The Current State of the Art in Hygiene Technology: What’s New in the Aerosol-focused world?

By dentalfoto / stock.adobe.com

Technology is always an essential enhancement for dental hygiene. But how has our aerosol-focused world changed the innovation in dental hygiene technology? We spoke to dental hygiene experts to get their take on the necessity of technology, the current state-of-the-art hygiene technology they like, and advice for how to get the practice to invest in it.

Katrina Sanders, RDH, is a dental hygiene educator, a practicing dental hygienist, and an international speaker. Sanders says the expectations for what hygienists can do in an hour are much higher today than they were 20 years ago. To integrate all that patient care efficiently, technology is essential. Sanders also feels dentistry as an industry is reticent to incorporate technology because practitioners worry about how patients would react to new things introduced into their care, a worry she thinks is unnecessary.

“The reality is, patients want it,” Sanders says. “Our fears are simply fears, not a reality for the majority of our patient population.”

In addition to new demands on hygienists’ time in the operatory, Sanders says the pandemic accelerated the incorporation of high-volume evacuation (HVE) for aerosol mitigation and personal protective equipment in the dental practice. She describes the pace of the change as uncomfortable, disruptive, and expensive for the whole industry. Sanders says she doesn’t want to wait for the next crisis to move the industry forward.

Moreover, she sees technology enhancing the hygienist’s role as a preventive specialist. Technology can help hygienists be the change agents in their patients’ lives through objective diagnoses and patient education on preventive care. This role might require hygienists to be technology advocates in the practice. However, it requires getting outside the usual routine, Sanders says, which can be challenging.

“There is a comfort in routine, and it happens in all relationships. Every 3, 4, or 6 months we put instruments into the same teeth, catch up with the same patients,” Sanders says. “The challenge for dentistry now is to figure out, how do we step out of that comfort zone and create the change that our patients need and deserve?”

Tina Clarke, RDH, professional speaker, consultant, and dental hygiene faculty member at Lane Community College, has a technology perspective influenced as both a practicing clinician and a dental hygiene educator. By taking a proactive approach to seeing what is out there to make their jobs easier, hygienists can elevate the level of patient care they deliver. Clarke suggests reviewing what is new every 6 months.

“When we get to do trade shows again, go through it and look at the technology, and talk with other people that are using them,” Clarke says. “Talk with your rep that comes in and ask if they have any suggestions for insights into what technologies could benefit your practice.”

Lynne Slim, RDH, MS, is a writer and speaker for dental hygiene and has practiced for 40 years. As a self-described “passionate, evidence-based hygienist,” Slim always looks for scientific evidence to support a product or technique claim. Before she invests in any new products, she investigates whether the company’s claims are backed by research. She says it is essential to be objective when looking at potential technology and products to determine efficacy. She also steers away from sources like internet chats and relies instead on unbiased online sources and clinical trials.

“I also look at cost because right now, during our second COVID-19 year, we are definitely being challenged to keep overhead way down,” Slim says.

Aurelia Byrne, founder and CEO of A-flexX Assist Arm, has been a hygienist for 5 years and working in dentistry for 27. She is a firm believer in incorporating new technology to the practice flow, having been part of a practice at the beginning of her career that was an early adopter for technology. Seeing how technology can enhance a dental practice and patient care shaped Byrne’s philosophy.

“It saves time,” Byrne says about dental technology. “The key is learning it and getting out of your comfort zone. And, once you do, it’s better for the patient.”

The State-of-the-Art Hygiene Technology Experts Love

This passion for technology in the operatory helped Byrne conceive the A-flexX Assist Arm. When COVID-19 hit, Byrne knew aerosols were going to be an issue. The A-flexX Assist Arm was designed to free up the hygienists’ hands and suck up the aerosols in the operatory. With a light, ergonomic hose hooked up to the HVE, the A-flexX Assist Arm attaches to the back of the chair then curves around to the front of the patient to aim down toward the patient’s oral cavity at a comfortable distance.

Byrne says the A-flexX Assist Arm has several benefits for the hygienist. It helps with indirect vision and repetitive motion disorders. The A-flexX Assist Arm’s small, compact design doesn’t take up much space in the room. The A-flexX Assist Arm is also reusable. The infection control protocols for the arm are to spray and wipe the arm and HVE hose and autoclave the HVE tip, valves, funnel adapter, and funnel. In May, Byrne’s company released new, autoclavable tips. Byrne says the goal is to send less waste to the landfill and save customers money in the long-term.

“We are moving to more sustainable products as a company," Byrne explains.

Clarke thinks the A-flexX Assist Arm, which provides additional suction of ambient aerosols in the operatory, can do a lot to help solo practitioners. Clarke likes how the arm leaves the hygienists’ hands free to deliver care and comes in low- and high-vac speeds.

“They have a lightweight tube, which makes it a lot easier for a clinician doing it solo to have reduced weight and drag,” Clarke explains. “So that’s wonderful.”

In addition, Clarke thinks face shields are making a difference in the operatory for hygienists. While face shields have been the standard for a while, the pandemic has hastened their adoption rate by clinicians. Clarke says that face shields boost the efficacy of the filtration of the hygienists’ masks. However, Clarke says she can’t recommend one face shield over another because it depends on the clinician’s loupes or the protective eyewear they are using.

“How far the light sticks out or how deep the magnification is can impact the face shield that they are working with,” Clarke says.

Clarke has been a longtime advocate for aerosol evacuation systems in the operatory. She likes the Isolite line by Zyris. It not only props the patient’s mouth open, Clarke says, but it also reduces the aerosol splatters and the fluid in the patient’s mouth. Clarke also likes the Purevac® HVE system with mirror tips by Dentsply Sirona, particularly when using a Cavitron and aerosols are fogging up your view of the lingual surface of the teeth.

“It’s a nice adjunct for your high-vac because it has the mirror on there, and it will take care of the aerosol generation but also keep that mirror clear so you can see,” Clarke says.

Slim is a fan of the stannous fluoride dentifrices for adult patients that address conditions like dry mouth, gum detoxification, and sensitivity. She admits that part of it is that she likes the packaging, but its effectiveness made her a user.

“I put it in my occlusal guard at night because I like the taste of these dentifrices so much,” Slim says.

Slim also likes Hu-Friedy’s AIRFLOW® therapy as a technology for the operatory. AIRFLOW delivers polishing through a mixture of air, specially processed powders, and water pressure. The hygienist controls the stream directly on the teeth to remove surface stains, plaque, and other material. However, for now, Slim says she has only read about it.

“Hu-Friedy’s AIRFLOW therapy really appeals to me, but I don’t have one to use right now,” Slim says.

Sanders is excited about the enhancements in some of the products she uses in the operatory. For example, she likes her Designs for Vision Aerosol Protection Loupes, which she says is something good that came from the pandemic.

“So not only do they magnify, but they have a protective barrier around them to stop the movement of aerosols or any particulate from entering the eye mucosal membrane,” Sanders says. “It also has a touchless light on top, so when I look down at the patient, the sensor turns on the light. When I look up to talk to my assistant, it turns off.”

Sanders also appreciates how teledentistry enhanced communication with patients. Hygienists used to talk with patients only when they were in the chair, but teledentistry changed that.

“We can perform postoperative instructions, oral hygiene instruction, and check in with our patient over teledentistry. We don’t necessarily need that butt in the chair, so to speak, to reach our patients,” Sanders says.

Teledentistry technology is pushing what can happen at home, too. She is starting to see intraoral camera systems that attach to an iPhone and send images directly to the provider. Sanders says it is a way to screen patients or treat emergencies before they come into the practice.

“That technology allows us to be more streamlined in our care and streamlined in our practice. It is also a great opportunity to be able to connect with our patients,” Sanders says.

Another technology that Sanders thinks can move dentistry forward is artificial intelligence (AI). AI can identify on x-rays areas of concern clinicians might have missed. AI also can determine the percentage of enamel the decay has broken through. Moreover, it can detect shifts in bone level and problem areas on panoramic films.

“Does that mean we are going to diagnose entirely off what a computer tells us? No, but I think we can all agree, human beings are imperfect beings. There are opportunities for users to fix some of those diagnostics and bring things to our attention in a different way,” Sanders says. “Hygienists have traditionally been the ones to cue up the doctor to those treatment opportunities, but AI can also support us in that.”

Patients also appreciate the benefits of technology, particularly in screening for disease. For example, digital x-rays show the patient what is happening in their mouth. Sanders also appreciates how technology allows her to make that diagnosis process objective.

“It gives us the opportunity to say, this is what’s on the x-ray, period,” Sanders says. “It gives us more definitive information to communicate with our patients, which I know patients appreciate.”

Sanders also likes the Florida Probe®, a computerized periodontal charting system that automates most of that part of the hygiene appointment for hygienists. However, Sanders particularly appreciates the “warning” feature the probe initiates when encountering a problem in the patient’s oral cavity. The patient hears that warning, and they ask about it, allowing the hygienist to talk about what’s happening in their mouth.

“So it’s a great tool for us, but it’s a great tool for the patients to understand better what’s going on,” Sanders says.

Technology is also enhancing the simulators that educate hygiene students. Sanders likes the Promethean Dental Systems simulator and how it is changing continuing education. Much of the hands-on training for hygienists occurs in school, with an instructor giving feedback while the hygienist provides patient care. The high-level simulators have calibrated sensors that can evaluate hygienists’ hand skills more objectively than when in school. Moreover, it’s an area that for many clinicians hasn’t been assessed in a while, Sanders explains.

“Many of us haven’t had those skills evaluations since dental hygiene school,” Sanders says. “It is an exciting thing.”

Getting the Technology You Need Might Require Personal Investment or Creative Asking

Not every dental practice has these technologies available to hygienists, and some might not be willing to buy them. “Not everyone has a superstar dentist that invests in these kinds of technology for the hygienist,” Byrne says. Having access to them might require a personal investment. Byrne believes hygienists who invest in technology are investing in themselves and their careers.

“It’s important to think about your comfort and safety, too,” Byrnes says. “There are so many affordable ways to go about it. Different options provide better ergonomics.”

Clarke also thinks hygienists should invest in technology to simplify their process and improve their performance. If the practice doesn’t buy the technology the hygienist wants, like loupes, the hygienist shouldn’t be afraid to buy them.

“If that’s something a hygienist wants, then they need to be willing to invest in it,” Clarke says.

Moreover, Byrne thinks it is vital to invest in technology that keeps people safe from viral aerosols. Adapting to changing viral threats isn’t anything new for the dental industry. When science discovered the HIV virus, no one in dentistry was wearing gloves. Many dental practitioners felt it was an ordeal to put on gloves when working with patients and were angry about the change. But clinicians made the adjustment and now, most wouldn’t consider practicing without gloves.

“Aerosol is the same thing,” Byrne says. “With any type of viral aerosol, you will need an aerosol-mitigating device or learn to use the HVE. Aerosol management should be a standard of care.”

Slim also thinks technology to help hygienists control aerosols is essential but wants hygienists to use scientifically proven technology. Slim says most hygienists are finding inexpensive ways to manage aerosols, but they are not necessarily evidence-based. For example, she explains that one popular hands-free dental suction system is ReLeaf™ (Kulzer). The green part, which is leaf-shaped, is disposable. However, Slim asks, do we know it makes a difference? Moreover, for suction devices, best practices for HVE and extraoral vacuum aspirators are limited, she says.

“Common sense right now says to use a hands-free suction system like Isolite or ReLeaf in addition to respirator and face shield. A portable HEPA air purifier is also important,” Slim says. “Research has shown these to be effective tools in reducing viral load, but I’m not certain that dentistry has current guidelines for these air filters.”

When it comes to products like an Isolite or an A-flexX Assist Arm, Clarke says it doesn’t hurt to ask the practice to invest in them. She recommends talking to the doctor about the benefits to the practice, both for patient care and the bottom line. Approach the conversation with the doctor as an opportunity to present how the desired technology will make what the hygienist does better for the dental practice, patient care, and productivity.

“You have to say, ‘Listen, this is what the technology is going to do. I’ll be able to care for more patients and be better at my job if I have these items,’” Clarke says.

Like Clarke, Sanders thinks presenting your ideas about how technology enhances the practice’s goals is key to getting the practice owner on board. She sees this discussion as the hygienist’s opportunity to let the doctor know what it’s going to cost and what it will mean for the patients, whether that is earlier diagnoses or improving patient education and treatment acceptance or productivity gains.

“The business of dentistry, first and foremost, is about patient care. Yes, dentistry is a business, and we need to contribute to production that brings in income to the practice, and doctors are constantly looking at the bottom line and their overhead,” Sanders says. “However, this is your opportunity to color this picture for the doctor to recognize that they cannot afford not to have whatever that technology is. Sometimes, that means getting creative.”