sterilisation in orthodontics practice.pptx

sterilisation in orthodontics

1. Sterilisation And Disinfection In Orthodontics Dr. PRINCYMOL.K Post graduate MBDC 9/25/2024 1

2. contents Introduction Definitions Pathways of transfer of infection Classification Sterilisation methods basics Sterilisation of orthodontic armamentarium Pliers Brackets Molars bands Arch wires Pencils TADS Hepatitis B Conclusion 9/25/2024 2

3. Introduction Microorganisms are ubiquitous Pathogenic microbes may be transmitted directly from the dentist to the patient or from the patient to the doctor, and indirectly from patient to patient. Thus ,it is necessary to remove them as they cause contamination , infection and decay. This presents an enormous challenge in the current scenario as it has been proved that blood and saliva are high risk sources of contracting hepatitis b, human immunodeficiency virus and herpes. 9/25/2024 3

4. 9/25/2024 4

5. 9/25/2024 5 Sterilization is defined as the process by which an article, surface or medium is freed by all living micro-organisms either in vegetative or spore state. Disinfection - means the destruction or removal of all pathogenic organisms or organisms capable of giving rise to infection. Antisepsis- used to indicate the prevention of infection, usually by inhibiting the growth of bacteria in wounds or tissues. Antiseptics- Chemical disinfectants which can be safely applied to skin or mucous membrane and are used to prevent infection by inhibiting the growth of bacteria.

6. Bactericidal/germicidal- are those which are able to kill bacteria. Bacteriostatic - are agents only that prevent the multiplication of bacteria which may however remain alive. Decontamination- refers to the process of rending an article or area free of danger from contaminants including microbial, chemical, radioactive and other hazards. Fumigation- exposure of an area or object to disinfectant, insecticidal or vermin killing fumes. 9/25/2024 6 Text Book of Microbiology- Ananthnarayan,8 th edition

7. Dentist Other patients patient DENTAL CLINIC 9/25/2024 7

8. CLASSIFICATION: CATEGORY 1 who are regularly exposed to blood, body fluids, or tissues- Dentist, dental assistants, Lab workers come under this category. CATEGORY 2 Whose regular task involve no exposure to blood, body fluids, or tissues, but whose employment may require exposure planned or unplanned. They include staffs and cleaning people. CATEGORY 3 Other employees. 9/25/2024 8

9. 9/25/2024 9 Spaulding's Classification Text book of Infection Control and occupational safety recommendations for oral health professionalS

10. CDC classification 9/25/2024 10 Centers for Disease Control and Prevention. Guidelines for infection control in dental health care settings—2003. MMWR 2003; 50(No. RR-17).

11. 9/25/2024 11 Sterilisation

12. 9/25/2024 12

13. method Red heat Flaming Incineration Hot air oven Temp/technique Till red hot Just pass over flame Burnt to ashes 160 deg Time/duration One hour materials Loops,tips of forceps Glass slides scalpels Soiled dressing Pathological waste Scalpels Scissors Forceps etc Dry Heat 9/25/2024 13

14. Moist Heat At temp Below 100 At temp of 100 At temp Above 100 Pasteurisation Inspissation Vaccine bath Boiling Tyndallisation Steam steriliser Autoclave 60 – 75 deg 100deg Temperature-121 C (250 F) Pressure -15 psi Pasteurisation - 30 min Inspissation – 30 min Vaccine bath – 60 min Boiling -10-30 min Tyndallisation – 20 min Steam steriliser – 90 min 15 – 20 mins 9/25/2024 14

15. 9/25/2024 15

16. Guidelines For Orthodontic Armamentarium Sterilisation Minimal requirement for sterilising the orthodontic instruments are : Ultrasonic Dry heat steriliser Autoclave Other than this chemical sterilisation with alcohol and other vapours can be done for the instruments which are not in direct contact with blood or saliva. 9/25/2024 16

17. Orthodontic pliers 9/25/2024 17

18. 9/25/2024 18

19. Dry Heat Vs Moist Heat 9/25/2024 19 Effect of steam versus dry-heat sterilization on the wear of orthodontic ligature-cutting pliers; Ricardo J. Vendrel et al; AJODO 2002;121:467-71 SS inserts Ultrasonic cycle for 5-10 min Rinsing with distilled water Drying with compressed air Lubrication with silicone based lubricants Dry heat sterilisation at 190 deg for 6-12 min Pliers should be open

20. Orthodontic brackets Made from stainless steel featuring a low profile catch that will not tear sterilisation wrap. Suitable for all types of sterilisation. Compartments are permanently marked for tooth identification. Bracket Tray marked for 6 - 1 | 1 – 6,6 - 1 | 1 – 6 Band Tray marked for 1st and 2nd Molars and 1st and 2nd Bicuspids. Sold individually. 9/25/2024 20

21. Molar bands Most overlooked materials in orthodontics. Sterilisation of tried in preformed bands has received attention nowadays. In orthodontic clinical practice the attachments on posterior teeth are commonly welded to stainless steel bands and cemented into position within the mouth. Unlike directly bonded attachments, where one size fits all, bands have to be selected according to the size of the tooth to which they are to be cemented. 9/25/2024 21

22. During appliance placement several bands may be tried in the mouth before the appropriate size is selected. 9/25/2024 22

23. Autoclave 9/25/2024 23 M. R. Fulford et al Decontamination of tried-in orthodontic molar bands : European Journal of Orthodontics 25 (2003) 621–622

24. Dry heat 9/25/2024 24

25. Glass bead Smith reported that glass bead steriliser can be used effectively to sterilise the tried in bands. He recommended : Single band for 1 min in bead steriliser due to fluctuations in temperatures other wise 45 sec is enough. Temp : 225 – 250 deg. 5 or more bands need to double the time. Steriliser with deep and narrow wells are preferred over shallow ones as 9/25/2024 25 SMITH.G; GLASS BEAD STERILISATION OF BANDS; AJODO September 1986 :90:243-49

26. Elastomeric ligatures and chains These are not chemiclaved as they are known to alter the physical properties Alcohol wipes are also not recommended as they are not so effective in blood and saliva Single patient packs are best suitable for preventing cross contamination Otherwise,in case of e chain spools it is better to cut little extra than required and discard rest 9/25/2024 26

27. 9/25/2024 27 Jeffries et al;Effects of 2% alakline glutaraldehyde on e- chains;Angle ortho ;1990;61(1),25-30

28. 9/25/2024 28 Maylani B. Evangelista et al;Effect of Disinfecting Solutions on the Mechanical Properties of Orthodontic Elastomeric Ligatures:Angle Ortho, 77, (4), 2007

29. Arch wires Arch wire sterilisation can ve done by routine 3 methods: Cold sterilisation Dry heat sterilisation Autoclaving 9/25/2024 29

30. After the disinfection period wires were subjected to tensile bending ,and laser tests . Results show no significant changes in fundamental stiffness/strength of wires after disinfection 9/25/2024 30 Effects of Cold disinfectants on the mechanical properties and surface topograph of niti arch wires:AJODO;1988;94;117-22

31. 9/25/2024 31 Influence of autoclave on the surface parameters and mechanical properties of 6 orthodontic wires;EJO:2005;27(1);72-81

32. Ten NiTi wires were used in the study per each group. Group 1 clinical recycling and dry heat sterilisation Group 2 only DHS Clinical recycling was done after 1 cycle. Results: showed that force levels increased after CR for NiTi wires between pre tx and first cycle. Thus suggesting that CR appears to reduce pseudoplasticity and pseudoelasticity of NiTi wires increasing their stiffness. 9/25/2024 32 Sunil Kapila , et al ; Load-deflection characteristics of nickel- titaniu alloy wires after clinical recycling and dry heat sterilization; AJODO;1992;102:120-6.

33. a study was conducted in which CR then sterilised and as received wires of different types SS,NiTi,TMA wires were analysed for change in the properties. Different test like:tensile loading,3 point bending test,laser topographic study were performed. Load/deflection and tensile tests showed no clinically significant difference between as-received and used-then-disinfected/sterilized wires. These results suggest that nickel-titanium arch wires can be recycled at least once. 9/25/2024 33 The effect of clinical use and sterilisation of selected orthodontic archwires : AJODO;1992;102:1539

34. Marking pencil Marking pencils can be potential source of cross contamination. Sterilisation options for these pencils are EO gas Alcohol wipes These pencils cannot be autoclaved. Use of permanent marking pens can also be considered for marking arch wires. But these pens cannot be autoclaved as it is made of plastic. cannot be cold sterilised as it contains ink. 9/25/2024 34 Disinfection of permanent markers;JCO;1996:30(1) ;646-649

35. Probable solution may be use of ink containing alcohols. Alcohols are considered as intermediate level disinfectants. Study was conducted using red,blue,black permanent markers with alcohol . Alcohol content ranging from 50-80%. 9/25/2024 35 Marking pencils as potential source of cross contaminaton;JCO;1998:32(5) ;307-310

36. Results suggest that alcohol are not so efficient in preventing cross contamination.but drying period of 10 min between 2 patients showed a decrease in bactrial count. This suggests that pens after use should be left capped for 10 min to dry. Finally,the best method to prevent cross contamination is use of inexpensive marking pencils which are disposable. 9/25/2024 36

37. TADS Acc to CDC,placement of TADS is a surgical procedure and nedd high level of sterilisation. Following are the requirements for procedure: Surgical hand antiseptic Surgical gloves Irrigant devices Sterile instruments Sterile implant 9/25/2024 37

38. Sterilisation of mini implants can be done by autoclaving Dry heat sterilisation Dry heat strilisation should be done with caution as the implant cannot tolerate high temp. And should be done with an temp indicators to identify when the ideal temp has reached for sterilsation . 9/25/2024 38

39. 9/25/2024 39

40. The results of this study suggest that mini-implants can be safely sterilized, with the method used in this study. This will lead to no clinically significant changes to their resistance to fracture. 9/25/2024 40

41. Torque readings and lateral dispalcement values were recorded 9/25/2024 41

42. Repeated cycles of sterilization altered the surface characteristics of the mini-screws, as evidenced by the significant changes in their maximum insertion torque. sterilization cycle as a main effect did not significantly affect lateral displacement force values. study did not indicate major structural damage to the mini-screws that may affect their clinical stability and consistency as they are sterilized up to 10 cycles. 9/25/2024 42 Sercan Akyalcin et al; Effects of repeated sterilization cycles on primary stability of orthodontic mini- screws;Angle Orthod . 2013 ;83:674–679.

43. Hepatitis B The most common inflammatory disease of the liver is due to hepatitis B (HBV). HBV is 50 to 100 times more infectious than HIV and is a major occupational risk for physicians, surgeons . according to the studies conducted orthodontist exhibits the second highest incidence of HBV. 9/25/2024 43 JIOS;hepatitis b facts and concerns to orthodontist in india

44. Preventive measures Vaccination of doctor and assistant Medical history taking Barrier techniques Sterilisation 9/25/2024 44

45. Hepatitis-B vaccination Three doses are generally required to complete the hepatitis B vaccine series, although there is an accelerated two-dose series for adolescents. First Injection - At any given time Second Injection - At least one month after the first dose Third Injection - Six months after the first dose Booster dose – every five years 9/25/2024 45

46. Do hepatitis b patients are contraindicated for orthodontic treatment? NO, proper barriers techniques and sterilisation procedures before and after treatment should be followed to prevent cross infection. And as they are not prescribed any systemic drugs there seems no contraindications. 9/25/2024 46

47. Dental impressions Common disinfecting solutions used for impressions are 1% naocl Sodium dichlolroisocyanurate 2% glutaraldehyde Rinse the impression under running water Immerse in disinfectant for 10 min Rinse under water Ready for model processing In case of hepatitis b infected patients casts should be poured with gypsum containing 0.25% chloramines. 9/25/2024 47

48. conclusion “Prevention is better than cure” a proverb well suited to sterilization. Thorough understanding of the application of sterilization will help ensure safety from the invisible but deadly world of microbial pathogens. Hence utilization of proper sterilization, disinfectants and aseptic procedures help us achieve the safety of our professional demands. 9/25/2024 48

49. All the above discussed sterilisation and disinfection methods and the studies conducted to evaluate their effects on mechanical and physical properties conclude that none of the properties are effected. Thus sterilisation guidelines should be maintained to protect Ourselves Patients Family and friends from cross infections. 9/25/2024 49

50. 9/25/2024 50 Thank you…..