Tabitha Acret reviews the links between oral health and heart health and how
A-DEC SETS STANDARD IN INFECTION CONTROL
When it comes to infection control in the dental surgery, A-dec has you covered
LOAD RELEASETHE LOGIC AND STRUCTURE OF CHECKING COMPLETED LOADS
Ensuring items have been cleaned, inspected, packaged into a sterile barrier system and then sterilised are key to clinical practice explains Prof. Laurie Walsh facebook.com/auxiliarynow
Prof. Laurie Walsh highlights the ways that dental assisting roles may change over the coming decade due to the impact of major forces that are shaping clinical practice
Publisher & Editor: Joseph Allbeury
www.oralhygiene.com.au
Cammeray 2062
New HART process challenge device
3
The HART - Hollow Air Removal Test - is manufactured to ISO 11140-6:2022 in the “helix” style to demonstrate the air removal and steam penetration efficiency for hollow items in small steam sterilisers. The HART is built to ISO11140-6, a more rigorous test for air removal and steam penetration (ARSPT) than previously manufactured “Helix Devices” to EN867-5. It is not the fault of the device. The device is, in fact, proving that the cycle choice is unable to remove all air from the chamber, a fundamental requirement for effective sterilisation of a hollow item. The test is fit for purpose and doing its job, highlighting this fundamental issue. ISO11140-6 sets a standardised approach to the design of Hollow PCD’s and all benchtop sterilisers designed to EN13060 should pass any brand of device manufactured to ISO11140-6. The device comes with 250 strips. Available from STS Professional on (08) 9244-4628 or visit www.stspro.com.au
ways to get the most out of www.dentist.com.au
When people want to find a dentist, they mostly use the internet and Google “Dentist in...”. That’s what the research shows. Word of mouth is no longer king! Google only shows 3 or 4 individual dental practices on the first page of its search results. The other results returned are for, among other things, the website www.dentist.com.au. This directory lists all practices and practitioners and is searched a million times a year
Get Listed! If you’re listed on dentist.com.au, your phone will ring! So just do it!
Upgrade your listing: Just like in Google, where your practice sits in the dentist.com.au search results list determines how often your phone rings. If you’re at the top of the list, then your phone will ring more often and if there is more detailed information listed about your practice, then this helps too. Unlike Google, you can increase your priority in searches for an annual fee. This increases your prominence in searches for your home suburb and often also in the surrounding suburbs. Plus you can add heaps of detailed information about your practice and practitioners.
Add your link for online bookings. If you accept online bookings, then once you’ve upgraded your listing, you can add the link to accept online bookings through your preferred booking engine and this will appear directly in the search results list. For details on how to upgrade, visit: dentist.com.au/information-for-dentists
Contaminated surfaces in healthcare settings play a key role in the transmission of pathogens that cause healthcare-associated infections (HAIs). Nosocomial pathogens are often found on high-touch surfaces and can remain viable for months. They spread when healthcare workers touch contaminated surfaces and fail to wash hands before patient care. Contaminated surfaces increase the risk of HAIs, highlighting the need for improved cleaning and disinfection methods. A new disinfectant wipe, highlighted by Kinnos, uses colour-additive technology to help users visualise cleaned surfaces. The wipes produce a transient blue colour that fades after cleaning, allowing staff to confirm which surfaces have been wiped and assess cleaning thoroughness. This study aimed to assess the impact of real-time visual feedback on room cleanliness and efficiency. A pre-post comparison was conducted using RODAC culture plate counts and room turnaround times, with and without the colour additive, at a 160bed hospital (Griffin Hospital, Derby, CT, USA) over 5 weeks in NovemberDecember 2023. The control product was Clorox hypochlorous acid wipes. A total of 400 high-touch surfaces were sampled (200 in the control phase and 200 in the intervention phase), with an average of 26.7 data points per surface. With control wipes, bacterial counts (CFUs) decreased by 60.45%, and the frequency of high-touch surfaces positive before cleaning dropped from 92% to 60%. The number of surfaces with very high counts reduced from 5% to 1%. With coloured test wipes, CFUs decreased by 91.33%, and the frequency of high-touch surfaces positive before cleaning dropped from 92% to 31%. Surfaces with very high counts reduced from 9% to 1%. Overall, coloured wipes improved cleanliness by 69.2% and sped up room turnover by 5.9%. The colour additive did not affect the disinfectant’s microbiocidal activity, indicating better cleaning techniques as the cause of the reduced microbial contamination.
Oremade O et al. The impact of a novel color additive for disinfectant wipes on room cleanliness and turnover time. American Journal of Infection Control 2024;52:1366-1370. 1 2 3
A new dimension of Varnish Gel
A new dimension of Varnish Gel
A new dimension of Fluoride Varnish
A new dimension of Varnish Gel
Profisil® Fluoride Varnish contains 5 % sodium fluoride in a mucosa-friendly, pleasantly flavoured dimethicone gel. This formula is not made with ethyl alcohol* or c (rosin), thus reducing the potential of soft tissue irritation or rosin-based allerg
Profisil® Fluoride Varnish contains 5 % sodium fluoride in a mucosa-friendly, pleasantly flavoured dimethicone gel. This formula is not made with ethyl alcohol* or colophony (rosin), thus reducing the potential of soft tissue irritation or rosin-based allergies.
Profisil® Fluoride Varnish contains 5 % sodium fluoride in a mucosa-friendly, pleasantly flavored dimethicone gel. This formula is not made with ethyl alco which helps prevent the risk of allergic reactions and other ailments
Product Properties
Profisil® Fluoride Varnish contains 5 % sodium fluoride in a mucosa-friendly, pleasantly flavoured dimethicone gel. This formula is not made with ethyl alcohol* or colophony (rosin), thus reducing the potential of soft tissue irritation or rosin-based allergies.
Product Properties
Product Proper ties
Product Properties
This formula is designed to securely adhere to the tooth surface for several hours while releasing fluoride ions up to 24 hours
This formula is designed to securely adhere to the tooth surface for several hours while releasing fluoride ions up to 24 hours
Immediate and continuous fluoride release
Transparent and colourless after applying for optimal aesthetics
Transparent and colourless after applying for optimal aesthetics
This formula is designed to securely adhere to the tooth surface for several hours while releasing fluoride ions up to 24 hours
Constant viscosity and easy to spread
Transparent and colorless after applying for optimal aesthetics
Constant viscosity and easy to spread
Transparent and colourless after applying for optimal aesthetics
Constant viscosity and easy to spread
Constant viscosity and easy to spread
The single dose blister contains sufficient varnish to cover all affected teeth of both arches
The single dose blister contains sufficient varnish to cover all affected teeth of both arches
Patients appreciate the smooth mouth feel and refreshing lubricating properties
The single dose blister contains sufficient varnish to cover all affected teeth of both arches
Profisil® Fluoride Varnish can be applied in any direction to all affected tooth surfaces, migrating even to difficult to access areas
Profisil® Fluoride Varnish can be applied in any direction to all affected tooth surfaces, migrating even to difficult to access areas
Patients appreciate the smooth mouth feel and refreshing lubricating properties
Protective coating to tooth surfaces by occluding tubules with calcium fluoride crystals
Patients appreciate the smooth mouth feel and refreshing lubricating properties
Protective coating to tooth surfaces by occluding tubules with calcium fluoride crystals
No need to dr y the teeth prior to application
Profisil® Fluoride Varnish can be applied in any direction to all affected tooth surfaces, migrating even to difficult to access areas
A prophylactic cleaning is not required prior to use
A prophylactic cleaning is not required prior to use
Profisil® Fluoride Varnish can be easily applied
A prophylactic cleaning is not required prior to use
Unnecessary to dry teeth prior to application of the varnish gel
access areas
Unnecessary to dry teeth prior to application of the varnish gel
Unnecessary to dry teeth prior to application of the varnish gel
Increases fluoride acceptance
Lubricious, non-clumping formula No need to replace gummy brushes
Lubricious, non-clumping formula No need to replace gummy brushes
Lubricious, non-clumping formula No need to replace gummy brushes
Unnecessar y to dr y teeth prior to application of the varnish gel
Product range
The varnish is available in following versions:
Won‘t clog suction lines
Product range
Product range
BER RY UNF LAVORE D
Lubricious, non-clumping formula
The varnish is available in following versions:
The varnish is available in following versions:
Available as single dose unit incl. a brush for easy application.
No need to replace gummy brushes
Available as single dose unit incl. a brush for easy application.
k
Protective coating to tooth surfaces by occluding tubules with calcium fluoride crystals
No bitter taste or burning not made with ethyl alcohol*
No bitter taste or burning not made with ethyl alcohol*
Great taste and texture that provides a smooth mouth feel that patients will love
No bitter taste or burning not made with ethyl alcohol*
Non-allergenic dimethicone formula
Available as single dose unit incl. a brush for easy application. MINT BER RY UNF LAVORE D
Mint Normal Pack
Mint N ormal Pa ck
Berry Normal Pack
ALWAYS READ THE LABEL AND FOLLOW THE DIRECTIONS FOR USE.
* ‘Mint’ and ‘Unflavored’ are not made with ethyl alcohol, ‘Berry’ may contain traces of ethyl alcohol.
J.Wisbey & Associates Pty
Non-allergenic dimethicone formula
Protective coating to tooth surfaces by occluding tubules with calcium fluoride cr ystals
Suitable for all ages and for children with primary teeth
Non-allergenic dimethicone formula
Suitable for all ages and for children with primary teeth
No stinging, burning or bitter after taste not made with ethyl alcohol
Suitable for all ages and for children with primary teeth
Patients can immediately resume eating and drinking*
of 30 x 0.5ml (10 x Mint, 10 x Berry, 10 x Unflavoured)
of 50 x 0.5ml Single Dose Blister Pack
Mint Normal Pack Box of 50 x 0.5ml Single Dose Blister Pack Berry Normal Pack
Unflavoured Normal Pack
MINT BER RY UNF LAVORE D Unflavoured N ormal Pa ck
Unflavoured Normal Pack
ALWAYS READ THE LABEL AND FOLLOW THE DIRECTIONS FOR USE.
‘Mint’ and ‘Unflavored’ are not made with ethyl alcohol, ‘Berry’ may contain traces of ethyl alcohol.
Box of 50 x 0.5ml Single Dose Blister Pack
Box of 50 x 0.5ml Single Dose Blister Pack
Box of 50 x 0.5ml Single Dose Blister Pack Berry N ormal Pa ck Box of 50 x 0.5ml Single Dose Blister Pack
Box of 50 x 0.5ml Single Dose Blister Pack Box of 50 x 0.5ml Single Dose Blister Pack
*Avoid hot liquids , hard crunchy foods and alcohol.
ALWAYS READ THE LABEL AND FOLLOW THE DIRECTIONS FOR USE. * ‘Mint’ and ‘Unflavored’ are not
J.Wisbey & Associates Pty Ltd trading as WISBEY DENTAL / ABN 98 052 034 238 Suite 17, 265-271 Pennant Hills Rd, Thornleigh NSW 2120. PO Box 291, Thornleigh. NSW T: + 61 2 9875 5588 www.wisbeydental.com
AKT14804
AKT14806
Box of 50 x 0.5ml Single Dose Blister Pack AKT14802
Combi pack
Box of 30 x 0.5ml (10 x Mint, 10 x Berry, 10 x Unflavoured) AKT14801
Combi pac
Box
Cologne hosts 41st IDS on March 25-29
FFrom 25-29 March 2025, the International Dental Show is again taking place in Cologne for the 41st time and will once again underline its position as the world’s leading trade fair for dentistry and dental technology.
Organised by the GFDI (Gesellschaft zur Förderung der Dental-Industrie mbH) and staged by Koelnmesse, IDS brings the most important players of the dental profession, the dental technology trade, the dental specialised trade and the dental industry together and offers a unique platform for innovations, networking and knowledge transfer.
Intensive marketing and sales activities have particularly been executed in South America, Asia and the USA
to further establish IDS as the leading global trade fair. With around 2,000 exhibitors from over 60 countries and a foreign share of around 77%, IDS 2025 is currently demonstrating its strong international alignment. The most strongly represented countries among the exhibitors are expected to be Korea, Italy, the USA, China, Turkey, Spain, France and Switzerland. The offer is enhanced by numerous country pavilions from all continents. The strong demand from home and abroad shows that as a platform for innovations, market trends and as a central business platform, IDS is the decisive management tool for the global trade.
The newly optimised hall layout with four entrances and an expansive exhibition space spanning 180,000 square metres across multiple halls offers ideal conditions for an efficient visit to the trade fair. IDS offers extensive services to make the trade fair experience as pleasant as possible for visitors.
In terms of visitors, IDS also remains a global highlight: In 2023 around 120,000 trade visitors from 122 countries attended the trade fair – IDS 2025 aims to exceed this benchmark.
Whilst the presentation of products continues to be of key importance, IDS sees itself as being far more than purely a product show, it considers itself to be an integrative network that promotes an exchange about central industry themes. The focus lies on current challenges such as the promotion of young talents, the lack of skilled labour, sustainability and the implementation of artificial intelligence.
For more information, visit the IDS 2025 website at www.ids-cologne.de
n Australia and New Zealand have over 25,000 dental practitioners
n dentist.com.au and dentist.co.nz lists every practitioner free of charge
n For 20 years, the Australian public has relied on www.dentist.com.au to find and connect with you. Now we have introduced the service to New Zealand
n Over 1 million searches are made every year
n Visit dentist.com.au or dentist.co.nz to check your details are correct
n Visit www.dentalcommunity.com.au and login to update your details any time without cost
Call (02) 9929 1900 or email info@dentist.com.au
Waterpik™ Water Flosser: Twice as effective as string floss for reducing gingival bleeding
The effect of interdental cleaning devices on plaque biofilm and gingival bleeding
Objective
To evaluate the efficacy of a manual toothbrush plus a Waterpik Water Flosser versus a manual toothbrush plus traditional floss, to reduce gingival bleeding and plaque biofilm..
Methodology
One hundred four subjects participated in this 30-day, randomized, single blind study. Group A used a Waterpik Water Flosser with the Classic Jet Tip plus a manual toothbrush, Group B used a Waterpik Water Flosser with the Plaque Seeker Tip plus a manual toothbrush, and Group C used waxed string floss plus a manual toothbrush. Subjects brushed twice daily and used either the Water Flosser or floss once daily in the evening. Gingival bleeding and plaque biofilm were evaluated at 14 and 30 days.
Results
After fourteen days, used in conjunction with manual toothbrushing, the Waterpik Water Flosser with the Classic Jet Tip was twice as effective as traditional floss at reducing gingival bleeding. At thirty days, the relative improvement in gingival bleeding for the Water Flosser groups was even more dramatic. There were no significant differences between the Waterpik Water Flosser Classic Jet Tip and the Plaque Seeker Tip
Conclusion
The Waterpik Water Flosser is a more effective alternative to traditional dental floss for reducing gingival bleeding and improving oral health.
To book your free Waterpik™ Professional Education Session, visit www.waterpikshop.com.au/lunch or take advantage of the Waterpik Professional Trial Offer, visit www.waterpikshop.com.au
Inner ergonomics - a practical recipe to career longevity
By Dr Anikó Ball, BDSc (Melb), Dip.Clin.Hypnosis, Adv.Dip. Alexander Studies
Wrldwide research shows an alarming incidence of musculoskeletal disorders in dentistry, resulting in early retirement or reduced work hours for many and a career change for some.
Ergonomic research and design have focused on dentists’ work environment - the so-called Outer Ergonomics, overlooking the importance of their efficiency in posture and movement - the Inner Ergonomics.
HOW a dentist sits on a stool and bends over the dental chair is as important as the stool and chair design. The WAY instruments are held is as important as the shape and the weight of the instrument.
Dental schools don’t provide a “User Guide” on how to bend over patients and what to do with shoulders and arms to ensure career longevity. An understanding of how your body was designed to work, especially during work postures held for prolonged periods, is essential.
OUser Guide for the spine
nce you know that all the intervertebral joints below C2 (just under ear level) are gliding joints, which are not designed for prolonged bending, you will want to avoid work postures that involve bending forward and leaning to the side. Intervertebral discs are distorted when the spine is bent and twisted, resulting in cumulative trauma and a high risk of developing a pain syndrome.
Unless you are using refractive loupes or an operating microscope, you cannot sit upright and see into patients’ mouths without spinal trauma.
Working with nonrefractive loupes or without loupes, you need to pivot your torso slightly forward at the hip joints, without bending the spine and look down by rotating your head at the atlanto-occipital joint (at ear level). As there is only a 10-degree freedom for downward head rotation available at this joint, non-refractive loupe users need an adequate declination angle to avoid compensatory neck bending.
User Guide for shoulders and arms
Most dentists work with a raised non-dominant shoulder and elbow.
The muscles moving the shoulders and arms are designed for a short contraction. Prolonged use of movement muscles to hold up the shoulder, or the arm against gravity when hovering with the mouth mirror without a finger rest, results in cumulative trauma. Always have a finger rest and don’t raise your shoulder or elbow.
Take care of yourself, you are your most precious instrument.
Dr Anikó Ball is the Founder of Optimum Dental Posture. For info, see www.optimumdentalposture.com
clinical photography MASTERCLASS
Presented by Dr Angelo Lazaris
SYDNEY
Whether it be creating the WOW in case presentations, communicating with his dental laboratories globally, documenting his work or giving patients the feel good factor after treatment, clinical photography is a well-practised art for Dr Angelo Lazaris and a vital skill for every aesthetic and cosmetic dentist...
Unlike other digital technologies, clinical photography demands a significant degree of user input and technical skill in order to produce photographs that are clinically relevant and diagnostic. This hands-on workshop has been developed to equip participants with the skillsets required to produce high quality, reproducible and clinically relevant photographic records through a standardised workflow that can be implemented in practice with immediate effect.
Dr Angelo Lazaris
BDS (Hons) (Syd), MSc (Aes) (Kings College)
Angelo has developed his own complete digital protocols from inception and design through to delivery and integrated these with biomimetic adhesive dentistry and contemporary restorative materials to create a complete clinical workflow that is equally applicable to single restorations, through to complex full mouth rehabilitations, culminating in outstanding clinical outcomes in a real-world commercial environment. His innovative approach to clinical dentistry is to start at the desired
endpoint, deconstruct complex treatments and develop solutions have made him a sought after KOL, educator and mentor. With appointments including honorary senior lecturer for Kings College London and the University of Sydney, Angelo has recently been assigned as course director for a post graduate diploma and masters degree in digital dentistry; a testament to his expertise and the influence of this discipline in dental practice.
The heart of the matter: How oral health impacts cardiovascular disease
By Tabitha Acret, BOH, Grad.Cert (Public Health), Current Master’s Student
Heart disease remains the leading cause of death worldwide, claiming over 18 million lives each year (WHO, 2023).
Traditionally, we’ve been told that cholesterol is the main culprit behind heart attacks and strokes. But new research is revealing a missing piece of the puzzle—inflammation. More specifically, the chronic inflammation caused by periodontal disease may be a silent driver of cardiovascular disease, putting millions at risk.
As dental and medical professionals, we can’t afford to ignore this connection any longer. If we truly want to prevent heart attacks and strokes, we need to start looking beyond cholesterol levels and toward a hidden culprit in the mouth—oral pathogens.
The oral-systemic link: What the research tells us
M ost people think of heart disease and periodontal disease as separate conditions, but research shows they are deeply intertwined. Studies by Drs Bradley Bale and Amy Doneen challenge the traditional understanding of cardiovascular disease, showing that it’s not just high cholesterol that causes heart attacks—it’s inflammation and bacterial invasion of the arteries.
Here’s how it works:
• Oral bacteria like Porphyromonas gingivalis, Fusobacterium nucleatum and Treponema denticola don’t just stay in the mouth. They can enter the bloodstream through infected tissues in the mouth;
• Once in circulation, these bacteria invade arterial walls, triggering an immune response; and
• The immune system creates arterial plaque as a protective mechanism. Over time, this plaque softens and ruptures, leading to sudden heart attacks and strokes.
Even more concerning, half of heart attacks occur in people with normal cholesterol levels (Bale & Doneen, 2016). This means that standard cardiac screenings—focused on cholesterol— may be missing a significant number of high-risk individuals.
Why traditional heart screenings miss the mark
Despite these findings, most routine heart screenings don’t measure for inflammation or bacterial activity. In countries like Australia, standard assessments typically include:
• Cholesterol levels;
• Blood pressure; and
• BMI and lifestyle risk factors.
What they don’t include is a way to identify inflammatory burden or detect bacterial invasion of the arteries—key drivers of cardiovascular events.
If we want to change the way we approach heart disease prevention, we need to start incorporating salivary diagnostics and advanced biomarker testing.
The game-changer: Salivary testing for heart disease risk
I magine if a simple saliva test at the dental surgery could help predict heart attack and stroke risk before symptoms ever appear. That’s no longer science fiction—it’s a real possibility with today’s advances in salivary diagnostics. Salivary testing can detect:
• Pathogenic bacteria (P. gingivalis, F. nucleatum, T. denticola)—known to trigger arterial inflammation;
• Inflammatory markers (IL-6, TNF-α, MMP-8, CRP)—associated with arterial plaque vulnerability; and
• Genetic predisposition (IL-1 genotype) —which influences how aggressively the body responds to inflammation. For example, studies have shown that patients with elevated MMP-8 levels (a marker of collagen breakdown in the gums) are also more likely to have unstable arterial plaque, putting them at a higher risk of heart attack and stroke (Gursoy et al., 2021).
3. Educate patients beyond brushing and interdental cleaning. Explaining the connection between gum health and heart health can motivate patients to take periodontal treatment seriously. Shift the focus from teeth to total-body wellness. Treating periodontal disease isn’t just about preventing tooth loss— it’s also about reducing potentially lifethreatening inflammation.
If we can identify these high-risk patients early, we have an opportunity to intervene before disaster strikes.
The dental professional’s role in saving lives
Dental professionals are on the front line of disease prevention—often spotting the signs of chronic inflammation before a patient’s physician does. So how can we take action?
4 practical steps for dental professionals
1. Start testing for salivary biomarkers in periodontal assessments. Identifying high levels of pathogenic bacteria could be a red flag for systemic health risks. Unfortunately we don’t currently have a lab in Australia but we can send to the USA where saliva testing is much more common;
2. Collaborate with cardiologists and GPs. Patients with periodontal disease and high inflammatory markers should be referred for advanced cardiovascular risk assessments; and
A call to action: Changing the narrative on heart disease
Let’s move beyond the narrow focus on cholesterol and start talking about the bigger picture—inflammation and its roots in oral health. The evidence is clear: Salivary testing and periodontal care should be part of every heart disease prevention strategy.
As healthcare providers, we have an incredible opportunity to transform lives—not just by treating periodontal disease but by preventing heart attacks and strokes before they happen. The question is: Are we ready to step up?
Join the Conversation! Have you seen the perio-heart connection in your practice? Are you using salivary diagnostics? Share your experiences and insights— I would love to hear from you! Email me at tabithaacret@gmail.com
Make sure you check out our latest episode of Disrupting Dentistry Podcast where we chat about this in detail!
Question 1. What is the leading cause of death worldwide?
a. Cancer
b. Diabetes
c. Heart disease
d. Stroke
Question 2. What is the primary new factor identified in the article that contributes to heart disease?
a. High cholesterol levels
b. Inflammation caused by periodontal disease
c. High blood pressure
d. Poor lifestyle choices
Question 3. Which of the following bacteria are associated with periodontal disease and heart disease?
a. Streptococcus pneumoniae
b. Porphyromonas gingivalis
c. E. coli
d. Staphylococcus aureus
Question 4. What key diagnostic tool is suggested for identifying heart disease risk in the article?
a. X-rays
b. Electrocardiogram
c. Blood glucose levels
d. Salivary testing
Question 5. Why do traditional heart screenings miss high-risk individuals?
a. They focus too much on cholesterol levels.
b. They don’t account for genetic predispositions.
c. They don’t measure inflammation or bacterial activity.
d. They rely on outdated technologies.
INSTRUCTIONS:
Question 61. What has been a major factor contributing to the shortage of dental assistants in Australia over the past five years?
a. Increase in dental school graduates.
b. The COVID-19 pandemic.
c. A decrease in dental insurance coverage.
d. A surplus of dental assistants in other countries.
Question 7. Which technology is highlighted in the article for tracking changes in tooth shade and dental plaque over time?
a. Intraoral cameras
b. Optical Coherence Tomography (OCT)
c. 3D intraoral scanners
d. Fluorescence diagnostics
Question 8. What is one potential benefit of Optical Coherence Tomography (OCT) in dental practice?
a. It uses ionizing radiation for high-resolution imaging.
b. It requires a special laser use license.
c. It has low resolution compared to other imaging technologies.
d. It can replace up to 75% of traditional intraoral radiographs.
Question 9. Which of the following is NOT mentioned as part of sustainable dental practices discussed in the article?
a. Using single-use disposable gowns.
b. Recycling polypropylene surgical wraps.
c. Reducing plastic waste generation.
d. Reusable surgical masks and respirators.
Question 10. What role might dental assistants play in the future regarding sustainability in dental clinics?
a. They will be responsible for diagnosing oral diseases.
b. They will help segregate materials for recycling.
c. They will be in charge of the technological development of dental tools.
d. They will oversee the marketing of sustainable dental products.
Question 11. What is the main purpose of A-dec’s end-to-end asepsis program?
a. To improve the speed of dental procedures.
b. To increase patient satisfaction.
c. To provide aesthetic improvements to dental equipment.
d. To maintain the dental units and ensure they do not pose a risk of infection.
Question 12. Which product does A-dec recommend using daily to maintain dental unit water lines?
a. ICX tablets
b. AlphaSan tubing
c. ICX Renew
d. Brass control block
Question 13. How often should water be tested in the dental unit according to A-dec’s guidelines?
a. Once a week.
b. Once a month, or every six months based on results.
c. Once every two months.
d. Only when the water quality seems poor.
Question 14. What is the function of the “Vaporiser” feature in the A-dec Pro delivery systems?
a. It increases the speed of dental handpieces.
b. It disinfects the dental unit water lines.
c. It purges the turbine with a blast of high-speed air to prevent contamination.
d. It reduces the noise produced by handpieces.
Question 15. What does the Pro delivery system’s “auto flush” do?
a. It increases water flow during procedures.
b. It purges all tubing to ensure only fresh water is in the water lines.
c. It cleans the dental unit after each use.
d. It monitors water temperature during treatment.e
Question 16. What is one of the key tasks of staff in the reprocessing area after sterilisation?
a. To inspect the packaging for tampering.
b. To check that the sterilised load meets the required standards.
c. To ensure that all items are properly labeled.
d. To perform the sterilisation cycle again if any errors are found.
Question 17. What can cause a weak seal in paper-plastic pouches used in sterilisation?
a. Using too much paper in the wrap.
b. Not inspecting the load before sterilisation.
c. Overfilling the pouch.
d. Using excessive heat in the steriliser.
Question 18. Why is it important to record the weight of the sterilisation load?
a. To prevent overloading the steriliser and ensure proper sterilisation temperature.
b. To ensure the items fit inside the steriliser.
c. To comply with sterilisation regulations.
d. To track the expiry date of the items.
Question 19. What is the purpose of using chemical indicators is...
a. To determine the weight of the sterilised items.
b. To provide a final check to confirm that steam has reached the wrapped items.
c. To verify the temperature inside the steriliser.
d. To record the cycle number.
Question 20. What should be avoided when cooling sterilised items before storage?
a. Storing the items in plastic containers.
b. Placing the items directly on a flat bench surface.
c. Storing the items in a humid environment.
d. Checking the expiry date of the sterilised items.
dentevents presents...
Infection Control BOOT CAMP
29 VIDEOS - 8+ HOURS OF EDUCATION
Presented by Emeritus Professor Laurence Walsh AO BDSc, PhD, DDSc, GCEd, FRACDS, FFOP (RCPA), FFDT (RCS Edin)
8
Learn from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control including from the Dental Board of Australia (July 2022), the ADA (4th edition guidelines August 2021 and the ADA Risk management principles for dentistry during the COVID-19 pandemic (October 2021)), the new guidelines from NHMRC (May 2019), Hand Hygiene Australia (Sept 2019) and the CDNA (Dec 2018) as well as recent changes in Australian Standards and TGA regulations that are relevant to infection control. The course provides a summary of how those changes interlink with one another and also covers practical implementation of the new requirements and what it means for everyday dental practice. Hear about the why and the how and keep up-to-date with the changes that are happening.
COURSE TOPICS
This one day course will cover changes in regulations and guidelines from 2018 to 2022 including:
n Risk-based precautions.
n Hand hygiene and hand care practices.
n Addressing common errors in personal protective equipment.
n Biofilm reduction strategies.
n Efficiency-based measures to improve workflow in instrument reprocessing and patient changeover.
n Correct operation of mechanical cleaners and steam sterilisers.
n Wrapping and batch control identification.
n Requirements for record keeping for instrument reprocessing.
n Correct use of chemical and biological indicators.
Laurie Walsh is a specialist in special needs dentistry who is based at the University of Queensland in Brisbane, where he is an emeritus professor. Laurie has been teaching and researching in the areas of infection control and clinical microbiology for over 25 years and was chief examiner in microbiology for the RACDS for 21 years. His recent research work includes multiple elements of infection control, such as mapping splatter and aerosols, COVID vaccines and novel antiviral and antibacterial agents. Laurie has been a member of the ADA Infection Control Committee since 1998 and has served as its chair for a total of 8 years, across 2 terms. He has contributed to various protocols, guidelines and checklists for infection control used in Australia and represented dentistry on 4 committees of Standards Australia and on panels of the Communicable Diseases Network of Australia and of the Australian Commission on Safety and Quality in Health Care.
REGISTRATION
n On-Demand access to 29 Online Learning Videos (Over 8 hours of education).
n Watch and re-watch at your leisure 24/7
n Digital Online Learning Companion.
n Digital Suggested Reading Material.
n Online Questionnaire to earn 8 Hours of CPD.
Oral Hygiene Abstracts 2025
By Emer. Prof. Laurence Walsh AO
Getting close to patients during treatment
Dental health care workers face heightened risks of respiratory infections due to their close proximity to patients’ oral and respiratory tracts, where respiratory infections are predominantly transmitted through close contact, typically defined as being within 1.5 metres. Exposure levels and risks during close contact are closely associated with patterns such as interpersonal distance, contact time, relative facial orientation and relative position. Despite the significance of these interaction patterns, there is a notable lack of research specifically addressing these dynamics between dental HCWs and patients. An observation study was conducted at a hospital in Shenzhen, China, utilising depth cameras (3 frames per second) with machine learning to capture closecontact behaviours of patients with HCWs. Additionally, questionnaires were administered to collect patient demographics. The study included 200 patients, 10 dentists and 10 dental assistants. Patients had significantly higher close-contact rates with dentists (97.5%) compared with dental assistants (72.8%, P<0.001). The reason for the visit significantly influenced patientpractitioner (P=0.018) and patient-assistant (P=0.007) close-contact time, with the highest values observed in prosthodontic and orthodontic patients. Furthermore, patient age also significantly impacted the close-contact rate with dental assistants (P=0.024), with the highest rate observed in patients below 14 years old at 85% [range: 70-93%]. These rates were significantly higher than close contact rates in other indoor environments, such as subways during peak hours (42.9%), and working in offices (33.7%). Thus, dental outpatient departments exhibit high HCW-patient close-contact rates, influenced by visit purpose and patient age. When such younger patients are being treated, dental assistants play a crucial role in providing psychological counselling and behaviour control for children and these increase the opportunities for patient close contact with assistants. More intricate clinical processes with prolonged treatment durations cause increased close-contact time with the dentist, thereby augmenting the risk of disease transmission. Enhanced infection control measures are warranted, particularly for prosthodontic and orthodontic patients or those below 14 years old.
Zhao F et al. What influences the close contact between health care workers and patients? An observational study in a hospital dental outpatient department. American Journal of Infection Control 2024;52:1296-1301.
Omicron and repeated COVID-19 boosters
The Omicron variant of SARS-CoV-2, which causes COVID-19, is associated with increased transmission and with reduced potency of neutralising antibodies, when compared to other circulating SARS-CoV-2 variants. This study systematically evaluated the effectiveness of currently available mRNA vaccines and boosters for the Omicron variant, based on literature published on PubMed, Embase, Web of Science and preprint servers (medRxiv and bioRxiv).
The Omicron variants blunt the potency of neutralising antibodies more extensively than other circulating SARS-CoV-2 variants, making vaccines less effective against these variants. The pooled effect estimate was calculated by the random-effects model. A total of 3,156 publications were screened for eligibility. A total of 34 eligible studies were included in the meta-analysis, including 10 cohort studies, 22 testnegative case-control studies and 2 case-control studies. The majority of studies (22 articles) were produced in the USA. For vaccination protocols with 2 doses, the vaccine effectiveness (VE) against severe infection with any Omicron strain was 63.80% (49.55% for adolescents, 62.80% for adults, 75.83% for the elderly and 64.52% for the general population. For 3 doses, the VE was higher at 87.22% for protection from severe infection (81.18% for adults, 89.89% for the elderly, and 86.80% among the general population). Six months after the last vaccine dose, the protection for the 2 dose protocol declined to 60.43%, while with the 3 vaccine doses, after six months the VE was greater at 73.39%. Hence, the 3-dose protocol continued to provide longer and more effective protection. This was especially so for elderly patients, who are a high risk group for severe complications and death from COVID-19. Many countries have now implemented booster policies for older adults. Moreover, in some countries a fourth dose of BNT162b2 (Pfizer) mRNA vaccine has been implemented to provide additional protection against COVID-19 infection and death in the elderly. Obviously, new strains will continue to emerge over time. The efficacy of the existing vaccines is further reduced due to the immune evasion of the strain. Hence, further attention should be directed to challenge of new strains that emerge as potential threats to health.
Guo K et al. Effectiveness of mRNA vaccine against Omicron-related infections in the real world: A systematic review and metaanalysis. American Journal of Infection Control 2023;51:1049-1055.
Emerging roles for dental assistants over the next decade
By Emeritus Professor Laurence J. Walsh AO
Dental assistants perform an invaluable role in providing safe and effective patient care. Over the past 5 years, in many areas of Australia there has been a developing shortage in dental assistants. Some of this has been attributed to the COVID-19 pandemic and the potential attraction of other forms of employment, in the wider context of a skilled worker shortage across Australia. Of note, there has not been a shortage of dental assistants in the UK over the same period.
A major difference is that dental assistants are registered in the UK under the General Dental Council and this provides a more regimented career structure for them, as well as recognition as part of the health workforce. Undoubtedly this is something that will be explored in Australia over the coming years.
This article focuses on the ways that dental assisting roles may change over the coming decade because of the impact of major forces that are shaping clinical practice, with a particular focus on new technologies and moves to more sustainable practice.
Figure 1. Examples of dental assistant additional tasks for risk assessment. Panel A: Point-of-care saliva-based diagnostics including RAT tests. Panel B: Violet light fluorescence imaging of mature dental plaque biofilm, which appears as red deposits. Panel C: GC Tri-Plaque ID gel showing light blue staining of the biofilm for areas of extreme caries risk.
Patient work-up in the operatory
a. 3D scans
There is growing interest in the use of a range of tools to help assess the risk for oral disease, so that approaches to active treatment and dental maintenance can better be tailored to the needs of the individual patient. Existing technologies such as 3D intraoral scanners can form part of this. Sequential 3D scans can be used to assess changes in hard and soft tissues, to track problems such as non-carious tooth structure loss and gingival recession. In such applications, the use of software and artificial intelligence is paramount because of the need to compare many points across the sequential scans.
3D scans that are taken in colour also provide the opportunity to track changes in tooth shade, including changes due to ageing and discolouration due to endodontic problems.
In a similar way, dental plaque deposits that have been stained with GC TriPlaque ID™ gel can be recorded using colour 3D scans. The colour patterns show whether there is imbalance (dysbiosis linked to acid production and caries risk) in the dental plaque biofilm. Tracking changes in the colour of teeth or in the colour of the stained dental plaque is something that AI software could be very useful for.
Dental assistants already do 3D scans, so there is a nascent opportunity for greater analysis of these scans, to present the clinician with information regarding subtle changes over time.
b. Fluorescence diagnostics
There are many dental devices that use violet light induced fluorescence as part of the diagnostic process, with intraoral cameras being the most widely used of these.
Figure 2. Initiatives in sustainable dental practice from the World Dental Federation, including a massive open online course, case studies, and practice-level resources.
Analysis of such fluorescent images provides a useful way of tracking the distribution of thick mature deposits of dental plaque biofilm, without the need to use a disclosing dye. These thick deposits have high levels of bacterial porphyrins, giving strong red fluorescence signals when excited by violet light.
Dental assistants can already use an intraoral camera to make recordings or videos of a patient’s intraoral situation, both within the clinic itself as well as in extra-mural settings such as with teledentistry.
Monitoring the distribution of plaque over time can provide valuable insights into a patient’s oral hygiene habits. This would then naturally bridge to the work of dental assistants who have completed a certificate 4 in oral health promotion, who would then be able to provide the patient with oral hygiene advice.
c. Point of care assessment of biological samples
The pandemic has highlighted the usefulness of rapid antigen tests and point-of-care diagnostic devices. These types of technologies can be deployed into clinical practices and applied to samples of saliva, crevicular fluid and microdroplets of blood collected with a periodontal probe from a site with gingival inflammation. Chairside diagnostic devices can undertake more sophisticated analyses, using microfluidic technologies. This can allow rapid analysis of samples of dental plaque for the presence and levels of key pathogenic bacterial species. This is a logical extension of the work that dental assistants already do in assessing samples of saliva for their chemical properties.
Od. OCT imaging
ptical Coherence Tomography (OCT) is used widely in medicine for rapid non-invasive non-ionising imaging of both soft and hard tissues. It provides exceptionally high resolution - in the order of 4 µm - which is similar to histology and superior to other imaging modalities including ultrasound, cone beam imaging and MRI imaging. The technique for using a dental OCT system is almost identical to using a 3D intraoral scanner. In fact, OCT scans provide high resolution surface details that can be used to fabricate various restorations and appliances, eliminating the need for 3D scans as we currently use them. OCT imaging systems use LEDs or very low power diode lasers and no user license is required. Hence, there are no barriers to an OCT scan being done by a dental assistant as part of the patient work-up. Because of the penetrating nature of the near infrared light used for OCT, it has been estimated that OCT imaging could replace up to 75% of traditional intraoral radiographs, such as bitewings and periapical radiographs. OCT images can assist in almost all types of oral diagnostic procedures and they do not attract concern or alarm from patients because the near infrared light is non-ionising and the light sources used are also eye-safe. This is why ophthalmology is one of the largest users of OCT for the diagnosis of retinal and corneal diseases and conditions. A typical OCT eye scan takes less than 0.5 seconds and existing prototype dental OCT systems can image an individual molar tooth in one second or less. The fact that OCT is a mature technology with many decades of use in medicine will make its adoption into dental practice relatively smooth.
Table 1. Dental assistant activities
• Take sequential 3D scans and submit to software for evaluation.
• Take violet light fluorescence images and submit to software for evaluation.
• Collect oral samples and process using a point-of-care device.
• Undertake OCT scans of individual teeth and of identified areas of concern.
• Use Nuralyte to induce analgesia immediately before dental procedures.
• Operate washer-dryer unit to reprocess reusable masks and respirators.
• Operate washer-dryer unit to reprocess reusable cloth gowns.
Sustainable dental practice
The second major area of development that is already reshaping dental practice and will affect the working lives of dental assistants in the future are moves to more sustainable dental practice. At the international level, the World Dental Federation (FDI) has led numerous initiatives in this area and likewise, the Australian Dental Association has spearheaded a range of activities to highlight the importance of sustainability considerations. As just one example of this, the 2021 edition of the ADA Guidelines for Infection Prevention and Control were the first national dental guidelines in the world to include specific considerations around sustainability.
As efforts grow to develop additional recycling streams, dental assistants will play an increasingly important role in the segregation of materials. To cite just one example, polypropylene (PP) is a widely used plastic polymer material that forms the foundation of disposable gowns, surgical masks and respirators and nonwoven wrapping materials for sterile instruments sets (such as KimGard™). There has been considerable interest in developing methods for recycling polypropylene. Once in the environment, its remarkable resistance to chemicals and degradation poses long-term issues for waste management. Nevertheless, it can be readily recycled using pressure and temperature to regenerate blocks of polypropylene from items used in healthcare, which can then be reused. Several pilot programs have already been undertaken successfully in Australia to collect polypropylene surgical wraps from operating theatres and these have proven to be highly effective and easy to implement for staff. Similar types of programs will likely be rolled out for small scale producers of polypropylene waste such as dental clinics, over the coming years. How far this thinking could extend into recycling the components of paper-plastic pouches remains to be explored. At the present time, there is considerable discussion at the international level around measures that reduce plastic waste. Dental assistants can champion initiatives in clinics that reduce plastic waste generation. An example of this would be to convert from using disposable plastic high-volume evacuation tips back to reusable plastic polymer tips or stainless steel suction tips.
Another example of sustainable dental practice is to move from single use polypropylene gowns for nonsurgical dental procedures back to cotton-based reusable gowns. These could be laundered within the practice, using a modern high-efficiency upright washer-dryer unit.
Figure 3. An example of washable reusable masks that withstand 100 cycles of machine washing without performance degradation, from etrema in Canada.
A further example is the recent development of surgical masks and respirators which can be washed and reused up to 100 times, such as the eTECH by Etrema in Canada, without degradation in their fluid resistance or their microbial filtration performance. If such products become approved and adopted in Australia, the logic around having a washer-dryer unit located within the dental practice becomes even stronger.
Finally, the activities of dental assistants both within the operatory and also at the “back of house” will likely change as more emphasis is placed on reducing the movement of patients and clinic supplies, since these represent a very large part of the overall environmental impact of a dental clinic, when measured in terms of greenhouse gas emissions.
“The activities of dental assistants both within the operatory and also at the ‘back of house’ will likely change as more emphasis is placed on reducing the movement of patients and clinic supplies, since these represent a very large part of the overall environmental impact of a dental clinic, when measured in terms of greenhouse gas emissions...”
Having longer patient visits where more work is done in a single appointment is a likely direction for the future for some parts of general dental practice. This can be facilitated by technologies such as the Nuralyte™ (from Dentroid in Canberra) that provides rapid onset potent analgesia for dental procedures in different areas of the mouth in the one appointment, without the need for injections of local anaesthetic. This light-based technique does not use a laser and so does not require a laser use license to operate. It is used in the same manner as a traditional curing light, which is a technique already familiar to dental assistants.
Conclusions
As dental practice continues to evolve over time, dental assistants will need to adapt and change. Their tasks may alter, to include new tasks not currently undertaken (Table 1), but the fundamental characteristics that make an excellent dental assistant will remain the same. Those who are eager to learn and take on new tasks will find that the next decade will offer a range of opportunities that invigorate their role.
Recommended further reading for the topics discussed in this article:
Oral diagnostics
1. Walsh LJ. Saliva as the ultimate analyte for the dental professional. Auxiliary 2014; 24(2):22-24.
2. Walsh LJ. Recent developments in chairside diagnostics for dental plaque assessment. Auxiliary 2009; 19(5):28-30.
3. Walsh LJ. Chairside rapid immunoassay testing for Streptococcus mutans: A new tool in caries risk assessment. Australasian Dental Practice 2008; 19(6):118-120.
Fluorescence
4. Walsh LJ. New paradigms for assessing caries risk and lesion activity. Auxiliary 2011; 21(3): 28-33.
5. Walsh LJ. Fluorescence applications in dentistry: current status and future prospects. Australasian Dental Practice 2013; 24(3):62-64.
6. Walsh LJ. Caries diagnosis aided by fluorescence. In: Arkanslan Z (Ed) Dental Caries - Diagnosis and Management. Croatia: InTech Publishers, 2018. Chapter 7, pp. 97-115.
OCT
7. Walsh LJ. New developments in optical imaging: bringing the invisible to light. Australasian Dental Practice 2010;21(6): 50-54.
8. Shakibaie F, Walsh LJ. Optical diagnostics to improve periodontal diagnosis and treatment. In: Manakil J (Ed) Periodontology and Dental Implantology. Croatia: InTech Publishers, 2018. Chapter 4, pp. 73-86.
Sustainability
9. Walsh LJ. Reusable personal protective equipment viewed through the lens of sustainability International Dental Journal 2024; 94 (Suppl 2): S446-S454.
10. Walsh LJ. Current challenges in environmental decontamination and instrument reprocessing. International Dental Journal 2024; 74 (Suppl 2): S455-S462.
11. Walsh LJ. Sustainability in dentistry: Part 1. Plastics and biodegradability. Australasian Dental Practice 2023; 34(3):112-116.
Nuralyte analgesia
12. Kulkarni S, Walsh LJ, Bhurani Y, George R. Assessment of the onset of analgesia and length of analgesia following the use of PBM with different wavelengths: A clinical study. Lasers in Medical Science. 2024; 39(1):236.
13. Sleep SL, Walsh LJ, Zuaiter O, George R. PBM for dental analgesia and reversal from injected local anesthetic agents: A systematic review. Lasers in Dental Science 2024;8:52.
About the author
Emeritus Professor Laurence J. Walsh AO is a specialist in special needs dentistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Dentistry, including 21 years as Professor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical microbiology. Laurie has served as Chief Examiner in Microbiology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years. His published research work includes over 400 journal papers, with a citation count of over 20,000 citations in the literature. Laurie holds patents in 8 families of dental technologies. He is currently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recognition of his contributions to dentistry.
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A-dec sets standard in infection control
By David Petrikas
When it comes to infection control in the dental surgery, A-dec has you covered.
As one of the world’s most respected manufacturers of dental equipment, A-dec has also developed a comprehensive end-toend asepsis program to make sure your dental units are fully maintained and do not pose a risk of infection to your staff or patients. In keeping with ADA Guidelines, A-dec recommends a three-step “Maintain, Monitor & Shock” approach to keeping water lines clean.
STEP 1: Maintain
A-dec provides the tools to maintain dental unit water lines on a daily basis using A-dec’s convenient ICX tablets. Each time you refill the dental unit water bottle, you simply drop in an ICX tablet directly into the water bottle to ensure the water is effectively treated against microbial contamination.
STEP 2: Monitor
Monitoring requirements will depend on your water quality and the clinic’s individual requirements. Initially, test water once a month. If the results pass your specified action level (i.e. 200 CFU/mL using the ADA guidelines), then reduce the testing protocol to at least every six months.
A-dec’s authorised dealers can offer a digital water testing service to diagnose dental unit waterline quality on the spot. Once treated with ICX Renew and flushed clear, the self-contained dental unit water system is ready for routine treatment with ICX tablets at each refill to maintain water quality.
STEP 3: Shock
Shock when the water quality test results exceed the quality action level to comply with ADA guidelines, as part of your clinic’s infection control. This is especially the case if the dental units have sat idle for an extended period. The most convenient way to do this is with A-dec’s ICX Renew liquid shock treatment.
Asepsis built into A-dec dental units
A-dec builds asepsis right into its chair design, starting with their fully self-contained dental unit water system, using A-dec’s proprietary microbial-resistant AlphaSan tubing and a corrosion resistant brass control block design that prevents water stagnating.
Fresh water circulates through the control block every time you activate a handpiece. See https://australia.a-dec.com/why-adec/optimal-infection-control
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The new turbine “Vaporiser” feature – exclusive to the A-dec Pro delivery systems – purges the turbine with a blast of high-speed air, preventing aerosols and water being drawn back into the turbine head, helping eliminate potential contamination. It also avoids the last drop from dripping onto the patient when the handpiece is removed from the oral cavity.
A-dec’s electric motor, suitable for contra angle and speedincreasing and speed-decreasing handpieces is also favoured by many for its quiet, powerful operation and for greatly reducing the production of aerosols compared to high-speed turbines.
The new A-dec Pro delivery systems also feature a unique “auto flush” function. Activating this operation purges all tubing to ensure only fresh water is in the dental unit water lines.
From beginning to end, the thoughtful design of A-dec delivery systems ensures the highest level of infection control for you, your team and importantly, your patients.
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Unwanted visitors like bacteria love to colonise in your dental unit waterlines. A daily waterline maintenance protocol with A-dec ICX® waterline treatment tablets, along with periodic ICX Renew™ shock treatments, will help reduce these nasty microorganisms.
Load release - the logic and structure of checking completed loads
By Emeritus Professor Laurence J. Walsh AO
This article explores issues around the release of a load from a sterilising cycle. The key concept around this is that the items that have been cleaned, inspected, packaged into a sterile barrier system (SBS) and then sterilised need to be suitable for use in the clinic. Checking the sterilised load conforms to requirements is one of the most important tasks that staff in the reprocessing area will perform as part of their daily work.
TThe sterile barrier system (SBS)
his typically is a paper-plastic pouch, a paper bag or a non-woven polypropylene fabric (such as KimGard™) used as a wrap. Paper-plastic pouches are either self-sealing or are sealed using a heat sealer. The seal must remain intact despite the rigours of the steam sterilisation process, during which pouches and bags expand and contract, expanding to twice their size and collapsing to half their size. These changes put considerable stress on the integrity of the seal. This problem is magnified when pouches are overfilled and when large objects are placed into pouches with limited clearance. With heat sealing, using an insufficient temperature to melt the plastic results in a weak seal.
This is why checking the temperature of the heat sealer and making a test piece to check that the heat sealer is performing properly are important.
A further type of SBS is a rigid container with a replaceable filter. This option is relatively new for office-based dental practice, but is based on a concept developed over 100 years ago by Aesculap, who pioneered fully reusable sterile barrier systems. These are basically rigid containers with replaceable filters. The filters allow the removal of air and the entry of steam. After a sterilising cycle, items inside the container will remain sterile for a specified maximum time, typically up to 30 days. The filter is replaced periodically during the life of the rigid container –which is typically over 2500 cycles.
Data entry prior to initiating the steam sterilisation cycle
Akey part of the record keeping for steam sterilising is the information that is entered before each cycle is commenced by the loading operator (Table 1). The cycle program that is selected and the identification of the loading operator are requirements that carry over from the previous AS/NZS 4185 and 4187 standards. A new requirement which comes from AS 5369:2023 is to have a list of the chamber contents. This is done to provide enough information to be able to retrieve items in the event of a recall from a failed load. The chamber contents list covers what items are present (Figure 1), including how many packages of different types (e.g. instrument sets or kits) as well as unwrapped items (e.g. GIC applicator guns). In the case of sets or kits, recording the number and types is sufficient and it is not necessary to also list the individual contents of each set.
An optional but useful additional piece of information to consider measuring and recording is the weight of the load. This can be measured using scales and can readily be calculated by adding the weight of known instrument sets and items. Each steam steriliser has a weight limit for the load and this varies based on the chamber size and other device characteristics. It will be stated in the steriliser’s operating manual in the specifications section. The manual may give different maximum weight limits for different load types, e.g. solid or porous.
Table 1. Cycle data for steam sterilisation
Entered before the cycle is started...
• Date and time
• Cycle program selected
• Chamber contents
• Loading operator identification
Entered after the cycle prior to release...
• Cycle number/batch identification number
• Check of cycle parameter data (from screen, printout or stored data)
• Check of external Class 1 chemical indicator
• Check of internal chemical indicators (if used)
• Check of packages for SBS integrity (no tears, breaches or broken seals)
• Check of packages for dampness
• Load release authorised based on the above
• Loading operator identification
Figure 1 - Panel B. An example of the part of a cycle record sheet showing the numbers of different kits and items.
Figure 1 - Panel A. The recurring journey of reprocessing, showing with an asterisk the critical control point of load release checks.
If the total weight of items placed into the chamber exceeds the maximum allowed weight, the load will not reach a suitable temperature for sterilisation. A practical advantage of measuring load weight is that it reduces the risk of the chamber being overloaded with items.
Chemical indicators
Prior to sterilisation, each packaged item needs to have a class 1 chemical indicator included. Typically, this is built into the pouch or paper material, or added on in the form of tape. A visual change in this indicates exposure of the wrapped item to steam has occurred. Hence, staff in clinics should always be checking the class I indicator on wrapped items before using the contents. This provides a final control measure should there be an accidental release of a load that has not been sterilised. The use of internal class 4-6 chemical indicators is optional when there has been complete validation of the steriliser using the most difficult load item. The precision of these varies, being 2° for temperature and 25% for time for a class 4 indicator.
chemical indicators, always use the manufacturer’s reference colour as the point of comparison. This is often printed onto the indicator. Some manufacturers also supply interpretation charts. As the colour of indicators changes through different stages, staff need to check that the final colour meets or exceeds the reference colour.
Table 2. Common errors in load release
• Cycle did not commence due to a fault (e.g. low water level or poor quality water)
• Incomplete record keeping
• Printout not checked for key data
• Lack of manual checking of load items
• Dampness of items not checked
• Seal integrity not checked
• Unreadable written records (illegible writing)
• Printout is not retained or is not legible
This improves to 1° in temperature and 15% on time for class 5 and to 1° in temperature and 5% on time for class 6. When internal chemical indicators are essential (e.g. when a loaner steriliser is being used), they should be positioned so that later they can be viewed through any transparent parts of the sterile barrier system, e.g. through clear plastic side and checked as part of load release. There is no requirement to keep any type of internal chemical indicators and moreover, these are not designed for archiving over the long term. During long term storage, the colour of the used indicator can change, causing confusion.
TChecking
tographed, photocopied or scanned to produce a permanent record that can be retrieved at a later date. Staff need to regularly back up the data cards which record cycle information, rather than waiting for these cards to fill up. Data cards in steam sterilisers operate in a hot and humid environment, which means they are more likely to fail than a USB stick or a data card in a smartphone or digital camera.
Checking wrapped items
The key requirements are that the sterile barrier system is completely intact, which includes several elements. First, no instrument ends have pierced through the SBS. Second, the seal, whether from self-sealing adhesive or heat sealing, is completely intact and unbroken. Third, the package is not damp or wet. Labels placed before sterilisation must still be attached and readable.
cycles
cycle parameter data for completed
his process includes reading the display or printout to verify that cycle parameters were achieved. Staff members need to identify where the key data is located on the printout or on the display and not only look for the words “pass” or “complete”. The information on how data is presented will come from reading the operating manual, paying particular attention to fault codes and their meaning. Cycle parameter data needs to be stored appropriately. While ink printouts can be archived because they do not
Checking wrapped items is an important competency requirement and visual inspection requires training so that the routine becomes established. Any non-conforming packages need to be separated so that the items can be repackaged and re-sterilised, addressing the problems that caused the SBS to be breached in the first place.
Record keeping
The final step in the process of load release is for the loading operator to complete the documentation for the cycle and to verify that all the requirements have been met and enter the cycle
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Cooling and storage
number/batch code information into the record book, before transferring the items to the cooling racks where they will sit until placed into storage.
The clinic must use a suitable steriliser cycle record. Commercially produced log sheets do not capture all the required types of information and typically miss all the previously mentioned visual checks that are essential. Many clinics prepare their own hard copy record books or sheets to cover all the required information. Hard copy books are retained (for at least 7 years) or can be scanned and then retained in digital format indefinitely. Regardless of the format, the records need to be legible. That includes clear identification of which staff members completed the records.
Release of items from a steriliser load back into clinical use is a serious decision-making process and staff need to be reminded of their important contribution to the safety of patients when they are doing this task. They need to be alert for trends as they are checking loads. For example, a sudden rise in the number of packages with broken seals indicates either over-loading of those pouches (the most common reason) or a problem with the sealing process itself.
Racks are essential for allowing cooling prior to storage. Items must never be placed directly onto the flat surface of a bench. If this happens, condensation during cooling will make the package wet and this creates a wicking effect by capillary action, bringing contaminants on the bench into the package. After items have cooled, they can then go into a relevant area for storage. Storage processes must factor in the date of sterilising and the expiry date and use a system for cycling through sterile stock. For example, the most recently sterilised stock goes to the back and clinics remove stock from the front. This ensures that the stock is cycled around and items will all be used before their expiry date. The expiry date is used wherever clinics do not have 24/7 air-conditioning for where sterile stock is stored. The expiry date can be printed on a label or written on a package with indelible ink prior to steam sterilisation. Storage areas need to prevent exposure of packages to direct sunlight, dust and splashes of fluid. Cupboards and drawers work well for these purposes. Some clinics use cupboards with clear panels which allows a visual inventory to be taken quickly of the sterile stock on hand (Figure 2).
About the author
Emeritus Professor Laurence J. Walsh AO is a specialist in special needs dentistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Dentistry, including 21 years as Professor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical microbiology. Laurie has served as Chief Examiner in Microbiology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years. His published research work includes over 400 journal papers, with a citation count of over 20,000 citations in the literature. Laurie holds patents in 8 families of dental technologies. He is currently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recognition of his contributions to dentistry.
Figure 2. Panel A: Storage of packaged oral surgery instruments in wall-mounted MaxiBins™. Panel B: A cupboard with sliding glass doors on both sides which provides a visual inventory of sterile stock. In this example, items for use in the clinic are taken from the left side and new items loaded in from the right side to provide proper flow.
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