The use of Ultrasonic Scalers for instrumentation and debridement has steadily increased since the technology was first introduced in 1955.1 More clinicians have adopted the use of ultrasonic instrumentation—both magnetostrictive and piezoelectric—due to the push for improved ergonomics in the clinical setting. Ultrasonic use may reduce workplace-related repetitive stress injuries experienced during manual instrumentation, thereby increasing career longevity.
This focus on improving ergonomics in the clinical environment, however, may have introduced oral health professionals to a new risk—aerosols created by the ultrasonic handpiece. Aerosols generated by ultrasonic scalers become contaminated from the patient's saliva and blood and/or from dental unit waterlines. When using ultrasonic instrumentation for patient therapy, there are many precautions that should be taken to protect clinicians and patients from these risks. Ultrasonic therapy, whether utilized everyday or periodically, necessitates that clinicians protect themselves and the surrounding dental environment to prevent the spread of potentially infectious diseases.
DENTAL OFFICE AEROSOLS
Dental aerosols and spatter, which arise from the dental burs on high-speed handpieces and ultrasonic scalers, are contaminated with saliva, blood, bacteria, viruses, and fungi. Microorganisms associated with tuberculosis, hepatitis, herpes, and conjunctivitis have been isolated from dental aerosols.7 Spatter is described as a visible mixture of air, water, and/or solid substances that contains particles larger than 50 microns.Dental aerosols are defined as liquid and solid particles less than 50 microns in diameter. These particles can remain suspended in the air for as long as 30 minutes.Aerosols mix with the air in a confined space, and this air is breathed by the dental team (dental hygienist, dentist, and dental assistant) and their patients throughout the day. Air contaminants pose an increased risk for acquiring respiratory infections by dental personnel.9,10 To protect clinicians and their patients—and to prevent transmission of infectious diseases when using ultrasonic instrumentation—oral health professionals should use personal protective equipment (PPE), ask patients to use a preprocedural mouthrinse, and utilize a high-volume evacuator (HVE) while performing the therapy.
PROTECTING CLINICIANS
The first step in protecting clinicians is to create a barrier by donning the correct PPE, as recommended by the Occupational Safety and Health Administration and United States Centers for Disease Control and Prevention (CDC).When using an ultrasonic scaler, clinicians should wear a cuffed, long-sleeved, water-resistant gown over their scrubs; a dental equipment mask to prevent aerosol inhalation; protective goggles; and a face shield to prevent mask saturation (as recommended by the CDC).A disposable surgical cap may be worn to prevent debris and contaminated aerosol from settling in the hair.
PREPROCEDURAL MOUTHRINSE
The second step to maximizing safety in the dental operatory is to control the aerosols in the clinical setting. Studies show that when a patient swishes with an antimicrobial mouthrinse for at least 30 seconds prior to treatment, the number of microorganisms in saliva and on the teeth is significantly reduced.
When using a preprocedural mouth - rinse, ask patients to swish the antimicrobial rinse around the entire oral cavity for at least 30 seconds.11 Clinicians have several choices when it comes to selecting an antimicrobial prerinse solution. A mild bleach solution of 8 ml bleach to 250 ml of water (or 2 tsp of bleach to 8 oz of water) can be used. This solution must be made on a daily basis, with the unused portion discarded at the end of the day.12 The use of over-the-counter antiseptic mouthrinses, such as products containing essential oils or cetylpyridinium chloride, may be easier to implement because most offices already have these rinses on hand. Another option is to have the patient use 15 ml (1 tbsp) of a broad-spectrum antimicrobial prescription mouthrinse, such as 0.12% chlorhexidine. The most important aspect of the preprocedural mouthrinse is that patients use the antimicrobial for the correct length of time, and immediately prior to the start of treatment.
