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.


What’s the Basis for Successful Endodontic Treatment

Root canal shaping is one of the most important steps in canal treatment. It is essential to determine the efficacy of all subsequent procedures, including chemical disinfection and root canal obturation are the basis for successful endodontic endo motor treatment, aiming to debride the root canal, to remove contaminated dentin, and to create an ideal canal shape for three-dimensional filling .

The main objective of a clinician is to mechanically and chemically cleanse the root canal system thoroughly, making it free of microorganisms and their substrates.

The root with a graceful tapering canal and a single apical foramen has long been established as an exception rather than the rule. Bifurcating canals, multiple foramina, fins, deltas, loops, cul-de-sacs, intercanal links, C-shaped canals, and accessory canals have most commonly been faced by the investigators in most teeth .

The instrumentation of the apical matrix to a large size leads to more anatomical irregularities and increases irrigant exchange in the apical third. Apical enlargement during canal cleaning and shaping procedures increases the likelihood of achieving maximum elimination of bacteria from root canal system , though a major part of the canal remains uncleaned even after thorough cleaning and shaping .

Until recently, most investigations have involved counting the number of canals and foramina and categorizing how the canals join or split. Majority of studies have tried to evaluate the shape of the canal systems( root canal treatment equipment ) and its clinical implications than to evaluate the actual preoperative size of the canal .

However, it is recommended not to widen the root canal to a larger extent to avoid unnecessary weakening of the root and increased risk of fracture. Regarding modern concepts, the final canal allows adequate irrigation and close adaptation of the filling material during obturation . Working width (WW) is relatively new concept, which involves perceiving a root canal in both perpendicular (working length) and horizontal (WW) dimensions. Thus, endodontic ―working width‖ has always remained unforgotten dimension during root canal procedure without solid scientific evidence; however, it is still not clear ―how large is enough.

What’s the Diagnosis of Endodontics Depends On

November 4, 2016 (Newswire) –Diagnosis, treatment planning and clinical outcome assessment in endodontics depend to a large extent on radiographic examinations. Conventional periapical radiographs, either captured on conventional x-ray film( dental x ray machine portable ) or digital are used for the management of endodontic problems provide limited information because of the combination of their two dimensional nature, geometric distortion, anatomical noise, and temporal perspective.

Useful information such as the presence, location and extent of periradicular lesions, the anatomy of root-canals( root canal treatment equipment ) and the proximity of adjacent anatomical structures provided by periapical radiographs are exposed during endodontic treatment procedures . Inspite of widespread use periapical images, either captured on x-ray film or digital sensors, provide limited information .

The most important limitation of periapical radiographs is that they do not always accurately reflect the anatomy being assessed because of the complexity of the maxillofacial skeleton . In endodontic practice, radiographs are recorded using the paralleling technique / long-cone or right-angle technique, instead of the bisecting angle technique, as it produces more geometrically accurate images.

For accurate reproduction of anatomy in the paralleling technique, the radiographic film or RVG sensor should be placed parallel to the long axis of the tooth, and the x-ray beam should be directed perpendicular both to the image receptor and the tooth being assessed. The lack of long-axis orientation results in geometric distortion of the radiographic image.

Another important principle in endodontic radiology is to display the structures of diagnostic interest onto a background as homogeneous as possible . However, the anatomical structures surrounding the tooth may superimpose and cause difficulty in interpreting periapical radiographs.Various studies have demonstrated the difficulty of radiographically visualizing the periapical lesions confined to the cancellous bone, as the denser overlying cortical plate masks the area of interest.

Anatomical noise also accounts for some underestimation of the size of periapical lesion on radiographic images .Anatomical noise is dependent on several factors such as non-optimal irradiation geometry, overlying anatomy,the thickness of the cancellous bone and cortical plate, and the relationship of the root apices to the cortical plate.

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