Dental Infection Control Basics

But would your home pass a Centers for Disease Control and Prevention (CDC) inspection? Maybe, maybe not. But if your dental office follows CDC-developed oral care center policies and guidelines, it'll make the grade.

Since being exposed to airborne and bloodborne diseases is a fact of life in modern dentistry, the CDC established protocols to prevent infection risk. These protocols include ones for instrument and equipment cleaning and the cleanliness of the office, clinical surfaces, and even dental professionals' hands. CDC criteria also exist for personal protective equipment (PPE), respiratory hygiene, and cough etiquette.

Learn about the measures dental offices take to ensure you and your family avoid infections of any kind.

The CDC details how dental instruments and equipment should be cleaned and disinfected unless there are disposable alternatives. Instruments and equipment are classified into three categories based on the risk of infection transmission: critical, semi-critical, and non-critical.

1. Critical instruments are used to penetrate soft tissue or bone, and they can also encounter blood. Instruments under this classification include scalers, scalpels, forceps, and bone chisels. Critical instruments should be sterilized after each use. Acceptable sterilization methods include autoclaving (done in a special sterilization machine), dry heat, or heat/chemical vapor.
2. Semi-critical instruments come into contact with mucous membranes (such as the inside of your cheeks) or non-dry skin. These instruments include mirrors, reusable impression trays, and amalgam condensers. They should be sterilized with dry heat after each use.
3. Non-critical instruments are those that touch only intact skin. They include blood pressure cuffs, X-ray heads, and pulse oximeters. These instruments can be reused between patients after receiving intermediate-level disinfection.

Intermediate-level is classified as a hospital disinfectant or "tuberculocidal," meaning it kills the bacteria that causes tuberculosis and a host of other bacteria and viruses. Some dental offices are also using what the Environmental Protection Agency (EPA) classifies as List N disinfectants to add an extra layer of protection against coronavirus (COVID-19) infection.

As we've learned, hand washing is imperative in preventing the spread of disease. According to the CDC, a 60-percent-alcohol-based hand sanitizing solution is acceptable except in one scenario: A dental professional with visibly soiled hands must wash thoroughly with antimicrobial or plain soap and water.

In addition to washing dirty hands, the CDC recommends performing hand hygiene under these other three conditions:

1. After the dental professional uses bare hands to touch equipment contaminated by blood, saliva, and other secretions.
2. Before and after the treatment of each patient.
3. Before putting on gloves and immediately upon glove removal.

Cleanliness and infection prevention applies to more than just dental instruments. According to the CDC, a dental office contains two types of surfaces: clinical contact surfaces and housekeeping surfaces.

Clinical contact surfaces include light handles, drawer handles, faucet handles, countertops, chairs, and other items you or your dental pro would touch during a procedure. Clinical contact surfaces, if not protected with barriers such as a clear plastic wrap, bags, and sheets, should be cleaned between patients with an EPA-registered hospital or List N disinfectant. Those surfaces should also be cleaned after every workday.

Floors and sinks are examples of housekeeping surfaces to be cleaned and disinfected periodically throughout the day. Walls, chairs, and other surfaces should be cleaned regularly.

In a profession that requires extremely close physical contact, dental professionals need to protect their patients – and themselves. The CDC recommends dental pros wear surgical masks, goggles or face shields, gowns or other protective clothing, and sterile gloves during any dental procedure.

Respiratory hygiene and cough etiquette are normally recommended, as well. This includes posting signs for procedures to follow if coughing or sneezing, practicing hand hygiene, and providing tissues and face masks as needed.

And during times of viral outbreaks:

• If a dental pro is practicing in a community with a moderate to a substantial risk of airborne transmission, N95 respirators or disposable equivalents are advised.
• All dental health care personnel should wear face masks and practice hand hygiene.
• You'll undergo a health screening that typically includes taking your temperature and answering some questions – as well as being required to wear your own face mask and practice hand hygiene.

Dental offices should offer ongoing education and training to their employees to ensure policies and procedures are practiced correctly. The CDC recommends the training covers safety guidelines for both employees and patients.

Like any business, a dental office must maintain the records of safety and cleanliness training as required by the federal and state governments.

We trust our dental professionals with the care and health of our mouths. But with dental infection control, you can trust them to do what's needed for your overall health. Next time you visit your dental office, notice how sparkling clean and fresh the environment is. And know that every effort went into ensuring each surface, instrument, piece of equipment, and person working there is a model of disinfection.

Oral Care Center articles are reviewed by an oral health medical professional. This information is for educational purposes only. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your dentist, physician or other qualified healthcare provider.