Orthodontic procedures involve repeated contact with critical and semi-critical instruments such as pliers, bands, wires, elastics, and impression materials.
These tools are potential vectors for cross-contamination if not properly disinfected between patients.
Unlike general dentistry, orthodontic practices often operate with high patient flow and frequent reuse of specialized instruments, requiring highly efficient yet non-corrosive disinfection protocols.
Over the past 7 years, research has focused on evaluating chemical disinfectants in terms of microbial effectiveness, compatibility with orthodontic tools, application time, and environmental safety.
This guide presents the most up-to-date recommendations based on scientific literature and clinical standards, with emphasis on chairside disinfection between appointments, instrument longevity, and staff safety.
Key Disinfectants in Orthodontic Clinics
1. Glutaraldehyde (2–5%)
❖ Level: High-level disinfectant (HLD).
❖ Effectiveness: Broad-spectrum (bacteria, viruses, fungi, spores at higher concentrations).
❖ Application:
- After pre-cleaning, immerse tools in 2% glutaraldehyde for 30 minutes at ~25°C.
- Rinse thoroughly with sterile water and dry completely.
❖ Advantages: Highly effective even in the presence of organic material.
❖ Drawbacks: Strong odor, potentially toxic with prolonged exposure; requires good ventilation and sealed containers.
2. Orthophthalaldehyde (OPA)
❖ Level: High-level disinfectant.
❖ Effectiveness: Kills most pathogens within 12 minutes.
❖ Application: Immersion of cleaned instruments, followed by sterile rinse and drying.
❖ Advantages: Less toxic than glutaraldehyde, longer solution life, low odor.
❖ Ideal for: Heat-sensitive orthodontic tools.
3. Alcohol (Ethyl or Isopropyl 70–95%)
❖ Level: Intermediate disinfectant.
❖ Effectiveness: Bactericidal and virucidal but not sporicidal.
❖ Use: Quick disinfection of metal pliers or plastic instruments between appointments (contact time: 2 minutes).
❖ Drawbacks: Evaporates quickly; not a substitute for sterilization; may corrode certain metals.
4. Sodium Hypochlorite (5–6%)
❖ Level: Intermediate.
❖ Effectiveness: Broad antimicrobial activity, particularly useful on surfaces and impressions.
❖ Use:
- 5% solution applied to alginate impressions or trays for 10 minutes.
- Not recommended for direct contact with orthodontic pliers (corrosive).
❖ Drawbacks: Damages metal tools with repeated exposure.
5. Acid Peracetic / Hydrogen Peroxide / Quaternary Ammonium Compounds
❖ Peracetic Acid (0.2–0.3%):
- Effectiveness: High-level; kills spores, bacteria, and viruses.
- Use: Immersion for 10–15 minutes; rinse and dry.
- Advantages: Biodegradable, low residue.
❖ Hydrogen Peroxide (>6%):
- Broad-spectrum, fast-acting, but less stable over time.
❖ Quaternary Ammonium Compounds (QACs, 2%):
- Ideal for rapid surface disinfection (1-minute contact time).
- Available as sprays or wipes for chairside tool cleanup.
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Suggested Protocol Between Orthodontic Appointments
❖ Step - Procedure
1. Pre-Cleaning: Rinse and scrub instruments in enzymatic detergent (10–15 min at 25–40°C).
2. Disinfection: Immerse in glutaraldehyde, OPA, or peracetic acid per manufacturer instructions. For quick use: wipe with QACs or alcohol-based spray.
3. Rinsing: Use sterile or distilled water post-immersion.
4. Drying: Ensure complete drying before storage.
5. Storage: Keep in sterile, closed containers or pouches until reuse.
6. Documentation: Record date, disinfectant type, batch, and responsible staff member.
Disinfectant Comparison
Disinfectant
❖ Glutaraldehyde 2%
- Level: High
- Contact Time: 30 min
- Corrosivity: Moderate
- Ideal Use: Pliers, bands, metal tools
❖ OPA
- Level: High
- Contact Time: 12 min
- Corrosivity: Low
- Ideal Use: Heat-sensitive items
❖ Peracetic Acid
- Level: High
- Contact Time: 10–15 min
- Corrosivity: Low
- Ideal Use: Mixed-material instruments
❖ Alcohol 70–95%
- Level: Intermediate
- Contact Time: 2 min
- Corrosivity: High
- Ideal Use: Fast chairside cleanup
❖ QACs 2%
- Level: Intermediate
- Contact Time: 1 min
- Corrosivity: Low
- Ideal Use: Surfaces, trays, plastics
❖ Sodium Hypochlorite 5%
- Level: Intermediate
- Contact Time: 10 min
- Corrosivity: High
- Ideal Use: Impressions, countertops
Conclusion
Proper chemical disinfection between orthodontic appointments is vital to patient safety and long-term instrument integrity.
Glutaraldehyde, OPA, and peracetic acid provide high-level disinfection for reusable tools, while alcohol and QACs offer rapid turnover options between patients.
Choose disinfectants based on instrument material, clinic workflow, and safety protocols.
📚 Recommended Reading
- Sheetal Jankare., et al. “Sterilization Protocol in Orthodontic Practice: A Review”. Acta Scientific Dental Sciences 3.12 (2019): 32-39
- Turk J Orthod. 2022 Mar 1;35(1):22–26. Disinfection of Orthodontic Elastomers and Its Effects on Tensile Strength.
