HVE: This Sucks.
Ok friends. A few thoughts from two practicing dental hygienists and practice coaches. For weeks now my business partner and I have tried several types of HVE systems to help our dental professionals find the best alternatives to help minimize aerosol exposure for team members and patients.
Aerosol exposure is nothing new. Washington state will most likely require HVE for all dental procedures by the end of 2020. With the current Covid-19 crisis, this is sure to move to the frontline.
Hygienists are highly susceptible to aerosol exposure due to ultrasonics we use without the assistance of HVE. We have one hand using an ultrasonic, the other hand utilizing the mirror for retraction, illumination and indirect vision. The saliva ejector is fish hooked in the patients mouth and half the time we are fighting soft tissue impeding the evacuation of saliva. There have been occassions where our pant legs have felt damp after a procedure and sometimes we can even taste the mint from the air polisher.
We need a better solution and the time is now. So many choices but what do you choose?
First of all lets consider a few things:
According to Harrel and Molinari 2004 JADA, the device needs to be 6-8mm’s in diameter to be efficient in aerosol removal. Jacks cited in 2002 J Dent Hyg that a HVE device placed within one inch of the commissure of the mouth will reduce aerosol by 89.7 to 90.8%. Saliva ejectors work great at removing fluids, not aerosols.
Currently we have many tools that address fluid removal but not many focus on aerosol removal. Tools such as Isolight, Dry Shields, Nu-Bird, M7, Leaf, Mr Thirsty as wonderful as they all are they all are best suited for fluid removal. Adding a LVE hose to a HVE doesn’t make it a HVE. The holes are all too small per Molinari and most all have opportunities for soft tissue to impede evacuation. Systems such as Nu-Bird and the M7 are fantastic but when using the mirrored suction to retract soft tissue it compromises efficacy. The others mentioned work well but take some skill in placement and some patients just don’t enjoy us cramming a large rubber device into the back of their esophagus.
It comes down to two…
The PureVac and the A-FlexX Assist Arm. The PureVac system has a lightweight hose and uses a swivel attachment HVE tip that is curved and has a mirror at the end. Although it does give a bit of strain on the hand, the lighter hose and the swivel attachment help significantly. The PureVac has an offset HVE tip that is difficult to use at first especially when scaling posterior quadrants and because you are using it while you are retracting soft tissues it becomes easily blocked. The mirror works but sometimes you have to compromise evacuation for visability. If a system like the Purevac worked so well, Dentists would have been using them for preps long ago and allow their assistant to have a coffee break. PureVac costs close to around $400 once you add extra tips.
So we want the HVE to be close to the mouth but not so much that it sucks up soft tissue and sounds like we are ripping out the patient’s uvula! This is where the A-FlexX Arm has the advantage. Imagine having another pair of hands holding the HVE for you…an assistant that allows you to use one hand with the ultrasonic and the other hand with the mirror for indirect vision and retraction. The A-FlexX Assist Arm is a simple, small device that you can quickly attach to the back of your chair or cart and holds the evacuation hose for you wherever you want. It is a mobile and agile arm attachment for either LVE or HVE systems and requires minimal training or adaptation to use. It allows you to work using a funnel like attachment on the HVE externally of the patients mouth and captures the aerosols immediately with no strain on your hands, the patients mouth and no miscalculated exposure from tissue blockage. Costs $389 for HVE kit, around $450 if you include more funnels and a few replacement attachment pads.
There are so many systems to consider and many more are sure to come. If you are looking for a simple and effective tool that requires minimal training and has 90% effectiveness of aerosol removal, we at Infinite Hygiene Consulting endorse and highly recommend you consider the A-FlexX Assist Arm! Owned and operated by a Dental Hygienist who understands clinical care, patient management and ergonomics!
Trina Poulsen and Santiago Valdez at Infinite Hygiene Consulting would love to help prepare your teams for a Covid-19 reboot, contact us today for a free consultation and we can discuss how!