Infection Control in Prosthodontics

Volume 2 Issue1
February 2011
Infection Control in Prosthodontics

Review
Infection Control In Prosthodontics

Dr.Naveen.B.H1, Dr.Kashinath.K.R2, Dr.Jagdeesh.K.N3,
Dr. Rashmi.B.Mandokar3
1
Reader,
Prof. & Head,
Senior lecturer, Dept of Prosthodontics, Sri
Siddhartha Dental College, Tumkur, Karnataka.
Abstract:
Dental
professionals
microorganisms
in
the
are
blood
exposed
and
to
saliva
of
wide
the
variety
patients.
of
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:
practice universal precautions in
Infection control is as old as

disease
control in health care
the
form
of
personal
barrier
techniques.
modalities. The dental profession
Recently, dental materials have
has
been disinfected using effective
developed
an
increased
appreciation of the potential for
techniques.
disease transmission in the dental
Hence, this literature review is
clinic and laboratory. The most
undertaken
efficient method of implementing
knowledge on the pros and cons
conscientious infection control for
of all the available procedures
our
and techniques in the field of
collective
protection
is
to
93 Journal of Dental Sciences and Research
to
upgrade
our
Volume 2 Issue1
February 2011

infection control in dental office
Patient evaluation
and laboratory.
Any treatment is performed
For convenience, the literature

was
reviewed
under
following
groups,
control
in
dental office.
Infection
after
patient
comprehensive
evaluation.
This
is
achieved by a medical history
Infection
only
control
designed
patients
control
in
dental laboratories.
Infection
specially
in
who
particularly
to
identify
are
either
susceptible
to
infection or who are at risk of

dental
office:
transmitting infection, known as

carriers of disease or by being in
Prosthodontic patients are a
a high-risk category.
(5)
high-risk group relative to their

potential to transmit infectious
diseases
The
as
their
Dentist can best manage
acquire
them.
patients infected with HepatitisB
profession
must
as
susceptibility
dental
Personal protection
well
to
viruses
(HBV)
and
protect
assume that every patient treated
themselves, and in turn other
is a risk of cross infection and to
patients, by being vaccinated with
adopt
HBV vaccine. Clare Connors
appropriate
control
(5)
measure.(5)
report has shown that the vaccine
The cycle of cross contamination
is
safe
and highly efficacious,
affording
protection
with
success rate of more than 95%.

In June 1982, the council on
dental
therapeutics
adopted
resolution recommending that all

dental personnel having patient
contact including dentists, dental
students
personnel,
and
dental
and
all
auxiliary
dental
Volume 2 Issue1
February 2011

laboratory personnel receive the
Hepatitis B vaccine.
(6).
Instrument
and
equipment
decontamination
The vaccination programme
It is generally recognized
must certainly be considered the
that disposable equipment should
most
infection
be used whenever possible. All
control measure to protect dental
other instruments that have been
personnel
used in the oral cavity should be
effective
cross
and
in
turn
their
patients, from a potentially fatal
cleaned
disease.(5,12)
ultrasonic
long-
sleeved,
high-
thoroughly
bath
in
before
sterilized in an autoclave.
an
being
(2)
Disinfectants must be used
necked clinical coat, eye shields,

gloves
to decontaminate non-sterilable
must be considered essential to
apparatus (e.g. Shade & mould
reduce cross contamination with
guides,
in prosthodontic practice . Dental
knifes, occiusal plane indicators,
personnel should wear eye shields
articulators, face bows, and other
and a facemask covering the nose
maxillo
and
apparatus).
facemasks
and
mouth
exposure
rubber
when
to
there
aerosols
is
and
splatter(5,6,23)
mixing
mandibular
R.R. Runnels
basic
spatula,
(22)
wax
registration
in 1988, six
infections
control
protection,
procedures as mandatory for the
cuts and abrasions on the skin
control of infectious disease in
should be covered with adhesive
dental practice. These commonly
dressings
gloves.
recommended procedures are as
confers
follows
For
Pregloving
maximum
beneath
the
disinfection
(6,22).
strong antimicrobial properties on
* All dental treatment personnel
the
should wear latex
internal
surfaces
of
the
gloves. Hands should be washed

using a disinfectant hand wash
agents such as povidone-iodine or
chlorhexdine.
(6)
examination
gloves during patient treatment.

should wear masks covering the
Volume 2 Issue1
February 2011

nose and mouth during patient
silicone,
treatment.
polyvinyl

should wear protective eyewear
polysulfide
and
two
siloxane,
immersing
in
after
a
2%
glutaraldehyde solution and (b)

the effect on acrylic resin after
during patient treatment.
sterilizing
by
immersion
when
* All items used in the oral cavity
acrylic resin trays with impression
should be sterilized in a heat or
were used in clinical practice.
heat pressure sterilizer whenever
Their results indicated that the
possible.
polyether
* All touch & splash surface

should be disinfected with an EPA
affected
dimensionally by immersing in the

disinfectant (as they shrunk when
dry
registered.
was
and
swelled
when
in
solutions.) The dimensions of two

ADA
accepted
disinfectant
whenever
sterilization
possible.
Presently
is
silicon - tray resin assemblies
not
were not greatly changed and the
available
adhesive used was not degraded
chemicals meeting these criteria
by disinfectant.
include
S. A. Belt et al
glutaraldehyde,
hypochlorite,
sodium
iodophor
and
synthetic phenolic compounds.
be
disposed
placing
it
off
in
carefully
a
by
sealed,
appropriately marked containers.

Roger E. Johansen et al
(21)
in
1987 conducted a study (a) to

measure and compare the linear
dimensional
changes
of
five
representative rubber elastomers

including polyether, condensation
studied the
biocidal effectiveness of chlorine

dioxide
* Contaminated material should
(2)
and
hypochiorite
5.25%
to
kill
sodium
pathogenic
organisms on denture base acrylic

resin strips in the presence of
10%
horse
serum
organic
material in 1989.
They concluded that, the chlorine
dioxide
achieved
complete
disinfection of all three organisms

within
hypochlorite
minutes.
Sodium
achieved
complete
Volume 2 Issue1
February 2011

disinfection
of
all
the
three
virus.
organisms within 4 minutes.

Disinfectants
applied
by
immersion for inactivation of the
spray
(19)
Rhonda F.K.J et al
atomization was examined by D.
determined
G. Drennon et al(7) in 1989 for
autoclaving
possible dimensional distortion of
dimensional change or decreased
elastomeric impression materials
strength in heat processed poly
namely polyether, polysulfide and
(methylmethacrylate)
addition silicone. Chlorophenol, a
material.
0.25% acid glutaraldehyde, an
Two types of methylmethacrylate
iodophor, a phenyl phenol and a
cranial
phenol
chemically
sodium
disinfectants
phenate
were
used.It
spray
was
that
in 1991
the
steam
causes
implants
linear
implant
were
activated
polymerized.
tested,
and
The
heat
heat-
also shown that the disinfectants
polymerized resin was tested and
applied by spray atomization were
processed, following autoclaving.
effective on the surface of an
It
elastomeric impression material
autopolymerising
contaminated with selected test
methylmethacrylate
organisms. In 1990, J. 0. Look
strength.
(13)
was
compared
for
to
an
impact
studied the biocidal
They concluded that, there was
action of germicides against an
no significant change in strength
enveloped virus on an irreversible
between
non-sterilize
hydrocolloid
processed
methyl
et at
surface.The
that
dipping
impression
authors
or
concluded
immersion
is
and
autoclaved
processed
avoid inhalation of an aldehyde.
significantly
The
autopolymerising
hypochlorite
methacrylate
heat-processed
methyl methacrylate. The heat-
strongly preferred to spraying, to
0.5% sodium
heat-
specimens
were
stronger
than
spray was effective in 3 to 10
methylmethacrylate cranioplasty.
minutes
required
range
3
to
and
iodophor
A significant linear distortion of
10
minutes
1.211% was measured between
Volume 2 Issue1
February 2011

the
autoclaved and non-sterile
heat
processed
methylmethaciylate
was
found
Full strength sodium hypochlorite

was
the
the
significant.
minute).
(10)
effective
disinfectant over all and required
but was not considered clinically
In 1992, H. S. Harold et al
most
shortest
contact
Brace & Plummer
time
(18)
(1
in 1993
determined the efficacy of eight
demonstrated
disinfectant solutions viz sodium
prostheses could be easily and
hypochloride (undiluted), sodium
effectively
hypochloride
chlorine dioxide procedure.
(diluted),
Alcide
that
dental
disinfected
with
L.D., OMC II, Biocide, Sporicidin,
In 1994, R. S. Schwartz et
Lysol, Impresept and sterile water
al(20) evaluated the effectiveness
(control)
of four disinfectants i.e., 0.525%
when
used
as
for
immersion and a spray against
sodium
three microorganisms (S. aureus,
Alcide L.D and lodofive, against
M. Phlei and Bacillus subtilis) and
five
normal mixed oral flora on the
(S.aureus,
S.choleraesuis,
surface
P.aeruginosa,
M.bovis
of
irreversible
hypochlorite,
different
OMC
11,
microorganisms
or
hydrocolloid impressions.
B.subtilis) and mixed oral flora on
This study concluded that, Alcide
irreversible
L.D., Lysol spray, OMC II and
impressions.
Biocide were relatively ineffective
were cultured after immersion in
against the three microorganisms
one of the disinfectanta
tested and on mixed oral flora.
This study concluded that Alcide
Full strength sodium hypochlorite
L.D achieved greater reduction of
and Impresept were essentially
all
equal in effectiveness against S.
hypochlorite
Aureus, M. phlei and mixed oral
effective against S. aureus, S.
flora.
choleraesuis, P. aeruginosa and
sodium
Sporicidin
and
diluted
hypochlorite
were
effective only against S. aureus.
test
hydrocolloid
The
impressions
organisms,
sodium
0.525%
mixed oral flora. lodofive
was
and
OMC 11 were ineffective against
Volume 2 Issue1
February 2011

all
organisms
tested
including
The
results
of
this
study
mixed oral flora.
concluded
In 1996, M. Dellinges and D.
hypochloride solution proved a
(16)
Curtis
evaluated the accuracy
more
that,
effective
sodium
method
than
of the new mechanical torque
exposure to microwave energy,
wrench
which in turn was more effective
system
for
implant
the
than leaving the lining material
effects of steam autoclaving or
dry overnight. Because sodium
chemiclave
hypochioride
restorations
and
tested
sterilization
procedures on the accuracy of the
some
wrenches.
use,
The
results
concluded
system
of
that
this
torque
before
study
wrench
sterilization
will
solution
disadvantages
including
effects
on
energy
metals,
simpler alternative.
sterilization increased the range
Furukawa K. H. et al
of torque values as compared
evaluated
with
both
sterilization.
Autoclaving
soaking
microwave
disinfections
values. Autoclave and chemiclave
before
clinical
period, bleaching and corrosive
considered
recorded
in
long
result in recordings close to target
values
presents
an
be
effective
the
spray
can
(15)
and
(1998)
effectiveness
and
of
immersion
disinfection of Coe Soft and Coe
higher
Comfort denture liners by using
torque values for the 10 Ncm
chlorine dioxide. Specimens made
Dyna Torque wrench.
of soft denture liners attached to
The effectiveness of microwave
acrylic
energy
contaminated
produced
in
statistically
the
disinfection
of
resin
bases
with
were
coli,
Molloplast-B long-term soft lining
aureus and Candida albicans.
material
They
contaminated
with
concluded
that,
chlorine
effective
against
stainless
steel
Candida albicans or S.aureas was
dioxide
studied by A. Baysan et al(1)
nonporous
(1998).
specimens but was inadequate for

denture
was
liners
at
the
Volume 2 Issue1
February 2011

recommended 3 minutes time of
genera of fungi present in used
disinfection.
dental laboratory pumice.
technique
The
was
immersion
more
effective
In 1988 M. .J. McGowan et al
than the spray technique, but the
(17)
difference
1%, 2%, 3%, 4%, and 5.25%
was
not
significant.
studied the effects of 0.5%,
They recommended that coe soft
concentrations
of
and coe comfort denture liners be
hypochlorite
Ticonium
removed
Vitallium alloys.
before
entering
the
on
sodium
and
laboratory. These materials, even
The result of this study indicated
adhering to proper disinfection
that the short term exposure of
procedures still contain sufficient
both Ticonium and Vitallium alloys
microorganisms
cause
to
clean
hypochlorite solution for a period
contamination
to
of
the
either
2%
sodium
laboratory.
of 5 minutes or a 5.25% sodium
In the year 2000, T. Larsen et al
hypochlorite solution for a period
(26)
examined the effect of UV.
of 3 minutes will produce no
radiation for the disinfection of
harmful effects on these metals.
dental impressions and occlusal
C. Shen et al(3) in 1989, studied
records.
the
effect
of
two
alkaline
study
glutaraldehyde base disinfectants,
concluded that the UV radiation
(one alkaline and the other an
delivered by the device did not
alkaline with a phenolic buffer,)
produce
on a heat cured denture base
The
results
in
this
sufficient
bacterial
reduction for the disinfection of
resin.
dental impressions and occlusal
From this study they concluded
records.
that,
Infection
control
in
dental
laboratories.
Henry N. Williams et al
disinfectants should not be used

as
(11)
in
1986 determined the number and
phenolic-buffered
disinfecting
disinfectant
to
be
agent.
used on
denture base resin should not

contain chemicals that may cause
Volume 2 Issue1
February 2011
(25)
dissolution, swelling, pitting or
J. M. Stanley et al
crazing of the resin.
studied the effects of chemical
The effects of a 2% concentration
disinfecting agents like Sodium
of ID 210 solution on impression
hypochlorite, Exspor, Cidex and
compound,
plaster
Wescodyne-D, on color stability of
and zinc oxide eugenol impression
denture acrylic resins. The tested
material
by
resins were CH Lucitone, Triad
P.
VLC and Trulinear.
impression
was
Wafter
investigated
S.D.
&
G.Fong(8)(1990).
This study concluded that, both
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
results
concluded
of
that,
this
a
study
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
diffused into stone casts poured

against such impressions.
1% sodium hypochlorite and 2%

Cidex disinfectant produced the
least color change in the samples
tested.
Polyzois
G.L,
Yannikakis
(9)
Zissis
and
(1995), evaluated
the effect of the glutaraldehyde

and
microwave
method
on
the
disinfection
dimensional
stability, hardness and flexural
penetration of disinfectant.
The
in 1991
properties of a heat polymerized

denture base acrylic resin.
The
results
showed
specimens
that
exhibited
all
linear
changes and small microhardness

differences
during
disinfection
procedures. These changes were

clinically
not
significant.
Flexural
properties
The
remained
unaffected during all disinfectant

procedures. They concluded that
microwave method is a useful
Volume 2 Issue1
February 2011

alternative
to
immersion
disinfection.
Jurgen setz et al
and water. The addition of an

antiseptic product that contained
(14)
(1996)
Octenidine as active agent to
studied the number of
conventional pumice reduced the
microorganisms in two different
number of microorganisms by
combinations of pumice and
99.999%. The mix of steribim
disinfectant and compared with a
with water reduced the number of
conventional mixture of pumice
bacteria by 99%.
In the light of the current knowledge disinfection protocol can be

summerised as:Burs - carbon,
steel, diamond
points.
Dapen dishes
Glass slabs
Hand instruments
Carbon steel
Stainless steel
Hand pieces
Impression trays,
Aluminum metal
tray, Chrome
plated tray,
Custom acrylic
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,
Steam autoclave- 121C for 15 to 20 minutes
Dry heat oven-160C for 1 hour,
Dry heat oven-l60C for 1 hour,
Ethylene oxide450-800 mgJl.
Dry heat oven-I 60C for 1 hour,
According to manufactures recommendation.

Ethylene oxide-450-800 mg/I.
at 15 lb pressure/square inch.


Volume 2 Issue1
February 2011
resin tray,
Plastic tray,
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
Ethylene oxide450-800 mg/I.
Discard; do not reuse
Dry heat oven-160C for 1 hour,
Dry heat over-160C for 1 hour,

Dry heat oven-l60C for 1 hour,
Ethylene oxide-450-800 mg/I
Water- air syringe

tips
X-ray equipment
Impressions
compound, Zinc
oxide eugenol
Irreversible
hydrocolloid
Reversible
hydrocolloid
Polysulfide
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.
Volume 2 Issue1
February 2011

Addition reaction
silicone materials
Condensation
reaction
silicone materials
Polyether
Dentures
Pumice
Metal framework
(Ticonium
&
vitallium)
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.
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.
References :
2. Bell. J.A., Brockmann Si.,
1. Aylin Baysan, Robert Whiley

and
Paul
microwave
S.W.
Use
energy
Feil. P and Sackuvich. D.A.
of
The effectiveness of two
to
disinfectants
on
denture
disinfect a long-term soft
base acrylic resin with an
lining
organic load. J. Prosthet.
material
contaminated with candida

aibicans or staphylococcus
aureus.
J.
Prosthet.
Dent., 1998;79:454-458.
Dent., 1989; 61: 580-583.

3. Chiayi
Shen,
Nikzad
S.J.
and Frank A.C. The effect

of
glutaraldehyde
disinfectants
on
base
denture
Volume 2 Issue1
February 2011

base resins. J. Prosthet.
Dent., 1989; 61: 583 -589.
4. Chris.
H.
The
Miller.
Sterilization-
8. Fong. P.G., and Walter. J.D.
Disciplined
microbial control. D. C. N.
effects
immersion
of
an
disinfection
regime on rigid impression

materials.
mt.
j.
Prosthodont, 1990; 3: 522 -
A, 1991; 35(2): 339-255.
527.
5. Clare
Connor.
contamination
Cross
control
in
prosthodontic practice. mt.

J.
Prosthodont, 1991;
4:
9. Gregory. L., Alkibiades. J.Z.

and
Stavros.
The
effect of glutaraldehyde and

microwave
337 -344.
A.Y.
disinfection on
some properties of acrylic

6. Council on dental materials,
instruments,
equipment,
and
council
on
denture
resin.
Tnt.
J.
Prosthodont., 1995; 8: 150

- 154.
dental practice, council on

dental
therapeutics.
Infection
control
recommendations
dental
office
for
and
the
the
laboratory. J. Am. Dent.

Assoc.,
1998;
116:241
Harold
V.B.
S.W.,
and
Donald
Richard
S.S.
Efficacy of various spray

disinfectants on irreversible
hydrocolloid
impressions.
Tnt. J. Prosthodont., 1992;

5 : 47 - 54.
248.
7. David. G.D., Glen. H.J and
Powell G.L. The accuracy
and efficacy of disinfection
by
10.
spray
impression.
atomization
J.
Prosthet.
Dent., 1989;62:468-475.
11.
Henry.
N.W.,
William.
A.F., Andrew G.S., and John

F.H. The isolation of fungi
form
laboratory
dental
pumice. J. Prosthet. Dent.,

1986; 56: 737 - 740.
Volume 2 Issue1
February 2011

12.
James.
A.
Hepatitis
Cottone.
current
status in dentistry. D. C. N.
A., 1991; 35(2): 269-282.
13.
John.
0.
Look,
restorations.
17.
McGowan. M.J., Shimoda.

and
Woolsey
Effects
of
J.C., Ke gong and Harold.
hypochlorite
H.M.
base
Preliminary
from
results
disinfection
irreversible
of
hydrocolloid
impressions.
J.
Prosthet.
Dent., 1990, 63: 701 - 707.

14.
Jurgen
Heeg.
setz
and
Peter
Disinfection
of
Prosthet.
Dent., 1996; 75: 93-98.
L.M.
David.
J.
sodium
on
denture
metals
immersion
during
for
sterilization.
G.D.
short-term
J.
Prosthet.
Dent., 1988; 60: 212 - 218.

18.
Michael.
Kevin.
L.
Brace
D.
and
Plummer.
Practical
denture
Pumice. J. Prosthet. Dent.,
disinfection.
1996; 76: 448 - 450.
Dent., 1993; 70: 538 - 540.
15.
Karl
K.F.,
Frank.
D.N,
19.
3.
Rhonda.
Prosthet.
F.K.J.
and
Dennis A.R., and Stephen
Stephen. M.C. The effect of
M.C.
of
steam
in
sterilization
Effectiveness
chlorine
dioxide
disinfection
on
two
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