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AIR POLISHING: HAVE I BEEN DOING IT WRONG?
As a hygienist, do you avoid using air polishing in your practice? You may have preconceived notions about how it works and what it can and cannot do. Like most hygienists, your initial introduction to air polishing, likely in school, left you feeling more disappointed than impressed. The early-to-market products were too messy and too harsh, giving you no reason to use air polishing over traditional scaling and rubber cup polishing methods.
AIRFLOW® Therapy changes all that. This system is more advanced than any air polishing product you’ve tried in the past. Incorporating AIRFLOW Therapy into your practice will improve how you handle biofilm management, saving you time and leading to healthier, happier patients. With AIRFLOW Therapy, there are no worries about messy procedures or patient discomfort. This system actually reduces the amount of time it takes to remove biofilm, making your practice more efficient and profitable while also allowing you to provide your patients with optimal care.
Air polishing technology has changed, and with proper training and manufacturer support, you can easily incorporate this biofilm management method into your workflow. Hu-Friedy offers the support you need to make it happen, along with an advanced air polishing solution that’s unlike any other system on the market.
Still not convinced you should incorporate air polishing into your practice? Here are the top concerns hygienists have about air polishing, and how AIRFLOW Therapy addresses each one. You’ll find air polishing technology deserves a second look, and that it’s come a long way from what you remember.
Concern 1: Powder is a problem
The older polishing systems were messy, gritty and uncomfortable for patients, and only designed for enamel surfaces. AIRFLOW’s powders are different. Designed for comfort, the system’s low-abrasive powders feel just like water and are safe for restorations, root surfaces, and dental implants.
What makes AIRFLOW’s powders so much better than other options on the market? They’re made with smaller microns and are efficient and effective. AIRFLOW’s PLUS Powder, for example, is made with erythritol, a sugar alcohol with a grain size of just 14 microns. It’s unique particle shape and strength are great for biofilm removal and light to moderate stain removal. Another low abrasive option is PERIO Powder, made with glycine, an amino acid with proven effectiveness for biofilm and light stain removal. Finally, for patients with heavier stain, AIRFLOW Classic powder is a more comfortable sodium bicarbonate option with a grain size of 40 microns.
Concern 2: Patient comfort
Another concern about air polishing is patient discomfort. The devices are optimized for low abrasive powders to deliver a gentle spray that can be directed toward the gingiva, minimizing the messiness for the patient. Using AIRFLOW for biofilm removal reduces the amount of instrumentation overall, leaving hand and ultrasonic scalers for hard deposits. Biofilm removal in periodontal pockets is made easier with the PERIOFLOW® nozzle – a flexible plastic nozzle that inserts into the pocket to disrupt the biofilm. Compared to metal subgingival tips, the PERIOFlOW nozzle is easier to fit around crown contours, particularly implant prosthetics.
AIRFLOW therapy improves biofilm management within your hygiene appointments. Patients will notice the comfort and efficiency, leaving your office with that “just cleaned” feeling everyone loves.
Concern 3: It doesn’t fit my workflow
Are you wondering how to fit AIRFLOW into your workflow? You may think another process will take extra time. Not so. AIRFLOW actually saves time, especially when implemented in the beginning of the prophylaxis clinical routine, which should follow these four steps:
AIRFLOW Therapy for biofilm removal
Scaling for calculus removal
Patient education and extra services
Why does AIRFLOW Therapy come before scaling? Finishing biofilm removal before calculus removal reduces instrumentation time and clears the surfaces to better detect hard deposits. The time consuming “stroke by stroke” biofilm removal you’ve gotten used to isn’t necessary anymore. This gives you extra time to focus on other tasks that bring value to your practice, such as talking to patients about the various services you provide and how those services can help them meet their oral health goals.
AIRFLOW systems come in different options, from a versatile tabletop unit to a basic device that connects to the handpiece hose. They are designed with ergonomics in mind, making them easy to incorporate into any practice.
Original Story from Hu-Friedy
Ensure Oral Health During Pregnancy
Pregnant women experience an increase in progesterone and estrogen, which exacerbates the inflammatory response to gingival irritants, such as plaque biofilm. Simultaneously, changes in the oral microflora favor the pathogens associated with gingivitis. As a result, pregnant women are more susceptible to gingivitis, pregnancy granuloma, periodontal diseases, and dental caries.
Gingivitis is a common oral condition that affects up to 75% of pregnant women. Increased levels of estrogen and progesterone, changes in the oral flora, and a weakened immune system affect gingival tissue and cause inflammation. Poor oral hygiene and increased biofilm can exaggerate the gingival response. Pregnant women may experience gingivitis beginning in the second month and continuing throughout pregnancy. Although the severity may improve post-partum, most women who experience gingivitis during pregnancy will likely have some form of the disease after pregnancy.
A pregnancy granuloma, sometimes called a pregnancy tumor, may form as the result of local irritants, such as plaque biofilm due to poor oral hygiene or forming on overhanging restorations. It is most commonly seen along the maxillary anterior labial aspect of the interdental papilla. The color ranges from dark red to bluish purple. It is usually no larger then 2 cm and bleeds easily. Pregnancy granulomas will often self-resolve. If surgical excision is required, it is best-performed post pregnancy, as recurrence during pregnancy is possible. The hormonal changes that occur during pregnancy increase a women’s susceptibility to periodontal pathogens and reduce the body’s ability to repair oral soft tissues. Periodontal diseases have been associated with adverse pregnancy outcomes.
Changes in the oral environment during pregnancy can increase the risk for caries. Pregnant women tend to crave a diet high in sugar and fermentable carbohydrates, increasing the risk for caries. In addition, many pregnant women experience nausea and vomiting, which can compromise oral hygiene efforts. Vomiting also increases acidity in the oral cavity. At later stages of pregnancy, the upward pressure from an expanding uterus may cause acid reflux. This type of acidic environment favors cariogenic bacteria and can also cause erosion. Additionally, cariogenic Streptococcus mutans passes from mother to infant through vertical transmission. The bacterium is transferred by sharing utensils or toothbrushes, kissing on the lips, cleaning a dropped pacifier by mouth, or the prechewing of food. Pregnant women with untreated caries have high levels of S. mutans in their saliva and are thus likely to pass the bacteria onto their offspring. Children who acquire the bacterium at an early age have a greater risk of developing early childhood caries.
Although the most common reason cited for not seeking care is lack of perceived need, research shows access to care also plays a role. The likelihood of low-income and uninsured women receiving such care is even lower. Oral health coverage for pregnant women varies by state, although states must cover pregnancy-related services. This means Medicaid-eligible pregnant women must receive oral health services if the oral condition is exacerbated by the pregnancy or could negatively impact the pregnancy. Access to care may also be hindered by low oral health literacy and language barriers. All health professionals should ensure patients understand the information presented and are given the opportunity to ask questions.
The Oral Health Care During Pregnancy: A National Consensus Statement declares that comprehensive oral care—including necessary radiographs and use of approved local anesthesia—are beneficial during pregnancy and pose no fetal or maternal risk. Furthermore, treatment can be safely rendered any time during pregnancy, although pregnant women may be most comfortable being treated in the second trimester. Pregnant women may experience nausea and vomiting in the first trimester and any manipulation of oral tissues may worsen the symptoms.
From Dimension of Dental Hygiene
Vista Dental introduces CanalClean, an endodontic irrigation kit
Endodontic retreatment rates are up over 35%, partially due to improper irrigation techniques and protocol. Vista Dental Products’ two-step irrigation protocol features Vista engineered chemistries for maximum canal disinfection.
The redesigned CanalClean irrigation procedure kit contains pharmacy fresh solutions, irrigating tips, and a micro-aspirator in a “peel and use” kit. Lions Dental Supply Will carry the CanalClean Endodontic Irragation System.
SmearOFF 2-in-1, which is included in the kit, eliminates the need for ethylenediaminetetraacetic acid (EDTA), chlorhexidine, and a rinsing agent. Chlor-XTRA and SmearOFF are 100% compatible and will not form a precipitate when mixed.
Chlor-XTRA is three times thinner than standard sodium hypochlorite compounds, and offers two times greater digestion capability. SmearOFF is a combination EDTA and chlorhexidine solution that will not form as a precipitate when mixed with sodium hypochlorite.
Cheaper handpiece repairs aren’t always better—they’re actually worse
When you walk into your practice, you want things to run smoothly—no glitches, unexpected cancellations, staff conflicts, or equipment failures. Unfortunately, these things happen more often than we’d like because, to some extent, many are out of our control. That’s when we modify, adapt, and make the most out of the situation. But maybe we have more control than we think. Curious? Keep reading.
Steve Frost, DDS, who runs a successful endodontic office in Arizona, was looking to purchase new handpieces. He made the investment with KaVo and purchased the lubricating and maintenance accessories per the manufacturer’s recommendations, as it is well documented that daily handpiece maintenance is essential. The demand he put on his handpieces was high. Over time the torque, stress, and strain from cutting through zirconia, metal, and porcelain crowns took its toll.
After about a year and a half of heavy and intense use, as normal wear and tear would have it, the handpieces needed to be sent in for service and replacement parts. The fixes would be simple . . . or so he thought. He sent them out to a local repair provider and didn’t think anything of it when they came back.
However, after about five or six months, much to his dismay, he noticed the turbines grinding in several handpieces, which subsequently led to vibrating and overheating. Not good. He sent them back to the repair provider a second time, and the same thing happened. Only this time, he noticed that the color on the head was different (albeit slightly) than the rest of the handpiece, so he called his KaVo sales representative. Dr. Frost was slightly frustrated as his investment up to this point was costly and getting a little out of hand.
“Counterfeit parts,” the sales rep told him. Those two words summed it up. “Original equipment manufacturer, or OEM, parts comply with the highest standards and are manufactured to meet rigorous quality and regulatory requirements, whereas counterfeit parts may not be,” he explained. Unbeknownst to him, Dr. Frost’s handpiece was repaired with counterfeit parts. As a result, the turbines were more or less shot and the entire handpiece needed a complete overhaul. This was not the kind of news he wanted to hear, especially after he had already spent enough on repairs to have paid for a new handpiece.
If this story sounds familiar, there’s a good reason. I interviewed the repair managers of the top five dental handpiece repair companies that came up from a quick Google search. When asked about their service and parts protocol, four out of the five companies said that, unless the customer stated otherwise, after-market parts are used over OEM parts. Why? Because they’re cheaper.
Your first thought may be, “I don’t want to pay a big bill, and if the parts are just as good, then I don’t have a problem with it.” That’s part of the dilemma. We are made to believe they are just as good, but are they? You know the old saying, “If it’s too good to be true, it probably is”? In the case of handpiece repair, it really is.
Handpieces are one of the most heavily used pieces of equipment in a dental office, yet most practices don’t have contingency plans for repairs. Or if a repaired handpiece breaks, dentists often default to thinking the issue is with the handpiece, instead of the inferior parts used in an earlier repair.
To get better insight into why counterfeit parts are such a problem, I talked with Nichole Hansen who is the manager of the handpiece repair department at KaVo. The first thing she told me is that repairs arrive at her facility daily because they were fixed without OEM parts. It gets even more interesting:
Counterfeit parts can significantly increase the risk of damaging genuine internal parts—yes, the parts may “fit,” but that doesn’t mean they will last or maximize the anticipated lifetime use of the handpiece.
Handpieces that come in with counterfeit parts will typically last less than six months The most common complaints include gear grinding, loud noises, inadequate or inefficient cutting, and overheating.
While cheaper repairs are initially more appealing, dentists might end up spending two to three times more using generic parts than they would if they had repaired it properly with OEM parts in the first place.
This one is worth repeating: OEM parts comply with the highest standards and are manufactured to meet rigorous quality and regulatory requirements. Counterfeit parts may not be.
With counterfeit parts, the likelihood of the handpiece malfunctioning increases, which raises extreme safety concerns for your patients.
Not all after-market parts are considered counterfeit, but KaVo always recommends using only genuine parts to ensure the maximum performance and lifespan of the handpiece.
Both after-market and counterfeit parts could potentially void any manufacturer warranties on the handpiece.
When repaired at an authorized facility by a certified technician, notes, test outcomes, and the technician ID will accompany the return.
We always look for ways to save money and be more efficient with what we do. That’s prudent and good business sense. So let me ask you this: Do you want to spend your money twice when it comes to your equipment?
Let’s put this into perspective. A patient comes in with a broken tooth needing a crown. The patient wants a cheap fix, and you say the best investment is a crown because it returns the tooth to full form and function. A large filling, on the other hand, is a temporary fix, and the patient can ultimately lose the tooth. The key question is this: Is it worth it in the long run to save a few bucks now, in exchange for increasing the risk of losing a tooth? I don’t know about you, but I’d get the crown done. The same goes with our handpieces. Don’t take a risk because it’s cheaper. Insist on getting the best parts for a maximized return on your investment.
Greg Gillespie, DDS, a general dentist in Washington state, has had his own share of negative experiences with faulty parts and nonauthorized repairs. He now insists on only OEM parts and recommends the following:
Use only repair providers who have been authorized by your device’s manufacturer.
Look for a guarantee. Many unauthorized repair providers do not guarantee that their repair will last.
Insist on only OEM parts. For example, KaVo uses OEM parts 100% of the time for all repairs, which allows them to return the handpiece back to its original performance.
Choose a repair provider who offers knowledgeable customer service to provide full support and answer questions about your instrument.
Ask for a report on your handpiece repair. Most authorized repair teams perform tests on handpieces with every repair. They include the test results and detailed notes with each repair, giving you invaluable information for the life of your handpiece.
Mishaps will happen within every practice. While many are out of your control, handpiece repair isn’t. The next time your handpiece starts to grind or overheat, make the wise decision to get it fixed correctly. Although the less expensive alternative may be enticing, you should insist on an authorized repair facility that only uses OEM parts. This will save you time and money as you properly maintain one of the most important tools in your practice. Dentistry is your livelihood, and this is definitely worth the investment.
Originally From dentistryiq.com
This month Lions Dental Supply focus on billing for soft tissue grafting. This includes dental practices whose dentists are performing the tunneling technique and/or the Chao Pinhole Surgical Technique.
D4270—Pedicle soft tissue graft
Purpose: A pedicle tissue graft is performed to "fix" gum recession. This procedure code can be used to report the tunneling procedure technique or the Chao Pinhole Surgical Technique. It involves augmenting the gingiva to obtain adequate root coverage.
There are many variables involved when it comes to dental insurance coverage and reimbursement for this procedure.
• Dental insurance companies usually cover only if the correct information is reported.
• Submitting the claim with x-rays and periodontal charting is not enough to facilitate coverage and payment.
• A clear written narrative that explains the need for the procedure must be submitted.
• Gingival recession must be noted in the narrative at 5 mm or greater in order for insurance companies to approve coverage.
• Gingival inflammation should be noted in the narrative: mild, moderate, or severe.
• The amount of keratinized/non-keratinized gingiva must be noted in the narrative in order for insurance companies to approve coverage.
• The amount of attached and unattached gingiva must be noted in order for insurance companies to approve coverage.
• Root sensitivity must be noted in the narrative at moderate sensitivity in order for insurance companies to approve coverage.
• If root caries exists, it must be noted in the narrative.
• Mobility must be noted. If mobility exists, the procedure may be denied.
• A 24- to 36-month exclusion applies. This means the same insurance will cover only the procedure in the same teeth reported every 24 to 36 months.
Lions Dental Supply has all the Dental Equipment needed to do any Dental surgery.
How to safely and effectively care for dental restorations.
Dental hygienists routinely deal with prophylaxis of not only teeth, but a vast array of restorative materials. These restorations involve metallic, ceramic, polymeric, and composite materials that are part of the huge armamentarium representing old and new products employed over the past 50 years. More than 1,000 restorative products may be encountered, most of which are not specifically identified in a patient’s record. A dental hygienist needs to be able to recognize various restorative materials and employ the correct treatment protocol. The goals of this review are to summarize the key principles for safe finishing and polishing operations, consider the structure and properties of restorative materials that put them at risk, and identify precautions for dental hygiene procedures.
Metals, ceramics, polymers, and composites are synthetic restorative materials. Metals include amalgam, removable partial denture frameworks, implants, gold, and other casting alloys. Ceramics may be porcelain, porcelain fused-to-metal, porcelain veneers, and high-strength ceramics. Polymers involve infiltrants and polymethyl methacrylate (PMMA) denture base materials. Composites encompass dental composites, glass ionomers, and temporaries. Management of these materials during a dental hygiene appointment requires some understanding of a material’s structure (arrangement, bonding, composition, defects) and properties (physical, chemical, mechanical, biological).1 Clean and smooth surfaces are essential for esthetics, biological health, and long-term resistance to restorative material degradation. This article will focus on identifying unintended effects of cleaning and prevention methods on surfaces.
The microstructure of all restorative materials is based on the chemical phases that exist within a material. A simplified view of microstructures is as a continuous and dispersed phase (Figure 1).2 For example, a dental composite with a dispersed phase of silica filler reinforces a continuous phase, which is based on crosslinked polymer and difunctional monomers. Another example is a dental amalgam with dispersed phases of residual crystalline amalgam alloy particles within a continuous phase of crystalline reaction products.
During a routine prophylaxis (plaque, calculus, and stain removal; surface smoothening) or prevention procedures (topical fluoride applications), a restorative material’s surface may be altered. Softer phases may be inadvertently or selectively removed. The dispersed phase is often chemically different and provides reinforcement properties. It may react differently to finishing and polishing. The best results are achieved by using polishing materials that are softer than both the dispersed and continuous phases of the restorative material.
For a variety of reasons, surfaces also may require gentle smoothening (finishing) by leveling of irregularities after setting, reactions after setting, or intraoral wear. Polishing is intended to remove plaque, stain, or corrosion. These abrasion processes are two-body (ie, surface and abrader) or three-body (ie, surface; lubricant, such as saliva or water; and abrader). The most commonly used, the three-body process is the preferred protocol. Cleaning is desired without substantial surface abrasion. Polishing agents must contain materials that are hard enough to remove plaque or stain, but soft enough to not damage surfaces.
Risks from wear or abrasion are relatively easy to rank in terms of a Mohs Hardness Scale (Table 1).2 Hardness of any material is its mechanical resistance to plastic deformation. Mohs scale comparisons involve two materials being rubbed together to see which one is scratched by the other. This scale spans all material hardness, from the softest (talc = 1) to the hardest (diamond = 10). Hardness is 5–6 for enamel, 3–4 for dentin, and 2–3 for cementum. Polishing agents should be softer than enamel or any of the soft phases in a restorative material.
While the primary consideration in polishing involves the hardness of materials, there are other factors, such as type of wear, duration of wear, applied pressure, and size of polishing particles. Larger particles produce greater wear. Smaller particles may erode softer phases. Dentifrices are designed to accomplish the same result as polishing procedures and are subject to the same conditions. Hardness ratios are typically used to summarize the relative likelihood of a potentially abrasive material to produce surface wear (Figure 2).2
Wear of composites intraorally occurs due to small silica particles (eg, 0.1 µm) within food that abrade the surface by removing softer continuous phases. For restorative composites, this risk is dramatically reduced by high filler particle loading, combining two or three particle sizes for better particle packing, and minimizing average interparticle spaces to less than 0.1 µm.3 Composites wear, but the process is very slow. Longevity for posterior composites equal those of dental amalgams.4,5 Particles in prophylaxis materials must be soft, and have little tendency to abrade the polymer phase.
SPECIAL PRECAUTIONS FOR DENTAL HYGIENE
While most smoothening and polishing procedures are straightforward, there are special precautions worthy to note.
Tooth-colored materials (composites, glass ionomers, temporary, or provisional restorations). Without prior knowledge, it is generally difficult to identify a composite vs a glass ionomer restoration. Both are esthetic and have a continuous polymer phase with a dispersed silicate phase. Dental hygienists should be careful not to apply too much pressure during the polishing stage of the prophylaxis or the continuous polymer phase could slowly become abraded. Surface stains are easy to remove. Marginal stains associated with Class I, II, III, and V restorations, as well as veneers, involve discoloration that cannot be removed without damaging the restorative material. Do not aggressively polish at the margins. A variety of composites (macrofill, midifill, minifill, microfill, nanofill, and bi-hybrid or tri-hybrids, and glass ionomer materials) are available, but the various types are sufficiently similar that the same approach should apply.6
Amalgam. Tarnish or electrochemical corrosion products create a darkened or blackened appearance. Removing corrosion products produces a reflective metallic appearance that may be good for cleanliness but does not increase the material’s longevity. Inadvertent dry polishing of an amalgam and/or excessive pressure generates surface heat that easily melts the Ag2Hg3 reaction product (melting point = 127° C)7 within the continual phase—releasing and smearing Hg on the surface. The amalgam looks shiny because of its Hg-rich surface layer, but that smear layer is quickly lost over the next few days, exposing the patient and clinician to some Hg vapor during or post-procedure.
Always polish amalgams while using water to lubricate and cool the surface. Also, utilize high-volume evacuation to ensure that any mercury-rich materials that form vapor are quickly eliminated and not inhaled by the patient or the dental hygienist.
Amalgam restorations do wear, albeit very slowly. They also expand slowly over time. The net change on occlusal surfaces is that there is no visible change. Yet, in sites protected from intraoral food abrasion, such as interproximal surfaces or facial surfaces, amalgams may slowly begin to stand out from the cavity above the surface of adjacent tooth structure.6 This appearance is not the result of bad dentistry, but simply the lack of natural abrasion. Use water cooling when resurfacing an amalgam restoration. Resurfacing an amalgam restoration may release some Hg vapor, so local high-volume evacuation should be utilized as well as a rubber dam to remove any associated liquid or vapor.
Infiltrated interproximal lesions. Interproximal lesions without cavitation can be infused with special low-viscosity resin that is polymerizable to halt lesion progression and reinforce tooth structure. Beware that radiolucencies on intraoral radiographs may not necessarily signify an advancing carious lesion. These infiltrations stop caries.8 The process should be noted carefully in the patient record during placement. Check for those treatments in the patient’s history.
Titanium implant posts and titanium alloys. These materials are protected by a film of titanium dioxide (called a passivating film) that forms rapidly, clings tightly to the surface. It is so thin that it appears transparent and invisible. Scaling or aggressive polishing procedures remove this protective film. It will immediately reform if the surface is clean. Effective but not overly aggressive instrumentation strokes should be used, along with light polishing pressure and pumice and water. The same protective film may be disturbed by acidic reactions associated with some topical fluorides.
Ceramic: all-ceramic and porcelain-fused-to-metal restorations. Ceramic is relatively resistant to degradation but surfaces can be partly dissolved by highly acidic intraoral solutions.9–11 Treatments with certain topical fluorides will also dissolve small bits of the surface. We have found that coating at-risk surfaces with a petroleum jelly film or other nonwater soluble agent is a simple way to provide temporary protection.
As delivered, ceramic materials should have very smooth external surfaces. Any intraoral adjustments produce surface scratches that require smoothening with diamond finishing pastes (particle sizes approaching 0.1 µm). Ceramics have high hardness and therefore require zirconia or diamond polishing agents for smoothening. Ceramics are very susceptible to crack formation from stressed areas containing surface defects. If these defects are recognized, they should be removed with special small particle diamond polishing pastes. They cannot be removed with normal polishing materials during a dental hygiene procedure.
Dental cements. Permanent restorations are attached with traditional acid-based cements, glass ionomer cements, or resin (composite) cements. The thickness of exposed cement at margins is typically 50 microns to 250 microns. These materials generally have lower hardness than restorative materials or tooth structure. Aggressive polishing may force abrasive material into the margin and potentially erode the cement.12 A technique of light pressure with prophy cup and prophy paste while polishing with swiping strokes across the margins is recommended.
Denture base materials. Most denture base polymer is PMMA with a hardness value similar to that of dentin. These materials are routinely cleaned with commercial denture base products and/or a soft toothbrush with soap and water. Abrasives in polishing materials or dentifrices will produce some surface scratching. Denture base material is commonly crosslinked by adding some difunctional monomer with the original methyl methacrylate monomers, which creates a more water-resistant material. Remember that a PMMA denture is prone to absorb water intraorally, and lose water when it is out of the mouth. Its mechanical properties vary as a function of water content. This is why dentures are stored in water when not being worn. Avoid procedures that would dry out the material.
Gold alloys. Alloys based on gold also corrode, but very slowly. Their surfaces are susceptible to electrochemical corrosion and over time may develop some surface pitting due to the presence of plaque. Therefore, gold restorations should be fully polished during recare visits. Rubber cup polishing with fine prophy paste is recommended. Any surface corrosion products that form are water soluble and, therefore, will not accumulate. Areas that are pitted can be polished, but will continue to slowly corrode if not kept clean.
Bonding systems. Bonding agents are extremely thin (< 5 µm) and only exposed at margins. Bonding agents are not at risk during routine prophylaxis and polishing operations. Do not attempt to remove stain that has crept into open margins of composites or veneers because of the possibility of damaging the margins. This situation is an esthetic failure and requires repair of margins.
Dental hygienists play a crucial role in the long-term maintenance of dental restorations. Appropriate care of restorations during dental hygiene procedures depends on recognizing restorative materials, understanding specific precautions, and carefully conducting finishing/polishing procedures. Removal of stain and plaque depends on the hardness of the prophylaxis agent, which should always be less than the hardness of the phases involved in the restorative material or tooth structure. The goal is always to remove plaque, calculus, and/or stain without disturbing the structure of underlying restorative materials.
From Dimensions of Dental Hygiene
Technique Tips for Handheld Radiography
Appropriate training and keeping up to date on research are key to ensuring the safe and effective use of a handheld X-ray device.
By Ann M. Bruhn, RDH, BSDH, MS and Kimberly Lintag, RDH, BSDH, MS On Oct 11, 2018
Handheld, portable dental X-ray devices, or handhelds, have gained popularity over the past few years because they enable operators to simultaneously hold the device while exposing radiographic images. In contrast, when using wall-mounted dental X-ray units, the operator must leave the room to make the X-ray exposure, maintaining a safe distance from the source of radiation. Handhelds are ideal for use in situations where wall-mounted dental X-ray devices are not accessible, such as mobile dental clinics and outreach events where midlevel dental hygiene practitioners may provide oral hygiene assessment and treatment.1 In addition, handhelds are useful in emergency situations of mass fatality incidents for disaster victim identification.2
Figure 1. Periapical images require steep increased or
decreased vertical angulation from 0°.
Handhelds are equipped with a backscatter ring shield around the position indicating device (PID) and inherent shielding to keep the operator in the “zone of protection” from resulting backscatter radiation that may be produced during dental X-ray exposures. Current research validates the safety surrounding handheld units cleared by the United States Food and Drug Administration (FDA); no additional radiation risk to the operator has been found when using handheld X-ray equipment when all required safety protocols are followed.3
A 2014 study on handhelds found that devices not cleared by the FDA led to an increased radiation dose to both the patient and operator, as operator shielding and collimation of the primary X-ray beam were not adequate.4 Handheld equipment must have inherent shielding, additional shielding around the PID, and an affixed backscatter ring shield. Handhelds should never be used if the backscatter ring shield is defective, not affixed to the PID, or broken.
Radiographers may also don a lead apron with attached thyroid collar to eliminate any possible scatter radiation exposure from suboptimal positioning of the handheld device and backscatter ring. In addition, some state regulatory boards require operators of handheld radiographic equipment to wear a dosimeter badge to measure the amount of radiation received within a specific preset period, such as weekly or monthly. However, dosimeter badges do not directly protect the operator from ionizing radiation exposure because levels of radiation are found after the badge is assessed. After the dosimeter badge readings are analyzed, the operator may realize that additional protective measures and precautions are necessary.
To further minimize radiation exposure when using handhelds, exposure settings such as milliamperage (mA), exposure time, and kilovoltage (kV) settings should be changed depending on the bone density of the area being imaged, similar to the use of a wall-mounted dental X-ray unit. High density areas within the oral cavity (posterior regions) will require increased exposure settings, while lower density areas will require decreased exposure settings (anterior region).5 Manufacturers of handheld X-ray devices may recommend appropriate exposure settings based on the type of image receptor used (direct digital sensor, phosphor plate, or film); teeth being imaged; location within the oral cavity (maxilla or mandible); and patient size (adult or child). Overall, exposure settings can be set lower for digital sensors and higher for phosphor plates and film, respectively.
Radiographers using handheld radiographic equipment should be knowledgeable on the lowest exposure settings needed to produce an acceptable image and be able to apply safe practices for the operator and patient.
Figure 2. Patients should be instructed to move their head
position upward for mandibular periapical images or
downward for maxillary periapical images.
The operator must follow manufacturer instructions for optimal radiation safety when using handheld X-ray devices. One of the directions for safe use of handhelds is to hold the device at the operator’s mid-torso height for all exposures. However, holding the device at mid-torso height requires a vertical angulation of approximately 0° (with the device parallel to the floor), which is not possible to maintain for all types of dental radiographs. Periapical images require steep increased or decreased vertical angulation from 0°, which would place the operator at risk for radiation exposure to critical organs and out of the “zone of protection” given by the backscatter ring shield of the handheld device (Figure 1).
To follow manufacturer directions and reduce possible operator radiation exposure when using handhelds, the patient should be instructed to move his or her head position upward for mandibular periapical images or downward for maxillary periapical images, instead of keeping the patient’s occlusal plane parallel to the floor and mid-sagittal plane perpendicular to the floor (Figure 2).
The operator must stand directly behind the handheld device during the exposure for optimal protection with the backscatter ring shield, which makes the visualization of accurate angulations necessary to achieve quality images difficult. Also, because the patient’s head will not be in the usual position for exposing radiographs and tilted either higher or lower for operator safety, accurate angulations for effective technique will be more difficult to determine.
The use of image receptor holding devices is beneficial to assist the operator with accurate positioning of the PID; however, the backscatter ring shield interferes with the metal extension arm of the image receptor holding device. Manufacturers of holding devices have shortened the metal positioning arm for use with handheld radiographic equipment; therefore, altered equipment should be used together with handheld devices.
With the increased use of handheld X-ray devices, operators need to understand the necessary alterations and safety mechanisms for radiation safety and protection. In order to receive the maximum benefit of handheld devices while minimizing operator scatter radiation, all safety precautions must be followed. Proper technique is vital, as scatter radiation is reduced if the operator is within the backscatter ring shield zone of protection. Operators need to ensure handheld devices are kept at mid-torso height for all exposures to maintain optimal protection with the backscatter ring shield. Training prior to the use of handheld devices and keeping up to date with research and guidelines surrounding handheld radiographic equipment will ensure operator safety and high-quality radiographic images.
from Dimensions of Dental Hygiene
Video Dental Concepts announces MobileX handheld intraoral x-ray system
Video Dental Concepts has expanded its portfolio of imaging solutions with the new MobileX handheld intraoral x-ray system, which is designed to offer dental professionals reliability and efficiency.
The MobileX has a unique, lead-infused acrylic shield that protects the operator from scatter radiation, while an internal proprietary housing encases the x-ray tube to block radiation leakage. When the MobileX is used as directed, these shields create a “safe zone” for the operator throughout the x-ray acquisition process.
MobileX produces sharp, clear radiographic images. The system utilizes the latest in x-ray technology—a 0.4 mm focal spot, plus a 70 kV DC x-ray generator that consistently delivers exacting, repeatable exposures.
This handheld x-ray system provides freedom in workflow that is unattainable with wall-mount units. Portable and easy to use, the MobileX can be moved freely between operatories and lets clinicians remain chairside—creating a more positive radiographic experience for all involved. MobileX also provides an immediate cost savings, compared to equipping multiple operatories with wall-mount units.
The MobileX is ready for use right out of the box. Video Dental Concepts does, however, provide free and complete technical service, along with an operating manual and video. Lions Dental Supply & Equipment Will be carrying the MobileX HandHeld Dental X-Ray Unit.
The MobileX features a cutting-edge battery technology, an intuitive user interface, and ergonomic design, making it easier to use and hold. The MobileX battery technology provides consistently reliable, long-lasting battery longevity. Clinicians can easily select the right dose for a patient’s particular need by choosing from a variety of easy-to-understand graphic settings in the redesigned touch pad interface. The MobileX is lightweight and easy to handle.