The FAQ about Dental Sterilization

Sterilization in dentistry is very important, and dentists and dental assistants typically clean and disinfect most surfaces in a their offices and treatment rooms to help prevent the spread of germs. Disposable dental supplies are also used whenever possible. Tools that are not disposable are generally scrubbed by hand and placed in a machine known as an dental autoclave. This machine then disinfects the tools by spraying them with very high-pressure steam, which kills most micro-organisms. Any tools that can not be subjected to high heat or moisture are usually disinfected with chemicals. There are some FAQ about dental sterilization:

1.Q Why is it important to package instruments for sterilization and storage?

A Packaging cleaned instruments prior to placing them in the sterilizer is a standard of care that protects instruments and maintains their sterility until they are ready for use on a patient. Unprotected instruments may be re-contaminated with dust and spatter or by coming into contact with any number of non-sterile surfaces during transport, storage, tray set-up, and operatory set-up.

2. Q What is the acceptability on glass bead sterilizers?

A Hot salt/glass bead sterilizers are not acceptable for the sterilization of items between patients. The endodontic(endo motor) dry heat sterilizer (glass bead sterilizer) is no longer cleared by the Food and Drug Administration (FDA). The FDA Dental Device Classification Panel has stated that the glass bead sterilizer presents “a potential unreasonable risk of illness or injury to the patient because the device may fail to sterilize dental instruments adequately.”

3. Q The instructions for the electrosurgery tips my practices uses say to “cold sterilize” them. What cold sterilization   methods does the Food and Drug Administration (FDA) approve for use?

A “Cold sterilization” entails the use of chemicals that FDA classifies as high-level disinfectants/sterilants. Chemicals in this category are required to have FDA clearance for their claims.

Ideally, all items that enter the patient’s mouth and come into contact with oral tissues should be heat sterilized. If this is not feasible because the device or instrument cannot withstand the heat sterilization process, a high-level disinfectant should be used.

The FDA maintains a list of products that have received clearance as chemical sterilants. The list includes information regarding proper contact time, active ingredients and reuse or shelf life. Always read instructions carefully before using a chemical germicide.


Types of Dental Autoclave Sterilizer in Dental Setting

It is vital that the type of sterilizer being used is clearly identified as this dictates not only what can be processed in the chamber but also how the machine is tested and validated.
When purchasing a new machine the cost is obviously a focal point. What is often not apparent is the ongoing cost of validating the machine after purchase. This is particularly essential when purchasing a vacuum sterilizer.

Autoclave Class B STERILIZER
For example, HTM01-05 daily steam penetration testing can cost a few pence per day for some B type sterilizers totaling under a hundred pounds for the year. Some S type sterilizers however can cost several pounds per day totaling several hundred pounds per year for the same test. The cost saving on initial purchase can be quickly eclipsed by the ongoing cost of validation.
Autoclaves commonly sterilise by exposing its charge (items to be sterilised) to elevated temperatures of 121 to 134ºC under pressure of 15 to 30 psi, for a holding time of anywhere between three to 30 minutes. Please note that the three to thirty minutes time is the holding time at the set elevated temperature and not the total process or cycle time. Total cycle time would be far greater. The combination of the three lethal parameters of time, temperature and steam, deliver a powerful kill rate which even the hardest of bacteria find hard to survive. This effective and yet clean method of lethality is unmatched by any of the other methods of sterilisation.
Saturated steam at this temperature is an excellent carrier of heat. The operative word is saturated steam. The steam condenses onto its charge and as it does so, it not only expands its huge latent heat but also draws in additional steam to replace the condensed steam. Thus, the heat transfer is very efficient and the penetration levels extremely high.
However, if there is residual air in the chamber and load, it will interfere with steam-instrument contact and may compromise sterilisation. This residual air can prevent penetration of steam to the depths of the load, leaving your sterilisation incomplete. When you load the autoclave with instruments and close the lid, there is already a lot of stale air trapped inside. For sterilisation to take place, this air needs to be effectively purged and replaced with saturated steam. To resolve this problem of purging entrapped air, normal dental autoclave sterilizer will have a manual, mechanical or electrically operated valve open till about 100ºC. Once it is closed, the pressure and temperature begins to rise. It is presumed that by this time, the entire entrapped inner air has been purged. However, tests have shown that this is not an effective method for vials, wrapped items, implants, garments and certain types of hollow ware. You can never be assured of efficient penetration of steam right inside, if you are using a regular autoclave. Even a small volume of entrapped air can compromise your sterility assurance level simply because ordinary entrapped air is a very bad conductor of heat and moisture. These pockets of air cannot conduct heat to the load with the same vigour as steam and therefore cold spots remain within the load.