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Oral Surgical Procedures

What is the Centers for Disease Control and Prevention definition of an oral surgical procedure?

Oral surgical procedures involve the incision, excision, or reflection of tissue that exposes the normally sterile areas of the oral cavity. Examples are biopsy, periodontal surgery, apical surgery, implant surgery, and surgical extractions of teeth (removal of erupted or nonerupted tooth requiring elevation of mucoperiosteal flap, removal of bone or section of tooth, and suturing if needed).

What infection prevention measures are recommended when performing oral surgical procedures?

Oral surgical procedures raise the risk of local or systemic infection because microorganisms from inside or outside the mouth can enter the vascular system and other normally sterile areas of the oral cavity (e.g., bone or subcutaneous tissue). These procedures require a higher level of infection prevention than routine procedures, including the following:

  • Surgical hand antisepsis using an antimicrobial agent that is fast-acting, has a broad spectrum of activity, and has a persistent effect (see Hand Hygiene)
  • Use of sterile surgeon’s gloves
  • Use of sterile irrigating solutions and devices designed for delivering sterile irrigating fluids such as a sterile bulb syringe, sterile single-use disposable products, or sterilizable tubing (see Dental Unit Water Quality)

Why is it necessary to wear sterile gloves when performing surgical procedures?

Sterile gloves minimize transmission of microorganisms from the hands of surgical dental health care personnel (DHCP) to patients and prevent contamination of the hands of surgical DHCP with the patient’s blood and body fluids. In addition, sterile surgeon’s gloves are more rigorously regulated by the Food and Drug Administration and therefore might provide an increased level of protection for the provider if exposure to blood is likely.

Our dental office has an independent water reservoir (bottle) attached to the dental unit. Can we place sterile water in it when performing surgical procedures?

No. Placing sterile solutions in the independent water reservoir will not result in sterile solutions being delivered during patient care. Appropriate delivery devices (e.g., sterile bulb syringe or sterile, single-use disposable irrigating syringes) should be used to deliver sterile water. Alternatively, oral surgery and implant handpieces, as well as ultrasonic scalers, are available that bypass the dental unit to deliver sterile water or other solutions by using sterile single-use disposable or sterilizable tubing.

References

CDC. Guideline for hand hygiene in health care settings: Recommendations of the Health Care Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51(No. RR-16). Available at: https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf [PDF-1.2M]. Accessed March 17, 2016.

CDC. Guidelines for infection control in dental health-care settings – 2003. MMWR 2003; 52(No. RR-17):1–66. Available at: https://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf [PDF-1.2M]. Accessed March 17, 2016.

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