Microbial contamination of laboratory constructed removable orthodontic appliances

This study aims to determine whether laboratory constructed removable orthodontic appliances are free from microbial contamination prior to clinical use and to evaluate the dental hospital cross-infection procedures to ensure that patient-derived contamination does not enter the construction process, thereby propagating a cycle of cross-contamination.

The construction process of removable orthodontic appliances from three individuals was evaluated at every stage, from impression to final delivery of the appliance using molecular microbiological techniques. The bacterial profiles at each stage of appliance construction were obtained using denaturing gradient gel electrophoresis, along with the bacterial profiles of the three participants' saliva. This enabled the bacterial profiles found at each stage of construction to be compared directly with the saliva of the person for whom the appliance was being constructed. Bacteria were identified at each stage using 16S rDNA PCR amplification and sequence phylogeny.

There was no evidence of bacterial cross-contamination from patients to the laboratory. The current process of disinfection of impression appears to be adequate. Contamination was found on the final removable appliances (0.97 × 10(2)-1.52 × 10(3) cfu ml(-1)), and this contamination occurred from within the laboratory itself.

Every effort is made to reduce potential cross-infection to patients and dental professionals. Newly constructed removable appliances were shown not to be free from contamination with bacteria prior to clinical use, but this contamination is environmental. Further studies would be required to determine the level of risk this poses to patients.

Dental professionals have a duty of care to minimise or eradicate potential risks of cross-infection to patients and other members of the team. To date, much less attention has been paid to contamination from the orthodontic laboratory, so contamination and infection risks are unknown.