by Anne Nugent Guignon, RDH, MPH
I pitched the idea for the Comfort Zone column to Mark Hartley, editor of RDH magazine, in February of 2000. He liked the idea of a column devoted to ergonomics and workplace safety,1-4 a concept I now refer to as healthy practice options.
At his request I submitted 12 subjects, and I didn’t realize this meant the column would last at least a year, providing the submissions were interesting, appropriate, and well written. The list included topics such as loupes, lights, chairs, and hand instruments, and I remember Mark asking me if suction systems were a viable topic. "Letting it all go down the drain" was my sixth column.
People who don’t work clinically might wonder why controlling moisture is a topic worth an entire column. But those of us who practice know that poor moisture management is highly annoying to both clinicians and patients.1 Since power scaling is now considered a standard of care in managing biofilm-based oral disease, we need to control the fluid irrigant as much as possible.
First, limit the amount of fluid flowing to the tip. Fluid creates a washed-field visibility, but too much produces unnecessary aerosol, is hard to eliminate, causes gagging, and obstructs the view. Unless you are using a very bulky magnetostrictive debridement tip at a high power level, you don’t need copious amounts of water to keep the tip cool. A heavy drip/light mist combination is generally adequate.
Even if you don’t have the fluid flow on high, there should still be an efficient way to eliminate excess fluid. Most use a standard saliva ejector attached to a slow-speed suction hose, which is often too short. Out of sheer frustration, Ann Arrington, RDH, created the Blue Boa, a medical-grade, autoclavable dental tubing that is more comfortable for the patient and improves suction capabilities while adding length. The Blue Boa attaches to a high-volume suction at one end, and depending on the model, a variety of standard or premium saliva ejectors fit on the other end.
The typical saliva ejector has a hard end, which has the potential to create trauma to soft tissue, especially when turned up too high or bent in the typical hook configuration. Zirc makes a small, disposable, blue sponge called the SE Cushion that slips onto the end of a standard saliva ejector. The blue color disguises blood and the comfortable spongy cushion keeps the suction away from delicate tissues while increasing the evacuation fluid flow rate.
There are several brands of saliva ejectors with built-in comfort factors. Hygoformic saliva ejectors have a series of small holes that evacuate fluid efficiently, and the spiral configuration is easy to bend, conforming to each patient’s unique oral anatomy. The Otis Formeject is designed with a latex-free cushion on the end, which does not dig into the cheek. Years ago I created a unique bend for a saliva ejector that allows it to hang freely in the corner of a patient’s mouth. The Blue Boa website has a very good video that demonstrates the bends and most efficient positioning of the ejectors.
The Kona Adaptor, created by Mark Frias, RDH is the newest addition to controlling moisture. The adaptor fits into the high-volume suction and uses Isolite brand mouthpieces that provide hands-free suction that also functions as a mouth prop and isolates the tongue from the working area.
There are some other tricks and devices that can really enhance moisture control and improve visual acuity with some very low-tech approaches. Young Dental’s Silver Dri-Aids are thin, triangular, absorbent wafers with a silver coating that reflects light. Typically Dri-Aids are placed over the parotid gland duct to soak up moisture, prevent soft tissue trauma from saliva ejector tips, and improve visibility.
Speaking of visibility, clinicians who have converted to Zirc’s Crystal Mirror rave about the clarity and brightness of the reflected images. The Crystal Mirror’s unique surface is made from 43 layers of metal oxide and is more scratch-resistant than traditional mirror surfaces. Crystal Mirrors are available in a screw-on format that is compatible with your current mirror handles. Stainless-steel versions come in sizes 0, 3, 4, and 5, while plastic-backed mirrors come in a variety of colors. There are also one-piece plastic mirrors with handles.
Since a clear mirror surface plays a big role in the clinical outcome, there are several ways to maintain optimal optical quality. Regardless of the brand, all mirrors are subject to scratches and eventually require replacement. Mirror surfaces last a lot longer if they are protected during cleaning and sterilization. Cassettes and special covers protect mirrors, and one of the most ingenious devices is the Mirror Gear, which comes in a variety of colors. The Mirror Gear, created by Marie Wickman-Dykes, RDH, is a soft medical grade silicone cover that slips over the head with several slits on the side that allow the detergent solutions in the ultrasonic cleaning bath to come in contact with the mirror surfaces.
Have you ever longed for a fog-free mirror, or one where the water sheets off and does not bead up on the surface? Help is as close as your favorite brand of mouthwash. Oasis is my favorite, but any brand will do. Periodically wipe the surface of the mirror with mouthwash-dampened gauze or spray the surface of the mirror.
All of these ideas are worth a try, and many clinicians use a combination of tricks to stay in the comfort zone.
- Hemphälä H, Eklund J. A visual ergonomics intervention in mail sorting facilities: Effects on eyes, muscles and productivity. Appl Ergon. 2011 Jul 2.
- Preston JD, Ward LC, Bobrick M. Light and lighting in the dental office. Dent Clin North Am. 1978 Jul;22(3):431-51.
- Lampi E. The sources of light and lighting at work. Acta Ophthalmol Suppl. 1984;161:66-83.
- van As G. Magnification and the alternatives for microdentistry. Compend Contin Educ Dent. 2001 Nov;22(11A):1008-12, 1014-6.
Resources for product information
Kona Adaptor – facebook.com/konaadaptor9
Otis formaject – Dental dealers
Anne Nugent Guignon, RDH, MPH, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971.
Past RDH Issues