for 30 minutes in 2% glutaraldehyde. Immersed for 15 minutes in 5.25% sodium hypochlorite solution and rinsed in water.

Water- air syringe tips

X-ray equipment Impressions compound, Zinc oxide eugenol

Polysulfide

103 Journal of Dental Sciences and Research

Infection Control in Prosthodontics Addition reaction silicone materials Condensation reaction silicone materials Polyether

Volume 2 Issue1 February 2011

Immersed in 2% glutaraldehyde for 1 hour, rinse in sterile water Immersed in 2% glutaraldehyde for 10 minutes and washed with sterile water Immersed in 2% glutaraldehyde for 1 hour at room temperature, rinsed with sterile water for 45 seconds and dried for 10 minutes Rinsed under running water, cleaned for debris in an ultrasonic cleaner and immersed for 12 hours in alkaline glutaraldehyde disinfection solution. Rinsed under running water, 4% chlorhexdine scrub for 15 seconds followed by a 3 minutes contact time with chlorine dioxide. Sterilized by ethylene oxide gas-450-800 mg/I.

Dentures

Pumice Metal framework (Ticonium & vitallium) References :

Addition of antiseptic product containing Octenidine to conventional pumice, Addition of benzoic acid to conventional pumice, Working pumice should be discarded after each use. Immersed 3 minutes in 5.25% sodium Hypochlorite solution and rinsed in water.

2. Bell. J.A., Brockmann Si., Feil. P and Sackuvich. D.A. The effectiveness of two disinfectants on denture

1. Aylin Baysan, Robert Whiley and Paul S.W. Use of to

microwave

energy

disinfect a long-term soft lining material

base acrylic resin with an organic load. J. Prosthet. Dent., 1989; 61: 580-583. 3. Chiayi Shen, Nikzad S.J.

contaminated with candida aibicans or staphylococcus aureus. J. Prosthet.

and Frank A.C. The effect of glutaraldehyde on base denture

Dent., 1998;79:454-458.

disinfectants 104 Journal of Dental Sciences and Research

Infection Control in Prosthodontics base resins. J. Prosthet. Dent., 1989; 61: 583 -589. 4. Chris. H. Miller. Disciplined

Volume 2 Issue1 February 2011 8. Fong. P.G., and Walter. J.D. The effects of an

immersion

disinfection

Sterilization-

regime on rigid impression materials. mt. j.

microbial control. D. C. N. A, 1991; 35(2): 339-255. 5. Clare Connor. Cross control in

Prosthodont, 1990; 3: 522 527. 9. Gregory. L., Alkibiades. J.Z. and Stavros. A.Y. The

contamination

prosthodontic practice. mt. J. Prosthodont, 1991; 4:

effect of glutaraldehyde and microwave disinfection on

337 -344. 6. Council on dental materials, instruments, equipment, council and on

some properties of acrylic denture resin. Tnt. J.

Prosthodont., 1995; 8: 150 - 154. 10. Harold and . S.W., Richard Donald S.S.

dental practice, council on dental Infection recommendations dental office therapeutics. control for and the the V.B.

Efficacy of various spray disinfectants on irreversible hydrocolloid impressions.

laboratory. J. Am. Dent. Assoc., 248. 7. David. G.D., Glen. H.J and Powell G.L. The accuracy and efficacy of disinfection by spray J. atomization Prosthet. 1998; 116:241 -

Tnt. J. Prosthodont., 1992; 5 : 47 - 54. 11. Henry. N.W., William.

A.F., Andrew G.S., and John F.H. The isolation of fungi form laboratory dental

impression.

pumice. J. Prosthet. Dent., 1986; 56: 737 - 740.

Dent., 1989;62:468-475.

105 Journal of Dental Sciences and Research

Infection Control in Prosthodontics 12. James. A. B Cottone. current

Volume 2 Issue1 February 2011 restorations. J. Prosthet.

Hepatitis

Dent., 1996; 75: 93-98. 17. McGowan. M.J., Shimoda. and Woolsey of on G.D.

status in dentistry. D. C. N. A., 1991; 35(2): 269-282. 13. John. 0. Look, David.

L.M.

Effects hypochlorite base

sodium denture during short-term Prosthet.

J.C., Ke gong and Harold. H.M. from Preliminary disinfection results of

metals for J.

immersion

irreversible impressions.

hydrocolloid J. Prosthet.

sterilization.

Dent., 1988; 60: 212 - 218. 18. Michael. L. D. Brace and

Dent., 1990, 63: 701 - 707. 14. Jurgen setz and Peter of

Kevin. Practical

Plummer. denture 3. Prosthet.

Heeg.

Disinfection

Pumice. J. Prosthet. Dent., 1996; 76: 448 - 450. 15. Karl K.F., Frank. D.N,

disinfection.

Dent., 1993; 70: 538 - 540. 19. Rhonda. F.K.J. and

Dennis A.R., and Stephen M.C. chlorine disinfection Effectiveness dioxide on two of in soft

Stephen. M.C. The effect of steam sterilization methacrylate on autoclave methyl cranial

denture liners. J. Prosthet. Dent., 1998; 80: 723 -729. 16. Mark Dellinges and Don

implant materials. Jut. S. Prosthodont., 1991; 4:345 352. 20. Richard S.S., Donald. J.H. and

Curtis. Effects of infection control procedures on the accuracy of a new

V.B., Sandra

Thomas. K.K. of

Jmmersion irreversible impressions.

mechanical torque wrench system for implant

disinfection hydrocolloid

Part I - Microbiology. Int. 106 Journal of Dental Sciences and Research

Infection Control in Prosthodontics J. Prosthodont., 1994; 7: 418 -423. 21. Roger. E.J. and James hepatitis

Volume 2 Issue1 February 2011 B and acquired

immunodeficiency syndrome. J. Prosthet.

A.S. Dimensional changes of elastomers during cold sterilization. J. Prosthet.

Dent., 1986; 56: 451 -454. 25. Stanley 3M., Ann S.V. Gerald of D. Woolsey. laboratory

and

Dent., 1987; 57: 233 -236. 22. Runnells. R.R. An over

Effects

disinfecting agents on color stability of denture acrylic resins. J. Prosthet. Dent, 1991; 66: 132- 136. 26. Tove Larsen, Nils - Erik

view of infection control in dental practice. J. Prosthet. Dent., 1988; 59: 625. 23. Sherry. A. Harfst. barrier

Personal

Fiehn, Anne Peutz feldt and Bengt Owall. Disinfection

protection. D. C. N. A., 1991;35(2): 357 - 366. 24. Shogo Minagi et al. for

of dental impressions and occiusal ultraviolet records by

radiation. Fur.

Disinfection impression Freedom

method

3. Prosthodont. Rest. Dent., 2000; 8: 71-74.

materials: from fear of

107 Journal of Dental Sciences and Research