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Infection Control in
Dentistry
Microbiology
Questions to think about…..
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How can you “break the chain” of
infection?
Are there areas of your daily practice
where cross-contamination could be
happening?
How can you make changes that will
prevent cross-contamination in your daily
practice?
Types of Microorganisms

Pathogenic
(causing disease)

Potentially
Pathogenic
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Non-Pathogenic
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Some infections only occur in individuals who
are immunocompromised because their
immune system is unable to fight the potential
pathogen. These are called opportunistic
infections.
Major Groups of Microorganisms
Bacteria
 Algae
 Protozoa
 Fungi
 Viruses
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Since a number of
diseases can be
transmitted during
routine dental care, it is
important to understand
the principles behind the
infection control
recommendations of the
CDC and OSAP.
Bacteria
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One celled microorganisms
Can live independently
Classified according to their shape
Some are harmless, some are disease-producing
(pathogenic)
Some types of bacteria form a capsule that
protects the cell; Bacteria with this protective
coating are particularly virulent, or disease
causing.
Viruses

Viruses cause many of the diseases in human beings,
but can also infect animals and plants.
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Examples of diseases caused by viruses:
Measles
Mumps
Colds
Severe acute respiratory syndrome (SARS)
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Fungi
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Defined as plants that lack chlorophyll
Includes mushrooms, yeasts and molds
Oral Candidiasis is the most common yeast infection
of the oral cavity.
Candidiasis is caused by Candida albicans
Candida is considered an opportunistic
infection, in other words, it usually occurs in
someone who’s immune system is not
functioning normally.
Body Defenses Against
Microorganisms/Germs

External natural defenses
 skin as mechanical barrier
 mucous membrane
 cilia – fine microscopic hairs in
nose
 coughing and sneezing
 hydrochloric acid in stomach
 others..
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How are diseases transmitted in the
dental setting?
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From the patient to the dental worker
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From the dental worker to the patient
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From one patient to another
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From the dental office to the community
Transmission can be…

Direct- from an infected person to another person who
is not immune,

Indirect- from contact with objects that are
contaminated, like surfaces or instruments,

Droplet-from spray or splatter contact with mucous
membranes, or contact with aerosols (stay suspended in
the air for longer periods of time)
The Infectious Process
“Chain of Infection”
Infectious agent
Susceptible host
Reservoir
Port of Entry
Port of Exit
Transmission
The Chain of Infection Components
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Infectious Agent-any potential pathogen (bacteria,
virus, fungi, etc.)
Reservoir-where the pathogen lives (a person, on
equipment, surfaces, instruments, etc)
Portal of exit- how the infectious agent leaves its
reservoir and reach a new host.
Transmission-direct, indirect, airborne, droplet
Portal of entry- how the infectious agent gets into the
new host (bloodstream, mucous membrane, etc.)
Susceptible host-someone who is not immune
The chain of infection example
Infectious agent
Hepatitis B
Susceptible host
Reservoir
Unvaccinated
Dental worker
Port of Entry
The bloodstream
Port of Exit
Puncture wound
Bleeding wound
Transmission
Direct via needle stick
What alters normal defenses, making
a person a susceptible host?
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Abnormal Physical Conditions
Systemic Diseases (diabetes, HIV infection, etc)
Drug Therapy (chemotherapy, steroids, etc.)
Stress
Prosthesis and Transplants (joint or organ
replacements)
Poor nutrition
What factors influence the
development of infection?

The number of microorganisms and
duration of exposure (how many and for
how long?)
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Virulence of organisms (ability to cause
disease; pathogenic properties)
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Immune status of the host (body defenses)
**Application to Practice**
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The goal of an infection control program is
to “break the chain” of infection by
consistently practicing protocols which
would prevent the infectious agent from
moving to one host to another and
preventing cross-contamination.
Cross-Contamination

Defined: The spread of microorganisms
from one source to another.
Handwashing …
an action of the past
Alcohol-based
hand rub
is standard of care
Personal Protective
Equipment

A major component of Standard
Precautions
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Protects the skin and mucous membranes
from exposure to infectious materials in
spray or spatter
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Should be removed when leaving
treatment areas
Masks, Protective Eyewear, Face Shields
Wear a surgical mask and either eye protection
with solid side shields or a face shield to protect
mucous membranes of the eyes, nose, and
mouth
 Change masks between patients
 Clean reusable face protection between patients;
if visibly soiled, clean and disinfect
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Protective Clothing

Wear gowns, lab coats, or
uniforms that cover skin and
personal clothing likely to
become soiled with blood,
saliva, or infectious material
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Change if visibly soiled
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Remove all barriers before
leaving the work area
Recommendations for Gloving
Remove gloves that
are torn, cut or punctured
Do not wash, disinfect
or sterilize gloves for reuse
Precautions for Surgical Procedures
Surgical
Scrub
Sterile Irrigating
Solutions
Sterile Surgeon’s
Gloves
Clinical Contact Surfaces
Housekeeping Surfaces
Dental Unit Waterlines
and Biofilm
Microbial biofilms form
in small bore tubing of
dental units
 Biofilms serve as a
microbial reservoir
 Primary source of
microorganisms is
municipal water supply
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Sterile Irrigating Solutions
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Use sterile saline or sterile
water as a coolant/irrigator
when performing surgical
procedures
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Use devices designed for the
delivery of sterile irrigating
fluids
Saliva Ejectors
Previously suctioned fluids
might be retracted into the
patient’s mouth when a seal
is created
 Do not advise patients to
close their lips tightly around
the tip of the saliva ejector
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Infection Control Program Goals
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Provide a safe working
environment
Reduce health care-associated
infections
Reduce occupational
exposures