Different Types of Dental Operatory Disinfectants: An Insight

How Have Disinfection Guidelines Changed Since the SARS-Cov-2 Outbreak?

Disinfection and cleaning of equipment ever since the outbreak and one of the SARS Cov-2 (Severe Acute Respiratory Syndrome Coronavirus 2) variants has led to medical professionals, dental professionals, and personnel being advised to implement the appropriate safety measures in terms of disinfection and thorough sterilization (full eradication of all microbiological life, including bacteria, viruses, and spores) to prevent any chain of infection in a clinical or hospital setting.

According to the guidelines from the Infectious Disease Surveillance Center at the National Institute of Infectious Diseases, using disinfectants is crucial during surgeries and other medical procedures. This applies to medical professionals, dentists, and maxillofacial surgeons.

Dentists and surgeons must use these recommended disinfectants in dental clinics and hospitals to ensure patient safety during operations.

What Are the Different Methods of Sterilization?

Heat sterilization is a widely used method for dental instruments.

• High-Pressure Steam or Autoclave Sterilization: Dental instruments that are suitable for high-pressure sterilization such as operative instruments used by the dentist commonly like mouth mirrors, probes, curettes, or other forceps, and surgical instruments, can be ideally sterilized at a temperature of around 121 degrees Celsius for 20 minutes in the autoclave (a device used to sterilize dental instruments by exposing them to high-pressure saturated steam).

• Dry Heat Sterilization: If the dentist is implementing dry heat sterilization for the instruments, then the temperature setting would be around 180 to 200 degrees Celsius for approximately one hour or the slow sterilization method at 160 to 170 degrees Celsius for approximately two hours.

• Boiling Sterilization: In the case of the boiling sterilization method, the temperature adopted is greater than or equal to 98 degrees Celsius for around at least 15 minutes.

What Disinfectants Are Commonly Used in the Dental Setting?

A dental operator or maxillofacial surgeon would follow specific procedures for instruments or materials that cannot undergo heat sterilization or are sensitive to heat. In a dental clinic or hospital setting, several common modern-day disinfectants exist that have the immense potential to prevent any possible bacterial, or viral contamination between the operator and patient. Have a look into the common disinfectants and how they are used:

• Sodium Hypochlorite:

  • This disinfecting solution works on the rationale of sterilization by immersion methods, in a solution with a chlorine concentration highly effective at around 0.02 percent to 0.05 percent (which means around 200 to 500 ppm) for at least one hour.

  • To achieve an ideal virucidal effect (capable of destroying viruses) or bactericidal effect (capable of killing bacteria) the recommendation for dental practitioners is to use the immersing sodium hypochlorite solution with a concentration of greater than or equal to 0.1 percent (1,000 ppm) approximately at least for 30 minutes.

  • Sodium hypochlorite is usually an extremely corrosive disinfectant as it reacts to both linen fabric and metal. That is the reason why if the surgeon is using linens, they can be soaked in a 0.1 percent solution (approximately around 1,000 ppm) for 30 minutes and then subsequently the linen can be washed with water. In the case of disinfecting either dishes or other accessory bowls or utensils can be easily soaked in a disinfecting solution of sodium hypochlorite around 0.01 percent to 0.02 percent solution (100 to 200 ppm) for at least five minutes, with the precaution that this is done after being washed with water.

• Ethanol Disinfection (Approximately Around 80 Percent Solution):

  • Ethanol is one of the most potent dental clinical setting disinfectants known over the decades. This is because this disinfecting solution is not only less toxic to the body, but it is more suitable for thorough disinfection of specifically the patient's hands and fingers either before or after a dental procedure.

  • Ensure ethanol solution is stored within an airtight container, its alcohol content which is responsible for the antiseptic effect may quickly evaporate. It is to be noted that with the loss of alcohol concentrations in it, ethanol solution can lose its potent disinfecting effect.

  • Ethanol should never be applied to any mucosal surfaces and should be kept far away from contact with the oral cavity. Despite isopropanol (70 percent), being another commonly used alcohol-based disinfectant, serving as an alternative to ethanol solution, research demonstrates that its antiviral effect is much less potent compared to that of ethanol.

• Peracetic Acid:

  • Peracetic acid is a disinfecting solution for dental settings that is effective at a low concentration (0.001 percent to 0.2 percent) and acts particularly well for surface disinfection, specifically against any kinds of microorganisms, bacteria, and spores. Research in dental science confirms that peracetic acid can be effective in disinfecting surfaces even in the presence of organic compounds. This means that even when the solution is degraded down to its components of water, oxygen, and acetic acid, it would still have no hazardous remnant as such.

  • Care should be taken by the dental operator or maxillofacial surgeon with the use of peracetic acid disinfecting, because of the metal's corrosive effect and its irritating smell.

• Glutaraldehyde (Two Percent Solution, PH 8):

  • Glutaraldehyde is a potent bactericidal and denaturing chemical that can act against many infectious and pathogenic microorganisms.

  • For disinfecting the floor of the clinic or the hospital and for disinfecting dental devices, glutaraldehyde solution can be used.

  • It is to be noted by the dentist or the dental personnel that disinfection with glutaraldehyde would require certainly the use of protective equipment as well as laminar flow or ventilation in the clinic.

• Iodine-Based Disinfectant (Iodophor): Iodophor though corrosive to some metals and further can easily stain the skin, mucosal tissues, or even linen or fabric can still be effectively used for surgical skin disinfection for intraoperative procedures.

• Benzalkonium Chloride, Chlorhexidine, and Other Miscellaneous Surfactants: Even though these accessory surface disinfectants are commonly available to medical and dental practitioners in commercial markets, their antiseptic properties, may not be as adequate in comparison to the disinfectants discussed above.

Conclusion:

The dental operator or the maxillofacial surgeon should take note that when the dental instruments or the objects or material in question are not suitable candidates for heat sterilization methods (which is the most efficacious method ), the use of these disinfecting materials or solutions can certainly help combat any possible chain of infection from occurring in between the dental operator and the patients in the clinical setting.