| FAQ - Miscellaneous - 2014
Stainless steel crowns are used in Pedo offices, after being tried in the mouth they don't fit and need to try a different one. What is the best way to clean, disinfectant the stainless steel crown for reuse once it's been tried in a mouth? There is no cold sterile in the office.
The 2003 CDC guidelines for infection control in dentistry states as follows:
Sterilization and Disinfection of Patient-Care Items
Patient-care items (dental instruments, devices, and equipment) are categorized as critical, semicritical, or noncritical, depending on the potential risk for infection associated with their intended use (Table 4) (242). Critical items used to penetrate soft tissue or bone have the greatest risk of transmitting infection and should be sterilized by heat. Semicritical items touch mucous membranes or nonintact skin and have a lower risk of transmission; because the majority of semicritical items in dentistry are heat-tolerant, they also should be sterilized by using heat. If a semicritical item is heat-sensitive, it should, at a minimum, be processed with high-level disinfection (2).
Noncritical patient-care items pose the least risk of transmission of infection, contacting only intact skin, which can serve as an effective barrier to microorganisms. In the majority of cases, cleaning, or if visibly soiled, cleaning followed by disinfection with an EPA-registered hospital disinfectant is adequate. When the item is visibly contaminated with blood or OPIM, an EPA-registered hospital disinfectant with a tuberculocidal claim (i.e., intermediate-level disinfectant) should be used (2,243,244). Cleaning or disinfection of certain noncritical patient-care items can be difficult or damage the surfaces; therefore, use of disposable barrier protection of these surfaces might be a preferred alternative.
FDA-cleared sterilant/high-level disinfectants and EPAregistered disinfectants must have clear label claims for intended use, and manufacturer instructions for use must be followed (245). A more complete description of the regulatory framework in the United States by which liquid chemical germicides are evaluated and regulated is included (Appendix A). Three levels of disinfection, high, intermediate, and low, are used for patient-care devices that do not require sterility and two levels, intermediate and low, for environmental surfaces (242). The intended use of the patient-care item should determine the recommended level of disinfection. Dental practices should follow the product manufacturer’s directions regarding concentrations and exposure time for disinfectant activity relative to the surface to be disinfected (245). A summary of sterilization and disinfection methods is included (Appendix C).1
As you are aware, dental patient care items used intraorally must be sterilized between patients. Currently, there are a number of different types of pre-formed pediatric dental crowns available on the market. Ask OSAP contacted several manufacturers of these crowns and found that there were some differences in the recommendations for re-use and processing. Therefore, Ask OSAP feels that it would not be prudent to make a generalization in this case. However, Ask OSAP does recommend that you contact the manufacturer of the specific pediatric dental crown in question for further information regarding recommendations for re-use, processing procedures, heat tolerance etc.
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 May 15, 2014.