| FAQ - Disinfection - 2013
I will be teaching at a Community College this fall. One of my courses is Dental Materials.
I would like my students to know how to disinfect the following:
2) Model Trimmer
3) Alginates/Stone - gypsum/plaster/ect.
4) Any past Newsletters on Dental Lab Procedures
Regarding the dental laboratory, the 2003 CDC guidelines for infection control in dentistry states as follows:
Dental prostheses, appliances, and items used in their fabrication (e.g., impressions, occlusal rims, and bite registrations) are potential sources for cross-contamination and should be handled in a manner that prevents exposure of DHCP, patients, or the office environment to infectious agents. Effective communication and coordination between the laboratory and dental practice will ensure that appropriate cleaning and disinfection procedures are performed in the dental office or laboratory, materials are not damaged or distorted because of disinfectant overexposure, and effective disinfection procedures are not unnecessarily duplicated (407,408).
When a laboratory case is sent off-site, DHCP should provide written information regarding the methods (e.g., type of disinfectant and exposure time) used to clean and disinfect the material (e.g., impression, stone model, or appliance) (2,407,409). Clinical materials that are not decontaminated are subject to OSHA and U.S. Department of Transportation regulations regarding transportation and shipping of infectious materials (13,410).
Appliances and prostheses delivered to the patient should be free of contamination. Communication between the laboratory
and the dental practice is also key at this stage to determine
which one is responsible for the final disinfection process.
If the dental laboratory staff provides the disinfection, an EPAregistered
hospital disinfectant (low to intermediate) should
be used, written documentation of the disinfection method
provided, and the item placed in a tamper-evident container
before returning it to the dental office. If such documentation
is not provided, the dental office is responsible for final disinfection procedures.
Dental prostheses or impressions brought into the laboratory can be contaminated with bacteria, viruses, and fungi
(411,412). Dental prostheses, impressions, orthodontic
appliances, and other prosthodontic materials (e.g., occlusal
rims, temporary prostheses, bite registrations, or extracted
teeth) should be thoroughly cleaned (i.e., blood and bioburden
removed), disinfected with an EPA-registered hospital disinfectant
with a tuberculocidal claim, and thoroughly rinsed
before being handled in the in-office laboratory or sent to an
off-site laboratory (2,244,249,407). The best time to clean
and disinfect impressions, prostheses, or appliances is as soon
as possible after removal from the patient’s mouth before drying
of blood or other bioburden can occur. Specific guidance
regarding cleaning and disinfecting techniques for various
materials is available (260,413–416). DHCP are advised to
consult with manufacturers regarding the stability of specific materials during disinfection.
In the laboratory, a separate receiving and disinfecting area should be established to reduce contamination in the production
area. Bringing untreated items into the laboratory increases
chances for cross infection (260). If no communication has
been received regarding prior cleaning and disinfection of a
material, the dental laboratory staff should perform cleaning
and disinfection procedures before handling. If during
manipulation of a material or appliance a previously undetected
area of blood or bioburden becomes apparent, cleaning
and disinfection procedures should be repeated. Transfer of
oral microorganisms into and onto impressions has been documented
(417–419). Movement of these organisms onto dental
casts has also been demonstrated (420). Certain microbes
have been demonstrated to remain viable within gypsum cast
materials for <7 days (421). Incorrect handling of contaminated
impressions, prostheses, or appliances, therefore, offers
an opportunity for transmission of microorganisms (260).
Whether in the office or laboratory, PPE should be worn until disinfection is completed (1,2,7,10,13).
If laboratory items (e.g., burs, polishing points, rag wheels, or laboratory knives) are used on contaminated or potentially contaminated
appliances, prostheses, or other material, they should
be heat-sterilized, disinfected between patients, or discarded (i.e.,
disposable items should be used) (260,407). Heat-tolerant items
used in the mouth (e.g., metal impression tray or face bow fork)
should be heat-sterilized before being used on another patient
(2,407). Items that do not normally contact the patient, prosthetic
device, or appliance but frequently become contaminated
and cannot withstand heat-sterilization (e.g., articulators, case
pans, or lathes) should be cleaned and disinfected between
patients and according to the manufacturer’s instructions. Pressure
pots and water baths are particularly susceptible to contamination
with microorganisms and should be cleaned and
disinfected between patients (422). In the majority of instances,
these items can be cleaned and disinfected with an EPA registered hospital disinfectant. Environmental surfaces should be barrier-protected
or cleaned and disinfected in the same manner as in the dental treatment area.
Unless waste generated in the dental laboratory (e.g., disposable trays or impression materials) falls under the category
of regulated medical waste, it can be discarded with general
waste. Personnel should dispose of sharp items (e.g., burs, disposable
blades, and orthodontic wires) in puncture-resistant containers. 1
Infection Control and Management of Hazardous Materials for the Dental Team states:
Any prosthesis coming from the oral cavity is a potential source of infection…Most prostheses and appliances cannot withstand heat sterilization procedures. An alternative technique for most prostheses is disinfection by immersion after a thorough cleaning. One should clean, disinfect, and rinse all dental prostheses and prosthetic materials (e.g., impressions, bite registration, and occlusal rims) using an Environmental Protection Agency-registered disinfectant (EPA-registered disinfectant) having at least an intermediate level of activity (tuberculocidal claim) before handling the items in the laboratory. One should consult with manufacturers regarding the stability of specific materials (e.g., impression materials) relative to disinfection procedures. 2
As stated before, perform laboratory work on previously disinfected impressions, appliances, and prostheses. Bringing untreated materials into the laboratory establishes the potential for cross-contamination. 2
It is recommended that the manufacturer’s operating manual for model trimmers be consulted regarding operation and maintenance procedures. Further questions should be directed to the manufacturer.
The following OSAP publications contain sections on the dental laboratory:
OSAP Check-Up: 2003 CDC Guidelines
CDC Guidelines: From Policy to Practice By OSAP
1) Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, Centers for Disease Control and Prevention (CDC). Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep 2003;52(RR-17):1-61. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm Accessed on August 6, 2013.
2) Miller CH. Infection Control and Management of Hazardous Materials for the Dental Team, 5th edition. Elsevier/Mosby Publishers. Pages 186-187.