Introduction

What do dentists do for you? Not only they treats you for any oral disease that you may acquire for whatever reason, they help you and advise you on how to prevent all types of dental problems and diseases. In addition, dentists are also responsible for ensuring the safety of their patients and their team during dental treatment by minimizing cross- infection.
Why Cross-Infection Control is Necessary?
Dentist are bound to treat all patients, even if they may be harboring serious transmissible diseases. In these cases, dentists must be extra-cautious, by ensuring thorough cleansing and disinfection of the used instruments. Since some dental instruments have to be reused on other patients, the possibility of cross-infection always exists.

Ensuring Cross-Infection Control

Every country’s law requires dentists to take all necessary steps to protect you, and their staff. The process of preparing instruments for recycling to other patients involves three steps:

1. Cleaning

This is the foremost and perhaps, the most important step in preparing dental instruments for reuse on other patients. Improper cleaning can deceive all further steps. Scientific evidence is available to the fact that an unclean instrument cannot be sterilized properly. The reason is that even a spec of soil remaining on the instrument can hide thousands of viruses and bacteria under it and protect them against the most effective sterilization process. These microbes survive, and may very well cause cross-infection in the next patient they are used on.

Methods of Cleaning

Various methods of cleaning are available, which can be manual or automatic. They have their merits and limitations. They will be discussed separately.

Manual Cleaning– This is the most common and natural method of instrument cleaning. The instruments are physically handled and cleaned by the person responsible who must be trained. He or she must be aware of the limitations and consequences of any default.
• Merits of Manual Cleaning– Manual cleaning method is flexible and versatile- any type and shape of instrument can be cleaned manually. However, the method has weaknesses.
• Limitations – Although flexible and versatile the method has limitations
o Lack of Standardisation– Firstly, the consistency and quality of cleaning cannot be standardized perfectly. Different persons will clean the same instrument with different levels of thoroughness. Some may not do it well enough.
o Risk of Infection– Another drawback is that the person who is cleaning is exposed to the contaminants and may acquire serious infection if he or she is not absolutely careful. It is necessary for these people to take due precautions and wear gloves and other protective gear while performing the cleaning.

2. Recommended procedure for Manual Cleaning

To minimize the effect of these limitations of manual cleaning standard stepwise operating procedures are recommended to be in place.
• Soaking– This is the first step in manual cleaning. Soaking in warm water a detergent solution will loosen and soften material which may be stuck or glued to the instrument. It is particularly useful to remove material which may have dried on the instrument since it was last used. Soaking should be done for at least ten minutes to be effective. However, the soak time will depend on the nature of the material, and the time it has had to dry up. Detergents help the process, and enzyme detergents are considered more effective.
• Brushing– Soaking has prepared the instruments for brushing. The instruments should be brushed thoroughly using a soft-bristled brush. Particular care is needed with recessed and tubed instruments. To avoid spray of infected water, brushing should be done keeping the instrument under water, and while wearing protective gear.
• Washing– The last step is to examine the instrument and to repeat brushing if deposits are detected. Then it should be rinsed in clean water and allowed to dry.

Automatic or Ultrasonic Cleaning

Manual cleaning is very effective in smooth surfaces, but may not be so on knurled or roughened surfaces. Ultrasonic cleaning followed my manual cleaning will ensure a better job. Ultrasonic energy in the detergent bath cleans very thoroughly through a complex mechanical process. It is effective even in invisible areas, eg, inside tubular surfaces. The duration of cleaning should be as per instructions of the machine manufacturer and according to the detergent used.

Automatic Washers

Automatic cleaners resembling dishwashers are suitable for practices that may need to clean a large quantity of instruments. Special designs may be required for special instruments. A good practice is to place the instruments in cassettes and expose to the washing. These machines are available in a large variety, and allow wide settings of water temperature, jet pressure and timing cycles. For all types of automatic washers, the instruments must be prepared. Some simple washers require a pre-soaking step as part of preparation, although sophisticated machines will have this built-in.
Disinfection-
The term disinfection is technically used for cleaning processes which remove all microbes except bacterial spores. Cleaning with special liquid detergents will also do the disinfection. Disinfection and even sterilization may soon be possible using ultraviolet light energy.