by Karen Kaiser, RDH
Dependence on the latest advancements in technology makes equipment care imperative. Here are some simple guidelines to help you avoid untimely interruptions.
It has happened before. The handpiece - for no apparent reason - starts to stall as you round the distal-buccal surface of tooth #18. You begin to wonder when the last time was that you even bothered to lube the thing. Reaching deep into the hygiene drawer, you soon realize you can't find the needed oil and - at the same moment - feel the warmth between your gloved fingers as the angle's turbine abruptly locks. Now you will have the unpleasant task of explaining to the doctor that another monetary investment has came to a costly halt because of an oil crisis.
Mainstream hygiene is becoming dependent on the latest advancements in technology. When it comes to equipment care, many hygienists wonder what to do with all of the high-tech devices in the hygiene operatory. If you encounter untimely interruptions while running your gadgetry, then this article is for you. Having read those tiny package inserts on the ease of maintenance and cleaning and having experienced malfunctions with equipment, I compiled a guide for the care of my instruments. Ultimately, you will discover that cleaning and maintenance of hygiene equipment is both simple and easy to perform.
A dependable, smooth-running handpiece can alleviate many a hygiene headache. The hygiene handpiece is not used strictly for coronal polishing. Among other things, it is used to adjust removable appliances and grind dentures to fit comfortably. With repeated and varied use, the motor needs to be lubricated. When lubricating, always follow the manufacturer's recommendations and use cleaning and oiling products designed specifically for your particular motor. Using WD40, for example, would void the warranty.
First, remove the prophy angle and disconnect the handpiece from its supply hose. Become familiar with the supply-hose connection; each opening provides a meaningful function. The exhaust return and the drive air are the larger openings. The drive air is what powers the handpiece. The smaller ports are for water and chip air. The chip air provides an atomized water mist instead of a full stream of water. This mode is important with a high-speed handpiece for cooling and lavage.
To clean, first spray approved equipment cleaner on the outer surface of your handpiece to remove stubborn debris. Scrub and rinse with warm water and thoroughly dry the external surface. Total immersion in disinfectant is not recommended for slow- or high-speed handpieces. Soaking could slow the operation, deteriorate the rubber seals, and corrode the gears. It may be necessary to replace the seals should the handpiece not seat firmly onto the supply hose.
To lubricate the inmost moving parts, place drops of recommended lube into the handpiece drive air tube. Dentsply's Midwest RDH™ handpiece requires three drops in its shorter, gold drive air tube. Next, reconnect the handpiece to the supply hose or a compressed air station and run the apparatus until it reaches normal working speed. Operation ensures that the motor's internal parts are lubricated entirely and excess oil is expelled. Skipping this step, prior to autoclaving, will cause the handpiece to discharge the remaining oil onto the oral mucosa - not a tasty experience for the patient!
The Midwest RDH hygiene handpiece has a free- rotating swivel attachment, which can reduce hand fatigue and improve control. The twist junction must be lubricated at least weekly to maintain smooth performance. Place a couple drops of oil on the swivel junction, and rotate the unit to work lube into the attachments. Wipe excess oil off the surface so gloved fingers won't slip. No further lubrication is required before use if maintenance is performed before autoclaving.
Rechargeable and electric-drive handpieces are making their way into hygiene operatories. Titanium and nonstainless-steel handpieces are much lighter. By design, they maintain a lasting cosmetic appearance with repeated autoclaving and they resist corrosion. An added advantage to using electric mechanical action is reduced noise. Some electric handpieces require lubrication; those with sealed mechanisms do not. Refer to the manufacturer's suggestions. Once a month, use motor cleaner on lube-free models. Spray lubricant is recommended for motors that require lube; not only does it lubricate, but it cleans as well.
NSK America's Taskal 7™ handpiece is a rechargeable prophy device exclusively for hygiene use. Best of all, it is cordless. This allows the hygienist more freedom to maneuver, because it is portable and it eliminates the hassle of tangled cords.
The sealed, quick-release prophy head is autoclavable and requires standard drop lubrication to the angle. The unit is not autoclavable and should not be immersed in solutions, because damage may occur to the handpiece's electrical workings. A protective barrier wrap or wipes maintain infection control. After charging the cord-free handpiece for one hour, the cadmium rechargeable battery will run for an equal amount of time.
Maintaining a dry field for placement of preventive sealant is challenging - even with the help of an assistant. Dealing with the cumbersome units needed for light polymerization materials can be frustrating as well. 3M/ESPE comes to the hygienist's rescue with its Elipar™ FreeLight. This cordless curing device gives the clinician one less thing to try to control. The unit consists of a charger, light guide, and a cordless handpiece powered by a nickel-metal hydride rechargeable battery. The special storage battery holds a charge for three to five years and is free from toxic heavy-ion metals found in some batteries.
The light guide on the handpiece is a removable component and can be wiped clean with a soft cloth and then autoclaved. Chemical and hot-air sterilization methods are not recommended. After the light guide is steam-sterilized, it is important to wipe both ends to avoid forming spots of liquid that could cause shadowing or light distortion.
If sealant comes in contact with the light surface tip, do not use a sharp tool to remove residual material, because you may scratch the guide. A preferred method would be to remove any remnants with an alcohol wipe or plastic instrument.
Unlike the light guide, the handpiece and its charger are not autoclavable (this would melt wires and ruin the electrical components). Towelettes or a soft cloth with mild cleaning agents will do the trick for disinfecting. Avoid abrasive cleaning solvents; they may damage the plastic portions of the handpiece and charging unit.
The widespread use of ultrasonic instrumentation delivers many supra- and subgingival mechanical cleaning benefits. These scalers deliver focused lavage to tissues, effective removal and flush of hard and soft deposits, and cause minimal tissue trauma.
With the introduction of water-focused, slim-design inserts, access to periodontal pockets is achieved more easily. These inserts are designed for repeated use, but not abuse. Precautions must be taken to guard the inserts against breakage. Generally, the insert should be withdrawn from service after 100 hours of regular use.
When inserts are first placed in the handpiece, lubricate them by filling the handpiece with water prior to seating the tip. This will increase the life of the O-ring and avoid a leaky insert. (Replacing the insert's O-ring may be necessary to stop a leak.) The Steri Mate® wand by Cavitron® houses the ultrasonic insert and is detachable from the unit and may be sterilized under pressure. All removable inserts are designed for steam autoclaving. Dry-heat sterilization, cold solution methods, and exposure to iodophors and phenols solutions are not recommended; they adversely affect the insert's tip and may produce rust.
Care should be taken when sterilizing ultrasonic inserts with other instruments in the autoclave. Inserts should not be placed in large loads or run under heavy cassettes where tips could be bent, broken, or magnetostrictive stacks distorted. To better protect the inserts, Cavitron has introduced a stainless-steel holding cassette that will guard the ultrasonic tips during sterilization.
The new Satin Swivel™ inserts from Hu-Friedy provide a smooth swivel feature while power-scaling. The insert's swivel mechanism does not require lubrication and is processed by the same methods as other ultrasonic inserts.
Air polishing with inserts and individual units, like the PROPHYflex 2® from KaVo, offer the clinician another choice over traditional angle polish. Air-polishing units have separate silicate powder reservoirs. All parts conducting cleaning powder must be absolutely dry before the powder chamber is filled. If moisture contaminates the powder, it can form hard clumps that are difficult to get through the nozzle head. In a word, moisture will clog up the works! Replace fresh powder daily or prior to use and do not store in the unit's reservoir. The Prophyflex 2® has a nonreturn valve for air and water, preventing moisture from intruding into the powder chamber.
The KaVo polisher utilizes a cannula tip to deliver the cleaning effect. The tip must be securely seated to the handpiece and be free of blockage for proper function. If an obstruction occurs, simply unscrew the powder reservoir and intake nozzle and pierce both openings with the cleaning wire. Pass the nozzle needle through a few times and then return the powder reservoir. Without proper maintenance of the delivery unit, a total obstruction with the powder may occur. For stubborn residual powder removal, try clipping the end of the cleaning wire at an angle so it will break up powder easier.
When using an insert tip, like the Prophyjet by Dentsply, take care when placing a warm nozzle insert into the handpiece, as pressure on the heat-softened O-ring may cause it to tear. The jet nozzle will insert easily if a small drop of silicone lubricant is applied to the O-ring prior to seating. Air polishers do not require standard lubrication with oil or care spray to maintain their mechanisms.
This nifty cavity detector requires basic maintenance for continued and reliable readings. The DIAGNOdent® uses standard AA batteries stored in the unit's posterior power cell. Change the batteries as indicated by the red-light warning on the front panel.
The unit has removable glass tips that the clinician selects for the surfaces to be read. Take care while using the aperture so as not to scratch or distort the tip by using added force on the wand. You will notice erratic readings if the tip is not properly cared for. To maintain clear readings, use a cotton tip applicator to wipe off any contamination prior to autoclaving the glass tips.
Perform weekly calibration of the unit - or more often if necessary - to maintain consistent measurements. To test performance, place the wand with seated tip on the yellow disc located in the sterilizable cassette. The digital readout on the DIAGNOdent must fall within +/-3 of the peak value as indicated on the value chip after tuning is completed. Follow these steps:
Match the tip with the calibration setting by pressing the ABC button on the unit.
A Touch the CAL button until it displays CAL 1. Hold this button down until the unit displays DONE.
A Follow this same process to test CAL 2. The unit should display within +/-3 on the yellow value disc.
This electronic advancement in technology measures the presence or absence of volatile sulfides found in periodontal pockets. The sensor of the Diamond Probe® responds to the various sulfides associated with tissue protein breakdown expected to be present in periodontally involved patients.
The unit has a sulfide sensor probe and component system acting with audible and visual cues that alert both the patient and the clinician if bacterial activity is present. The robust system is designed for quick setup and efficient maintenance. The unit does not require any fine-tuning on the part of the operator.
The sensor tips are single-patient-use and packaged sterile. Do not soak the Diamond Probe in disinfecting solutions because immersing the handle could short the electronic connections. The sensor probe handle is autoclavable.
The intraoral camera has found an enduring position in the hygiene operatory. It magnifies dental tissues, making it a powerful tool in education and co-diagnosis. For the camera to achieve clarity through the sapphire window, barrier protection and cleaning is in order. If images become fuzzy or show fog-like spotting, a cotton tip swab moistened with acetone or alcohol may be used to clean the surface window. Do not use a saturated swab; excess cleaning fluid will leave marks on the filter after it evaporates.
The Acu Cam Concept III® has a camera head that is immersible in certain fluids, including glutaraldehyde. The head can be sprayed directly with disinfecting detergents, rinsed with filtered water, and dried with soft cloth. Autoclaving the camera head or cable will severely damage the imaging device and is not recommended by the manufacturer. Avoid pre packaged sterilization sleeves as well. The imaging head is resistant to most solvents, but the sterilizing packs have a vapor-action phase that can damage the sensor. Be sure to avoid abrasive cleaners on the head and cable as well, because they may mar the finish or damage the window.
The intraoral camera has an illuminating bulb source that needs replacement periodically. Your oral images will be darker if the bulb needs to be switched. Replacement may be the only clinician-serviceable component of your intraoral camera. Make sure the bulb is cool and the power is off before you swap bulbs. Never touch the lamp bulb with bare fingers because skin oils can cause the lamp to fail as it heats
Imaging and X-ray technology is a far cry from the X-ray dip tanks of manual processing. Digital radiography reduces X-ray exposure to patients by at least 50 percent. The DenOptix® imaging system uses a centrifuge and laser scanner to read imaging plates. The scanner has a magnet-driven well area (resembling a top-loading breadmaker). A carousel insert with exposed imaging plates is seated into the well for scanning.
The imaging carousel may be cleaned by removing it from the scanner well, depressing levers, and separating the image-holding plate from the barrel. Spray the soiled carousel with nonabrasive general household cleaner or soap and water. Do not use alkaline- or ammonia-based products to clean the holder, because they may cause discoloration or deteriorate the carousel's surface. Never directly spray inside the unit's well or allow solvent to drip onto or penetrate the magnet area. Fluids in this area may cause electric damage and produce an ozone smell.
The scanner's inner works need to be lubricated regularly, between six months and a year. Establishing a schedule depends on use. Apply a manufacturer-recommended lubricant (like Triflow) two drops at a time at two-inch intervals on the inner guide rails and lead screw. This periodic maintenance may be completed without technical support if you have a 9/64 ball hex-driven wrench. However, observing a professional service technician the first time around may give you more confidence to tackle the job yourself next time. If the scanner is not lubricated, the magnet-driven barrel will start, stop, spin, and not initialize. If the scanner does not initialize, no X-rays will be read - a stressful interruption of service.
The actual imaging plates are a combination of barium crystal layers which absorb the exposed images. They resemble standard-size X-ray films. For the best image quality, these imaging plates must be free from damage and scratches. They may be wiped with cotton gauze using a general household cleaner or soap and water. If
stains remain, use anhydrous isopropyl alcohol or anhydrous ethanol via cotton gauze and gently wipe. There is no need to routinely sterilize imaging plates.
Contaminated plates may be soaked in disinfecting solution, but do not allow the plates to remain in solution overnight or autoclave them. This will cause the layers of the imaging plate to bubble, blister, and separate. Imaging plates are reusable, but they can become damaged if patients bite or bend them. The barium layers make them toxic if ingested, so use barrier covers to avoid direct contact with patient saliva.
Equipment loss or ineffectiveness produces stress on both the hygienist and the patient, not to mention the interruption in the delivery of care. If equipment service becomes necessary, being familiar with the manufacturer's recommendations facilitates effective communication between you and the repair professional. Technology advancements and the growing necessity of this equipment to become integrated with hygiene services is becoming evident. With the launch of high-tech hygiene, properly performed equipment maintenance fosters reliable, dependable, trouble-free operation.
To clean, first spray approved equipment cleaner on the outer surface of your handpiece to remove stubborn debris.
After the light guide is steam-sterilized, it is important to wipe both ends to avoid forming spots of liquid that could cause shadowing or light distortion.
When inserts are first placed in the handpiece, lubricate them by filling the handpiece with water prior to seating the tip. This will increase the life of the O-ring and avoid a leaky insert.
Take care while using the aperture so as not to scratch or distort the tip by using added force on the wand. You will notice erratic readings if the tip is not properly cared for.
All parts conducting cleaning powder must be absolutely dry before the powder chamber is filled. If moisture contaminates the powder, it can form hard clumps that are difficult to get through the nozzle head.
Do not soak the Diamond Probe® in disinfecting solutions because immersing the handle could short the electronic connections. The sensor probe handle is autoclavable.
Imaging and X-ray technology
The imaging carousel may be cleaned by removing it from the scanner well, depressing levers, and separating the image-holding plate from the barrel. Spray the soiled carousel with nonabrasive general household cleaner or soap and water.
To achieve clarity through the sapphire window, barrier protection and cleaning is in order. If images become fuzzy or show fog-like spotting, a cotton tip swab moistened with acetone or alcohol may be used to clean the surface window.
Karen Kaiser, RDH, has been in the dental field since 1987. She received her hygiene degree from Forest Park College in St. Louis, Mo., in 1994. She enjoys promoting dental hygiene in her community by attending health and science fairs, educating groups of children on oral care, and speaking at career days to promote dental hygiene. She currently does consulting for 3M ESPE and is on their Dental Hygiene Advisory Panel. She may be contacted by email at [email protected].