Subject: Safe Handling of Extracted Teeth
Effective Date: September 2012
Review Dates: November 2015
Extracted teeth are collected and frequently used in dental education settings. The purpose of this policy is to provide guidance on the safe handling and the decontamination process.
Individuals handling extracted teeth for pre-clinical training or clinical assignments must be aware of the potential exposure to Bloodborne pathogens. Therefore individuals who collect extracted teeth must decontaminate and handle teeth according to standards set by the Center for Disease Control (CDC) and Seattle-King County Public Health Department as well as the University of Washington School of Dentistry.
Excerpts from CDC Website accessed 4-13-15: http://www.cdc.gov/oralhealth/infectioncontrol/faq/extracted_teeth.htm (link no longer accessible)
What are the recommendations for using extracted teeth in educational settings?
Extracted teeth are occasionally collected and used for preclinical educational training. The teeth should be cleansed of visible blood and gross debris and maintained in a hydrated state. Because the teeth will be autoclaved before clinical teaching exercises, using an economical storage solution (e.g., water or saline) may be practical. A liquid chemical germicide (e.g., sodium hypochlorite [household bleach] diluted 1:10 with tap water) could reduce bacterial accumulation during storage, although it does not completely disinfect/sterilize the tooth. Extracted teeth must be placed in a well-constructed container with a secure lid to prevent leaking during transport and labeled with the biohazard symbol.
Prior to being used in an educational setting, teeth should be heat sterilized to allow for safe handling. Pantera and Shuster demonstrated elimination of microbial growth using an autoclave cycle for 40 minutes. However, since preclinical educational exercises simulate clinical experiences, students enrolled in dental educational programs should still follow standard precautions. Autoclaving teeth for preclinical laboratory exercises does not alter their physical properties sufficiently to compromise the learning experience. However, autoclave sterilization of extracted teeth does affect dentinal structure enough to compromise dental materials research.
The use of teeth that do not contain amalgam is preferred because they can be safely autoclaved. Extracted teeth containing amalgam restorations should not be heat sterilized because of the potential health hazard associated with possible mercury vaporization and exposure. If extracted teeth containing amalgam restorations are to be used, their immersion in 10% formalin solution for 2 weeks has been found to be an effective method of disinfecting both the internal and external structures of the teeth.
Hazardous Waste Regulations and Safe Handling of Extracted Teeth:
- Under infectious waste disposal regulations governing dental offices and clinics, extracted teeth are considered as infectious waste and must be handled properly.
- The CDC has issued guidelines for decontaminating extracted teeth for use in dental educational settings.
- The objective of these recommendations is to minimize the risk of: transmission of Hepatitis B virus (HBV), human immunodeficiency virus (HIV), and other blood borne pathogens during the handling of extracted teeth for use in dental educational settings.
- All extracted teeth should be considered contaminated because they contain blood.
- All individuals who collect, transport, or extracted teeth should handle them with the same precautions as a specimen for biopsy.
- Universal precautions must be adhered to whenever extracted teeth are handled. All persons who might come in contact with blood or blood contaminated patient material in an occupational setting should receive hepatitis B vaccine per UW School of Dentistry policy.
The following precautions are recommended:
- Use recommended PPE for handling extracted teeth.
- All extracted teeth should be stored in a well-constructed container, such as a glass jar, with a secure lid to prevent leaking during transport and labeled with a biohazard symbol.
- Containers should have sufficient amount of either of the following:
- Common household bleach, diluted with water at a 1:10 ratio
- Other liquid chemical germicides commonly used for clinical specimen fixation (e.g. Formalin).
- As per the CDC guidelines, if extracted teeth contain amalgam restorations, immersion in a 10% formalin solution for 2 weeks is an effective method of disinfecting both the internal and external structures of the teeth (CDC Guidelines for Infection Control in Health Care Settings, 2003).
- The CDC does not recommend the use of extracted teeth with amalgam for educational settings.
- Before working with extracted teeth, they should be cleansed of visible blood and gross debris.
- Scrub with detergent and water or using an ultrasonic cleaner.
- Store in a fresh 1:10 solution of diluted bleach or suitable liquid chemical germicide (e.g. Formalin).
- Work surfaces and equipment should be cleaned and then decontaminated with an appropriate liquid chemical germicide after completion of work activities.
- Extracted teeth should be decontaminated in a 1:10 solution of bleach for 30 min. prior to giving to a patient who requests their tooth following surgery.
- Extracted teeth containing restorations should never be heat processed.
- Extracted teeth may be returned to the patients upon request and are not subject to the provisions of the OSHA Bloodborne Pathogens Standard.
The Seattle-King County Department of Public Health regulates hazardous waste in the Seattle area should teeth be transported to and from the UW School of Dentistry.
- Teeth should be stored in a well-constructed container with a sealable lid for transport.
- Teeth must be placed in a sealable, clear plastic sealable bag secondary to placing in the container in the event of possible leak.
- The container and clear plastic bag must be adequately marked with a biohazard label. Labels are available from the course director.
- In order to transport extracted teeth in a personal vehicle, compliance with these regulations are required.
- In order to transport extracted teeth on airlines or ship via UPS, USPS or other mail, the bleach solution must be replaced with tap water for transport. (Bleach is considered a hazardous chemical, and is prohibited for commercial airlines or USPS transport.
Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings. (2003) MMWR; 52 (No. RR17)
Dean of UW SOD
February 2, 2016