How to make sure that your orthodontist follows the Center for Disease Control(CDC) and American Dental Association(ADA) guidelines on sterilization

Make sure your orthodontists follows the Center for Disease Control(CDC) and American Dental Association(ADA) guidelines on sterilization!
In 1988, the CDC and ADA issued new sterilization guidelines and sterilizer standards because of the AIDS epidemic. Parts of the guideline was formally adopted by the American Association for Medical instruments in 1996 as standard number ANSI/AAMI ST35:1996. On Aug 14, 1998 the FDA formally accepted the standard, and by publishing it in the Code of Federal Regulations. Click here to read the standard. Unfortunately, not every orthodontist is aware of, or follows all of the guidelines. Consequently, I recommend that you ask an orthodontist whether he or she follows the standards.
How to make sure that your orthodontist follows the Center for Disease Control(CDC) and American Dental Association(ADA) guidelines on sterilization

It is not so easy to tell whether an orthodontist follows the guidelines. Most orthodontists think they follow the standard even when they do not. My recommendation therefore is to ask specific questions and judge for yourself whether the orthodontist is really doing everything correctly. Questions you might ask include:

  1. Are all dental materials, instruments etc be sterilized in an approved sterilizer before they are put into a patients mouth. All items include all of the orthodontists tools plus all orthodontic materials including: brackets, bands wires, ligating devices, facebows etc.Be sure to ask what types of sterilizer is used. One common mistake is for an item to be “sterilized” in a sterilizer which is not certified for that purpose. For example an instrument sterilizer is not certified for brackets because the sterilizer does not heat the brackets properly. However, the orthodontist might sterilize his brackets in his instrument sterilizer. The orthodontist thinks that he has sterilized his brackets, but in fact the item is not sterilized. The result can be a source of infection.

    Another common mistake is to not sterilize everything before it is put in a patient’s mouth. For example, the orthodontist might buy a wire and assume that the wire came sterilized from the manufacturer and so he would not sterilize the wire himself. I used to own an orthodontic company, and in fact all of our wires were heated to at least 300 C (hot enough to kill all germs) at some point in the manufacturing process.
    However, we could not guarantee that the item will remain sterile after it left our plant. The ADA and CDC recommend that everything be sterilized immediately before it is put in a patients mouth. Unfortunately, in many orthodontic offices, brackets, wires, ties, ligating modules, facebows etc are not sterilized before use. Ask the orthodontist if he sterilizes everything and if not will he sterilize everything for you. Ask specific questions: how do they sterilize their brackets, ligating modules? The orthodontist should be prepared to answer your questions.

  2. Are all sterilizers checked at least weekly for efficiency?Sterilizers are used day in and day out in the dental offices, and like anything else, the do break occasionally. It is not always obvious that the sterilizer is not working. Most states require that all sterilizers be tested monthly. However, the new FDA standard requires weekly testing. It costs about $200/yr more for the orthodontic offices to do this extra testing, but the ADA and CDC say it is essential since once a sterilizer starts to fail, it generally gets worse, and after 30 days the sterilizer could be useless.
  3. Are all sterilizers checked annually by an outside service?Again, the CDC recommends that every year an outside service come into the dental office and recertify the sterilization processes. The outside service checks the sterilizer, but it also checks the staff to make sure that they are doing everything properly.

    For example it is possible for the front of the sterilizer to be working fine and the back to be malfunctioning. If only the front of the sterilizer is checked, then people might not know that the back of the sterilizer is malfunctioning. The outside service makes sure that the staff of the dental office checks the sterilizer properly so that they are sure everything is correct.

    Outside checks of sterilization is part of the new guideline adopted by the FDA on Aug 14, 1998. Be sure to ask if the orthodontic office does it and tell them about the rule if they do not.

  4. Ask if the offices uses “protective barriers” to safeguard patients.In current practice, every orthodontist uses rubber gloves to protect himself, and most change their gloves between every patient. Most orthodontists put plastic covers on their handpieces (drills), on their trays, and on anything else that can be contaminated by blood or saliva. I cannot imagine that any office would not do this. However, if your orthodontist does not use protective barriers go to another office.
  5. Ask if all dental offices personnel offered periodic testing for infectious diseases, but do not turn the orthodontist down because he does not do this.The CDC guidelines call for periodic testing of all medical personal for infectious diseases (AIDS, TB, Oral Herpes etc.) and at one point the ADA recommended it too. However, in some states the courts have held that mandatory testing of medical personnel is discriminatory against people with AIDS or other diseases. The result is that many orthodontists who would like to periodically test their personnel do not do so, to avoid a discrimination suit. The FDA does not require periodic testing; I assume for similar reasons.

    My advice is that you should ask about periodic testing, but not turn down an orthodontist because of it. The orthodontist might not have any choice but to not offer periodic testing because of the discrimination laws in his state.

  6. Ask the office about their water.A recent study by ABC news found that 90% of the water samples in dental offices did not meet federal drinking water standards. On average the water from dental offices was dirtier than the water in public toilets! The problem is that bacteria build up in the tubing in most dental drills, and so the water is contaminated.

    Ask the orthodontist if he/she filters the water for bacteria, and periodically sanitizes the inside of all of his machinery. If the answer is no, go elsewhere.

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