Dental Infection Control [Resources & Best Practices]

Dental infection control is a critical aspect of patient and dental healthcare provider (DHCP) safety. Adhering to established guidelines and protocols helps prevent the transmission of infectious diseases in dental settings.

This article provides an overview of key resources and best practices to maintain a safe environment for both patients and DHCP, focusing on standard precautions recommended by the Centers for Disease Control and Prevention (CDC). Rest assured that our dental lab is following all updated infection prevention and control methods.

CDC Standard Precautions

All dental health care personnel should follow these infection prevention practices in all settings. Remember, basic infection prevention principles cannot be taken lightly.

1. Hand Hygiene

Effective hand hygiene is the most crucial measure for preventing the spread of infections among patients and dental healthcare providers (DHCP). Education and training programs should clearly outline when and how to perform hand hygiene before routine dental exams and oral surgical procedures. For routine examinations and nonsurgical procedures, either plain soap and water (hand washing), antimicrobial soap (hand antisepsis), or an alcohol-based hand rub can be used, provided they are appropriate for healthcare settings.

While alcohol-based hand rubs are effective, soap and water are recommended when hands are visibly soiled with substances like dirt, blood, or body fluids. Before performing surgical procedures, a surgical hand scrub must be conducted before donning sterile surgeon’s gloves. For all hand hygiene products, follow the manufacturer’s instructions.

For comprehensive guidance on hand hygiene, including surgical hand antisepsis and the use of artificial nails, refer to the CDC’s Guideline for Hand Hygiene in Health-Care Settings PDF.

2. Use of Personal Protective Equipment

Personal protective equipment (PPE) includes gear designed to protect DHCP from exposure to infectious agents. PPE should be readily available and suitable for various patient interactions, ensuring that it effectively shields personal clothing and skin from contact with blood, saliva, or other potentially infectious materials (OPIM). PPE options include:

• gloves,
• face masks,
• protective eyewear,
• face shields,
• and protective clothing such as gowns, jackets, or laboratory coats.

For example, gloves should be worn in situations where there is a risk of contact with blood, body fluids, mucous membranes, non-intact skin, or OPIM. Dental health care providers must wear protective clothing during procedures where exposure to blood or body fluids is likely, and mouth, nose, and eye protection should be worn during activities that may produce splashes or sprays. DHCP should be trained in the correct selection, application, and removal of PPE to minimize the risk of contamination.

Hand hygiene must always be performed after removing and disposing of PPE. Training should also emphasize reducing contamination risks while wearing PPE by avoiding face contact, limiting the surfaces touched, and removing PPE before leaving the work area.

3. Respiratory Hygiene/Cough Etiquette

Respiratory hygiene and cough etiquette are essential infection control measures aimed at reducing the transmission of respiratory pathogens via droplets or airborne particles. These strategies focus primarily on patients and their companions who may have undiagnosed transmissible respiratory infections but also apply to anyone, including DHCP, showing symptoms such as coughing, congestion, or increased respiratory secretions.

DHCP should be trained to prevent the spread of respiratory pathogens when interacting with symptomatic individuals. Respiratory hygiene and cough infection control procedures and etiquette were incorporated into Standard Precautions in 2007. For more information, see the 2007 Guideline for Isolation Precautions PDF, and for influenza prevention, visit the CDC’s influenza infection control recommendations link.

4. Sharps Safety (Engineering and Work Practice Controls)

Percutaneous injuries, such as needlesticks or cuts from sharp objects, are common in dental clinics and typically involve items like burs, needles, and other sharp instruments. The implementation of OSHA’s Bloodborne Pathogens Standard has significantly reduced the risk of blood exposure and sharps injuries, but these incidents still occur and pose a risk of transmitting bloodborne pathogens.

To mitigate this risk, a dental health care setting should have clear policies and procedures on sharps safety. DHCP must be vigilant when handling sharps and take precautions during use, cleanup, and disposal. Engineering controls, which isolate or remove hazards from the workplace (e.g., self-sheathing needles, safety scalpels), should be the primary method for reducing exposure to bloodborne pathogens.

If engineering controls are unavailable, work-practice controls should be implemented. Employers should involve DHCP in evaluating and selecting devices with engineered safety features annually. Additional engineering controls include sharps containers and needle recapping devices. Work-practice controls should be used when engineering solutions are not viable.

5. Safe Injection Practices

Safe injection practices are designed to prevent the transmission of infectious diseases between patients or between patients and DHCP during the preparation and administration of parenteral medications. These practices include measures DHCP should follow to ensure that injections are performed in the safest possible manner to protect patients.

In a dental office, parenteral medications are most commonly handled during the administration of local anesthesia, where needles and cartridges are used exclusively for one patient, and the dental cartridge syringe is sterilized between uses. Unsafe practices that have caused patient harm include using the same syringe for multiple patients, reinserting a used syringe into a medication vial or solution container to draw additional medication, and preparing medications near contaminated supplies.

Safe injection practices are now a formal component of Standard Precautions due to reports of disease transmission resulting from improper handling of injectable medications.

6. Sterile Instruments and Devices

Proper instrument processing involves several steps and requires specialized equipment. Each dental practice should establish clear policies for handling, transporting, and processing instruments and equipment that may be contaminated with blood or body fluids. Manufacturer’s instructions for reprocessing reusable dental instruments should be easily accessible, ideally within or near the reprocessing area.

Single-use Devices

Most single-use devices are intended for one-time use only and should be discarded after use. It’s crucial that the cleaning, disinfection, and sterilization of dental instruments be performed by trained DHCP to ensure the safety of the equipment used in patient care. Training should also cover the correct use of personal protective equipment (PPE) for safely handling contaminated items.

Automated Cleaning Equipment

Automated cleaning equipment, like ultrasonic cleaners or washer-disinfectors, should be used to effectively remove debris and reduce exposure to blood. After cleaning, instruments should be thoroughly dried, inspected, wrapped, or packaged before being sterilized using heat. Each package should be labeled with details like the sterilizer used, cycle or load number, sterilization date, and expiration date if applicable, to help track processed items in case of a sterilization failure.

The sterilization process should be monitored using a combination of biological, mechanical, and chemical indicators. Biological indicators, such as spore tests, are the most reliable method as they directly assess the sterilization process by destroying highly resistant microorganisms.

Monitoring

These tests should be conducted at least weekly. Since biological test results aren’t immediate, mechanical and chemical monitoring should also be employed. Mechanical monitoring involves recording sterilizer readings for pressure, temperature, and exposure time, providing an early indication of issues during the sterilization cycle.

Chemical monitoring uses indicators that change color when exposed to the appropriate conditions, giving instant feedback on the cycle’s success. A chemical indicator should be placed inside each package to confirm that the sterilizing agent has reached the instruments. If the internal indicator is not visible from the outside, an external indicator should also be used. If the chemical indicator does not change color as expected, the instruments should not be used.

7. Clean and Disinfected Environmental Surfaces

Routine cleaning and disinfection of environmental surfaces is be a key component of the infection control guidelines. Cleaning is essential as it removes large numbers of microorganisms from surfaces and should always be performed before disinfection. Disinfection, though less lethal than sterilization, is highly effective at eliminating nearly all recognized pathogenic microorganisms, although it may not destroy all microbial forms, such as bacterial spores.

Priority should be given to cleaning and disinfecting surfaces that are most likely to become contaminated, including clinical contact surfaces like light handles, bracket trays, switches on dental units, and computer equipment in the patient-care area. These surfaces can transfer microorganisms to other surfaces, instruments, or even to the eyes, nose, or mouth of DHCP or patients if touched. While hand hygiene is crucial for preventing the spread of microorganisms, clinical contact surfaces should also be protected with barriers or cleaned and disinfected between patients. EPA-registered hospital disinfectants or detergents/disinfectants that are approved for use in healthcare settings should be employed for disinfection.

It’s important to use these products as directed by the manufacturer, including instructions on dilution, contact time, and safe disposal. Additionally, dental practices should have procedures in place for promptly cleaning and decontaminating spills of blood or other potentially infectious materials. Housekeeping surfaces like floors, walls, and sinks pose a lower risk of disease transmission compared to clinical contact surfaces and can be cleaned with soap and water, or disinfected if visibly contaminated with blood.

Best Practices for Handling Extracted Teeth

Extracted teeth are classified as regulated medical waste and require proper disposal. Teeth with amalgam fillings have specific disposal requirements due to the presence of mercury.

Extracted teeth can be contaminated with blood or other infectious materials, posing a risk of transmitting diseases like HIV or hepatitis B.

Handling Extracted Teeth

Teeth being discarded must be disposed of in regulated medical waste containers, in accordance with OSHA’s Bloodborne Pathogens Standard.

Patients may request their extracted teeth, and once returned, these teeth are no longer considered a risk to dental staff and are exempt from OSHA regulations.

Teeth Containing Amalgam

Do not dispose of amalgam-containing teeth in medical waste containers that use incineration, as burning can release mercury into the air, leading to environmental contamination.

Follow state and local regulations or contact metal recycling companies for proper disposal.

Hand Hygiene Guidance for Patients in Dental Health Care Settings

Patients are at risk of infections while receiving treatment. Cleaning your hands helps prevent the spread of germs, including antibiotic-resistant ones, protecting both you and healthcare workers. Inform patients that hands can carry both good germs (essential for health) and bad germs (which cause illness).

Explain that alcohol-based hand sanitizers effectively kill most harmful germs. While sanitizers remove both good and bad germs, the good ones quickly return. Using hand sanitizers does not contribute to antimicrobial resistance, as they work differently from antibiotics.

When to Clean Your Hands (for patients):

• Before preparing or eating food.
• Before touching your eyes, nose, or mouth.
• Before and after changing wound dressings or bandages.
• After using the restroom.
• After blowing your nose, coughing, or sneezing.
• After touching hospital surfaces like bed rails, tables, doorknobs, remote controls, or phones.

How to Clean Your Hands (for patients)

With Alcohol-Based Hand Sanitizer:

• Apply the product to your hands and rub them together.
• Cover all surfaces until your hands feel dry, which should take about 20 seconds.

With Soap and Water:

• Wet your hands with warm water and apply liquid soap.
• Rub your hands together to create a lather, covering all surfaces, including between fingers and under nails.
• Continue rubbing for at least 15 seconds—enough time to sing “Happy Birthday” twice.
• Rinse well under running water.
• Dry with a paper towel, and use the towel to turn off the faucet and open the door if needed.

Partner With Stomadent Dental Laboratory

Since 2000, Stomadent Dental Laboratory has partnered with dental practices across the U.S., becoming a trusted full-service lab using advanced technologies and producing all products domestically. We follow all infection control rules and safe practices, using cutting-edge CAD/CAM systems to ensure precision and high-quality control for products like Valplast dentures, crowns, and bridges.

We use our state-of-the-art facility to provide top-quality products, from same-day repairs to custom crowns and dentures. We prioritize efficiency and precision, ensuring your practice saves time and money.

Trust Stomadent to meet your patients’ needs with prompt, accurate service. Order your dental starter kit and experience the Stomadent advantage!