ARMAMENTARIUM AND

STERILIZATION

Dr. Shakaib Ahmed

FCPS II Resident
 Armamentarium
 Classical Latin an arsenal ; from
armamenta:

 The aggregate of equipment, methods,

and techniques available to one for
carrying out one's duties
 Preparation for endodontic treatment
requires a somewhat different approach
compared with many other types of
dental therapy

 The good clinician realizes that time

spent before treatment in the
organization and sterilization of
instruments and supplies will lead to
fewer post treatment patient problems
and result in a more efficient practice.
Routine Armamentarium For Endodontics
 Mirror, Periodontal probe & standard dental explorer
 Anesthetic syringe
 Rubber dam instruments
 High-speed handpiece and burs
 Low-speed handpiece and burs
 Long shank excavator (31L)
 Canal-irrigating syringe(s),
 Mixing spatula and mixing surface
 Obturation instruments
 Plastic instrument for temporary filling
Instrument management system
Pretreatment Sterilization
and Disinfection

 Sterile

 Disinfection
 Sterile :- Absence of life forms.
Killing all micro-oraginisms

 Disinfection :- killing most life forms,

especially pathogens. As commonly used,
the term disinfection.

* Not include killing spores

Elements of a Sterilization Plan
1. Transporting contaminated items from the operatory
 Items should stored in container to prevent perforation.

2. Instrument-processing area.
 Instruments must be sorted, cleaned, and rinsed with
water in an area separate from sterilization.
 Instruments should be inspected, assembled into trays,
and wrapped for sterilization in packages containing
sterilization indicator.
 Instrument packages should be sterilized according to
approved methods.
 Instruments should be stored for event-related use.
 3. Environmental infection control
 Clinical contact surfaces (barrier protection, spray
disinfectants)
 Housekeeping surfaces (floors, walls, and sinks)

 Dental unit water lines

 4. Nonregulated and regulated medical waste

 5. Monitoring plan
 6. Training plan
Methods Of Sterilization
 1. Steam pressure sterilization
(Autoclave)

 2. Chemical vapor pressure sterilization

(chemiclave)

 3. Dry heat sterilization (dryclave)

 4. Ethylene oxide (ETOX) sterilization

Autoclave
 Sterilization with steam under
pressure is performed in a
steam autoclave for a light load
of instruments the time
required at 250°F (121°C) is a
minimum of 15 minutes at 15 lb
of pressure.
 Flash sterilization for 10
minutes at 273°F (134°C) to
give 30 lb of pressure
Advantages Disadvantages
• Most rapid and  Temperature
effective method. sensitive items can
not be autoclaved.
E.g. such as rubber
• Automated models or plastics goods.
are available.
 Corrosion.
• Good for surgical
cloth and towels
Chemiclave
 A Chemiclave chemical vapor
sterilizer uses a solution of 72%
ethanol and 0.23%
formaldehyde in place of water
in its autoclave.

 It uses 270° F (132° C) at 20 psi

for 20 minutes, including drying
time.
 Advantages Disadvantages
 Avoids the instrument Only fluid purchased
corrosion typical of from the sterilizer
steam autoclaves manufacturer can be
used.
 Carbon steel and Ventilation is needed
other corrosion- to handle for
sensitive burs are said formaldehyde fumes.
to be sterilized without Towel and surgical
rusting
cloth may not be
sterilized
Dry Heat
 is readily achieved at temperatures greater
than 320°F (>160°C).
 Packs of instruments must be placed at least
1 cm apart to allow heated air to circulate.
 Approx. 60 to 90 min may be required to
sterilize a medium load of lightly Wrapped
instruments in an oven set at a range of
335°F (168°C) to 345°F (174°C).

* Not approved by FDA

Short-Cycle, High-Temperature Dry
Heat Ovens. COX Sterilizer.
 Dry heat ovens operate at
approximately 370°F to 375°F (188°C-
191°C).
 It uses a forced draft oven that
circulates air with a fan or blower.
 It reduces total sterilization time to 6
minutes for unwrapped instruments
and 12 minutes for wrapped
instruments.
 Advantages Disadvantages
 Carbon steel instruments •Sterilization cycles are
and burs do not rust or prolonged at the lower
lose their cutting edges if temperatures.
they are well dried before
processing. Heavy loads of
 Industrial forced-draft hot
instruments, crowding of
air ovens usually provide packs, and heavy
a larger capacity at a
wrapping easily defeat
reasonable price.
sterilization.
 Rapid cycles are
possible at high
Adding instruments
temperatures.
without restarting the
timing
 Ethylene Oxide Sterilization
 ETOX sterilization is the best
method for sterilizing of complex
instruments and delicate
materials.
 Automatic devices sterilize items
in several hours and operate at
elevated temperatures well
below 100°C.
 Less expensive devices operate
overnight to produce sterilization
at room temperature.
Boiling Water
 It does not kill spores and cannot
sterilize instruments.
 It is method of high-level disinfection
 Well-cleaned items completely
submerged and boil at 98°C to 100°C.
 Pressure cooking, similar to steam
autoclaving, is preferable and would be
required at high altitudes.
New method for sterilization
 Microwave oven: limitations with metal
item also damaging the machines.

 UV light: its not highly effective against

RNA virus and bacterial spores but good
for sanitizing room air against
tuberculous bacteria.
Chemicals For Disinfectant

1.Low level:- All bacteria except mycobacterium

and spores.
Some fungi and some viruses.
Surfaces without blood.
e.g Ammoniums, phenolics, some iodoforms.
2. Intermediate level :- Mycobacterium, not spores
Most fungi and most viruses.
Surfaces with blood, Quaternary ammoniums with
alcohol, chlorines, phenolics, iodoforms.
3.High level :-All microbes except spores
Immersion Glutaraldehyde, strong peroxides,
o-phthalaldehyde
* High level can be used for room sterilization
with extended contact times
 Environmental Infection
Control
Vaccinations for Diseases Potentially Spread
to Dental Office Workers
 Hepatitis B
 Influenza, needed yearly
 Measles
 Mumps
 Rubella (German measles)
 Varicella (chickenpox)
Medical History
 Collection of a proper medical history is
mandatory for proper treatment planning.
 e.g. Infectious microscopic droplets of TB
hang in the air for hours after dental
treatment.
 The use of pretreatment oral chlorhexidine
gluconate has been recommended for
reduction of microflora in aerosols.
 Patients with heart defects may also need
special treatment.
 Allergies for drugs, injections or latex etc.
Cross Infections

Distribution of saliva spatter during a dental hygiene procedure. The hygienist

needs to wear a long-sleeved overgarment, mask, protective eyewear, and
gloves.
Thinking What
What must be done if accident and
exposure to infected material
 Prompt and meticulous washing of
the injured area.
 Immediate placing of a gauze with a
disinfectant solution on the injury e.g
formaldehyde, iodine or 75% alcohol
etc.) for at least 15 minutes.
 The professional must be examined
as soon as possible for HIV.
 Chemoprophylaxis with antiretroviral drugs
must begin as soon as possible after the
incident.
 After 72 hours have passed, there is no
point in administering chemoprophylaxis
medication

 Chemoprophylaxis with antiretroviral drugs

lasts four weeks and has a 80% chance of
success in preventing seroconversion.
Personal Protection

 Gloves

 Hand Washing

 Protective Eyewear, Masks, and Hair

Protection

 Protective Overgarments.
Disposal of Clinical Waste
We should have 4 different colors of
boxes for waste materials.
 Black: Pen, stationery, papers, clips.
 Edibles should not be allowed in the
dental office strictly.

 Yellow: Contaminated things, cottons,

gloves, masks, protection sheet, matrix
strip.
 Red box: Infectious materials, blood
containing items, soft tissues, extracted
teeth, blood cottons, etc.

 Blue box: Sharps; sharp instruments,

needles, suturing needles, blades,
broken instruments, burs
Biological monitoring Plan

 Biological Monitoring Strips

 The use of biological monitors strips (spore
tests) is the most reliable method to validate
that the sterilizer is functioning and that the
sterilization of instruments is effective.
 Should be weekly monitor of adequate time
and temperature exposure.
 Spores dried on absorbent paper strips are
calibrated to be killed and send to licensed
reference laboratory for testing.
 Mechanical monitoring
Document time, pressure & temperature
 Chemical Indicator Strips
 Color change strips placed inside packs
to check heat penetration.

 External sterilization strips

Tapes and bags, are marked with heat-
sensitive dyes that change color.
External markers are important to
distinguish between the packs.
Training plan
 New Doctors and update Old fellows

 Students

 Assistants and Hygienist

 New Devices and Equipments