Die Stone Disinfection: Incorporation

*
of Sodium Hypochlorite
Lawrence G. Breault, DMD, MS, James R. Paul, DDS,’
Steven 0.Hondrum, DDS, MS,3 and h r e n C. Christensen, DDS4

Purpose: Previous research has shown that dental gypsum casts may be effectively disinfected
b y the substitution of 10% of the gauging water with 5.25% solution of sodium hypochlorite. The
purpose of this investigation was t o determine the properties of gypsum produced from such a
solution as opposed t o tap water alone.
Materials and Methods: Tests included setting time, compressive strength, rigidity, diametral
tensile strength, setting expansion, hardness, and detail reproduction.
Results; The addition of sodium hypochlorite t o the gauging water resulted in a statistically
significant increase in the compressive strength and rigidity, and a decrease in setting time ( p 5 .51.
All other properties remained unchanged.
Conclusions: This substitution may be an effective and convenient method of disinfecting
gypsum casts in the laboratory without adversely effecting physical and mechanical properties.
JProsthod 1998;7:13-16. This is a US government work. There are no restrictions on its use.

INDEX WORDS: dental die stone, disinfection, sodium hypochlorite, physical properties

I NFECTION CONTROL is a topic that is still

receiving attention from within the profession of
dentistry, as well as from outside agencies. Occupa-
tional Safety and Health Administration (OSHA)
guidelines arid American Dental Association (ADA)
recommendations have received much %greaterem-
phasis since the advent of thc human immunodefi-
ciency virus and acquired immunodeficiency syn-
drome.
In prosthodontics, routine infection control and
disinfection protocols have been developed. Specifi-
cally, emphasis has been placed on the disinfection of
impressions and casts used for the fabrication of
prostheses. Leung and Schonfeld’ demonstrated that
‘Lientrnont Colonel, Chiej, Periodontics?Main Dental Clinic, Schqfilirld
Barrackr, US Amp Dental ArtiuiQ, Hazlaii. Diplorriate, l h Arrwicau
Board of Pm’odontolo,g>Fellow? Acadeny of General Dentisby, member,
American Acadernjj ofPm’odonfoloQ,nwmher Amrican Dental Assoriation.
‘hfajm, Chief; Pmrthodonticr, Ottawa Health Caw Center, Ottawa,
Ontario, Canada.
3C010nel, Chipf;Dental Materialr Lahoratq, Area Dental Lahmntoty,
Ft. Gordon, GA.fiblomate, Federal Senices Board of General Denti@,
Fellow, Academy of Dental Materials, Fellozt, American .k.rociation of
Hospital Denlists, memher, Amencan Dental Association.
‘Colvnel, US /lmy Restwe Comniund Dental Surgeon. Di,blomate>the
American HoardoSP/osttladonlcs, Fellou., the Arrmican Board ofFrosthodon-
tish, F m r Dirertor ofthz iiihanc~dEducation Progrurri zn Prosthodontiw:
Ft. .Weak, IUD.
AccefltedJanuay 5. 1998.
Compondence to: Lleutenant Colonel L a m m e G. Breault: DAD:
M Y , 95.523 Wuikalunih o e . hfililani, HI 96789-333.9.
T h b a Wgvuemment work. T h m arc no restrictiotuon its use.
IO%-94 I~!YB/O7U~-OOO3$~.O~!O
there is a potential for cross-infection bctwccn pa-
tients and dental personncl via contaminated dental
ca.sts.
Many protocols for disinfection procedures have
becn directed at breaking the chain of contamination
at thc impression stage.2-iPresent guidelines recom-
mend rinsing the impression under running water to
remove H o d and saliva, followed by spray or immer-
sion disinfection at varying lengths of time.3-7Most
rcports have found that dimensional stability is not
significantly sacrificed with immersion techniques.
However, problems may develop with the hydrocol-
loid and polyether materials because of imbibition of
water.”,g This has resulted in some reluctance in
adhering to disinfection recornmendations when
working with these materials.
Another option is disinfection of the dental cast.
Stern et all0 evaluated the effects of various spray
disinfectants on dental stone after repeated applica-
tions. They reported an increase in abrasion resis-
tance and compressive strength or type IV dental
stone after applications of iodophor, phenol, or glutar-
aldehyde sprays.
Sarma and Neiman” testcd the effects of immer-
sion disinrection of stone casts with various glutaral-
dehyde, phenol, iodophor, and chlorine disinfectants.
They found that sodium hypochlorite produced the
fewest undesirable eKects with regard to surface
erosion, surface hardness, compressive strength, and
chemical reactivity with the casts.
Bass et all2 compared the efrects of immersion
disinfection of’casts in a mixturc of sodium hypochlo-

Journal ofProsthodonlic\, Viil7,N o I (Marchj, 1998:gp 13-16 13

14 Die Stone Disinjction
rite and slurry water for 30-minute and I-hour
intervals. They reported no difference in the quality
of the cast surface when submerged in the disinfec-
tant slurry compared with plain slurry water.
Donovan and CheeI3 tested a new dental stone
(Steridie) in 1989. This stone contained a disinfec-
tant in the gypsum. The disinfectant, Chloramine-T,
is similar to a dilute form of sodium hypochlorite
when activated with water. They reportcd compa-
rable physical properties of this stone in almost all
areas.
Schutt14 also reported that Steridie disinfected
both irreversible hydrocolloid impressions as well as
the stone cast after a60-minute setting time.
Tebrock et all5 determined that a cast probably
can be produced without contamination from the
impression by adding as little as 25% by volume of
5.25% sodium hypochlorite to the gauging liquid.
Mansfield and Whit?.'" investigated the antimicro-
bial effccts of the above combination and confirmed
that the addition of sodium hypochlorite reduced the
bacterial level in experimental stone casts to that of
negative controls in 1 hour.
Moon (unpublished data, 1993) determined that a
substitution of 10% of the gauging water with a
5.25% solution of sodium hypochlorite effectively
disinfected casts. The purpose of this investigation
was to determine the properties of a Type V dental
stone produced from such a solution as opposed to
using tap water alone.
Materials and Methods
The gypsum material sclccted for this study was a Trpe V
dental stone (Die Keen, Heraeus Kulzer, Inc, South Bend,
IN). The disinfectant was a 5.25% solution of sodium
hypochlorite (Clorox, Clorox Co, Oakland, Ch).
The specimens for the control group were made by
mixing the prepacked powder with the manufxturer-
prescribed volume of tap water under the conditions
described in ADA Specification 25 for Dental Gypsum
Products. The procedure for making the specimens in the
Table 1. Summary of Tcst Kcsult
Llltirnate Dimetral
Compressive Temile
Sfrenzth Strength
Control (water only) (n = 8) 2,690 (845)) 341 (74)
Experimental (watcr and NaOCL)
(n = 8) 4,160 (901)" 310 (51)
Note. Dataare means (SD).
*Significant difference ($ S .05)
Breault et a1
experimental group was the same as the control, except
that 10% gauging water was replaced with the 5.25%
solution of hypochlorite. The powder-rater was hand-
spatulated for 30 seconds, then mechanically spatulated
under vacuum [or another 30 seconds.
Tests conformed to ADA specification 25 and included
the following: Vicat setting time (Vicat apparatus, Hum-
bolt hfanufacturing Company, Chicago, IL), setting expan-
sion, dctail reproduction, and compressive strength 1 hour
after the start of the mix on a universal testing machine
(hhdel TI'CI, Instron Corp, Canton, MA) at a cross-head
speed of 1 idmin. Rigiditywas calculated from the slopes of
the compressive strength stress/strain curves.
In addition tu the four ADA tests, diametral tensile
strength was determined at 1 hour after the start of the
mix. Specimens were made from molds 1 inch in diameter
and 1 inch high, and testcd at a cross-head specd of' 1
idmin. h o o p hardness (Tukon,Model 300, Wilson Instru-
ments, Hinghatnton, NY)was determined at a load of 2,200
g at 1 hour on specimens made from the compressive
strength molds.
Sample size tvas eight specimens for each group. Para-
metric data were analyzed with the Student's t test
(p 5 .05).
Results
Results are described in Table 1. Statistically signifi-
cant differences (@5 .05) were seen for compressive
strength and rigidity (the experimental sample dem-
onstrated significantly higher compressive strength
and rigidity compared with control), and setting
time, (experimental was significantly less than con-
trol).
All detail reproduction specimens, both control
and experimental, clearly reproduced the required
50-pm line in the test block. However., upon removal
of the experimental specimens from the detail repro-
duction test block, small spots of apparent corrosion
were seen on the test block. No such spots were seen
on the control specimen test blocks.
Elmtic
Settin,o Setting Hardness Modulus
Time (min) Eqamion &) (KHA7 (ALPa)
15.0 (1.3) 0.144 (0.046) 39.9 (2.3) 1,284 (449)
10.5 (1.3)* 0.135 (0.025) 41.5 (5.3) 2,017 (389)*
 March I W , Volume 7, Number I
Discussion
The addition of sodium hypochlorite to Type V
gypsum did not have any detrimental effects. The
data suggest that a harder die may result from the
addition of sodium hypochlorite to the gauging wa-
ter. However, increased surfxe hardness does not
necessarily mean increased abrasion resistance, be-
cause this is only one factor in the dctermination of
abrasion resistance for any material.17-22
The increase in compressive strength and rigidity
may be due TO the fact that there is less total water
present. The amount of water that reacts with the
calcium sulfate hemihydrate is determined stoichio-
metrically. The excess water is distributed as free
water and contributes to volume but not strength.
Therefore, strcngth increascs as thc W/P ratio de-
creases. While the sodium hypochlorite contributes
to a fluid, workable mix, it does not take part in the
reaction itself. Simultaneously, the reduced total
water contcnt allows the reaction to proceed fastcr,
and sctting time is decreased.
Another possible explanation for the increase in
compressive strength and rigidity, and the decrease
in setting time, is that sodium hypochlorite acts as an
accelerator, perhaps by increasing the solubility of
the hemihydrate. Accelerators may simultaneously
increase the strength ofthe product as the decreased
reaction time results in less porosity.
Whcthcr an increase in compressive strength is
an advantage may be dependent on the circum-
stances of each individual case. An increase in com-
pressive strength may not improve abrasion resis-
tance. Moreover, gypsum materials most often
fracture in tension, and an increase in compressive
strength without a proportionate increase in tensile
strength is typical of brittle materials. Therefore, a
test for tensile strength is probably more relevant
than compressive strength. In addition, from exami-
nation of our disc specimens, it was determined that
they always fractured right down the center, with no
visible deformation before fracture.
The effect that the sodium hypochloritc had on
the stainless-steel test block may be important. This
may portend a reaction with base-metal removable
partial denture frameworks, eg, in a pick-up impres-
sion in an altered cast techniquc. For these specific
applications, a noncorrosive disinfectant may be more
appropriate than sodium hypochlorite. While outside
the scope of this report, further investigation of the
compatibility of the sodium hypochlorite and altered
15
stone with various impression materials must be
completed.
Conclusions
Substitution of a 5.23% solution of sodium hypochlo-
rite in place of 10Y0 of the gauging water when
mixing a Type V stone resulted in an increased
compressive strength and rigidity and a decrease in
setting time. There was nochange in tensile strength,
setting expansion, hardness, or detail reproduction.
Incorporation of sodium hypochlorite in the gauging
water may be an cffective, convenient, and inexpen-
sive method o i disinfecting gypsum casts in the
laboratory without adverse11 ei'fecting physical and
mechanical properties. However, there may be a
reaction between sodium hypochlorite and base-
metal alloys.
Acknowledgment
The authors thank D a p a B. Breault for assistance with
roanuscript preparation.
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