When I was a hygiene student years ago, our options for managing liquids and aerosols in the operatory consisted of the flexible low-volume saliva ejector straw and the rigid high-volume evacuation (HVE) tip. I remember struggling to maintain control of the bulky, heavy HVE while simultaneously performing meticulous ultrasonic instrumentation, wondering why there wasn't a better way. Thankfully, I wasn't the only one thinking about this-countless products and devices have been invented to support dental clinicians' evacuation needs.
Low-volume suction
Many practitioners don't have a problem with the weight of low-volume evacuation devices but wish there was a way to secure it in the patient's mouth for continual suction relief. To meet this need, manufacturers have created slender, moldable tips that allow users to place the suction where they need it. By manipulating the shape of the long, coiled tubing, it can be gently hooked around the patient's cheek tissue for easy, hands-free evacuation.
Another concern with traditional low-volume saliva ejectors is the patient's risk of exposure to contaminated backflow when closing their lips around the straw.1 To prevent this, the CDC recommends avoiding the age-old practice of instructing patients to "close down" on the suction, but old habits die hard. To combat this, manufacturers have developed disposable saliva ejectors with built-in valves for backflow prevention; switching to these enhanced ejectors significantly eliminates risk and keeps patients safe.
High-volume suction
There are many HVE options! It's helpful for a clinician to possess a variety of device types and configurations, as some are better than others when considering patient age, size, occlusion, and the procedure planned.
A high-speed design that many providers prefer is the flexible suction that is attached to a bite block and is shaped like a whale tail. Once placed, the suction component retracts the tongue and buccal tissue for easy accessibility while the bite block maintains an appropriate clearance for instrumentation. Patients often report that it feels slightly obtrusive at first, but the water management and bite block allow them to rest and relax during treatment after a while.
A lightweight system with a soft leaf-shaped suction head that rests against the buccal tissue is also popular right now. Patients enjoy the freedom they have to open and close their mouths while the device prevents water from pooling during power instrumentation. Because of its simple design, the replacement parts for this type of configuration are inexpensive and easy to obtain.
Wearable suction devices are another sought-after option for dental hygienists-like a lightweight hose and nozzle attached to a cover that fits over the user's index finger. Clinicians who use these types of systems appreciate their ability to eliminate aerosols at the source, as the system design allows the user to hold the suction right next to their working area. HVE devices with attached mirrors have also become common in many hygiene operatories. Hygienists often describe a lack of visibility when using the ultrasonic handpiece as using a mirror would require them to have a third hand. Combo systems with mirror-in-suction designs solve this issue by meshing the two together.
Additional tools
Aside from the evacuation devices themselves, there are other aids available that increase clinician comfort and convenience. From adjustable positioning systems that hold the suction in place to wearable arm and wristbands that relieve the clinician of cord weight, hygienists have many options to meet their evacuation needs. Gone are the days of the suction struggle-efficiency and comfort are in!
Reference
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Mann GL, Campbell TL, Crawford JJ. Backflow in low-volume suction lines: The impact of pressure changes. J Am Dent Assoc. 1996;127(5):611-615. doi:10.14219/jada.archive.1996.0273
