Material Safety in Pediatric Dentistry
All dental materials used in pediatric dentistry should be FDA-cleared, biocompatible, and properly sterilized or disinfected according to CDC infection control guidelines, with special attention to fluoride-containing materials in children under 6 years to prevent enamel fluorosis. 1
Core Safety Principles for Material Selection
Restorative Materials
Glass ionomer cements are the safest first-line choice for pediatric restorations due to their chemical bonding to tooth structure, biocompatibility, fluoride release capability, and ability to inhibit secondary caries. 2, 3
Resin-modified glass ionomer cements offer improved physical characteristics with reduced hardening time through photopolymerizable components, making them particularly practical for pediatric use. 3
Composite resins are appropriate for anterior restorations and should use highly filled formulations for better strength, though they are more technique-sensitive and time-consuming than amalgam. 2
Amalgam remains effective for class II restorations with less technique sensitivity, but extracted teeth containing amalgam must not be disposed in regulated medical waste intended for incineration. 1, 2
Critical Age-Specific Fluoride Safety
Children under 6 years should use only a pea-sized amount (0.25g) of fluoride toothpaste maximum twice daily to prevent enamel fluorosis, as children in this age group swallow an average of 0.3g per brushing and can inadvertently swallow up to 0.8g. 1
High-fluoride toothpaste (>1,500 ppm) is contraindicated in children under 6 years due to excess fluoride ingestion risk. 1
Fluoride mouthrinse is only appropriate for children over 6 years when the swallowing reflex is adequately developed. 1
The critical period for fluorosis susceptibility is 15-24 months for boys and 21-30 months for girls for upper central incisors, with no risk after age 8 years when enamel maturation is complete. 1, 4
Parents of children under 2 years must consult a dentist or physician before introducing any fluoride toothpaste. 1
Infection Control and Sterilization Requirements
Instrument Processing
All critical dental instruments must be cleaned and heat-sterilized before each use using only FDA-cleared sterilization devices following manufacturer instructions. 1
Semicritical items (those contacting mucous membranes but not penetrating tissue) require cleaning and heat-sterilization before each use, with heat-stable alternatives strongly encouraged. 1
Metal impression trays and face-bow forks must be cleaned and heat-sterilized between patients. 1
Burs, polishing points, and other contaminated items should be heat-sterilized if heat-tolerant, or cleaned and disinfected with EPA-registered hospital disinfectant with tuberculocidal claim if heat-sensitive. 1
Laboratory Materials and Prosthetics
All dental prostheses and prosthodontic materials (impressions, bite registrations, occlusal rims) must be cleaned, disinfected, and rinsed using EPA-registered hospital disinfectant with intermediate-level (tuberculocidal) activity before laboratory handling. 1
Consult manufacturers regarding material stability relative to disinfection procedures, particularly for impression materials. 1
Include specific disinfection information (solution used and duration) when sending laboratory cases off-site and upon return. 1
Personal Protective Equipment
Wear medical gloves when potential exists for contacting blood, saliva, or mucous membranes, using a new pair for each patient and washing hands immediately after removal. 1
Masks, protective eyewear, and gowns are required when splashing or spattering of blood or body fluids is anticipated. 1
Change masks between patients or during treatment if the mask becomes wet. 1
Screen all patients for latex allergy and ensure a latex-safe environment with emergency treatment kits containing latex-free products available. 1
Surgical Procedures
For oral surgical procedures, perform surgical hand antisepsis with antimicrobial product before donning sterile surgeon's gloves, and use only sterile saline or sterile water as coolant/irrigant delivered through devices specifically designed for sterile irrigating fluids. 1
Environmental Safety
Examination rooms must have properly functioning sinks with soap dispensers and alcohol-based hand rub, with equipment cleaned after each patient contact. 1
Cover examination tables with disposable paper or linen changed between patients, and if visible contamination occurs, clean with detergent followed by 1:100 dilution of household bleach applied for 1 minute or EPA-approved low-level disinfectant. 1
For blood or body fluid spills, remove visible organic matter with absorbable material first, then clean and decontaminate with 1:100 bleach dilution (or 1:10 if surface not pre-cleaned) or EPA-registered germicidal product. 1
Biocompatibility Considerations
Despite containing potentially toxic substances (resin monomers, photoinitiators, acidic polymers), dental materials demonstrate excellent safety records with extremely low adverse event rates due to medical device regulations, responsible manufacturing, and clinical vigilance. 5
All materials should undergo biocompatibility testing through in vitro, in vivo, and clinical investigations before clinical application. 6, 7
Long-term oral placement requires materials with minimal local and systemic toxicity for both patients and dental staff. 7
Common Pitfalls to Avoid
Never reuse single-use disposable items during any procedure. 8
Do not wash, disinfect, or sterilize gloves for reuse - always use new gloves for each patient. 1
Avoid allowing unsupervised fluoride product use in children under 6 years to prevent excessive ingestion. 1
Never use adult-sized amounts of fluoride products for children - always use age-appropriate quantities. 1
Do not incinerate extracted teeth containing amalgam due to mercury vapor release. 1
Failing to heat-sterilize extracted teeth without amalgam before educational use creates infection risk. 1