sterilizers. Monitor and record at least weekly the
temperature in the sterilizer well. If using salt in place
of beads in the sterilizer, line the well with aluminum
foil to prevent corrosion.
CRITICAL CATEGORY ITEMS
All critical category items require sterilization.
Table 10-3 lists a variety of different dental
instruments and materials and shows what type of
sterilization or disinfection is effective and preferred
for each particular item. It also lists methods that are
effective and acceptable, effective but risk damage,
and ineffective with risk of damage to materials.
Sterilize critical category items before turning them in
for service or repair.
Following BUMEDINST 6600.10, sterilize
critical category items as follows:
Surgical instrumentsEffective and preferred
methods of sterilization are the steam autoclave, dry
heat oven, chemical vapor, or ethylene oxide.
HandpiecesHandpieces include: low-speed
motor attachments, sonic scaler, and tips. Follow
manufacturers instructions. See table 10-3, for
recommended method of sterilization. Follow
manufacturers instructions for the cleaning of the fiber
Burs and diamondsClean burs and diamonds
and dry before sterilizing. Many burs and diamonds
are used only for single patient use. One accepted
method of sterilization for burs and diamonds are to
place them in a screw cap glass test tube (fig. 10-13) or
an aluminum foil wrapped bur block and dry heat
sterilize for 90 minutes at 320-345°F. Place a chemical
indicator in each tube or wrapped bur block. At least
weekly, place a biological monitor in one tube or foil
wrapped block during the first load of the day,. retrieve
and send for culture testing following the
Endodontic files and Gates-Glidden burs
Arrange sets in file blocks and seal in peel packs before
autoclaving. When additional files or burs are
necessary, take them from a new package or from a file
storage box and sterilize them in a bead or salt sterilizer
before use. Use endodontic broaches once and discard
into a sharps container. Dental Technician, Volume 2,
NAVEDTRA 12573, chapter 7, illustrates and
explains endodontic broaches.
Any number of factors can reduce the
effectiveness of sterilizers. Overloading and improper
wrapping can prevent adequate penetration into the
instrument surface. Improper timing, temperature
variations, worn gaskets and seals, and sterilizer
malfunctions can prevent sterilization. Heat
sterilization methods are generally reliable and
effective. Nevertheless, regular monitoring of
sterilization cycles is necessary to detect inadequate
process conditions caused by human error or
Types of Sterilization Monitors
Commands should base selection of sterilization
monitors on reliability, appropriateness to the process,
safety, and cost effectiveness. Many types of monitors
are available. The three most commonly used
sterilization monitors in the Navy DTFs are biological
monitors, internal indicators, and external indicators.
monitors are designed to assess whether sterilization
actually occurred. These systems consist of bacterial
endospores impregnated in paper strips or sealed in
glass ampules or plastic vials.
indicators are chemical dyes that change color when
exposed to steam, dry heat, or chemical vapor for a
specified period of time.
When placed inside an
instrument pack, they determine whether the
conditions necessary for sterilization have been met.
indicators are chemical dyes that change color upon
short exposure to sterilizing conditions.
generally printed on packaging materials or supplied in
tape form and are necessary to distinguish processed
packages from those that have not been cycled.
External indicators are not sensitive enough to be
processed as an internal indicator and should not be
After endospore tests are processed through a
sterilization cycle, they must be incubated according to
the manufacturers instructions. A pH indicator in the
medium changes color when the ampule of endospores
germinate and produce acids. This visually identifies a
failure in the sterilization process. As a minimum,