Infection Control in Prosthodontics

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Professor & Head
Senior lecturer
Senior lecturer
Department of Prosthodontics,
KSR Institute of Dental Science & Research,
Tiruchengode, Tamil Nadu.
Pin : 637 215
Address for correspondence :
Dr. Narendra Kumar. R
Senior Lecturer, Department Of Prosthodontics
KSR Institute Of Dental Science And Research,
KSR Kalvinagar, Thokkavadi Post,
Thiruchengode, Namakal Dist- 637215.
Phone Number: 9843698559.
E- Mail Id: Naren_capri@yahoo.co.in.
Abstract:
Infection control has become one of the most discussed
topics in dentistry. Much of this discussion has been dedicated to
general dentistry and oral surgery. Little has been discussed about
infection control in other disciplines, such as prosthodontics. As more
evidence has been gained concerning the pathogenicity and
invasiveness of hepatitis-B (HBV), herpes, tuberculosis (TB), and
acquired immunodeficiency syndrome (AIDS) in prosthodontics,
research is evolving that relates directly to this previously neglected
discipline. The aim of this review was to provide a background about
the possible ways of transmission of infection spreading, and
procedures recommended for preventing their spread in the discipline
of prosthodontics .
Keywords:
Sterilization, Disinfection, Saliva,
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Rachuri Narendra Kumar , Karthik K S , Sudhakara V Maller .
LITERATURE REVIEW ARTICLE
Introduction:
I n pr ost hodont i cs, obj ect s pot ent i al l y
contaminated with pathogenic microorganisms are
transported between dental laboratory and the dental
clinic. It has been claimed that, to avoid cross-
contamination, specific disinfection measures should be
followed. In the literature, the usual solution to this problem
has been to chemically disinfect the impression, and the
efficacy of such disinfectants has been the subject of several
1,2,3
studies .
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Sterilization :
Sterilization is a process by which all forms of
microorganisms are destroyed, including virus, bacteria,
fungi, and spores. Products that are capable of sterilization
are referred as sterilants.
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Disinfection :
Disinfection is generally a less lethal process than
sterilization. It eliminates virtually all recognized
pathogenic microorganisms but not necessarily all
microbial forms (bacterial endospores), on inaminate
objects. Consequently, products that have the ability to
disinfect are referred to as disinfectants.
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Need for infection control :
A number of bacteria, fungi, and viruses present in
the prosthodontic environment have been linked to
debilitating and life threatening diseases. Every effort
therefore must be made to avoid cross contamination of
these microorganisms and to prevent the potential transfer of
diseases in prosthodontic setting. The establishment and
maintenance of comprehensive and effective infection control
programs are requirements for dental offices and laboratories.
These programs must be monitored regularly and examined to
ensure that they are consistent with the standards of time.
But the success of any infection control effort rests
with each member of the prosthodontic team. For that team
to function optimally everyone in it should posses an
understanding of the fundamental principles of infection
and the prevention of cross-contamination.
Infectious diseases found in dentistry:
There are many infectious agents that are
commonly encountered in the day to day prosthodontic
practice. It is important to understand the route of
transmission and potential complications of these
infectious agents, for a better applications of the principles
of sterilization and disinfection.
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Levels of disinfection :
Disinfection can be achieved in three specific levels:
High.
Intermediate/Medium.
Low.
Most of the dental disinfectants come under
intermediate/medium level of disinfectants, but a minimum
standard of intermediate/medium level disinfection can be
exceeded by using high level disinfectants like
glutaraldehydes.
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Table I: Route of infection transmission and complications :
There are studies done to observe the type of
organisms that are specifically found on some of the
specimens received in the prosthodontic laboratories from
the dental offices and it was found that there were
organisms specific to some of the specimens observed.
It was seen that Alpha-hemolytic streptococcus
speci es, St aphyl ococcus speci es, Mi crococcus,
Diphtheriods, Bacillus species, pseudomonas, Nisseria
species, Enterobacter species, Corynebacterium species,
Escherichia coli, Gamma-hemolytic streptococcus species,
Klebsiella oxytoca were found on crowns, wax occlusal
rims, dentures, rubber base impressions, irreversible
hydrocolloids, impressions, relining materials and artificial
stone casts.
Major categories of chemical disinfectants:
1. Chlorine compounds.
2. Iodophors
3. Combination synthetic phenolics
4. Glutaraldehydes
5. Phenolic/alcohol combinations.
These chemical disinfectants can be used by different
methods of disinfection such as spraying and immersion
techniques.
Factors influencing disinfectants effectiveness:
The type of micro-organisms present.
The number of micro-organisms present.
The concentration of disinfectant.
The length of exposure to the disinfectant or sterilant.
The amount of organic matter (bio-burden)
remaining.
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Infection control procedures :
Most of the governmental regularities and health
care professional organizations list seven basic infection
control procedures such as;
1. All dental treatment personnel should wear latex
examination gloves during patient examination.
2. All dental treatment personnel should wear masks
covering nose and mouth during treatment of
patients.
3. All dental treatment personnel should wear protective
eye wear during patient treatment.
4. All items used in the oral cavity should be properly
sterilized. Systems recommended in dental practice are
chemical vapor sterilization, dry heat sterilization, and
steam autoclaves.
5. All touch and splash surfaces should be disinfected
with agents like glutaraldehyde, sodium hypochlorite,
iodophoros, and synthetic phenolics.
6. Contaminated material should be disposed carefully by
placing in sealed, appropriately marked containers.
7. Immunization programs have been scheduled for the
active immunization against hepatitis, HIV, tetanus,
chicken pox, influenza.
Disinfection of impressions and prosthesis:
1. All prosthesis removed from the mouth should be
carefully rinsed under running water, cleaned of debris
in an ultrasonic cleaner whenever possible, and
disinfected.
2. All impressions should be rinsed and disinfected
before dental stone models are fabricated.
3. Working pumice should be discarded after use.
4. Lathe attachments, such as stones, acrylic burs, and
rag wheels, should be removed from the lathe after
each use and stored in a disinfectant.
5. Lathe shields and air filtrations should be used to
contain contaminated splashes, and airborne
contamination.
6. Care should be exercised to clean and disinfect touch
and splash surfaces in the laboratory.
7. Clothing worn during patient treatment should be
covered with a disposable apron specially when
contaminated prosthesis and impressions are
handled.
Impressions can also be disinfected and sterilized
using ultra-violet radiation and gas (ethylene-di-oxide) in
closed chambers.
However, there are a number of problems
associated with chemical disinfectant use. They take time
and are expensive to perform in a dental practice.
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Infection Control in Prosthodontics Narendra Kumar, Karthik & Sudhakara Maller
Moreover, all chemical disinfectants are potentially harmful
to the health of the user and the environment, and they may
have an unpleasant odour. Further more they are not
readily compatible with irreversible hydrocolloids, which is
one of the most frequently used impression materials.
Consistently, to a large extent, the disinfection procedures
during impression procedures are not followed in clinical
practice. When they are, their clinical efficiency on the
micro-flora appears to be inadequate or questionable.
Even a cast from a properly disinfected impression
may subsequently become contaminated by a technician or
clinician. Also, the prosthesis will become contaminated by
the patients after trial and adjustment in the mouth and will
recontaminate the cast after repositioning. In practice
contaminated gypsum casts are difficult to disinfect
chemically. If elimination of cross-contamination is
considered a requirement, then disinfection measures
should be applied through out all phases of treatment to
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both the cast and the prosthesis
Pilot studies have been carried out to disinfect the
gypsum casts through microwave irradiation. Unlike
disinfection of the impression, this method can be used to
eliminate cross-contamination via the cast, because it can
be repeated at every stage as required, and so far it has
been observed that, in contrast to the presently described
chemical disinfection procedures, microwave irradiation of
the casts for 5 minutes at 900 W gives high level disinfection
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of the gypsum casts .
Conclusion:
1. All dental disciplines must be considered with the
dangers involved in the spread of certain infectious
diseases.
2. Prosthodontits and their ancillary personnel may be
exposed to certain diseases predominantly found in
adult patients such as, hepatitis-B and tuberculosis.
3. Dentists must ensure that at least six basic infection
control procedures should be observed when treating
patients.
4. Additional control procedures should be observed in
the fabrication and handling of the impression and
dental prosthesis.
5. Dental offices and dental laboratories should work
closely together to co-ordinate control of potential
cross-infections between the two disciplines.
The control of infectious diseases in prosthodontics is not
difficult. It requires the expenditure of a little time, and most
important, a great deal of discipline. The rewards are well
worth the additional effort and could even be lifesaving.
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MATERIALS, Eleventh Edition. Saunders (Elsevier) Publications.
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Susan E. Brackkett: Fundamentals of Fixed partial prosthodontics; Third
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mic robial cross combination. J Prosthet Dent 1983; 49:210-212.
13. G. Lynn Powell, Robert D. Runnells, Barbara A. Saxon: the presence and
identification of organisms transmitted to dental laboratories. J Prosthet
Dent: 1990;64:235-7.
14. Mohd Aleem Abdula: surface detail, compressive strength and dimentional
accuracy of gypsum cast after repeated immersions in hypochlorite solution.
J Prosthet Dent: 2006: 95:462-68.
15. Morrow RM, Rudd KD. Dental laboratory procedures: complete dentures.
Vol 1-2ed. St Louis: Mosby. 1986:Page 194.
16. Saso Ivanoski, Savage NW. disinfection of dental stone cast: antimicrobial
effects and physical property alterations. Dent Mater: 1995: 11: 19-23.
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Narendra Kumar, Karthik & Sudhakara Maller Infection Control in Prosthodontics