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Infection prevention through education
7 disinfection mistakes in the dental office and how do you avoid them
In hygiene management, usage errors can be difficult to detect visually. As a manufacturer, we support you with educational materials designed for every stage of work, from hand hygiene to the correct handling of products in the clinic.
Infection control in a dental office means more than just choosing a disinfectant. Proper instrument reprocessing, hand hygiene, and surface disinfection are part of a protocol where each step must be performed correctly.
In daily practice, however, even well-established protocols can have vulnerable points: a skipped step, an overlooked surface, insufficient contact time, or a product used outside its indications.
Below, we review 7 common situations that can compromise the accuracy of the disinfection and reprocessing process in a dental office and explain what to keep in mind to avoid them.
“The first mistake is not adapting the disinfection to the risk of the area or the device to be disinfected. The second is not following the manufacturer's recommendations regarding concentration and contact time. Even the best disinfectant becomes ineffective if used incorrectly.”
Risk level
You choose the reprocessing method without considering the type of instrument or device.
Not all types of dental instruments and medical devices used in the dental office present the same risk of infection transmission.
The reprocessing method is determined based on their use and the type of tissue they come into contact with during treatment.
How is it done correctly?
The Spaulding Classification categorizes instruments and medical devices in the dental office into critical, semicritical, and noncritical.
- Critical - penetrate sterile tissues or bone (such as surgical instruments or scaler tips); they must be cleaned and sterilized before reuse. For heat-resistant items, moist heat sterilization (autoclave) is the standard method.
- Semicritical – come into contact with mucous membranes or non-intact skin. This includes everything from examination instruments to impression trays. When heat-resistant, thermal sterilization is mandatory. For heat-sensitive components that do not withstand autoclaving, the standard requires strict protection measures (single-use barriers) and decontamination according to the manufacturer's instructions.
-
Noncritical - touch only intact skin (such as dental unit components), requiring cleaning and disinfection with products having an adapted spectrum.
Categories with special requirements: - Handpieces (turbines, contra-angles) - historically classified as semicritical, they are now considered high-risk devices. Due to the backflow phenomenon, they must be cleaned, lubricated, and sterilized in an autoclave between patients.
- Dental impressions - require immediate decontamination after impression taking, using only dedicated products that do not alter their dimensional stability.
Clean does not mean disinfected
You are applying the disinfectant without prior cleaning.
Blood, saliva, tissue debris, and other organic matter can interfere with the disinfection process if they are not removed beforehand.
Therefore, cleaning and disinfection are distinct steps and must be performed in this order, unless the procedure and product used specify otherwise.
Cleaning removes dirt and organic matter. Disinfection is the subsequent step, performed under the conditions specified for the product.
This principle applies to both surfaces and instruments.
How to do it correctly
- Clean before disinfecting: First, remove visible dirt and organic matter using a suitable detergent.
- Follow label instructions: Apply the disinfectant according to the application method, concentration, and contact time indicated by the manufacturer.
- Change cloths between steps: Use one cloth for cleaning and a new one for disinfection, thus avoiding cross-contamination of surfaces.
The missing link
You disinfect the impression before leaving, but you forget about the work coming back from the laboratory.
The impression is part of a circuit with a high risk of cross-contamination between the dental office, the laboratory, and the patient. Before being sent out, the impression must be decontaminated using methods compatible with the impression material.
Decontamination is equally important upon the return of the prosthetic work or orthodontic appliance from the laboratory to the dental office. Although the surface may appear clean upon simple visual inspection, the risk is real: a study in the British Dental Journal shows that 58% of prosthetic works analyzed upon receipt from the laboratory exhibited microbial growth (staphylococci, pseudomonads, Candida). The conclusion is clear: infection control should not be left to the laboratory, but is the responsibility of the dentist before the try-in or cementation.
The safety protocol must cover both directions of the route, not just the exit from the dental office.
How to do it correctly
- Decontaminate on exit (Clinic → Laboratory): Remove organic debris and disinfect the impression, respecting contact times and chemical compatibility with the impression material.
- Decontaminate on entry (Laboratory → Clinic): Clean and disinfect any prosthetic work or orthodontic appliance received from the laboratory in the clinic before it comes into contact with the patient.
- Document the workflow: Explicitly include both directions of the circuit in the clinic's protocol and observe safe transport and storage conditions.
Source: British Dental Journal (2011) – “Microbial contamination of removable prosthodontic appliances from laboratories and impact of clinical storage”.
Two roads, one protocol
OUT · impression → laboratory
Decontamination before shipping
IN · restoration → patient's mouth
Decontamination before try-in or cementation
58%
of the removable prosthetic appliances kept in storage at the dental office showed microbial growth (staphylococci, pseudomonads, Candida), in a study published in the British Dental Journal.
Infection control should not be left to the laboratory — it is the physician's responsibility, before the trial or cementation.
Contact time
You wipe the surface or remove the instrument from the solution before the contact time has elapsed.
The effectiveness of a disinfectant is directly conditioned by three fundamental parameters: working concentration, application method, and contact time. The active substance does not act instantaneously, but requires a defined interval.
If the surface is wiped, the product evaporates, or the instrument is removed from the solution before this interval has expired, the chemical reaction is interrupted. In this situation, the disinfection is incomplete, and the surface remains a potential vector for infection.
How to do it correctly
- Check contact time: Identify the exact duration required on the label based on the targeted spectrum of activity and the method of application (spraying, wiping, or immersion).
- Maintain the liquid film: Ensure the surface remains visibly wet for the entire indicated duration, whether you are using a spray or pre-saturated wipes. Reapply if evaporation occurs too quickly.
- Allow the product to act completely: Do not dry, wipe the surface, or remove instruments from the basin before the contact time has elapsed.
Contact surfaces
You disinfect what looks dirty and skip what is touched often
In a dental office, some of the most frequently contaminated surfaces are not necessarily the ones that look dirty.
Lamp handles, unit controls, light switches, trays, and other surfaces touched during treatment can be contaminated through direct contact, spatter, or aerosols generated during procedures.
These are clinical contact surfaces and must be explicitly included in the office's sanitization protocol.
How to do it correctly
- Identify clinical contact surfaces in each dental unit and include them in the work procedure.
- Use disposable protective barriers where appropriate and practical, and change them according to the protocol.
- For non-barrier surfaces, perform cleaning and disinfection according to the practice's procedure and product instructions.
- Observe the contact time of the product used.
- Take into account the product's compatibility with the surface material, especially for sensitive equipment and materials.
Suction lines
Treat the suction system as a regular surface
The suction system is different from standard office surfaces: saliva, blood, irrigation water, and other debris from the oral cavity pass through the tubing repeatedly.
Organic residue remaining in the system can promote deposits and biofilm formation. Therefore, suction system maintenance must be a clear part of the practice's protocol and account for the specific characteristics of the equipment.
How to do it correctly
- Respect the manufacturer's instructions for the dental unit and the suction system regarding cleaning and disinfection.
- Follow the maintenance frequency specified for the equipment used, without automatically transferring a protocol from one system to another.
- Use a non-foaming formula product intended for suction systems.
- Strictly observe the concentration, preparation method, and contact time indicated for the product used.
The dental unit's water circuit
You disinfect surfaces and instruments, but ignore the quality of the water.
The internal waterlines of dental units have a very small diameter and long periods of stagnation, providing an ideal environment for the development of bacterial biofilm. Unfiltered or improperly treated water becomes a direct source of contamination during dental procedures.
In Georgia, in 2015, 24 children developed odontogenic infections with Mycobacterium abscessus following pulpotomies. The CDC investigation showed that water collected from the office's 7 dental stations had an average bacterial load of 91,333 CFU/mL — over 180 times the recommended limit — and the M. abscessus isolates from the water proved to be genetically identical to those in the tissues of 7 of the infected patients. The office used tap water for pulpotomies, with no disinfectant in the waterlines and no monitoring of water quality.
In Orange County, in 2016, the same cause — untreated tap water used for pulpotomies — produced the largest outbreak of this type ever documented: 71 cases (22 confirmed by culture, 49 probable), out of a total of 1,089 exposed patients. The investigation linked the infections directly to the office's own water system, not to the tap water itself.
For routine procedures, dental unit water must meet drinking water standards (≤ 500 CFU/mL heterotrophic bacteria). For surgical interventions, the use of sterile water or saline is mandatory, delivered through circuits separate from the unit's tubing.
How to do it correctly
- Treat the circuits chemically: Implement a continuous or periodic disinfection protocol for the water lines, using exclusively products compatible with the internal materials of the unit.
- Perform daily purging: Purge the water lines at the beginning of the workday and for 20–30 seconds between patients to reduce the stagnant microbial load.
- Monitor water microbiologically: Periodically test the water quality of the unit and archive the analysis reports for internal quality control.
- Separate surgical procedures: Use only saline solution or sterile water administered from an independent external system (peristaltic pump) during surgical procedures.
Sources: 1. CDC, "Notes from the Field: Mycobacterium abscessus Infections Among Patients of a Pediatric Dentistry Practice — Georgia, 2015", MMWR, April 2016 — cdc.gov/mmwr/volumes/65/wr/mm6513a5.htm
2. Singh J, O'Donnell K, Ashouri N, et al., "Invasive Mycobacterium abscessus Outbreak at a Pediatric Dental Clinic", Open Forum Infectious Diseases, 2021, 8(6):ofab165 — academic.oup.com/ofid/article/8/6/ofab165/6226701
What happened when the water was not treated?
Georgia, 2015 · 24 childrenMycobacterium abscessus
Orange County, 2016 · 71 casesMycobacterium abscessus
≤ 500 CFU/mL
the CDC recommended limit for water used in non-surgical dental procedures. In Georgia, the water was untreated and unmonitored; in Orange County, the source was also untreated water from the unit's internal system.
Why it matters
Because a good protocol is evidenced by the consistency with which it is applied.
An instrument may look clean without the cleaning process having been performed correctly. A surface may look impeccable and yet, disinfection may not have been carried out under the conditions specified for the product.
That is why infection control should not depend on memory or on how busy the day is. A good protocol clearly establishes what is cleaned, what is disinfected, what is sterilized, with which product, under what conditions, and at what interval.
From instrument reprocessing to suction system maintenance and water quality control, every step must have a clear place in the practice's procedures.
Everything you need
Dental practice packages
We include products intended for the cleaning and disinfection stages of hands, surfaces and floors, instruments and medical devices, adapted to the requirements of dental offices.
ESSENTIAL PACKAGE - Disinfection and cleaning for medical offices
- 127,59 lei
141,77 lei- 127,59 lei
- Unit price
- per
INSTRUMENT CARE PACKAGE - cleaning and disinfection for dental offices
- 272,66 lei
302,96 lei- 272,66 lei
- Unit price
- per
COMPLETE DENTAL PACKAGE - Disinfection and cleaning for dental offices
- 461,71 lei
513,01 lei- 461,71 lei
- Unit price
- per
ESSENTIAL PACKAGE - Disinfection and cleaning for medical offices
- 195,98 lei
217,76 lei- 195,98 lei
- Unit price
- per
The disinfectants included in our packages are approved by the Ministry of Health through the National Commission for Biocidal Products, and the technical documentation is available upon request. ⚠️ Use biocides responsibly. Always read the label and product information before application. Follow the instructions provided by the manufacturer to ensure effective disinfection and safe use.
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Frequently Asked Questions
What are the offices asking us?
Are handpieces (turbines, contra-angles) semi-critical or do they have a special status?
In the classic classification, handpieces are categorized as semi-critical devices, but today they are subject to special regulations due to the phenomenon of retraction. For this reason, turbines and contra-angles must be cleaned, lubricated, and autoclaved after every patient, regardless of the duration or complexity of the dental procedure.
Can I use the same cloth for cleaning and disinfection?
The same cloth cannot be used for the cleaning and disinfection stages of surfaces in a dental office. Cleaning is intended to remove gross soil and organic matter, and reusing the same cloth for disinfection will recontaminate the surface that has already been prepared. The correct protocol requires the use of a separate cloth for each individual stage.
What is the actual risk if I do not disinfect the prosthetic work upon its return from the laboratory?
The risk of not disinfecting prosthetic work received from the laboratory is the direct recontamination of the patient with dangerous bacteria. A study published in the British Dental Journal demonstrated the presence of an alarming microbial load (staphylococci, pseudomonads, Candida) in 58% of the prosthetic works analyzed upon receipt. Although the risk is not visible to the naked eye, infection control at this point in the dental workflow is the exclusive responsibility of the dentist, not the dental laboratory.
Does strong ventilation or high room temperature affect the effectiveness of the disinfectant?
Yes, both strong ventilation and high room temperature directly affect the effectiveness of the disinfectant by shortening the time the surface remains wet. This phenomenon can cause the product to evaporate before the contact time required to destroy microorganisms has elapsed. In areas with strong airflow or high temperatures, surfaces must be visually monitored, and the disinfectant must be reapplied if it dries prematurely.
Which surfaces in the office are most often missed during disinfection?
The clinical contact surfaces most often omitted during disinfection are lamp handles, unit controls, switches, and trays, as they show no visible traces of dirt. These areas become heavily contaminated through direct touch, splashing, or aerosols generated during treatments and must be mandatorily and explicitly included in the daily sanitation protocol.
Why can't I use any surface disinfectant for the suction system?
A regular surface disinfectant cannot be used for the suction system because dental tubing requires a special, non-foaming formula. Saliva, blood, and organic debris from the oral cavity constantly pass through the suction system. Using an unsuitable product or failing to follow the maintenance frequency recommended by the manufacturer promotes the rapid accumulation of bacterial biofilm and clogging of the system.
How long should the dental unit waterlines be flushed between patients?
The dental unit waterlines must be flushed for 20–30 seconds between patients to eliminate and reduce stagnant microbial load inside the tubing. For complete safety, this water flushing procedure must also be performed at the beginning of each workday, before attending to the first appointment.
Romanian company specializing in the production and commercialization of disinfectants, cleaning products, and personal hygiene solutions, tailored for both professional sectors (B2B & B2G) and individual consumers (B2C).
The quote in this material comes from an exclusively educational conversation focused on best practices in clinical disinfection. Prof. Univ. Dr. Codruța Nemet expresses strictly professional opinions and does not recommend or endorse any commercial products.
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