#1 – Sterilization/Disinfection of Instruments

You don’t have to have 10 years of dental experience to visualize this scene. The assistant brings the client to the treatment room. The client is seated, the dentist enters, and everyone settles in for treatment. The dentist asks for an instrument, the assistant drops it, picks it up, wipes it off on her sleeve and hands it to the dentist. Yuck!! So how important is your job?

Background on Infection Control

Regulatory and Governmental Agencies
Occupational Safety and Health Administration (OSHA) – An agency within the Labor Department.  OSHA makes the rules we all follow to keep staff and clients healthy
U.S. Food and Drug Administration (FDA) – Establishes guide lines for x-rays and performance of medical devices
Centers for Disease Control and Prevention (CDC) – Part of U.S. Public Health Services. No regulatory authority over us. Develops evidence bared guidelines for infection control

Microorganisms cause infections in clients/staff 2 ways
Direct contact with infected blood, saliva (eyes, nose, mouth, open sore)
Direct contact with blood/salvia contaminated instruments, surfaces
For a person to be infected, all these conditions must be met
1. The pathogenic organism is strong enough and there are enough of them to cause an infection
2. The organism must be transmitted from the source to the person.
3. The person provides a place for the organisms to multiply
4. The person is not immune.
General thoughts
1. Blood is the most dangerous carrier – even dried blood
2. By 2007, it cost $12.00 in materials to clean a room, sterilize the client’s instruments and replace
the disposables.

We have an organized system of sterilization and instrument circulation. New techniques and technology will consistently change how we do what we do in this section. Be sure to pencil in all changes. Keep these thoughts in mind:

Sterilization is the total destruction of all living micro-organisms.

Disinfection is less effective. It kills viruses and some bacteria.
Therefore, everything that touches the clients should be sterilized if at all possible. There are 3 ways to sterilize instruments.
a. Steam pressure autoclave for 30 mins
b. Cold sterilization for 12 hours.
c. Dry Heat Sterilizes


When instruments are brought back on the trays from the operatories, there are a series of steps required to prepare them for their next use:

  1. Put on a pair of heavy nitrile gloves and place disposable sharps in the biohazard sharps container blood saturated items, anesthetic carpules, needles, sharp pointed things etc.
  2. Throw away all disposable things on the tray. Some will be able to go into the trash.  a. Place suction tips, saran wrap, cotton balls, gauze, air/water syringe tips, tray covers, and anything else of this type in trash. b. There is a container on the shelf above the C&S area for amalgam scraps just dump them in after the filling procedure and screw the lid back on. Amalgam caps go into the trash. c. There is a jar on the shelf above the C&S area for burs and endo files that need to be cleaned, the jar is full of cold sterile and should be kept in here d. Surgery Instruments: Rinse blood off under water before sterilizing
  3. Rinse off any instruments in a holding solution container ( including burs)
  4. Any instruments that are on the tray that cannot withstand heat should be placed in cold sterile, such as dappen dishes; brush handles, rubber dam frames hole punches, etc. This is a tupperware container filled with Glutaraldehyde overnight (requires 9 hours to sterilze).
  5. Instruments that will be sterilized by heat will be moved over to the ultrasonic.  a. Rinse all blood and saliva from instruments first with hot water then load the ultrasonic, but don’t overfill. Place no more than 20 instruments (no more than 2 layers) in ultrasonic (liquid must cover all instruments) filled with BriteShield (Germicide). Cover the top to prevent the spray of microorganisms from spreading in the room. Turn on the ultrasonic for 10 minutes. Various instruments need different cleaning times. You will learn them as you gain experience. Saliva and blood can act as a shield to prevent the germicide from killing the microorganisms solution daily. Change this solution daily.  b. Separate all dissimilar metals (prevent corrosion).  c. Cover the ultrasonic while it’s on (10 minutes) to remove any remaining debris.  d. Rinse instruments after the cycle with hot water.
    e. Inspect instruments for any debris and carefully brush off under running water.   1. use a long handled brush  2. place instruments low in the sink under running water  3. only clean 1-2 instruments at a time  4. be sure to remove all composite and amalgam from the instruments   f. allow instruments to air dry ( burs- place on paper towel and blot dry)
  6. After the instruments have dried, they should be put in bags. Run through the autoclave. The autoclave is a steam sterilizer that sterilizes the instruments. The instruments should be put in the trays in the autoclave but not overfilled for effective sterilization and drying, turn the dial to “fill water.” When water appears at the line in the bottom of the autoclave close the door, lock, turn to sterilize. The load should be run for about 50 minutes.
  7. After the cycle is complete, turn to dry and run for 10 minutes. After the pressure is down, open the door 2 inches to allow the instruments to cool for 20-30 minutes. Make sure the indicator tape has changed color.
  8. At the beginning of each day, drain the ultrasonic and holding tanks, rinse with hot water and wipe with paper towels and dry tank. Mix 2 capfuls of BriteShield with hot water and fill to within 1/2” of top of tank. Run the first cycle for 45 minutes. All other cycles are 20 minutes.
  9. Once a week run a biological monitor (spore test) in each sterilizer. Place the monitor into a pack. After the sterilization cycle is complete, place this monitor and a “control” monitor that was not sterilized into a container recording the sterilizers serial #, model, time, and date and send to the spore testing company.


( high speeds, slow speeds & surgical handpieces) – require constant maintenance to keep in top condition. Handpieces on the tray should be put in the holding container on the C&S counter. When it is time to clean the handpieces, they should be taken to: _______________. There are different types of handpieces that will be cleaned in a different ways. There are slowspeeds, highspeeds, straight sleeves and latch types.
a. Slowspeed/Lowspeed is a smaller handpiece that you place burs in and help to assist the dentist in removing decay from the tooth. This handpiece operates slowly and only removes the decay area of the tooth without damaging the healthy part of the tooth. Straight sleeves are slowspeeds that are used to adjust dentures and temporary crowns outside of the mouth. The latch type handpieces are used in root canals procedures, for polishing tooth colored fillings and other things. The first step of cleaning the slow speeds is spraying 2 squirts of Midwest handpiece solution in the back end and running it on the cart in the operatories for 20 seconds. After that, 2 drops of Midwest lubricating oil should be added to the bottom of the low speed and run on the cart for 10 seconds. Scrub the head with water on a soft toothbrush to remove debris.

b. A highspeed handpiece is used with a bur on it to cut away the enamel and hard parts of the tooth so that the dentist can see the infected part inside the tooth; this handpiece uses water to cool down the friction heat of the highspeeds. This prevents the high speeds from getting clogged and not being able to release water. Finally, wipe the fiber optic window with an alcohol dampened cotton swab.

The Quatrocare is an automatic handpiece cleaner. It sprays the cleaner through 4 handpieces (high speed, endo heads) at the same time. Remove the bar from the handpiece. Open the unit, connect the handpieces, close the door, and push the start button. Everything is automatic. The cleaning agent is included in the oil lubricant.

After all of the handpieces are cleaned, they need to be sterilized. Handpieces and x-ray Rinn holders and bars are sterilized in the statim. The statim is a steam sterilizer that will sterilize the items in a short amount of time. It does not hold a large amount of instruments. The instruments should go in the statim without a bag on it. However, the instruments can be placed in the bag not sealed and use the unwrapped cycle. Close the statim cassette and push it in. Press unwrapped instruments on the statim panel, followed by the start. Let the cycle dry after it is finished. It may be interrupted at anytime if necessary.

Sharps container (red plastic containers with biohazard label)
1. Replace a container when one is filled with 1 ½ inches from the top.
2. Filled containers go in the regulated biohazard trash.

Hepatitis, AIDS, colds, flu, herpes, mononucleosis, TB, and many other infections are transmitted by blood and saliva. This is how I would like for you to think of infection control.

Contamination →  No infection if good procedures

Infection →   No disease if properly immunized

Disease →   Survive if strong and lucky


It’s easy to see that the place to break the chain is good sterilization procedures.


Operating Instructions for Tuttnauer autoclave provides efficient combination of steam and pressure.

  1. Packaging –  a. Loose instruments should be in 1 layer   b. Bag should not be larger than necessary   c. Write date on package – write on tape with pencil
  2. Seal bag. The color of the bag changes from blue to purple when the correct temperature is reached, but we don’t know if it was hot long enough.
  3. Place bags on trays. Don’t overload the sterilizer. This will cause poor sterilization and drying. Keep 1” between trays.
  4. Check water in reservoir daily fill tank with distilled water (you get distilled water from the sink behind operatory 9 out of the curved faucet) until water level reaches the base of the safety valve holder. Distilled water prevents mineral build up in the auto clave.
  5. Turn bottom knob to fill. Stop when water reaches groove at front.
  6. When water reaches groove, turn to sterilize.
  7. Close door, lock it, and turn on for 60 minutes for the first cycle of the day and 50 minutes thereafter. When cycle complete, turn knob to dry and set the timer for 10 minutes. Crack door and let instrument packs dry before handling.
  8. Allow adequate “warm up” time. Also allow extra time (5 10) for heavy loads (minimum is 20 minutes, 250 degrees, 15 psi)
  9. Do NOT use sealed jars, closed containers or aluminum foil for packaging materials.
  10. Wrap/pack instruments securely enough to prevent the formation of interior air pockets, but NOT so tight as to prevent adequate steam penetration.
  11. Place wrapped packages on their edges and NO more than 2 layers of packs on EACH shelf; turn the upper layer cross wise to the one below; allow for free steam movement; avoid touching chamber walls and place jars on their sides.
  12. Avoid overloading. It’s better to run a second load than to cram everything into one load.
  13. Open autoclave door 2 inches and let packages dry for 20-30 minutes before removing
  14. Packs should be stored in drawers. They will remain sterile for long periods and seldom require resterilization.

Distilled water – test the water using the tester in drawers by the industrial water distiller. Any reading over 5.0 is bad and you should let your team leader know.

Operating instructions for Statim

1. Place open bags/unwrapped instruments into cassette –  a. Each item separate from all others   b. Curved instruments turned down   c. Hinged instruments open
2. Check Water Level
3. Push cassette into Statim
4. Display panel will read “select a program”
5. Push button for wrapped instruments
6. Push start
7. Check water-using tester in drawer under distillers. Any reading greater than 5.0 is bad.
8. Once sterilization time is done, there is a 60 minute dry cycle that can be interrupted at any time. Clean – use a scotch bright pad to clean bottom half of cassette to remove dirt build-up.

Autoclave failures

1. When the bag monitor or the chemical test strip inside the bag doesn’t change color (indicating correct temperature not achieved), re-sterilize the instruments.
2. Don’t use this autoclave until it is safely/correctly sterilizing
3. Place spore test (if previous one failed) or, if package indicator failed, repack the instruments and re-sterilize.
a. Make sure all gauges, dials etc. read properly – 1. Autoclave packed too full?   2. 20 minute cycle time at proper temperature/pressure (15-30psi) plus 5-10 minutes to reach proper pressure. 3. Was sterile water used?
b. If second run is ok, you can use the autoclave, if not let your team leader know.

Indiana University followed up the autoclave failures they received. 25% were caused by a malfunction of the autoclave. 75% were caused by operator mistakes! For example:
a. Autoclave not ran long enough
b. Non autoclave type bags used that steam couldn’t penetrate
c. Autoclave overloaded or improperly located
d. Oversize bags used
e. Instruments packed in too tight in the bag
f. Packages not placed on their sides with space between them
g. Closed metal containers won’t allow steam to penetrate
h. Not cleaning items thoroughly before sterilizing
i. Inadequate temperate, pressure, check rubber gasket seal
j. Problem with equipment
k. Instruments not cleaned properly
l. Cycle interrupted. If this happens, repeat a complete cycle.
m First use of the day. Check instructions – may need to run empty to warm unit up, then use the rest of the day.

Never run more than 5-6 bags per tray at a time. Always use the autoclave for:
a. Everything used for clients on their trays – no plastic or rubber on bottom tray (it may melt)
b. Impression trays (bagged)
c. Syringes and amalgam wells (not bagged)
d. Ultrasonic scaler tips (bagged)
e. Anything you think needs autoclaved
f. Jet Dry Surface at inside of Statim (also Rubber) daily.

Autoclave Strip Failures

If the autoclave test strip fails at the spore test company, they usually can tell within the first 24 hours. They will CALL immediately with that result. The Dental Board still allows us to use the autoclave after one failure reading. If there are two consecutive failures, they require the autoclave not be used and be serviced.

The testing center says “no news, is good news” from them. So if we haven’t heard from them within 2 or 3 days after the test strip has been sent, we are ok.

If questions, please call them at _______________-  with our number ______.

Cold Sterilization

Autoclaving is the quickest, safest method of sterilization. Some instruments can’t be autoclaved such as: x-ray film holders, plastic instruments, dappen dishes, or they rust and dull instruments. These instruments are cold sterilized. These sterilizers are located on the counters near the autoclave.

The active ingredient in cold sterilizers is Glutaraldehyde and should be changed weekly (or sooner if daily test strip indicates a weakened solution). The Test Strip is dipped in the solution every day till it turns red (about 3 seconds), set it on a paper towel and wait 15 seconds, if the test strip is still red, then the solution is good, if yellow blotches appear, change the solution. Throw the strip away, and use a new one each day. Do not read the strip after 30 seconds; it can give a false reading.

Changing Solution
1. dump old solution down the drain
2. rinse container with water, dry, refill with fresh solution.

Empty items in the cold sterile first thing every morning. Rinse off with hot water, air dry, and blot with towels before putting items away.

This solution has several disadvantages:
1. You can’t tell if you’ve killed everything
2. It takes much longer
3. The solution may not touch all surfaces (where the instruments touch each other) and therefore may not kill all microorganisms.
4. Gluturaldehyde give off fumes above 68ºF, so container must be covered.

No instruments or disposables should be left out, Store in drawers. Always wear heavy-duty gloves, mask, and eye protection when cleaning instruments. Avoid splashes, place instruments in solutions, do not drop them. Cover the container.

1. wear nitrile gloves, mask, and safety glasses.
2. Clean the instruments in the autoclave
3. Only hand scrub for removal of resistant material
4. Allow to dry.

Holding instruments

1. Occasionally instruments can’t be cleaned at the end of an appointment. If the instruments are left out, the blood and debris will dry/harden on the instruments. The holding solution keeps them wet until you are ready to clean them.
2. Holding solution is usually the ultrasonic cleaning solution (contains detergents, anti-rust agents, and a neutral pH that won’t harm instruments. Never use gluturaldehyde.
3. Don’t hold for more than 3 hours (increase chance of rusting)

Dry Heat Sterilization

1. Use for burs
2. Failures:  a. Operator errors include:  i. Overloading and/or  ii. Inadequate time, temperature   b. Failed equipment   c. Time – will take 1-2 hours

How do I know which sterilization method to use?

Instruments are broken down into 3 categories:
A. Critical touch bone or penetrate tissue (scalers, scalpels, etc.)
B. Semi-critical touch saliva (mirrors, amalgam condensers, etc.)
C. Non-critical touch exterior skin (chair, counters, etc.)

Recommendations for Autoclave Maintenance

1. Check cycle time, temperature and pressure gauges daily. Reread the operations manual.
2. Use distilled or deionized water only! No tap water!
3. Check ALL fittings and seals regularly, especially the door gasket; consult the operations manual.
4. Wash all internal surfaces weekly with autoclave cleaner, rinse well.
5. Once a week, place an indicator test paper. When done send to the testing company. These strips show us
a. Correct heat (274 degrees)
b. Correct time (30 minutes)
c. Correct penetration (since it’s in the bag)

Spore testing process

1. Place a biologic indicator in an early day bag and mark the bag.
2. Place this bag in the center of the packs being sterilized and sterilize.
3. Record – type of sterilizer, cycle temperature, time, your initials
4. Mail the processed spore test and the control to our monitoring service.
5. Keep a running result of the test results – 1 log book for each sterilizer.
Record the results in your sterilization log.
6. Once every Monday:
a. Place spore indicator strip, out of left side of envelope, in autoclave ,in a pouch between packages, and run normal cycle. Take strip out at end of cycle, put back in white spore check system envelope, seal, stamp and mail. Test must be ran and mailed on the save day. Our mail runs at about 10a.m. These tests are kept in cabinet above autoclave.
b. Every Wednesday, clean inside of chamber and trays with autoclave cleaner (See instructions on bottle) and paper towels. Rinse, drain, and refill after cleaning. Wipe trays and inside of autoclave with Jet Dri.
c. Put 2 drops of oil on each hinge and door-tightening bolt.

Advantages of Steam Sterilizer
1. Quick and easy
2. Very reliable

Disadvantages of steam
1. If instruments left wet, will rust
2. Must package instruments
3. Can dull sharp instruments

Monitoring our sterilizers
Check steps when autoclave sterilizer fails.
1. Was the biological indicator expiration date ok?
2. Was the incubator working properly?
3. Run a second test to confirm results.

Specific Cleaning/Sterilization Procedures
Some things in the office need special cleaning procedures:

Impression Trays

Impression trays can be metal or plastic. They are used to place alginate on & to take impressions of people’s teeth.
1. After the metal trays are done being used, the bulk alginate needs to be removed.
2. The trays should be placed in a bucket under the sink in the cleaning & sterilization area.
3. The following day, all of the excess alginate should be removed. A toothbrush & some running water usually do the trick.
4. Ultrasonic the impression trays and then place in the a sterilization bag – size tab showing.
5. Sterilize in autoclave.
6. After the trays are sterilized, they can be kept in separate baskets for upper & lower trays.

Endo files

(look like little drill bits used to clean the infection out of a tooth during a root canal)

Endo files are used in the root canal procedure to help measure and clean out canals. GT and profiles are also used in the root canal procedure. These are used in to clean out the canals where the nerve and blood vessels were.
1. Used files are kept rubber banded in the contaminated area on the shelf above the C & S area.
2. Gauze moistened with orange solvent will clean files ( use Nitrile gloves)
3. Check files under microscope:
a) All debris off
b) No spirals have “stretched out” or deformed –
This is a weak area that could lead to a breaking of the instrument in a client’s tooth.
4. The endo files get inserted into the gauze in specific numerical order. There are 21mm, 25mm & 30mm files. Place the files in gauze numerically (one of each size) #6,8,10,15 (one pack) 20,25,30,35,40 (one pack)
a) label what files are on front of pack: 21,25,30mm
b) engine (GT files) by length (21,25mm) and taper(2,3,4,6)
c) any extra files-clean and sterilize in separate packs.
5. The endo files should then be placed in a bag & sterilized. Use the coding system:
1st use – red, 2nd – black, 3rd – purple, 4th – pink, gates – use clips
6. The profiles are disposable after used 5 times. The pen slash marks on the tape indicate this.

Root canal file packs are being set up as follows:
In one bag; 21m Gates Glidden – 2,3,4,6 rings in gauze –stoppers, don’t need to record number of times used Handfiles – 6 (pink),8 (gray),10 (purple),15 (white),15 in gauze or 20 through 60 in gauze –stoppers GT or profiles – 2 (red),3 (green),4 (blue),5 (yellow) in gauze –stoppers, 21 or 25mm -profiles can only be used for 7 canals, so be sure to write how many canals you treated on the tape at the top of the profile gauze
In one bag: 25mm Gates Glidden – 2,3,4,6 on gauze – place stoppers Hand files – 6,8,10,15,15, on gauze – place stoppers Profiles – 2,3,4,5 on gauze – place stoppers There are special sized profiles: 30 mm should be bagged in gauze by themselves; there are different sized tapers of the profiles and they should be bagged on gauze by themselves and used only upon request by a doctor.

Gates Glidden

(also look like little drill bits, used to widen the canal)
They are sterilized like burs, but packed in gauze and bagged. The Gates Glidden are set up in fours II, III, IIII, VI. They can be used as many times as needed. Your dentist will let you know when its time to replace old Gates Glidden.
Gates Glidden are also used in a root canal. They help to open up the canals. The Gates Glidden should be sterilized in the same manner as the endo files. They go into the gauze in a specific order: 2,3,4, They get sterilized in the autoclave.

Profile Sterilization

(profiles are the endo files that go on a handpiece)
All dentists use profiles during endo appointments. Profiles can be used for 7 canals. – place on gauze and put in endo bags – # 2,3,4,5
Burs (these are used for drilling the decay out of teeth) – This only describes cleaning for carbides. We clean diamonds with the “Clean a Diamond” dressing stone

  1. Burs should be removed from glass jars in operatories and placed on paper towel. The burs are used in handpieces to cut tooth and remove decay.)
  2. Use a stainless steel wire bur brush to remove debris with orange solvent under the microscope – scrub very thoroughly
  3. Put the burs in the screen holder jar in ultrasonic for 5 minutes
  4. Remove burs, rinse and Pat dry with paper towels
  5. Burs are put in a special metal tray and dry heat sterilized. The dry heat sterilizer is in the lab. It helps keep the burs from rusting.
  6. Place scrubbed DRY burs on trays in the heat sterilizer (if they are not completely dry they will rust), close door and turn knob to 60. When burs are done the light will go off. Be careful because the trays will be HOT.
  7. Place in bur blocks.

Lab pumice and rag wheels (round, cloth wheel that goes on the lathe used to polish crowns, etc.) Use dilute Clorox 10 to 1 with water (sodium hypochlorite) to wet the pumice. Each evening clean out lathe pan and spray, scrub, spray and let dry with Dentaphene. Remove rag wheel and autoclave. Add new pumice every Tuesday.


(appliance (metal) that you stick into a person’s ears and they bite on a stick – the dentist uses this measurement to determine the upper jaw in relation to their head) Place the “Y” shaped mouthpiece in hot water bath (120 degrees) until soft enough to remove copper wax.
Place in sterilizer bag and run through autoclave. Store in wax drawer.

Oral Surgery Instruments- clean with water and soft cloth.
Completely dry instruments prior to placing in articulator bag. Instruments with joints (scissors, forceps, hemostats) should be placed in the bag in an open position) Seal bag prior to sterilization
High Speed Handpieces (HP)
(1) Remove bur
(2) Wipe HP with alcohol soaked gauze
(3) Place HP on Kavo cleaner
(4) Place HP into autoclave bag
(5) Place in autoclave and run full cycle
(6) Remove and store
If you have specific questions about sterilization techniques and can’t find the answers, call Cottrell Ltd. at 1 800 843 3343.

Cleaning and Sterilization Trouble Shooting Guide

What causes a positive sporecheck?

1. Sterilizer doesn’t work properly.

2. Packs too full.

3. Too many packs run at one time.

4. Not processed for enough time.

Problem / Cause  / Prevention

Spotting /  Mineral deposits

1. Check operating instruments and left by slow or operation of autoclave. Improper drying

2. Use chloride free solutions for sterilizing, disinfecting, rinsing, and cleaning. Distilled or mineral free water preferred  (approx.7.0)

Rust & Corosion / Film left by steam

1. Check purity of water supply. (Corrosion) steam

2. If water softeners are used, check for composition.

3. Purge steam pipes, especially new installations.

4. Rinse with warm water before autoclaving

Rust  / Deposit

1. Do not mix stainless steel with other metals especially where there is evidence of defective plating.

2. Rinse with distilled water (particularly important where tap water may have high metallic content).

3. Remove all debris from lock areas, teeth, etc.

4. Dry all instruments thoroughly. Use full time cycle. This is most important when instruments are wrapped.

5. Thoroughly clean all interior surfaces of sterilizer.

6. Drain water reservoir, refill with ½ pint vinegar and distilled  water. Run 3 sterilization cycles. Empty.

Pitting  / Chemical and electronic attack of surfaces

1. Rinse instruments thoroughly immediately after use.

2. Avoid long exposure to chlorides and acids.

3. Do not use detergents having high pH levels. (should be neutral pH)

4. Do not mix different metals in ultrasonic cleaners.

Black to purple compounds  / Ammonia

1. Avoid exposure to stains ammonia in solutions and cleaning .

2. Rinse instruments thoroughly (distilled water preferred).

Brown stains  / Dried blood

1. Check water supply in sterilizer.

2. Check cleaning compounds and detergents. Avoid excessive use.

3. Rinse and clean instruments throughly

White Stains  / Mineral Deposits

1. Use proper drying cycle

2. Use distilled water


Instrument Processing

Dentist finishes

1. Clean up operatory, carry disposables, instruments, handpieces to sterilization area

2. Sort out non-disposables, dispose of all else

3. Handpieces – remove bur, wipe external surface

4. Handpieces – follow maintenance instructions

5.Instruments – place in ultrasonic

6. Instruments –dry remove any blood and debris with running water, brush if necessary

7. Rinse with clean water

8. Place in pouch

9. Sterilize, dry

10. Store

Draw pictures of sterilization areas and label what goes where for each step.

Dirty trays placed here


Replacement instruments

Cleaning solutions


Chemical / biologic indicators


Trash disposal

Cleaning of instruments


Drying area

Bagging area

Handpiece clean/lubricate/packaging


Instrument storage

Pack storage

Tray make up area


Chairside assistant has read and routinely applies information in this section.

Watch “If Saliva Were Red”

_____________________________ ___________________ Trainer Date