Comfort Zone: Letting it all go down the drain

We need to be able to park that spit-sucker in the corner of our patient's mouth and just go to town.

Welcome back to the real world of dental hygiene - chock full of plaque, spit, chunks of calculus, full-tilt schedules, and, most of all, your special patients. After a brief period of New Year's reflection, I decided to usher in the true new millennium with an in-depth look at one of our most basic clinical tools - the lowly suction system!

Before you flip to the next page, consider that there may be more than one way to suck spit. Back in the dark ages, the cuspidor was king. Patients rinsed, rinsed, rinsed, and rinsed. Other than the rare moments that we used our ultrasonic scalers to blast off big chunks of junk, the saliva ejector was relegated to its holder like a rejected stepchild! Power-driven scaling was for sissies. Today, it's the standard of care. Effective time management is also high on everyone's priority list, so we need to be able to park that spit-sucker in the corner of our patient's mouth and just go to town.

So what about our patient's comfort? What about going that extra mile? Can the humble saliva ejector elevate each us to the level of "Hygienist Extraordinaire?" This mundane tool can become a point of practice excellence, place our patients in the comfort zone, and give us an inexpensive "third hand." What a lofty goal for a tube of plastic that's shaped like a question mark!

Nothing unnerves me more than sitting down to perform a procedure, such as a complex periodontal debridement, and having the saliva ejector rule the appointment. You know what I'm talking about. You ask your patients to turn their heads ever so slightly so you can maintain good ergonomic posture, and out pops the saliva ejector, right on down to the floor. Infection control is out the window. The clock is ticking. Valuable instrumentation time is lost to a renegade spit-sucker!

If I ruled the dental hygiene world, I would wave a magic wand over all saliva ejector hoses. Poof! Old, short, heavy, rigid hoses would be magically transformed. Lightweight, supple, long hoses would suddenly appear everywhere.

OK, so an independent-minded saliva ejector has never undermined you. Well, what about the times you're merrily scaling along with your ultrasonic, and all of a sudden you shift your focus? Suddenly, you notice a rising tide of water in the bottom of your patient's mouth. In seconds, your fussiest patient of the day is sopping up dribble. Quickly, you assess the problem. Your trusty saliva ejector has become firmly embedded in the folds of the buccal mucosa - sucking cheek tissue relentlessly and probably giving the patient a hicky or, worse yet, enough soft tissue trauma to start a painful apthous ulcer! No wonder your "AARP eligible patients" are praying for that old cuspidor!

Technology to the rescue! Granted, the saliva ejector is low tech, but at this point any improvement in our old "Mr. Thirsty" saliva ejector system is welcome. A quarter of century ago, the plastic saliva ejector was hailed as a new high-tech system. But this is a new century, and now what's on the horizon?

Designer saliva ejectors are the new way to handle all of the water works. The ultimate saliva ejector is a dental hygiene assistant. But, alas, most of us will have to settle for the new millennium of Mr. Thirsty's - curly Q saliva ejectors, saliva ejectors with little spongy pillows attached at the end, soft foam cylinders designed to fit over the existing suction apparatus, or a special mirror with suction holes on the bottom.

Why bother to make a change? Well, how about your comfort and the patient's comfort? Let's examine the choices. Pulpdent's Hygoformic curly Q models stay in place and keep the tongue at bay once they are positioned correctly. They take a bit of getting used to, but hygienists experienced with these devices swear by their effectiveness. The Hygoformic ejectors require a special plastic adapter to be attached to the traditional apparatus. If you lose the adapter supplied in the bag of ejectors, a 1-inch plastic piece cut from a traditional saliva ejector is an acceptable substitute.

Foam pads and pillows also increase patient comfort, prevent soft tissue blockage, and act like skid pads. In other words, the saliva ejector stays put because the foam gives a bit of traction. The padded saliva ejector now plays double duty as a handy cheek retractor. As the number of holes in the ejector system increases, the effectiveness of the system improves. To put it simply, more suction holes in the apparatus improve negative airflow back into the patient's mouth, reducing the amount of contaminated aerosol.

The Otis Formajet is fabricated with a small sponge glued at the end. Patients find it very comfortable, and it is easily bent for exact positioning in the mouth. However, it requires an adapter to fit the existing valve apparatus and tends to clog easily with larger pieces of debris. "Sof Stop" foam cylinders fit over the existing saliva ejector just like a pillow. It does not clog easily, but occasionally slips off when it becomes wet.

Panadent makes a special mirror suction device that attaches to the existing suction system. Even though it works well, the high-quality metal mirror and handle can get a bit heavy during a lengthy appointment. So it is important to request the special plastic hose support to reduce this weight. Practicon Dental offers several variations of the mirror suction system. A single-use plastic mirror that is attached to a metal mirror handle inserts into either a saliva ejector hose extension (attached to the high-volume suction) or directly into a standard saliva ejector valve.

So what are the advantages to you and your patient? If you configure the saliva ejector properly, it can be placed comfortably in the vestibule and will work continuously while you keep on scaling.

First, bend the straight plastic saliva ejector to look like a candy cane. Then visually divide the length of the tube into thirds. Gently bend the middle third of the plastic tube towards you, creating a gentle 90-degree angle. Finally, bend the bottom third down forming another 90-degree angle. Make sure your bends still allow water to flow through freely. If you have done this correctly, you will have something that resembles a little chair with a question mark-shaped back. Now the renegade saliva ejector is transformed into a tamed ally!

Remember, patients love to be pampered. Yes, these systems cost a bit more than the "plain Jane" plastic saliva ejector, but is your comfort, your patient's comfort, and more efficient use of your appointment time worth an extra 10 to 15 cents per appointment? Small things add up in a big way. This seems like a very inexpensive way to become your patient's new best friend.

Now aren't you glad that you didn't turn that page a few minutes ago? Happy suctioning in the comfort zone!

Anne Nugent Guignon, RDH, MPH, practices clinical dental hygiene in Houston, Texas. She writes, speaks, and presents continuing- education courses on ergonomics and advanced ultrasonic instrumentation through her company, ErgoSonics (www.ergosonics.com). She can be reached by phone at (713) 974-4540 or by e-mail at anne@ergosonics.com.

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