If your child is involved in any sports activity, you
should consider whether getting them a mouthguard is a smart
thing to do. Many organized sports require mouthguards, but
the children don’t always wear them as required. Parents
should make sure that their children comply with mouthguard
requirements.

The American Dental Association recommends a mouth guard for
participation in the following sports: acrobatics,
basketball, boxing, discus throwing, field hockey, football,
gymnastics, handball, ice hockey, lacrosse, martial arts,
racquetball, rugby, shot putting, skateboarding, skiing,
skydiving, soccer, squash, surfing, volleyball, water polo,
weightlifting and wrestling.

Dentists estimate that between 13% and 39% of dental
injuries occur while playing sports. Five million teeth will
be knocked out of children and young adults in the United
States during sports activities. Safechild.net reports that
60% of organized sports-related injuries occur during
practice rather than during games.

The front teeth are most at risk. Approximately 80% of all
dental injuries affect one or more of the front teeth. Soft
tissue damage, as a result of biting the tongue or cheek, is
also common.

Approximately 200,000 oral injuries will be prevented by
mouth guard use in the next year. Bicycle-related head
injuries account for more than 150,000 emergency room visits
annually.

If a single tooth is knocked out through an accident
sustained in sports activity, the treatment will involve
either re-implantation with root canal therapy and possibly
crown or replacement therapy with a bridge or implant when
your child is old enough. There may be an interim period
where your child will have to wear a cumbersome removable
temporary appliance until they are old enough for a more
permanent solution. The expense of these treatments will
often be as much as 15-30 times the cost of a custom fit
mouthguard.

Mouth guards range from $5 (low-end bought in store) to $150
(top of the line custom fit). The ready-to-wear, U-shaped
mouth guards, made from rubber or vinyl materials, can be
bought without a prescription in many sporting goods stores.
However, they do not evenly distribute the force of an
impact due to the looseness of a non-custom fit. Dr. Brazis
recommends that you avoid using these type of mouth guards
and suggests going to a dentist to have a custom-fitted
mouth guard made to fit comfortably in your mouth and offer
better protection.

If having a mouth guard custom-fit by a dentist isn’t an
option, then the best alternative would be a “boil-and-bite”
mouth guard from the sporting goods stores. These mouth
guards are made from a type of plastic that softens in
boiling water. You place the mouth guard in boiling water,
and once the plastic is soft, you put it into your mouth,
bite down on it, and mold the softened plastic around your
teeth using your fingers, lips and tongue.

Be careful not to scald yourself when removing the mouth
guard from the boiling water, and make sure that it isn’t
too hot to put into your mouth. If the mouht guard doesn’t
fit comfortably the first time, you can reheat it and do it
again.

Dentalnotes, a publication from the Academy of General
Dentistry, says mouth guards have to be kept clean. Users
should brush their teeth before inserting the guards, and
the guards should be cleaned after use. And, of course,
mouth guards should not be shared.

Dental problems range in their degree of seriousness. The
following tips can prove helpful:

Dental problems in children could be hereditary. Regular
brushing and flossing may not be enough to prevent serious
cavities. Consult your dentist to correct the problem while
your child is young. Heredity affects hardness of enamel,
size, and shape of teeth and jaws. Problems may require
dental restorations or orthodontic intervention.

Children now do not always have to wear painful braces and
metal wires to correct irregular teeth. There are various
dental corrective appliances available in plastic. Dentists
now advise dental corrections at a young age.

It is now easy to fill dental cavities. Dentists have more
choices for filling teeth. Materials for filling teeth
include composite resins rather than the traditional silver-
mercury alloy. Composite resins are bonded and hence,
fillings do not have the tendency to pop out. Resins are
available in a range of tooth colors.

Dentists prefer using stainless steel and/or plastic crowns
to cover teeth in case of malformation of baby teeth,
fracture, or extensive decay. This maintains tooth form and
position for optimal jaw development.

You should schedule regular meetings with your dentist to
make your child comfortable with dental visits. Practice
good dental habits like regular brushing and flossing to
prevent major dental problems. Also, limit the intake of
sugary and sticky foods for your children, as these affect
dental health immensely.

What Should You Do in Case of a Dental Emergency?

Dental emergencies can occur anytime and hence, being
prepared beforehand is essential and helpful. Always keep
all contact numbers of your dentist in a handy place so that
it is easy to contact them in an emergency. Common dental
emergencies in children include chipped teeth due to
accident and teeth knocked out or loosened due to trauma.

If a traumatic incident occurs, knocking your child’s tooth
out or just causing a loosening or mobility, contact dentist
immediately within an hour, if possible. Dentist can re-
implant tooth and save it. Until then, rinse tooth in water
(distilled if possible) without touching tooth root. You can
try to place tooth back into socket and secure it with a wet
wrap. If this is not possible, preserve tooth in a cup of
milk or saliva until you meet the dentist.

If your child feels pain due to a chipped tooth, it
indicates possible injury or exposure of the tooth nerve.
Meet with your dentist as soon as possible for evaluation
for possible root canal treatment or similar measures to
save tooth. Your dentist may treat the tooth temporarily and
later fix a bonded restoration to make up for the chipped
tooth. If there is no pain, set an appointment with your
dentist and meet them at the earliest convenient time. The
emergency is not as pressing, but future nerve damage cannot
be ruled out until the dentist examines the injury even if
there is no immediate pain.

If your child is into sports, ask them to use protective
mouth guards. These plastic guards protect teeth as well as
the lips, gums, and cheeks. Semi-formable mouth guards
available at sports shops require boiling to give a perfect
fit. Dentists also make mouth guards with molds that fit in
snugly.

Dental emergencies can occur due to severe toothache arising
from dental cavities, infections, food stuck between teeth,
and broken fillings. Rinse your child’s mouth every hour
with warm water. Clean affected tooth area with toothbrush
and floss thoroughly. Use toothpick to dislodge any food
material stuck in between teeth. Use an ice pack on affected
area to relieve pain. Refrain from placing aspirin on
child’s gum, as it could cause aspirin burn. If there is any
swelling around eyes or cheeks, place ice pack. Ice packs
should only be left in place for ten minutes at a time, then
removed for ten minutes. Then repeat the cycle. Take your
child to a dentist immediately.

If you have small children, keep your home safe and free of
furniture with sharp edges and corners as much as possible.
Toddlers often suffer dental injuries while they are
learning to stand. Children sometimes injure their teeth
while ramming into water fountains while drinking water.
Accidental bumping into each other could cause teeth
injuries in children.

Development of Primary Teeth
Primary teeth are the first teeth that appear in a baby.
These teeth start appearing in your child at around six
months of age and often, all primary teeth appear by the
time your child is three years old.

Whenever ages are mentioned in this article, remember that
these are guidelines only and if your child’s teeth are not
following this schedule that does not neces-sarily indicate
a problem with their development. If you have any specific
questions about their development always ask your dentist.

That said, your baby’s teeth start forming in the six-week
old fetus. Hard substance in the region where the teeth will
appear starts forming at around three to four months of
gestation. Among the primary teeth, the first to appear are
the central incisors. These are the front middle teeth.
Next, teeth on either side of these central incisors appear.
Thereafter, the second molars appear.

Normally, four primary teeth appear every six months. Those
in the lower jaw appear ahead of those in the upper jaw.
Primary teeth appear in pairs, one on the left side and the
other on the right side. Girl babies generally get their
primary teeth ahead of baby boys.

Primary teeth are bright white in color and much smaller
than the permanent teeth that appear later. There are only
twenty primary teeth in all. Primary teeth form the
foundation for the permanent teeth that appear in their
place after they fall out.

Your child starts the growth and development of the facial
and jawbones from the age of four. This could create some
spaces in between primary teeth. Spaces help to accommodate
the larger permanent teeth, as they appear later.

Although all primary teeth will eventually fall out paving
way for permanent teeth, you still want to make sure that
you care for these teeth. Healthy teeth are part of your
child’s overall physical health. They also guide the shape
and appearance of facial muscles and structure. These
muscles help in efficient chewing and crushing of food.
Missing or irregular teeth can disrupt normal chewing of
food and lead to food settling between teeth. This could
cause tooth decay and gum problems.

Healthy primary teeth make way for healthy permanent teeth.
Tooth infections and decay in primary teeth, although not
directly related to problems in the underlying permanent
teeth, is a sign of hygiene habits that need to be changed
before the arrival of the permanent teeth.

Development of Permanent Teeth

There are 32 permanent teeth in all. These consist of six maxillary
and six mandibular molars, four maxillary and four mandibular
premolars, two maxillary and two mandibular canines, and four
maxillary and four mandibular incisors.

Permanent teeth come in place of primary teeth except the
permanent molars, which come in behind the primary molars.
Normally, primary teeth start falling out from the age of
six and continue until the age of twelve. Permanent teeth
push the primary teeth from underneath. However, in between
the ages of six and twelve your child will have both primary
and perm-anent teeth. In most cases, all permanent teeth
appear by the eighteenth year. In some cases, they may
appear until the age of twenty-one.

The first primary teeth that start falling are the central
incisors. The first molar could appear by the sixth year.
Lateral incisors appear by the eighth year, premolars and
second molars appear by the ninth and tenth years, while
canines appear by the eleventh or twelfth year. The second
molar appears by the twelfth or thirteenth year while the
third molar appears in between seventeenth and twenty-fifth
years.

When primary teeth push out permanent teeth, the jaws and
mouth undergo various transformations. These change the
shape of your child’s face into that of a growing adult.
Permanent teeth grow to a certain size and thereafter, the
root closes, and teeth stop growing.

In this day and age of fast and processed foods it can be a
challenge to ensure a healthy diet for your family. Everyone
wants to provide good food for their families, but how to do
that when the stores are full of processed foods and fast
food chains are everywhere boggles the mind. However, for
the parent willing to look, there are good whole food and
health food stores also. Look for foods that are high in
fiber and nutrients and low in chemical additives and
sugars.

Some suggestions for finding excellent health foods and
snacks online:

http://www.myforevergreen.org/stevenbrazis/home.html

http://www.sunfood.com

Essential Nutritious Food

Children are in their growing stages and therefore require
foods from each food group to maintain proper health.
Include carbohydrates, proteins, and fats in every meal.
Normally, a child’s diet has a higher concentration of
carbohydrates. Carbohydrates contain starches and sugars,
some harmful and some essential. Try to emphasize the
complex carbohydrates found in vegetables and fruits as
opposed to the starchy carbohydrates found in pasta and
breads.

All types of foods and snacks are able to cause dental
cavities. Cookies, candies, pastries, and cakes are the
obvious troublemakers. Yet, fruits, milk, peanut butter,
pretzels, chips, and juices are equally detrimental.
Regulating eating habits along with regular brushing habits
will help tremendously.

Water

Water is a subject that is so often overlooked in
discussions of nutrition that I want to give it special
attention here. If you give your child water to drink early
on in life instead of flavored drinks of any kind, they will
grow up to appreciate water and want to drink it naturally.
Most people do not get enough good water in their bodies.

Water is a natural lubricant and cleanser. It is a necessary
catalyst for most of the essential metabolism of the body as
well as acting as a cleansing agent to flush waste and toxic
materials from the cells and body as a whole.

Today, most water sources need extra filtering to make sure
it doesn’t contain more harmful ingredients than good.
Bottled water is an alternative, though that can be
expensive. Good inexpensive water filters can be found with
a little research and well worth the effort.

Finally, just drinking water during and after eating will
wash out the mouth and help dilute any remaining food
substance left, reducing the risk of tooth decay enormously.

Tips to Maintain Good Dental Health in Children

* Avoid giving sticky food like raisins, honey, caramel,
syrups, and molasses to children. Otherwise, insist on your
children brushing their teeth immediately after eating such
foods.

* Give them raw vegetables and fruits for snacks. Vegetables
and fruits like cucumber, pear, celery, and melon stimulate
the secretion of saliva during eating. This helps wash away
sugars present in such fruits and vegetables and prevent any
buildup of food residue.

* Give cheddar cheese as an alternative snack or for lunch.
This triggers saliva formation and helps wash down food
particles.

* Give children water instead of juices or soda. Juices and
soda have high levels of sugar. Soda also has carbolic acid,
which is extremely destructive to teeth. Diluting fruit
juices with some water is also helpful.

* Use a fluoridated toothpaste if you choose for brushing.
Fluoride helps improve the hardness of enamel and prevents
tooth decay. Flossing removes food deposits between the
teeth where brushing cannot.

* It is best to brush teeth well twice a day and preferably
also after meals and snacks. Drink lots of water!

Over the past twenty years, dental implants have been
constantly improving. The science and technology for dental
implants now makes implants as predictable and reliable as
more traditional dental restorative procedures like crowns
and bridges.

Implants are a two stage process. A titanium artificial
tooth root is surgically placed into the jaw bone by an oral
surgeon, periodontist or general dentist with specialized
training. The titanium implant is just below the level of
gum tissue and a small hole is left in the gum over the top
of the implant. A “healing cap” is screwed into the threads
of the implant to prevent the gum tissue from growing over
or into the implant.

A period of 6 weeks to several months is required for the
titanium implant to “integrate” with the jaw bone. That
means that the bone actually attaches to the implant to
provide stability. It should be realized that this
attachment is NOT the same as with a natural tooth. There is
no periodontal ligament involved, which is the feature in
bone to tooth attachment that allows for tooth movement
through bone. Implants cannot be moved orthodontically nor
be exposed to forces that cause natural teeth to move in
response. For this reason, if implants are being considered
with multiple missing teeth, your dentist must plan the
number of implants and type of restoration placed on the
implants carefully.

The type of restoration placed on the implant are varied. In
the case of a single tooth, a piece called an abutment is
screwed into the implant to replace the healing cap when
osseo-integration of the implant has been accomplished. A
crown (or cap) is then cemented over the abutment just as if
this were a natural tooth that had been prepared for a
crown.

There can be several single tooth implants placed either
adjacent to one another or in various locations around the
mouth where teeth are missing. However, when the span of
missing teeth is too great, it becomes more cost effective
as well as biologically supportable to place two or three
implants and link them together with a fixed bridge. There
will be more teeth showing on the bridge than there are
implants, just like with traditional bridges on natural
teeth. These are also supported be abutments screwed into
the implants as with single tooth implants.

When there are many missing teeth (or all of them) implants
are usually used to support a removable denture. When this
is done, instead of an abutment screwed into the implant, a
post is used and the posts for several implants are linked
together with a cast metal bar. The denture is then made
with clip inserts that clip onto the bar between the
implants. A denture made this way is vastly more comfortable
than a traditional denture because it largely rests on the
bar instead of the tissue, thus eliminating many of the sore
spots caused by dentures. Additionally, the denture is
locked into place by the clips and is extremely stable,
unlike dentures which tend to slip and shift or come
completely out much more easily.

Although implants can be very expensive by comparison with
other more traditional dental prosthetics, the potential
benefits make them equally valuable. Most patients who have
had traditional dental prosthetics replaced by implant
supported prosthetics are so happy that they would never go
back.

Fluoride has been shown to have definite beneficial effects
on the growth of strong teeth, as it hardens tooth enamel.
Fluoride in higher doses has also been shown to be
detrimental to health in other ways. The controversy over
fluoride rages on today. You will have to make your own
decisions about the use of supplemental fluoride, as there
are compelling arguments on both sides of the controversy.

Normally, tap water in most cities contains some fluoride
supplementation. Otherwise, you could ask your doctor to
prescribe fluoride tablets for regular and daily use.
However, to avoid possibility of harmful effects do not
exceed recommended doses of fluoride.

Cavities are the most common dental problem among children.
If you allow your infant to sleep with a bottle of milk or
juice, sugar present in milk or juice can remain on the gums
and teeth for a prolonged period. This leads to cavities.
Don’t allow your child to walk around all waking hours with
a bottle. Instead, teach your child to start drinking from a
cup as soon as they are able.

Additionally, if your child consumes lots of sugary foods
like candy, cookies, raisins, and many sweetened fruit
juices, there is a high risk of developing cavities. If most
of your family members suffer from cavities, your child
could also develop cavities early in life. The tendency
towards tooth decay may be hereditary, but the actual
development of cavities requires bacteria. The best way to
take good care of your child’s teeth is to feed them good
nutritious non-sweetened foods and brush regularly twice
everyday, in the morning and at bedtime. Flossing once a day
is equally essential.

Caring for Your Child’s Teeth ‚Äì Before Birth to 6 Months

A healthy pregnancy contributes to healthy formation of
teeth in your baby. A woman should eat a nutritious and
balanced diet with lots of vitamins and minerals during her
pregnancy. She should also, undergo a thorough dental
examination and have any decayed teeth filled or oral
infections resolved. Your baby’s teeth start forming from
the second trimester of pregnancy. A baby at birth has all
twenty teeth, although within the jaws beneath the gums.

After the birth of your child, in addition to a good
nutritious diet, follow simple dental habits. As mentioned
previously if bottle-feeding your child, do not put your
child to sleep with a bottle of milk or juice. Sugars from
juice and milk stay for prolonged periods and cause bacteria
to develop. Remove bottle soon after feeding. Breast-feeding
to sleep does not cause any problems.

Clean your child’s mouth and gums with a wet gauze after
feedings and at bedtime. If anyone in the household smokes,
you will want to keep your child away from the tobacco and
cigarette smoke. Aside from the obvious harmful medical
effects, this could cause gum inflammation.

Caring for Your Child’s Teeth – 6 Months to 3 Years

Infants start the eruption of their first teeth from the age
of six months. They normally have six teeth around their
first birthday. Use a wet cloth or sponge to wipe their gums
after feedings. After the first few teeth appear, use a soft
brush and water to clean your infant’s teeth. Develop the
habit of drinking from a cup around nine months of age to
discourage bottle-feeds.

Put a pea-sized amount of toothpaste on the toothbrush to
brush your child’s teeth after your child is a year-old.
Until the age of three, you should brush your child’s teeth
both in the morning and at night. Teach your child not to
swallow toothpaste.

Develop good eating habits in your child by giving foods
that help in growth and development of strong gums and teeth
like fruits, vegetables, and whole grains. Do not give
sugary or high-carbohydrate foods like pastries, pasta, and
processed carbohydrates.

Caring for Your Child’s Teeth – 3 Years to 6 Years

At three years of age, your child may be learning to talk
and starting to understand a few things. This is a good time
to teach your child good dental habits.

Teach your child to brush their teeth on their own with your
supervision. You can encourage your child to watch other
elder siblings and elders brushing their teeth to learn the
correct techniques.

Flossing is essential as soon as teeth start touching each
other. Use plastic flossing tools available in the market to
teach proper flossing habits to your child.

Infants and small children often suck their thumbs. A four-
year old normally stops thumb sucking on their own. If not,
you can take necessary guidance from your dentist to stop
this habit and avoid unnecessary orthodontic complications.

Caring for Your Child’s Teeth – 6 Years to 16 Years

From the age of six, your child starts losing all primary
teeth and permanent teeth start growing in their place. By
now, your child should be able to brush their own teeth
independently. Make your child realize importance of
brushing regularly in the morning and evening. Teach your
child to floss regularly. You can ask your dentist to guide
your child on correct technique of flossing.

Take your child to the dentist regularly. If your child
develops cavities, the dentist will suggest proper treatment
remedies. Give chewable disclosing tablets to your child
regularly to detect any plaque left on your child’s teeth
after brushing. These are available at local drugstores.
They cause the plaque on the teeth to stain red so that it
can be seen.

You can discuss with your dentist if it is essential to put
dental sealants on the molar teeth of your child. Sealants
are of hard plastic. They protect chewing surfaces of your
child’s teeth from decay.

Teach your child to eat nutritious food like fruits,
vegetables, and whole grains. Educate your child about ill
effects of highly processed carbohydrates and sugary foods.
This paves the way for healthy dental care in your
youngster.

Bonding in dentistry technically means attaching a material
substance to the tooth structure through a chemical bond.
Typically it is used by many people to describe three
different processes: recontouring front teeth to fill
unsightly gaps, repairing chipped corners or edges on front
teeth or putting a veneer of composite resin over the whold
surface of a tooth to change its color or contour.

Bonding is actually used in many ways in cosmetic dentistry
today:

1. Repair or fill abraded and sensitive areas of teeth at
the gum line
2. Fill cavities or chipped and broken areas of front
teeth
3. Minor reshaping or recontouring teeth to provide more
natural contours and contacts between teeth
4. Filling cavities in back teeth with composite resins
in place of silver amalgam
5. Sometimes resurfacing the whole face of a tooth (best
accomplished by bonding a porcelain veneer rather than
composite resin)
6. The sealants used to “seal” and protect the grooves in
children’s teeth are bonded flowable composite resins
7. Bonded cements are used now to chemically bond crowns
and bridges to their anchor teeth.

If properly applied, bonded restorations preserve more tooth
structure than traditional fillings because deeper drilling
is not required just to “retain” the material as with older
methods. Bonded restorations are strongest at the place
where tooth and bonding meet, so these restorations do not
tend to chip and pull away from tooth structure and leak at
the margins as the older materials did.

Since there is ofte less drilling required and less marginal
leakage, bonded restorations are typically less afterwards
than the older methods and often can be done during the
appointment without anesthetic.

These restorations are much better looking than the older
materials. Composite resins come in many shades to better
match tooth color. Due to the bonding and expansion
properties of composites, there seem to be fewer cracked and
broken teeth with these restorations.

Tooth bonding itself is a one visit procedure, though the
bonding can be associated with restorations that have been
made in a laboratory. If the area of tooth to be restored is
small, the materials used usually require only one visit.
Larger areas require the two visit procedures. If done in
two visits, there will be a temporary restoration (usually
also a composite resin) placed with a sedative temporary
cement.

Before bonding, any decay or old filling material present is
removed. Then the tooth surface to be bonded is slightly
roughened and treated with a mild etchant to provide maximum
bond strength. Then the bonding materials are placed in a
layered sequence and “cured” with a high intensity light
after each layer. Then the restoration is shaped and
polished to a smooth finish and proper contour and fit with
adjacent and opposing teeth. Sometimes the tooth and bonding
are then treated again and “sealed” with a clear sealer
layer of bonding material.

It is very important to maintain the bonded restorations
just like teeth by carefully brushing and flossing using a
non-abrasive toothpaste. If many of the biting surfaces of
teeth have been restored or there is a history of grinding
or clenching of the teeth, then the dentist may recommend a
plastic guard, called “occlusal guard” or “night guard”
since many people wear them at night. This guard protects
the jaw joints and teeth as well as the restorations.

What are dental sealants?

Sealants are plastic coatings that are applied to the pits and fissures of a tooth surface to prevent accumulation of decay causing plaque in these areas. They are applied as a flowable liquid that flows into the pits and fissures of the chewing surfaces of the back teeth, then hardened with a high intensity dental curing light. This is a simple painless procedure requiring no anesthetic or drilling.

Fluorides have markedly reduced incidence of tooth decay in children on the smooth surfaces of teeth since the early 1970’s. By the mid 1980’s approximately 90 percent of the decay in children’s teeth occurred in surfaces with pits or fissures and almost two-thirds were on the chewing surfaces of the back teeth. These are the areas dental sealants protect. They have been approved for many years by professional health associations and public health agencies. Many people are still unaware of dental sealants today. In fact, fewer than 25 percent of children in the United States have sealants applied.

When Should Sealants Be Applied?

Children should get sealants placed as soon as their permanent molars start coming in, before any decay has a chance to occur. This usually starts at about the age of six. Second molars usually come in around the age of twelve, so children should be checked for sealant application regularly from the age of six through their early teen years. Adults at high risk of decay can also benefit from sealants in areas that have not already had to be filled or restored.

How Are Sealants Put On?

• The tooth is cleaned
• The tooth is dried, and isolated with cotton
• A solution is put on the tooth that makes the surface a little rough. This makes the bonding of the sealant material stronger
• The tooth is rinsed and dried
• The sealant is applied in liquid form and hardened for 10 seconds with a dental curing light
• The sealant is finished

How Long Do Sealants Last?

Sealants can last as long as ten years. However, they need to be checked at regular intervals during normal dental checkups to make sure they are not chipped or worn away. If needed, the dentist or dental hygienist can repair the sealants by adding more.

How Can I Get Dental Sealants For My Children?

Talk to your dentist, state or local dental society, or health department. Some schools have programs for sealant application. Check with your school about whether it has a sealant application program.

In 2003, the Centers for Disease Control issued Guidelines
for Infection Control in Dental Health-Care Settings.The
guidelines are intended to educate dental personnel
regarding infection control and to prevent the transmission
of bloodborne pathogens. This comprehensive document covers:
hand hygiene, personal protective equipment, contact
dermatitis/latex allergy, disinfection/sterilization,
environmental infection control, waterlines/biofilms and
special dental considerations such as hand pieces,
radiographs and laboratory procedures.

The CDC’s Guidelines for Infection Control in Dental
Settings are evidenced based and well documented. Much
detail is included.; One of the areas that must be
emphasized at Job Corps Centers is sterilization of dental
instruments. Along with the proper sterilization of
instruments and materials, sterilizer monitoring is an
essential part of the infection control program.

Many factors can cause sterilization to fail–from
procedural errors that are easily remedied, like
overloading, to mechanical problems that can take a
sterilizer out of service until repairs can be made. Since
this variety of factors can influence successful
sterilization, the CDC and the American Dental Association
encourage dentists to regularly assess the efficiency of
their in-office sterilizers.

Sterilization should be monitored using both chemical and
biological indicators. Chemical indicators, such as
indicator tapes, are to be used with each instrument load.
These indicators change color after exposure to the proper
sterilization environment.

Failure of the indicator to change color indicates that it
was not exposed to the proper sterilization environment
(e.g., proper pressure or temperature). In such cases, the
instrument load should be re-sterilized. Indicator tapes are
sterilizer-specific (i.e., tapes for steam sterilizers
cannot be used to test chemical vapor sterilizers). Chemical
indicators should not replace biological indicators, as only
a biological indicator consisting of bacterial endospores
can measure the microbial killing power of the sterilization
process.

The CDC and ADA both recommend that sterilizers be monitored
at least weekly with biological indicators. Each state
dental board may actually have a requirement for biological
monitoring.

Biological monitoring can be done in two ways. In-office
incubator and spore monitoring strips can be purchased from
dental supply houses. This method usually gives results in
24-48 hours. Mail-in spore monitoring programs are also
available. This process usually takes a week. Although it
takes longer to get results, mail-in monitoring programs may
be more reliable and credible than in-house monitoring. A
log of spore test results should be maintained in the dental
office, usually in the sterilization area.

A positive test using chemical or biological indicators
signifies that sterilization failed. If the chemical
indicator does not change color or the spore test result is
positive, the following steps are recommended. The
sterilizer should be taken out of service. Instruments that
were used after the last documented negative spore test
should not be used. The sterilization process being followed
in the office should be reviewed to rule out operator error
as the cause of failure.

Any identified procedural problems should be corrected, and
the sterilizer retested using mechanical, chemical and
biological indicators. If the repeat biological indicator
test is negative and the other test results fall within
normal limits, the sterilizer can be returned to service.
If the biological indicator test is positive, or the
chemical test results indicate failure, the sterilizer
should not be used until the reason for failure has been
identified and corrected. The dental repair company should
be contacted for a service call and possible loan of an
interim sterilizer.

Before the sterilizer can be returned to service, negative
results should be returned for biological indicator tests
conducted during three consecutive empty-chamber
sterilization cycles to ensure that the problem has been
corrected.