The implementation of biosafety protocols protects patients and staff at the dental clinic and includes basic measures such as hand hygiene, the use of personal protective equipment (PPE), sterilization and disinfection, as well as safe waste management. However, to break the chain of transmission, it is essential to identify current risks and establish clear protocols that reinforce safety in the dental office.
Advances in Biosecurity
The set of preventive measures designed to minimize the risk of transmission of infectious agents in healthcare settings—what we refer to as biosafety—is also applied in dentistry, particularly with regard to the prevention of cross-infection between patients and medical staff.
In the wake of the pandemic, biosecurity measures were strengthened, and implemented more systematically: constant review of infection risks, adherence to standardized protocols, verification of regulatory compliance, and the use of digital technology to improve safety.
The World Health Organization has a Global Strategy for Infection Prevention and Control (IPC) and, in addition, a Action Plan and Monitoring Framework 2024–2030 to support its implementation.
Fundamental principles of biosafety: standard precautions
Standard precautions should be applied to all patients regardless of their health status: hand hygiene, use of PPE, sterilization of instruments, and surface disinfection, as well as the management of medical waste.
These are the cornerstones of infection control, in accordance with the recommendations of the Ministry of Health, the General Council of Dentists of Spain, and the WHO.
1. Hand hygiene
The WHO considers hand hygiene to be one of the most important and effective measures for preventing infections in healthcare settings. It should be performed using soap and water or hydroalcoholic solutions. In dentistry, clinic staff must wash their hands before patient contact and before performing aseptic procedures, as well as after coming into contact with body fluids, with the patient, or after touching surfaces near the patient.
2. Personal protective equipment
Proper use of PPE protects both clinic staff and patients, with the basic items: disposable gloves, masks (surgical or high-filtration), protective goggles or face shields, and clinical gowns.
That said, it is worth noting that procedures involving turbines and ultrasound are risky due to their potential to disperse infectious particles; therefore, in these cases, it is recommended to use high-filtration masks and combine aerosol control measures: use of a rubber dam, high-volume suction, HEPA filtration systems, and cross-ventilation.
3. Disinfection of instruments and surfaces
Depending on their intended use, dental instruments are classified as critical, semi-critical, and non-critical.
| Critical instruments | Comes into contact with internal tissues or blood. Requires thorough sterilization. |
| Semi-critical instrument | It comes into contact with mucous membranes or deep non-sterile areas. It requires high-level disinfection. |
| Non-critical instrumentation | Touch only intact skin or external surfaces. Medium or low-level disinfection is sufficient. |
In accordance with the measures recommended by the Ministry of Health, the Spanish Agency for Medicines and Health Products (AEMPS), and the General Council of Dentists, the steps to follow to ensure that instruments are free of germs are:
| Cleaning | Remove any visible traces of blood, saliva, and organic matter. |
| Disinfection | Use approved disinfectants to eliminate most microorganisms. |
| Sterilization | Use an autoclave or other approved methods to eliminate all microorganisms. |
| Biological control | Conduct regular checks (using test strips or indicators) to verify that the sterilization process is working properly. |
4. Medical Waste Management
Clinics must comply with current regulations regarding the management of medical waste, including biological, sharps, and chemical.
| Biologicals | Traces of blood, saliva, tissue, or materials that may be contaminated with microorganisms. |
| Sharp and cutting | Needles, scalpels, files, or any instruments that can cut or pierce. |
| Chemicals | Cleaning products, disinfectants, and other chemicals used. |
Only approved containers for each type of waste, separating and disposing of them in accordance with the procedures established by Spanish and regional regulations.
How to Identify and Manage Risks in a Dental Practice
Identifying the risks present in a dental clinic is the first step toward implementing biosafety measures. Among the main factors to consider are the generation of aerosols, contact with biological fluids, the use of sharp instruments, as well as high patient turnover, which increases the likelihood of exposure.
To prevent the spread of infections, biosafety protocols are based on the three components of the transmission chain: source of infection, route of transmission, and susceptible host. In other words: the place or person from which the germ originates, how it is transmitted (through the air, saliva, blood, or contact with contaminated surfaces), and the person most at risk of becoming ill.
The goal of any biosafety protocol is simply to break this chain.
1. Patient flow
Certain measures, such as scheduling staggered appointments to ensure that there aren't too many people in the clinic at the same time, reducing wait times in the waiting room, conducting pre-screening, and digitizing forms to avoid contact with paper, help reduce the risk of infection while improving the dental clinic’s efficiency.
2. Staff training
A biosafety protocol only works if all staff members follow it correctly, and this requires ongoing training, real-life simulations at the dental clinic itself , and a periodic review of the regulations. Ideally, a person responsible for biosafety should be designated from among the clinic’s staff.
3. Digitization
Digitization reduces physical contact and improves traceability, which is why it is so helpful to have a patient’s complete medical history on the computer, along with signed consent forms and teledentistry options that allow for remote follow-up or the resolution of questions. Technological tools also facilitate audits and quality control.
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