LITERATURE REVIEW ARTICLE

Infection Control in Prosthodontics

Senior lecturer Senior lecturer 3 Professor & Head 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: [email protected].

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,

Introduction: In prosthodontics, objects potentially contaminated with pathogenic microorganisms are transported between dental laboratory and the dental clinic. It has been claimed that, to avoid crosscontamination, 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 studies1,2,3. Sterilization4: 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. Disinfection4: 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. Need for infection control4: 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. Levels of disinfection4: 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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Infection Control in Prosthodontics

Narendra Kumar, Karthik & Sudhakara Maller

Table I: Route of infection transmission and complications5:

The concentration of disinfectant. The length of exposure to the disinfectant or sterilant. The amount of organic matter (bio-burden) remaining. Infection control procedures5,6,7: 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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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 species, Staphylococcus species, Micrococcus, 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.

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 both the cast and the prosthesis8,9. 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 of the gypsum casts10. 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. References:
1. Einar Berg, Nils Skaug. High-level microwave disinfection of dental gypsum casts. Int J Prosthodont 2005; 18: 520-525. 2. Kenneth J. Anusavice: PHILLIP'S SCIENCE AND ART OF DENTAL MATERIALS, Eleventh Edition. Saunders (Elsevier) Publications. 3. Herbert T. Shillingburg, Sumiya Hobo, Lowell D. Whitsett, Richard Jacobi, Susan E. Brackkett: Fundamentals of Fixed partial prosthodontics; Third edition. Quintessence Publishing co, Inc. 4. W. Patrick Naylor. Infection control in fixed prosthodontics. DCNA July 1992; 36(3):809-31. 5. R. R. Runnells. A review of infection control in dental practice. J Prosthet Dent 1988: 59(5); 625-629. 6. Stephen F. Rosenstiel, Martin F. Land, Junhei Fujimoto: contemporary fixed prosthodontics; First Edition. The C. V. Mosby Company. 7. Robert G. Craig: Restorative Dental Materials; Tenth Edition. Harcourt Brace & Company Asia PTE LTD. 8. Donna L. Dixon, Larry C. Breeding. Microwave disinfection of the denture base materials colonized with Candida albicans. J Prosthet Dent 1999; 81:207-14. 9. Mitchell A. Stern, Glen H. Johnson. An evaluation of dental stones after repeated exposure to spray disinfectants. Part I: abrasion and compressive strength. J Prosthet Dent 1991; 65:713-8. 10. Einar Berg, Nils Skaug. High-level microwave disinfection of dental gypsum casts. Int J Prosthodont 2005; 18: 520-525. 11. Vidya S. Bhat, Mallika S. Shetty, Kamalakanth K Shenoy: infection control in prosthodontic laboratory. J Prosthet Dent; 2008: 62-65. 12. Ralph L. Leung, Steven E. Sehonfeld: gypsum cast as a potential source of 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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