Dental handpieces: Overcoming the aerosol challengeUncategorised
Posted by: The Probe 23rd August 2020
There’s no doubt that COVID-19 has forced industries worldwide to adapt quickly to a new state of normality. Dentistry is, of course, no exception, with many changes in infection control protocols and associated dental armamentaria expected to arise post-pandemic. This is unsurprising given that dentistry is classed as a high-risk profession, particularly as aerosols are produced during many day-to-day dental procedures.
Comprised of water, saliva, blood, debris, and microorganisms such us bacteria, viruses, fungi and protozoa, aerosols can pose a threat to health due to their ability to stay airborne and potentially enter respiratory passages. As processes within dentistry come under greater scrutiny, dental professionals must seek to further minimise the risk of disease transmission by reducing the amount of aerosol in general practice. This begins with the dental handpiece, the high-speed options of which – like ultrasonic equipment – create high levels of airborne contamination via aerosol.[i]
The research surrounding aerosols and handpieces emphasises the need for solutions that effectively minimise the risk of spreading infectious agents. For instance, some pre-procedural mouthrinses such as povidone-iodine (PVP-I) are clinically proven to not only reduce the bacterial load and viral contamination of aerosol, but also the negative impact of aerosol being inevitable during dental treatment.[ii], [iii] As their compatibility with dental handpieces remains unknown, it is important to be aware that solutions such as PVP-I should only be used as a pre-procedural mouthrinse, and not as a cooling or irrigation liquid for equipment.
Alongside pre-procedural mouthrinses, innovative technology could also help to reduce aerosol in practice. High-speed dental handpieces (e.g. turbines) with anti-retraction systems can be particularly useful in this regard, as they are designed to minimise and offset any negative impacts from the run-out time when the handpiece rotor continues to move momentarily before stopping. This is achieved by circulating air within the turbine head to minimise the amount of aerosol being sucked back into the turbine as the rotor slows to a stop.
Some dental turbines and couplings are further enhanced with an anti-retraction valve that is located within the turbine itself. This prevents the backflow of potentially contaminated water particles via the turbine or coupling into the hose, treatment centre and central water supply system, thus providing an additional level of protection. Indeed, a recent study has shown that anti-retractive dental handpieces significantly reduce the backflow of oral bacteria and HBV into the tubes of the handpiece and dental unit, compared to handpieces without an anti-retraction system. Therefore, dental handpieces with anti-retraction functions or other anti-reflux designs are strongly recommended as an extra preventive measure for cross-infection.[iv]
It is important to remember that dental handpieces are not created equal. Some turbine handpieces produce more exhaust air during use, increasing the amount of aerosol in the environment. This risk can be minimised with the use of straight and contra-angle handpieces, especially if such instruments enable the clinician to adjust the speed of the handpiece, thereby reducing the amount of aerosol dispersed. Furthermore, straight and contra-angle handpieces tend to operate at lower speeds than dental turbines at a maximum of 200,000 revolutions, which minimises the suction effect of any aerosol.
Dental professionals can take steps to further minimise aerosol dispersion through robust cleaning and sterilization of dental handpieces. In this case, automatic handpiece maintenance equipment can be of significant benefit. The most reliable systems restrict aerosol to the inside of the unit, whilst filtrating any exhaust material prior to expulsion. Additionally, these systems confine residual waste to the unit in order to ensure easy cleaning, as the waste is not dispersed widely over practice surfaces. The use of automatic handpiece maintenance units also prevents the dental team from breathing in aerosol produced by spray cans of lubricant and other solutions.
The current global health climate demonstrates just how important it is to invest in top-quality dental equipment that can help minimise the risk of disease transmission. Many practitioners choose leading manufacturer, W&H, for the most effective solutions, including the innovative Synea range of dental handpieces. These are designed with a patented hygiene head, featuring a proven anti-retraction system for minimal aerosol production. W&H also offers the Assistina TWIN automatic maintenance unit, which is optimised to further reduce the risk of aerosol dispersion via the reprocessing and oiling of handpieces. In addition, W&H provides a full range of type B vacuum sterilizers to ensure effective sterilization of hollow instruments.
The global COVID-19 pandemic has ultimately highlighted the importance of maintaining the highest standards of infection prevention and control within the dental practice. Clinicians have a duty of care to implement measures that ensure their practices are safe environments for delivering first-class treatment. By implementing rigorous decontamination procedures and investing in reliable equipment, dental professionals can effectively protect themselves and their patients, not just from COVID-19, but any potentially harmful disease.
[i] Harrel, S. K. and Molinari, J. (2004) Aerosols and splatter in dentistry: a brief review of the literature and infection control implications. Journal of the American Dental Association. 135(4): 429-437. DOI: 10.14219/jada.archive.2004.0207.
[ii] Eggers, M. (2019) Infectious Disease Management and Control with Povidone Iodine. Infectious Diseases and Therapy. 8(4): 581-593. DOI: 10.1007/s40121-019-00260-x.
[iii] Eggers, M., Koburger-Janssen, T., Eickmann, M. and Zorn, J. (2018) In Vitro Bactericidal and Virucidal Efficacy of Povidone-Iodine Gargle/Mouthwash Against Respiratory and Oral Tract Pathogens. Infectious Diseases and Therapy. 7(2): 249-259. DOI: 10.1007/s40121-018-0200-7.
[iv] Peng, X., Xu, X., Li, Y., Cheng, L., Zhou, X. and Ren, B. (2020) Transmission routes of 2019-nCoV and controls in dental practice. International Journal of Oral Science. 12(1): 9. DOI: 10.1038/s41368-020-0075-9.
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