Best Practices for Oral Surgical Procedures

Why it matters

Oral surgical procedures raise the risk of local or systemic infection. Microorganisms from inside or outside the mouth can enter areas of the body that are normally sterile, such as bone, subcutaneous tissue, or the vessels that carry blood and lymph through the body.

Background

Oral surgical procedures involve the incision, excision, or reflection of tissue that exposes the normally sterile areas of the oral cavity. Examples include:

• Biopsy.
• Periodontal surgery.
• Apical surgery.
• Implant surgery.
• Surgical extractions of teeth that require elevation of a mucoperiosteal flap, removal of bone or section of tooth, and suturing.

Recommendations

CDC recommends that dental health care personnel performing oral surgeries:

• Perform surgical hand antisepsis using an antimicrobial agent that is fast-acting, has a broad spectrum of activity, and has a persistent effect.
• Use sterile surgeon's gloves.
• Use 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.

CDC recommendations on oral surgical procedures can be found on pages 19, 29, 32–33, 41, and 46 in the Guidelines for Infection Control in Dental Health-Care Settings—2003.

Water use during oral surgical procedures

Conventional dental units cannot reliably deliver sterile water even when equipped with independent water reservoirs. For this reason, sterile solutions like sterile saline or sterile water should be used as a coolant or irrigant when performing surgical procedures.

Placing sterile solutions in the independent water reservoir will not result in sterile solutions being delivered during patient care. Sterile irrigating solutions should always be manually delivered by a sterile water delivery device, such as a sterile irrigating syringe or a bulb syringe. Alternatively, devices that bypass the dental unit by using sterile single-use disposable or sterilizable tubing to deliver sterile water are available.

More information can be found on our Best Practices for Dental Unit Water Quality web page and in the Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care.