Last year was a challenging one for orthodontic practices. We’ve all heard about the practices in California, New Jersey, and Oklahoma, where dental professionals failed their patients and our profession by not sterilizing instruments and equipment properly. As a result, patients were infected with everything from hepatitis, HIV, and enterococcal endocarditis, to oral cellulitis. Walking into work the morning after news like this breaks, the thought crosses our minds: How many patients are going to ask us about our sterilization procedures and policies? And how are we going to reassure them that we are doing everything in our power to protect them? The answer to the latter question: We look at our practice’s infection prevention procedures and make sure we aren’t missing anything. None of us want to be the next practice making national headlines for lack of care.

Dirty to Clean

While patients may be focused on whether or not they are receiving the best treatment and outcomes, they are implicitly hoping and trusting that we are protecting them from infection. To ensure that we are giving them the best care possible, we need to start with taking a good hard look at our sterilization room: Is it adequate? Is it a flex space shared with the breakroom? Does it have a fish tank hanging through the wall? Are the counters suitable?

Let’s start by cleaning out all the junk, the things that just don’t belong in a sterilization room. That would include the fish tank, the fridge for lunch, and anything that cannot be cleaned with a disinfectant if contaminated. Once the room is acceptable, a dirty to clean flow needs to be established. If you enter on the right with the dirty, you continue to the left as the instruments become sterile, ending in storage. At the entry point to this process,  you should have storage for dirty instruments waiting to begin the process, then an ultrasonic or instrument washer, followed by the sink and drying/wrapping area. From there, it’s  on to the autoclaves. The last station is going to be storage for all instruments and cassettes that are now sterile and waiting for patient use. Storage for disposable goods and disinfecting products can be in this area, but those items should be properly sorted. On the dirty side of the room, consider only storing disinfecting products, and on the clean side the patient products and disposable goods. You might be thinking this is overly difficult, that you can’t change the layout of the room, but try modifying the flow of the existing room to satisfy the procedure.


If you use cassettes, you rock! They not only help keep you organized for the procedure, but increase your safety while carrying them to and from the operatory. If not, that’s okay. Just be sure to carry instruments in a closed container to avoid accidental drops and pokes. All instruments that can be autoclaved should be, and they should be in sterile wrap or pouches to maintain the sterility once they exit the autoclave. If they cannot withstand the heat, then a cold sterile is appropriate, but be sure to follow the manufacturer’s directions.

Maintenance and Sterilization

Maintenance needs to be performed and logs need to be kept. Here are some best practices to keep in mind.

  • How do you know the ultrasonic is working? An aluminum foil test should be performed monthly. The ultrasonic only passes if there are small holes in the foil after holding it in the ultrasonic for 30 seconds.
  • Biological indicators/spore tests should be run through the autoclaves weekly to ensure proper functioning, and results should be logged. This test confirms that the autoclave is killing all of the microbes. It can be done in office or sent out to a company to run the test.
  • When it comes to processing instruments, there are indicators you can use to ensure they have been processed, including indicator tape and pouches; but this doesn’t guarantee sterility.
  • If using disinfecting products that are time sensitive, be sure they are replaced when appropriate and this fact logged so there is no confusion about the product’s expiration.

Sterilization can be a bit daunting, but know you can do it. The best sterilization advice is to read any product’s instructions and be confident and consistent in your procedure. Look at the process from the patient’s perspective: Do you want those instruments to be placed in your mouth without knowing how they have been sterilized? The answer lets you know if you have confidence in your procedures or if it is time for a makeover. Your goal is to provide your patients with the same care you would expect if you were in their shoes. OP

Ashley Cutler, BSDH, RDH, is clinical director at Parks Orthodontics in Yorktown, Va, where she has worked for 17 years. She is a graduate of the dental hygiene program at Old Dominion University.