When the Bugs Get Stronger: Reinforcing Disinfection and PPE in Dental Practice

In a dental setting, we habitually talk about “Infection prevention,” “sterilization,” and “barrier protection.” But as pathogens evolve, or as outbreaks resurge, it’s worth revisiting some fundamentals in an era of stronger pathogens: what “stronger bugs” we might face, what disinfectants actually eliminate them, and what personal protective equipment (PPE) is needed when you’re using more potent chemicals.

Viral mutations, global travel, and environmental pressures have contributed to more resilient microorganisms and more frequent re-emergence of previously controlled diseases — for example, measles. To meet these challenges, dentistry has responded with broad-spectrum, hospital-grade disinfectants capable of neutralizing the toughest microbial threats. But that same chemical strength demands an equally strong commitment to safe handling and appropriate PPE.

Understanding “Stronger Bugs”: Viruses, Bacteria, and Benchmark Organisms

Not all microorganisms share the same structural defenses or susceptibility to disinfection. Understanding these biological differences is key to interpreting disinfectant claims and their relevance in a dental setting.

Viruses: Enveloped and Non-Enveloped

• Enveloped viruses (e.g., influenza, SARS-CoV-2, measles) possess a fragile lipid membrane that is easily disrupted by detergents and disinfectants (Health Canada, 2025).
• Non-enveloped viruses (e.g., norovirus, adenovirus, poliovirus) lack this lipid layer and are protected by a durable protein shell, making them much harder to inactivate (Health Canada, 2025).

From a microbiological standpoint, non-enveloped viruses are the most resistant viral structures. That’s why the non-enveloped viruses, for example polio, is a good benchmark test organisms when evaluating virucidal efficacy. Disinfectants that can inactivate polio earn the classification of “virucidal,” a key indicator of intermediate- or high-level efficacy.

What about Bacteria?

In addition to viruses, certain bacterial species serve as performance benchmarks for disinfectant testing. One of the most important is Mycobacterium tuberculosis (TB), a slow-growing bacterium with a thick, wax like cell wall, such a cell wall makes it extremely resistant to many chemical agents (Batt et al., 2020). For this reason, disinfectants that can inactivate Mycobacterium tuberculosis earn the classification of “tuberculocidal,” a key indicator of intermediate- or high-level efficacy.

Stronger Disinfectants Require Stronger Protection

Dental-grade disinfectants achieve their wide-ranging efficacy through reactive chemistry, usually by oxidation, protein denaturation, or cell wall disruption. While these agents protect the dental team and clients from infectious risk, their chemical potency also presents an occupational hazard when used without appropriate PPE. Dental professionals must recognize that Infection Prevention and Control (IPAC) is two-sided, it neutralizes the microbial threat but also introduces a chemical risk to the user.

Essential PPE for Safe Use of Broad-Spectrum Disinfectants

1. Gloves: Use nitrile, neoprene, or butyl chemical-resistant gloves.
2. Gowns: Wear fluid-resistant or chemical-resistant outer garments when wiping surfaces.
3. Eye and face protection: Use eyewear, goggles or full face shields for eye protection.
4. Masks or respirators: Chose the ‘mask for the task’.

The Measles Outbreak: A Modern Reminder

Global measles outbreaks have re-emphasized the importance of robust IPAC, even for diseases long thought contained (Government of Alberta, 2025). Measles as an enveloped virus is readily inactivated by disinfectants (CDC, 2025). CDC states it remains one of the most infectious airborne pathogens known as it can linger in airspace for up to two hours, infecting anyone who enters an untreated area (CDC, 2025).

Health Canada and Public Health Ontario have reaffirmed:

• Use fit-tested N95 or equivalent respirators for suspected or confirmed measles cases.
• Perform broad-spectrum disinfection of all clinical surfaces and airspace contact points.
• Verify staff immunization (MMR) and promptly report exposures.
• Remain diligent in screening for symptoms and possible exposures.

These reminders reinforce that even a virus that is chemically easy to kill can be operationally difficult to control, especially in high-aerosol environments like dental operatories.

The COVID-19 Lesson: What We Learned and Why Diligence Matters

The SARS-CoV-2 pandemic transformed infection prevention across all healthcare sectors and dentistry was no exception. The virus that causes COVID-19 is an enveloped RNA virus, which makes it relatively easy to inactivate with standard disinfectants, including those used routinely in dental offices (Jackson, et al., 2022). However, the pandemic revealed that disinfection alone is not enough. The transmission risk came from aerosolized respiratory particles, prompting sweeping changes in air management, PPE protocols, and surface disinfection discipline. Existing dental disinfectants were fully capable of eliminating SARS-CoV-2, yet the outbreak underscored a larger truth: the science only protects us if we apply it consistently.

The COVID-19 years taught dentistry that IPAC is not a temporary protocol but a permanent professional culture. Diligence in cleaning, proper PPE use, and ventilation must not fade as the emergency subsides. Each operatory wipe, sterilization load, and respirator fit test continues the same vigilance that kept teams and patients safe through a global crisis.

Strengthening the Chain of Safety

Dental practices should continuously assess their IPAC readiness with a focus on biological and chemical risk.

1. Verify product claims: Ensure every disinfectant in use carries broad-spectrum claims with a valid Health Canada DIN.
2. Match PPE to the chemistry: Consult each product’s Safety Data Sheet (SDS) to guide glove and eye protection selection.
3. Adhere to dwell times: Maintain full surface contact for validated kill times.
4. Audit regularly: Incorporate PPE and disinfection checks into your IPAC quality assurance cycle.

Conclusion

“Stronger bugs” have driven the evolution of stronger disinfectants and the science behind them reflects that strength. Modern dental disinfectants are validated against benchmark organisms like poliovirus and Mycobacterium tuberculosis to confirm their broad-spectrum efficacy. But that same power must be matched by equally strong PPE practices to safeguard dental professionals from chemical exposure. The COVID-19 pandemic, and now renewed outbreaks of diseases like measles, remind us that IPAC is not a static checklist but an ongoing professional responsibility.

Michelle Aubé (Simmonds) RDH, maxill Dental Hygiene Educator

Michelle is a Dental Hygiene Speaker, Consultant and Educator with over 30 years of experience as a RDH and 4 years as a CDA. She is a professor and curriculum writer at Fanshawe College in both the dental hygiene and continuing education program sharing her knowledge in IPAC, professional practice, periodontal classification, social justice, advocacy and clinical applications. She is maxill's CE and IPAC Director and wears various IPAC hats including auditing federal correctional facilities dental clinics for IPAC standards. Michelle is ODHA's Regional Board Director and authors articles for CDHA's OH Canada professional publication and continues to practice clinically in London ON. She is a CDHO IPAC Remedial Facilitator and IPAC Expert Opinion. Her strong ethics has allowed her to serve on the Discipline Committee at Algonquin College and hold the position of a CDHO Quality Assurance Assessor for 7 years. As a lifelong learner she is completing a BA in Adult Education at Brock University. Her diverse dental background and current status as a practicing RDH offer a fulsome and realistic view of dental-related topics. As a passionate champion for the profession, she advocates for equity, professional autonomy, and systemic change, true grassroots leadership at its finest.

Michelle can be reached at [email protected]