Medication is often used in dentistry. Patients receiving fillings may need local anaesthetic and medication may be prescribed following a surgical procedure. Other injectable items may also be available in some clinics.
Some medications will require specific storage conditions. Some may require controlled room temperature and some must be stored in the fridge. The safest option is to follow the information provided.
The Therapeutic Goods Administration (TGA) regulations state medications must contain information regarding the storage conditions on their labels. This may include storing the product below a certain temperature, away from light or in the refrigerator.
Incorrect storage can affect the performance of medications. Some injectables may require extra consideration.
Follow the product instructions
Medicines are tested under specific storage conditions. These requirements are included within the TGA’s Product Information framework, which includes information about shelf life and any special storage requirements.
It is best to avoid broad rules within the clinic, such as assuming that every injectable product needs refrigeration.
Local anaesthetic, for example, is commonly used during dental surgery and other procedures, but its storage requirements still depend on the specific product being used.
For any medicine kept within the clinic, check the label and approved product information first and store it according to those instructions.
What happens if a refrigerated medicine gets too warm?
A temperature excursion does not automatically mean every affected medicine needs to be discarded.
What happens next depends on the product, how far the temperature moved outside its approved range and how long it stayed there.
If refrigerated stock has been stored outside its required conditions, separate it from usable stock and document what happened. The manufacturer or supplier can then be contacted if there is any uncertainty about whether the medicine is still suitable for use.
Simply putting the medicine back into the refrigerator does not undo the temperature excursion.
The TGA’s Good Wholesaling Practice guidance follows the same basic principle for temperature-sensitive medicines. Products should be stored according to their labelled conditions, and advice should be sought when stock has experienced a significant temperature deviation.
A dental clinic is not a medicine wholesaler, but the practical response is similar: isolate the affected stock, record what happened and seek product-specific advice before using it.
What temperature should refrigerated medicines be stored at?
Many temperature-sensitive medicines are stored between 2°C and 8°C, although the instructions for the individual medicine should always come first.
The Australian Government’s National Vaccine Storage Guidelines, Strive for 5 were developed specifically for vaccine storage. They use 5°C as the target midpoint of the recommended 2°C to 8°C range and provide practical advice on temperature monitoring, cold-chain management and what to do when storage conditions fall outside the required range.
Those same principles can also be useful when managing other refrigerated medicines.
The Royal Australian College of General Practitioners advises that vaccine and medicine fridges in general practice should be kept between 2°C and 8°C, with temperatures monitored and recorded regularly.
For clinics storing refrigerated medicines, Strive for 5 provides a practical framework for temperature-controlled storage. The requirements of the individual medicine should still take priority.
Medical fridge vs Domestic fridge
A domestic fridge is designed to store food and drink. It would not be suitable to store medication that requires specific temperature controls.
There can be variation in temperature throughout the cabinet. Some areas can get cold enough to cause freezing of sensitive stock. This is why the Australian Government advise against using domestic or bar fridges for vaccine storage.
Medical and vaccine fridges are specifically designed to keep temperature more consistent.
According to Strive for 5, vaccine fridges should be able to provide a temperature between 2-8 degrees Celsius. They should have alarms for temperature, a visual temperature display, alarm if door is left open and minimum, maximum and current temperature monitoring.
Some fridges will have extra features such as remote monitoring, SMS/email alerts, lockable doors and data logging. This can be helpful outside of normal clinic hours.
For example, the fridge may stop working overnight, causing a temperature increase for several hours. The fridge may then return to the correct temperature by the time staff arrive. The current temperature may look fine but there was a temperature excursion overnight.
Recording temperatures or using a data log will give staff more understanding of what has occurred.
You should also have a plan in place for power cuts or faults. Ensure staff know who to contact if there is an alarm. How the temperature excursion will be decided upon and where to move the stock.
Australian Government have a collection of resources for vaccine storage. They have advice for power cuts and other cold chain issues.
Correct refrigeration also requires good stock handling
Even a medical fridge needs to be used correctly.
Ensure the stock is organised to allow air to circulate. Staff should be able to easily access medications without leaving the fridge door open for long periods.
Check expiry dates regularly. Ensure staff handling medications know what should be stored in the fridge.
Medications that require room temperature storage should still be stored correctly. Just because they do not need to be in the fridge doesn’t mean they can be placed by a sunny window or area that regularly gets too hot.
The easiest way to manage medication in a dental clinic is to make it part of your routine. Check the storage requirements for the specific medication. If it needs to be stored in a fridge, ensure you have the right fridge. Monitor the storage and have a clear plan in place.
This will help staff understand where the medication needs to go, if it has been stored correctly and what to do if it hasn’t.
