Operatory Disinfection

Dental units and equipment are complex systems. Key maintenance may be overlooked when performance is adequate. Maintenance will not only keep equipment at its peak but also protect you and your patients. 

After a period of non-use or storage, dental equipment may require maintenance and/or repair. It is important to review the specific manufacturer's instructions for use (IFU) for all equipment and devices. Some considerations for equipment maintenance may include testing, shocking and/or treatment of dental unit waterlines. 

Dental Unit Waterlines 

"Dental unit waterlines (ie, plastic tubing that carries water to the high-speed handpiece, air/water syringe and ultrasonic scaler) promote bacterial growth and development of biofilm due to the presence of long narrow-bore tubing, inconsistent flow rates and the potential for retraction of oral fluids. Dental healthcare personnel and patients could be placed at risk of adverse health effects if water is not appropriately treated." ²

Dental Unit Waterline Considerations 

• Follow the facility's dental unit waterline maintenance protocol
• Policies and protocols have not been established, create program and train all staff

"All dental units should use systems that treat water to meet drinking water standards (ie, ≤ 500 CFU/mL of heterotrophic water bacteria). Independent reservoirs—or water-bottle systems—alone are not sufficient." ³

• Consult with the dental unit and/or waterline treatment product manufacturer for appropriate methods and equipment to monitor and maintain the quality of dental water. 

Other Recommendations

Replace/change water filters on devices containing removable filters on devices containing removable filters such as those found on ultrasonic scaling units

"CDC recommends that all dental instruments that use water should be run to discharge water for 20-30 seconds after each patient and for several minutes before the start of each clinic day." ⁴

Single-use disposables, also called single-use devices, are designed for use on one patient and then must be discarded. Examples of single-use devices include saliva ejectors, masks, prophylaxis angles, disposable barriers and air/water syringe tips.

According to the Food and Drug Administration a single-use device, also referred to as a disposable device, is intended for use on one patient during a single procedure. It is not intended to be reprocessed (i.e., cleaned and disinfected or sterilized) and used on another patient. The labeling may not identify the device as single-use or disposable. If a device does not have reprocessing instructions, regardless of labeling, it should be considered single-use and disposed of appropriately (i.e., according to federal, state, and local regulations) after one use.⁵ Using disposable items improves patient safety by eliminating the risk of patient-to-patient contamination.⁵

Considerations for surface barriers:

• Utilize disposable barriers to protect clinical contact surfaces that are difficult to clean (eg, switches on dental chairs, computer equipment) Change surface barriers between patients and then clean and disinfect surfaces.^5,6

Considerations for air/water syringe tips:

• Narrow internal lumens of metal air/water syringe tips may be difficult to clean and sterilize effectively.
• Utilizing disposable air/water syringe tips reduce the risk of potential contamination.

Dental studies show:

"During dental treatments bacterial aerosols increase 5x7 and aerosols can spread up to eight feet.” ⁸

High-speed handpieces, ultrasonic scalers, air polishers and air/water syringes produce potentially infectious droplets, splatter and aerosols. DHCP should utilize a multi-layered approach in order to minimize the risk of cross-contamination in a dental setting. 

1. Personal Protective Equipment (PPE)

• DHCP should don appropriate PPE as recommended in current guidelines and/or state regulations. 
• Taking precautions to isolate the oral cavity with the placement of a rubber dam during restorative procedures may also reduce the aerosol production. 

2. Pre-procedural mouth rinse

• Despite the lack of scientific evidence per CDC Guidelines, clinicians may use their professional judgment to use a pre-procedural virucidal mouth-rinse in order to sanitize the aerosol. 

3. High-volume evacuation 

• Using HVE instead of standard saliva ejectors is an important component to reduce the amount of aerosol. 
• Several studies published show that utilizing HVE can reduce the amount of aerosol by 90%-98%.⁹

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"The ADA recommends that all blood-contaminated aerosols and splatter should be minimized" ¹⁰

OSHA standards state that, "all procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing, spraying, splattering, and generation of droplets of these substances." ¹¹

In the CDC guidelines for infection control in dental settings, the use of HVEs are considered to be 'appropriate work practices' - precautions that always should be followed during dental procedures.¹²