OCTASE™

Recommendations

Cross-infection in Dentistry

Cross-infection means mutual infection between medical practitioners and their patients.
Compared to the medical field, the possibility of cross-infection in dentistry is high, for the following reasons.
First, many patients require invasive treatment which causes bleeding, therefore contact with blood is common.
Second, most patients are outpatients, making pretreatment checks for infectious diseases difficult.
Third, organized infection countermeasures such as infection countermeasure committees in general hospitals are difficult to provide, and ordinary dental clinics lack specialized facilities such as central sterilizing rooms.

Cross-infection in Dentistry

Number of Blood-borne Virus Carriers in Japan

Number of blood-borne virus carriers in Japan

First, there is HIV, which can develop into AIDS.
There are estimated to be tens of thousands of HIV carriers in Japan.
Although views on hepatitis B vary, there are roughly three million carriers.
With the addition of approximately two million carriers of hepatitis C, there are an approximate five million carriers of blood-borne viruses in Japan, or one in forty of the population.
This means that one out of every forty cases at medical institutions is a blood-borne infection.

Significance of primary cleaning

Some pieces of dental clinical equipment are disposable, but others are sterilized or disinfected for reuse.
Primary cleaning is essential in the sterilization or disinfection process. This means the task of removing organic material from the object.
Pathogenic microbes exist along with dirt – in other words, organic material - on the object, and primary cleaning increases the efficacy of later sterilization or disinfection.

Number of Blood-borne Virus Carriers in Japan

Necessity of Primary Cleaning

If primary cleaning is omitted, the following damage can occur.
The initial number of germs clinging to the object to be disinfected (the absolute quantity of microbes) is high.
The effectiveness of sterilization or disinfection decreases.
The organic layer on the object’s surface becomes a barrier, preventing sterilization or disinfection.
The organic material weakens the germicidal strength of the chloride disinfectant.
Through sterilization or disinfection with glutarate solution, high-pressure steam sterilization, or functional water, the proteins adhering to the object are compressed, dulling the movement of scissors and the cutting edge of blades.

Necessity of Primary Cleaning

Risks of Manual and Brush Washing

For the reasons stated above, washing is required before disinfection.
Although some dental clinics have introduced the use of a warm-water washing and disinfecting machine called a washer-disinfector, manual washing with a brush is still commonly practiced.
However, brush washing involves the following risks.
Hand injuries from sharp instruments may occur, seriously increasing the danger of infection.
The surrounding environment may be polluted via water splashes from the brush.
The brush tips may fail to reach scratches or corners smaller than the brush hairs, leaving unwashed areas.

Risks of Manual and Brush Washing

Area Contamination from Manual and Brush Washing

The presence or absence of area contamination from splashes in brush cleaning is verified with a simple experiment.
This experiment uses a “manual washing evaluation kit” consisting of an ultraviolet light and washing lotion.
The washing lotion glows under the ultraviolet light. During the evaluation of manual washing, the lotion is rubbed onto the hands as they are washed, and by confirming how much of the lotion remains, the cleansed status of the hands can be evaluated.
Washing lotion is rubbed onto a tool that represents used dental equipment, and brush-washed under running water.
At this stage, no change can be seen around the sink.
When comparing high-resolution photographs under the ultraviolet light of the sink before and after washing, we observe splashes of washing lotion around the sink.
This experiment suggests that casual brush-washing has the potential to contaminate the surrounding environment.

Area Contamination from Manual and Brush Washing

Recommendation of Enzymatic Cleaning Fluid

The risks of manual washing (brush washing) include:
1) Contamination through hand injuries
2) Area contamination through splashes
3) Insufficient cleaning of all areas.
As a method of eliminating these risks, I recommend the use of enzymatic cleaning fluid.
The image shown is of the enzymatic cleaning fluid Octase 90fX.

Recommendation of Enzymatic Cleaning Fluid

Action Mechanism of Protein Breakdown via Enzymes

The action mechanism of protein breakdown using an enzymatic cleaning fluid, in short the way it works, is as follows.
Proteins are composed of multiple amino acids forming a chain.
Biological proteins found in blood, tissues and elsewhere are “high-molecular proteins”, and have “hydrophobic” properties, which is to say they do not mix with water.
Therefore, it is not easy to remove biological proteins with water washing.
The use of an enzymatic cleaning fluid - that is, the effects of protein breakdown enzymes - on proteins works on the connecting extremities of the amino acids, severing them in multiple places.
As a result, the proteins become “low-molecular proteins” which have few amino acids.
Low-molecular proteins are “hydrophilic,” which means that they mix well with water, and can easily be removed with a simple water wash.
This is the action mechanism of protein breakdown enzymes.

Action Mechanism of Protein Breakdown via Enzymes

Superiority of Octase 90fX

The superiority of Octase 90fX compared to other protein breakdown enzymes is confirmed with an experiment using the breakdown of gelatin film. Gelatin is a denatured form of protein.
Layers of yellow, red, and black gelatin film are built up on the base of the test paper.
Three test tubes are prepared: from the left, Octase 90fX (diluted 500-fold), Company A’s enzymatic cleaning fluid (diluted 500-fold), and tap water.
Three sheets of gelatin film are placed in each test tube, and chronological observation takes place.
This video shows 10 minutes condensed to 10 seconds.
In the Octase 90fX tube, the black, red, and yellow films are already broken down, and the white base can be seen.
In the Company A fluid tube, the black film has been broken down and the red film is just visible.
In the tap water tube, there is no change.
When the test paper is removed from each tube, in the Octase 90fX tube the white base is almost completely revealed, while in the Company A fluid tube the yellow level is still visible.
No change at all has occurred in the tap water tube.
The above experiment demonstrates the superiority of Octase 90fX compared to a rival manufacturer’s product.

Superiority of Octase 90fX

Application Methods of Octase 90fX

Application methods of the enzymatic cleaning fluid Octase 90fX are as follows.
First, the dipping method. This has the merit of simplicity in that you need to do no more than dip the equipment to be cleaned.
Second, use together with ultrasound cleaning.
This method combines dipping and ultrasound cleaning, and through the combination of physical and chemical effects, greatly increases the efficacy of protein breakdown.
Third, foam cleaning. This method involves putting cleaning fluid into a plastic bottle with a foaming nozzle and covering the equipment to be cleaned in the foam produced by spraying.
An explanation of each method follows.
Use of Octase 90fx with ultrasound cleaning involves the use of ultrasound cleaning equipment while dipping the tool to be washed (image omitted).
Foam cleaning involves covering the tool to be washed in foam, by which it is cleaned via the collapse of the bubbles and rinsing off the foam.
The images show the tool to be washed being covered in the foam sprayed from the container, allowed to sit for roughly five minutes until the foam has disappeared, and then rinsed.
Sterilization is performed in an autoclave as usual.
An advantage of the foam cleaning method is that there is no risk of transfer of contamination from one tool to another, because the fluid is not reused but is washed away each time.

Application Methods of Octase 90fX

Foam Cleaning of Dental Impressions

A type of contamination unique to dentistry involves the denture molds used to take tooth impressions, which are called “dental impressions”.
The dental impression may have traces of remaining blood, or have been insufficiently cleaned or insufficiently disinfected. Plaster is poured into this dental impression to make a plaster cast, which has potential to spread contamination not only in the area of dental technology but throughout the whole of the dental field.
The foam cleaning method is effective for these dental impressions as well.
The entire surface of the dental impressions is covered in the foam sprayed from a plastic bottle with a foaming nozzle.
It is left for around five minutes until the foam has disappeared, and then lightly rinsed.
After foam cleansing and disinfection with chloride fluid or disinfection equipment specialized for dental impressions, the remaining plaster is washed away and a working model is created for making false teeth or crowns.

Foam Cleaning of Dental Impressions

Efficacy of Foam Cleaning of Dental Impressions

The efficacy of foam cleaning can be confirmed visually.
Blood residue often remains on dental impressions after taking the impression of the patient’s teeth, as the image shows.
The enlarged image clearly shows the blood residue on the impression.
After foam cleaning is used for this kind of blood contamination, no traces of blood can be confirmed visually.
In this way, by breaking down the blood left on the surface of dental impressions, we consider that a significant quantity of microbes are eliminated.

Efficacy of Foam Cleaning of Dental Impressions

Evaluation of Dental Impression Cleaning with Enzymatic Cleaning Fluid

An important point in the process of cleaning and disinfecting dental impressions is to keep changes in dimensions, in other words variations, to a minimum.
Crowns or false teeth made from dental impressions with variations will not fit patients’ mouths.
Accordingly, we investigated the changes in dimensions of dental impressions using protein breakdown enzymes, and presented our experimental results* in images at the 2006 Academic Conference of the Nippon Academy of Dental Technology.
We used protein breakdown enzymes and impression-specific disinfectant fluid on dental impressions and measured the changes in dimensions. The results were that even when left for three hours, the changes in dimensions were miniscule compared to preservation in water or a desiccator.
These experimental results indicated that protein breakdown enzymes do not exert a negative influence on dental impressions.

*Akiko Sato and Masakazu Oonishi
On the influence of experimental sterilization systems on changes in dimensions of dental impressions, Journal of the Nippon Academy of Dental Technology, Vol. 27, December 2006

Evaluation of Dental Impression Cleaning with Enzymatic Cleaning Fluid

Summary of Effects of Enzymatic Cleaning Fluid

I will summarize the effects of enzymatic cleaning fluid.
First, the reduction of worker contact with the object being disinfected leads to decreased risk of infection.
Second, the reliability of disinfection and sterilization increases.
Third, it becomes possible to switch to a disinfectant that exerts less stress on the human body.
Fourth, even when using the same disinfectant, a reduction of the time required for disinfection is possible.
Fifth, residues of organic substances are removed after disinfection or sterilization, meaning a decrease in damage such as dulled blades and stiff scissors.
However, primary cleaning is carried out before disinfection or sterilization, and naturally the possibility exists that objects become contaminated.
Obviously, methodical care should be taken that workers use personal protection and dispose appropriately of used fluids.

Summary of Effects of Enzymatic Cleaning Fluid