Dental Sterilization Protocols and Instrument Management

Dental Asepsis and Sterilization Protocols

Instrument Classification for Sterilization

• Semicritical Material: Items that contact the mouth but are not sharp. This material must be sterilized.
• Non-critical Material: Material that contacts the patient's mouth or skin but does not penetrate tissue (e.g., X-ray goggles). Disinfection is generally sufficient if sterilization is not performed.

Sterilization Methods and Equipment

Pre-Sterilization Cleaning: Ultrasound

Ultrasound cleaning uses movement to detach debris from instruments. Articulated instruments must always be placed open in the ultrasonic bath.

Sterilization Techniques

• Physical Methods (Autoclave): Uses pressure and heat. Typical programs run at 121°C and 131°C.
• Chemical Methods: Uses chemical agents like Glutaraldehyde. Requires 10 to 30 minutes of contact time for sterilization of critical or semicritical materials.

Autoclaves

Autoclaves are metal chambers where instruments requiring sterilization are placed.

Monitoring Sterilization Efficacy

Effective sterilization requires rigorous control measures:

• Physical Control: Monitoring and recording the pressure, time, and temperature achieved during the cycle.
• Chemical Control: Indicator strips or bags that change color when they reach the required temperature (e.g., 110°C).
• Biological Control: Spore capsules are introduced into the autoclave. If the spores remain viable (indicated by a color change after incubation), the sterilization cycle has failed.

Daily Hygiene and Asepsis Procedures

Start of Day Protocol

1. Remove all jewelry (rings).
2. Cover any open wounds.
3. Check equipment sterilization status using indicator strips.
4. Cover surfaces and store sterilized items from the autoclave.

Between Patients Protocol

1. Eliminate all waste immediately.
2. Remove contaminated material and place it in the designated soak container.
3. Clean and disinfect all surfaces that contacted the patient.
4. Clean the basin (using the ultrasonic machine if possible).
5. Flush the water aspiration system.

End of Day Protocol

1. Perform general cleaning of the consultation room.
2. Empty all waste containers.
3. Organize and store all sterilized material.
4. Circulate Glutaraldehyde or disinfectant through the aspiration system.
5. Disinfect and clean all sinks and washbasins.

Handling Specific Materials

Disinfecting Impressions

Impressions are disinfected using bleach solution and then placed in sealed bags.

Rotary Instrument Sterilization (Handpieces)

Rotary instruments (turbine, micromotor, contra-angle) require specific care:

1. Run the instrument briefly (a few seconds) to clear internal debris/lubricant.
2. Disconnect the hose and disinfect the external surface (e.g., with bleach solution).
3. Place instruments in a metal box suitable for autoclaving.
4. Autoclave at 121°C (often a specific cycle for lubrication/fat removal).
5. Pouch or bag the instruments after the cycle.

Waste Management Categories

Waste must be separated into categories:

• Biological waste.
• Sharp objects.
• X-ray film waste.
• Amalgam waste.

Essential Dental Instrument Trays

Exploration Tray Contents

• Cotton Pliers
• Explorer Probe
• Dental Mirror
• Periodontal Probe

Isolation Tray (Rubber Dam Setup)

• Rubber Dam Material
• Rubber Dam Clamps
• Rubber Dam Punch
• Rubber Dam Forceps
• Clamp Holder

Anesthesia Tray Contents

• Anesthetic Cartridges
• Needles
• Syringes

Amalgam Restoration Tray

Note: This procedure requires the basic Exploration, Isolation, and Anesthesia sets, plus specific instruments:

• Amalgam Carrier
• Condenser/Plugger (Atacador)
• Burnishers
• Amalgam Carvers (Hollenback, Cleoid-Discoid)
• Matrix System

Composite Restoration Tray

Note: This procedure requires the basic Exploration and Anesthesia sets, plus specific instruments:

• Plastic Spatulas
• Transparent Matrices
• Curing Light (Polymerization lamp)
• Curing Light Shield
• Ball/Groove Forming Instruments