Reducing aerosols with the Aerosol Cannula
Alison Edisbury explains why she will use the Aerosol Cannula long after the COVID-19 pandemic has passed.
As a dental hygienist, my return to work after lockdown meant changing a number of ways in which I practise.
I work in three private practices in the north west of England. The core of my periodontal care is in providing preventive hygiene appointments, non-surgical periodontal treatment and supportive periodontal therapy. As well as the treatment and maintenance of peri-mucositis and peri-implantitis.
When seeking to disrupt the sub-gingival biofilm in the supportive periodontal therapy of deep (5mm+) pockets and peri-implant cases where the threads of the implant are exposed, I use a combination of ultrasonic scaling and air polishing. Due to COVID restrictions, this is less frequent but still a critical part of my treatment day.
It is therefore paramount that when I do carry out treatment that produces an aerosol, I manage this in a highly efficient way.
Introducing fallow time
Dental professionals are considered at increased risk of COVID-19 infection due to face-to-face communication, and the exposure to saliva, blood and other bodily fluids.
Providing aerosol generating procedures (AGP) is also a factor that increases the potential spread of transmission. Not only to the dental team, but also to other patients.
‘AGPs are procedures that create a higher risk of respiratory infection transmission. They are defined as any medical, dental or patient care procedure that can result in the release of airborne particles <5µm in size from the respiratory tract of an individual. These can remain suspended in the air, may travel over a distance and may cause infection if they are inhaled when treating someone who is suffering from an infectious disease, transmitted wholly or partly by the airborne or droplet route.’
Following the completion of ultrasonic scaling, the arms, chest and inner surface of the face mask of the operator are the most contaminated areas. With the aerosol cloud remaining in the air for up to 30 minutes after treatment.
It is for this reason that the UK introduced fallow time.
Public Health England requires additional precautions if clinicians are to undertake an AGP. The amount of fallow time required after performing an AGP is dependent on the number of air changes per hour (ACH). Along with other mitigating factors, such as use of high volume suction and dental dam.
As it currently stands, fallow time is between 10 minutes and 60 minutes post-AGP for specific at-risk patient groups.
Use of efficient high-volume suction is absolutely essential when carrying out ultrasonic scaling and/or air polishing.
The SDCEP Working Group recently agreed that the use of high-volume suction can reduce the potential risk of COVID-19 transmission associated with dental AGPs.
This comprises of an intra-oral suction device fitted to an evacuation system. This can draw a large volume of air within a short period of time.
High-volume suction units should have a large bore tip with a diameter of at least 8mm to ensure efficient control of aerosols.
Saliva ejectors have a small aperture and are therefore not high-volume suction. Efficient HVE is a cost-effective method to reduce aerosol by more than 90%.
In my experience we can improve the effectiveness when a dental assistant provides HVE during ultrasonic scaling and air polishing. It enables the hygienist to focus on the application of the instrument. Whilst the assistant can focus on removing the water, eliminating spray, and reducing the aerosol cloud.
All Dürr Dental high-volume suction systems offer a suction volume of at least 300l/min. Dürr Dental offers a range of cannulas that have a 16mm diameter.
I have had the opportunity to trial the Dürr Dental Aerosol Cannula. The stand-out features of the Aerosol Cannula are the wide 25mm aperture at the tip of a 16mm bore shaft. And the specially designed protective shield that can rotate through 360 degrees, maximising optimal control and precise positioning.
My patients, my nurse and I all commented on how the Aerosol Cannula is much more effective than other suction tips. It allows the controlled and precise positioning and hence aspiration at the source of aerosol production, ie in the mouth.
Not only does this provide an improved working environment and greater visibility, but it also increases patient comfort during treatment. All whilst ensuring we achieve HVE and minimise extra-oral aerosol.
Whilst I believe that every hygienist should have dedicated nursing support, this may not always be achievable. The Dürr Dental Aerosol Cannula is an ideal alternative for those working alone, who may otherwise rely on the use of a saliva ejector.
COVID-19 has undoubtedly increased anxiety for both the patient and the dental team. Especially when carrying out ultrasonic scaling and air polishing due to the visible aerosol cloud produced.
Being able to use the Aerosol Cannula when carrying out AGPs during the pandemic has been invaluable.
My dental nurse and myself feel much more confident about the added layer of protection it provides when trying to control aerosols. As a result I have now started to use this across the three practices that I work in. And I will continue to do so long after the pandemic.
This user report was written by Alison Edisbury: www.linkedin.com/in/alison-edisbury-56b03b19.