Oral Hygiene Jul/Aug 2022

VOL.32 NO.4 JULY/AUGUST 2022 oral hygiene , therapy , infection control , management and more ... 100003758NO.POSTPRINT Paint on a newbrightsmile!VivaStyle®PaintOnPlusProfessionalresultsathomein14applications–Idealforwhiteningindividualteethduetotheselectiveapplicationwithabrush–Nocustomisedtraysorbulkyaccessoriesarerequired Making People Smile Contact us to find out more https://bit.ly/3xeI8bL ivoclar.com | 1300 486 Paint252 on a newbrightsmile!VivaStyle®PaintOnPlusProfessionalresultsathomein14applications–Idealforwhiteningindividualteethduetotheselectiveapplicationwithabrush–Nocustomisedtraysorbulkyaccessoriesarerequired Making People Smile Contact us to find out more https://bit.ly/3xeI8bL ivoclar.com | 1300 486 Paint252 on a newbrightsmile!VivaStyle®PaintOnPlusProfessionalresultsathomein14applications–Idealforwhiteningindividualteethduetotheselectiveapplicationwithabrush–Nocustomisedtraysorbulkyaccessoriesarerequired Making People Smile Contact us to find out more https://bit.ly/3xeI8bL

Helps provide deep repair* and long-lasting protection against dentine hypersensitivity** 1-4 Advanced

SENSODYNE REPAIR & PROTECT BRAND FOR SENSITIVE TEETH5 Science. Deep Repair*.

Always read label and follow the directions for use.

SENSODYNE REPAIR & PROTECT DEEP REPAIR*

4.

INTRODUCING SENSODYNE REPAIR & PROTECT DEEP REPAIR* DC. J Clin Dent 2010; 21:72–76. Earl JS et al. J Clin Dent 2011; 22:68–73.

5. GSK Consumer Healthcare calculation based in part on data reported by NielsenIQ and IQVIA through the IQVIA™ & NielsenIQ© RMS Sell Out] Service for the Oral Health Database, Sensitive Segment for the 52 week period ending 17/08/2021 for the Australia Grocery Pharmacy market according to the client defined product hierarchy. 6. Earl et al; J Clin Dent 2011; 22(3): 62-67(A). 7. Parkinson C et al. J Clin Dent 2011; 22(3): 74-81. 8. GSK Data on File; In vitro study number ML880; G7215/018; 2018. 9. GSK Data on File, Addendum to in vitro report ML880; 2021. 10. Wang Z et al. J Dent 2010; 38: 400-410. 11. Hall C et al; J Dent 2017; 60: 36–43. 12. GSK Data on File; Clinical Study number RH01748, 2013. 13. Hall, C et al; J Dent Res, 2017; 96 B:062 BSODR. Trade marks are owned by or licensed to the GSK group of companies. © 2022 GSK group of companies or its licensor. GlaxoSmithKline Consumer Healthcare Pty Ltd, Sydney, Australia. PM-AU-SENO-22-00121.

INTRODUCING

*Forms a protective layer over the sensitive parts of the teeth. Brush twice a day for lasting sensitivity protection **With twice-daily brushing.

References: 1. Greenspan DC. J Clin Dent 2010; 21:61–65. 2. Burwell A et al. J Clin Dent 2010; 21:66–71. 3. LaTorre G, Greenspan DC. J Clin Dent 2010; 21:72–76. 4. Earl JS et al. J Clin Dent 2011; 22:68–73.

INTRODUCING

DEEP REPAIR* NO.1

5. GSK Consumer Healthcare calculation based in part on data reported by NielsenIQ and IQVIA through the IQVIA™ & NielsenIQ© RMS Sell Out] Service for the Oral Health Database, Sensitive Segment for the 52 week period ending 17/08/2021 for the Australia Grocery Pharmacy market according to the client defined product hierarchy. 6. Earl et al; J Clin Dent 2011; 22(3): 62-67(A). 7. Parkinson C et al. J Clin Dent 2011; 22(3): 74-81. 8. GSK Data on File; In vitro study number ML880; G7215/018; 2018. 9. GSK Data on File, Addendum to in vitro report ML880; 2021. 10. Wang Z et al. J Dent 2010; 38: 400-410. 11. Hall C et al; J Dent 2017; 60: 36–43. 12. GSK Data on File; Clinical Study number RH01748, 2013. 13. Hall, C et al; J Dent Res, 2017; 96 B:062 BSODR. Trade marks are owned by or licensed to the GSK group of companies. © 2022 GSK group of companies or its licensor. GlaxoSmithKline Consumer Healthcare Pty Ltd, Sydney, Australia. PM-AU-SENO-22-00121.

Helps provide deep repair* and long-lasting protection against dentine hypersensitivity** 1-4

Helps provide deep repair* and long-lasting protection against dentine hypersensitivity** 1-4 *Forms a protective layer over the sensitive parts of the teeth. Brush twice a day for lasting sensitivity protection **With twice-daily brushing. Always read label and follow the directions for use. References: 1. Greenspan DC. J Clin Dent 2010; 21:61–65. 2. Burwell A et al. J Clin Dent 2010; 21:66–71. 3. LaTorre G, Greenspan

*Forms a protective layer over the sensitive parts of the teeth. Brush twice a day for lasting sensitivity protection **With twice-daily brushing. Always read label and follow the directions for use. References: 1. Greenspan DC. J Clin Dent 2010; 21:61–65. 2. Burwell A et al. J Clin Dent 2010; 21:66–71. 3. LaTorre G, Greenspan DC. J Clin Dent 2010; 21:72–76. 4. Earl JS et al. J Clin Dent 2011; 22:68–73. 5. GSK Consumer Healthcare calculation based in part on data reported by NielsenIQ and IQVIA through the IQVIA™ & NielsenIQ© RMS Sell Out] Service for the Oral Health Database, Sensitive Segment for the 52 week period ending 17/08/2021 for the Australia Grocery Pharmacy market according to the client defined product hierarchy. 6. Earl et al; J Clin Dent 2011; 22(3): 62-67(A). 7. Parkinson C et al. J Clin Dent 2011; 22(3): 74-81. 8. GSK Data on File; In vitro study number ML880; G7215/018; 2018. 9. GSK Data on File, Addendum to in vitro report ML880; 2021. 10. Wang Z et al. J Dent 2010; 38: 400-410. 11. Hall C et al; J Dent 2017; 60: 36–43. 12. GSK Data on File; Clinical Study number RH01748, 2013. 13. Hall, C et al; J Dent Res, 2017; 96 B:062 BSODR. Trade marks are owned by or licensed to the GSK group of companies. © 2022 GSK group of companies or its licensor. GlaxoSmithKline Consumer Healthcare Pty Ltd, Sydney, Australia. PM-AU-SENO-22-00121. Builds a dentinelayerhydroxyapatite-likestrongdeepwithinthetubulesofexposed for deep repair* and protection** 1,3,6-9 hydroxyapatiteReparative*layer is harder than underlying dentine and resistant to dietary acid and physical brushing 2,4,7,10 Proven for effective relief and long-lasting protection against hypersensitivity**dentine11-13 new formula To request free Sensodyne Repair & Protect samples scan the QR code or register at gskhealthpartner.com To request free Sensodyne Repair & Protect samples scan the QR code or register at gskhealthpartner.com

Emer. Prof. Laurie Walsh highlights how certain wavelengths of light have been shown to kill bacteria without causing harm to living tissue in animals or humans SHINING LIGHT ON COMMON MISCONCEPTIONS ABOUT THE ROLE OF LIGHT IN DENTAL BLEACHING

Overseas: A$38.00 p.a. Australasian Dental Practice (including OralHygiene) $99.00p.a. ABSTRACTS

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On the cover...

VOLUME 32 | NUMBER 4 JULY/AUGUST 2022 CPDCPDMEREADFORREADMEFOR

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TEST NOW TO PROTECT DENTAL WATERLINES

Publisher & Editor: Joseph Allbeury

UVC LIGHT FROM 200-230 NM: A NEW WAY TO IMPROVE AIR QUALITY?

Maria Lucas and Laurie Walsh explore the role of light in dental bleaching from several different perspectives, emphasising the translation from the scientific principles to the explanation given to patients

Did you know an hygienist spends 2 hours per day on average power scaling? With so much usage and often a different insert for many procedures, you must regularly evaluate your inserts to ensure they continue functioning properly instagram.com/dentevents

Oral Hygiene (formerly Auxiliary) ISSN 1323-4919 is printed in Australia and published six times per year by Main Street Publishing P/L ABN 74 065 490 655 • PO Box 586, Cammeray 2062

OH | CONTENTS

Vivastyle® Paint On Plus is a unique varnish system for whitening teeth without having to use a tray. The preparation contains hydrogen peroxide and provitamin D-panthenol for the gentle lightening of teeth.

22

A-dec dealers have stepped in to help dental practices with a new end-toend waterline maintenance approach and routine waterline testing service

OralHygiene $22.00 p.a.

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32 MAINTENANCE CHECKLIST FOR ULTRASONIC INSERTS

Telephone: (02) 9929-1900 Facsimile: (02) 9929-1999 Email: info@dentist.com.au © 2022. All rights reserved. The contents of this magazine are copyright and must not be reproduced without the written permission of the publisher. Permission to reprint may be obtained upon application. Correspondence and manuscripts for publication are welcome. Although all care is taken, the editor and publisher will not accept responsibility for the opinions expressed by contributors to this magazine, or for loss or damage to material submitted for publication.

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Dental Unit Waterline treatment agents reduce the dispersion of viruses in dental aerosols

Romesh P. Nalliah, Tanima Basu, Chiang-Hua Chang. Association between periodontal care and hospitali zation with acute myocardial infarction. The Journal of the American Dental Association, 2022; 153 (8): 776 DOI: 10.1016/j.adaj.2022.02.003

Blocking function of a blood-clotting protein, called fibrin, prevented bone loss from periodontal (gum) disease in mice, according to new research. The study suggests that suppressing abnormal fibrin activity could hold promise for preventing or treating periodontal disease, as well as other inflammatory disorders marked by fibrin buildup, including arthritis and multiple sclerosis.

Lakmali M. Silva, Andrew D. Doyle, Teresa Greenwell-Wild, Nicolas Dutzan, Collin L. Tran, Loreto Abusleme, Lih Jiin Juang, Jerry Leung, Elizabeth M. Chun, Andrew G. Lum, Cary S. Agler, Carlos E. Zuazo, Megan Sibree, Priyam Jani, Vardit Kram, Daniel Martin, Kevin Moss, Michail S. Lionakis, Francis J. Castellino, Christian J. Kastrup, Mat thew J. Flick, Kimon Divaris, Thomas H. Bugge, Niki M. Moutsopoulos. Fibrin is a critical regulator of neutrophil effector function at the oral mucosal barrier. Science, 2021; 374 (6575) DOI: 10.1126/science.abl5450

ivastyle® Paint On Plus is a unique varnish system for whitening teeth without having to use a tray. The preparation contains 6% hydrogen peroxide and the provitamin D-panthenol for the gentle lightening of teeth. The precise application of the varnish with a brush allows individual or crowded teeth to be effectively whit ened. The varnish does not dissolve in saliva and it takes effect within 10 minutes. Customised trays and expen sive, bulky accessories are unnecessary. Vivastyle Paint

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4 oral|hygiene July/August 2022 in | BRIEF

A study at the University of Michigan found that people who receive peri odontal care have better outcomes after heart attack. Researchers studied patients receiving periodontal care, dental cleanings or no dental care during 2016-2018 and who had acute myocar dial infarction (heart attack) in 2017. They found that patients who had heart attacks and received periodontal main tenance care had the shortest length of stay in the hospital and more follow-up visits. The longest length of stay was experienced by the no-dental-care group. The study, published in the Journal of the American Dental Association, did not establish a causal relationship between periodontal disease and heart disease, but research like this adds weight to the understanding that there is an association between oral health and overall health.

ral microbes are dispersed during dental treatment and reduction methods have been proposed. Methods to mitigate dispersion or microbial load, such as dental suction, dental dam and antimicrobial mouthrinses, have been studied, but few authors have examined the effect of dental unit waterline (DUWL) disinfectants on microbes contained within dental bioaerosols and their effect on viruses has not been studied. Products are available for periodic DUWL disinfection, including those intended for continuous use at concen trations safe for patients This study investigated the effect of the DUWL disinfectant product ICX on viral dispersion in dental bioaerosols. It also estab lished a dual-tracer system using live bacteriophage and fluorescein supported by optical particle measurement. Bacteriophage MS2 was used as a viral tracer and fluorescein as a fluorescent tracer. Validation experiments were conducted to exclude interference of one tracer with the other or of DUWL disinfectants on detection methods. Simulated “saliva” containing the tracers was infused into the mouth of a dental mannequin during 10 minute dental procedures with an air turbine handpiece (n = 3 replicates). Aerosols and droplets were sampled in an enclosed dental operatory using air samplers and settlement onto sterile filter papers. Bacteriophage was quantified using plaque assays and reverse transcription quantitative polymerase chain reaction (RT-qPCR). Fluorescein was quantified fluorometrically. The effect of DUWL disinfectants on total aerosol concentration was assessed in separate experiments using an optical particle counter. DUWL disinfectants reduced bacteriophage viability and interference between tracers was not observed. In simulated clinical proce dures, the disinfectant ICX reduced bacteriophage detection substantially (P < 0.001; 2-way analysis of variance). MS2 RNA was detected in all experimental samples but not negative controls. Samples positive on RT-qPCR but not plaque assays may indicate that virions at distant sites are nonviable. Fluo rescein tracer showed good agreement with the bacteriophage tracer. DUWL disinfectants designed for continuous presence in irrigants reduce the disper sion of viable virus in dental bioaerosols during simulated procedures. Their use may therefore be important for routine infection control and as a mitigation factor during infectious disease outbreaks. Future studies should explore this using a range of viruses and other microbes.

V

Allison JR et al. Waterline disinfectants reduce dental bioaerosols: a multitracer validation. J Dent Res. 2022. 1010(10):1198-1204.y.

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news | EVENTS

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6 oral|hygiene July/August 2022 news | EVENTS

The latest videos added to the site appear under “Recently Added” and a new “VOTE” button has been added to enable anyone visiting the site to vote for the videos they like.

D

“You have to login to Dentevents.TV to watch the videos and vote,” Mr All beury said. “Each person can only vote once for a video, but they can vote for multiple videos.

Upload your videos to Dentevents.TV now and win a smartphone gimbal

Whether you have a webinar recording, a product hack, a clinical technique, a product review or unboxing, a diatribe on difficult patients or some wisdom or humour about dentistry, you’re invited to share your video with your peers.

Only videos added between 1 July and 30 November 2022 can be voted for. So if you load a video onto the site, then it’s in your interests to encourage your friends to login as well and vote for it. The VOTE button activates after you have watched the video.”

For more information on the contest, visit Dentevents.TV. It’s free to login and watch any of the videos 24/7 and VOTE.

“Many people working in dentistry are already prolific content creators and we want to engage with these people and encourage them to use dentevents. tv as an additional way to share their videos with their peers. Part of this is making it far easier to load videos and part of this is incen tivising videos creators to share their content.”

entevents.TV has launched a brand new feature to allow anyone working in dentistry to upload and share videos that’s easier than ever. Simply login at www.dentevents.tv and click “Upload Video” to get started.

Plus, the author of the video that receives the most votes before 30 November will receive a DJI OM 5 Smartphone Gimbal Stabiliser (Phone not included) to help you make even better videos in the future.

“Dentevents.TV has con tinued to grow in popularity following its launch during the first COVID lockdown, but moving forward, we need to attract more content to take it to the next level,” said Dentevents. TV publisher Joseph Allbeury. “We have a great catalogue of dental videos available free and on demand 24/7 already, but now we’re looking for more content created by members of the dental community.

STREAMING NOW ON-DEMAND Dentevents.TV is a brand new dental video streaming service Watch a growing list of hundreds of videos related to dentistry all in one place www.dentevents.tv

The switch

8 oral|hygiene July/August 2022 news | EVENTS

• Drive success and hit those all-important practice KPIs.

W hile transitioning to a new Prac tice Management System can feel daunting, EXACT offers support every step of the way, allowing you to turn challenges into success.

• Manage their workload more effectively and reduce work-related stress; and

The solution

Their hands-on approach, means they take the stress away from you; guiding you at every stage, with all the tools and support you need to run a great business, so you can focus on more of what matters - patient care.

entistry has gone through many changes over the past two years with factors such as the pandemic and staff shortages to name a few. All dentists and practice staff understand these challenges well, yet finding ways to work with them and remain efficient as a business is the key to navigating them, both now and for the future.

With its combined range of software solutions and expert advice, EXACT will work with you to unlock the full potential of your practice. To join the thousands of dental practices across Australia that manage and grow their business with EXACT software, contact sales@henryscheinone.com.au or visit www.exactdental.com.au

• Focus on delivering an enhanced patient experience;

P atient Portal allows practices to send forms direct to a patient’s mobile

Streamline form filling

C

This, alongside tools such as auto mated recalls/reminders and remote form filling, means that as a practice you can ultimately rest easy knowing your dental software is taking care of the “boring stuff” while you can get back to deliv ering your vital services safely.

device, prior to an appointment, enabling patients to complete forms at home, in advance. This benefits the practice, reducing the time needed for administra tive tasks and avoiding duplication of effort. Better still, patients spend less time in the surgery, which is a real bonus especially if they are busy or anxious.

How can you make a practice more efficient?

Introduce patient portal

O

“The transition was much easier than I thought it would be. EXACT is very logical,” said Dr John Collins from Collins Dental House in Perth.

The technology required to streamline these workflows is already here, along with the expert help and advice to inte grate the systems that can transform the future of your practice. EXACT, the leading practice management solution, helps dental practitioners like you to auto mate many of the tasks that would have once been designated to admin staff, not

P

D

only elevating practice efficiency but providing your team with the time they need to:

ractice efficiency is not necessarily about speeding up treatment time but about streamlining all the peripheral, but necessary, elements of a dental appoint ment, leaving more time for the clinical aspects and reducing the frustrations often experienced at the front desk.

Here’s just a few ways how...

Offer appointmentonlinebooking

reating a digital workflow for forms smooths out the experience for patients and reduces duplications and the chance of error. Clinipad provides a streamlined way for patients to update their medical history and consents, as well as including a host of other forms. Completed forms are submitted electroni cally and sent direct into the patient’s file - eliminating the need for scanning and document filing.

nline booking is now considered the norm. Integrating this small change can make a dramatic difference to the patient’s overall experience, providing a higher level of convenience and less admin work for the reception team.

Receive customised support through our customer success programme

Empower patients to take control of their contactless journey

EXACT provides dentists all of the tools and data they need to make their patient experience better and their practices more profitable.

Discover how automation can streamline admin tasks to free up your team’s time

Visit us at exactdental.com.au

Optimise practice workflow efficiency

Hone skills of best practice with expert guidance and resource

n Online marketing including premium listing upgrade on www.dentist.com.au to expose your practice to 1 million potential new patients a year valued at $2,000

n New uniforms, patient welcome packs from Erkine Oral Care and more valued at $2,500

Medifit National Marketing & Busi ness Development Manager, Marton Jakab, visited the practice recently to start the planning process for the fit out.

n Marketing consultancy for 6 months valued at $10,000

“This is going to be an amazing expe rience. We’ve pulled together the top experts in the dental field to pretty much ‘throw the kitchen sink’ at the practice. It’s basically everything we could think of to take the practice from good to amazing in the shortest possible time.”

n Treatment presentation coaching valued at $2,000 from Dr Jesse Green

n And more...

n Brand new website and Search Engine Optimisation (SEO) package to max imise your Google rankings in organic searches valued at $12,000

The Ultimate Practice Makeover includes...

10 oral|hygiene July/August 2022 news | EVENTS

n New practice management software valued at $5,000 from Centaur Software

n Training for you and your team valued at $2,000

n Tablet with SpeedPix™ loaded for better case conversions valued at $1,500

Ultimate Practice Makeover 2022 winner Dr Michael Back from Authentic Dentistry in Canberra with Ultimate Practice Makeover host Angus Pryor and Marton Jakab from major sponsor Medifit Design and Construction.

n Telephone answering training valued at $3,500 from Call Tracking Excellence

n Full marketing review and strategy development by Dental Marketing Solutions valued at $5,500

n Full business identity branding package including logo, colours, style guide and more valued at $1,000

n Reception and waiting area upgrade to provide patients with the best possible first impression of your practice from Australia’s leading surgery builder, Medifit Design and Construct valued at up to $40,000

E

Apart from Michael’s practice receiving the makeover, the whole experience will be filmed for the Ultimate Practice Makeover reality TV show which will be released on www.dentevents.tv in 2023 so the entire dental community can enjoy the process.

“There quite a few options for the prac tice,” Marton said. “Our goal is to give new patients a ‘wow’ experience when they walk through the door. We’ll work with Michael to come up with something that not only looks great, but has high functionality for Michael’s team.”

arlier this year, more than 100 dental prac tices from all around Australia applied to win the 2022 Ultimate Practice Makeover - a $100,000 makeover including a $40,000 fit out from Medifit, a comprehen sive marketing makeover from Dental Marketing Solutions, high-level coaching and con sulting from a hand-picked team of experts and much more.

After a rigorous selection process, the lucky winner was Dr Michael Back of Authentic Dentistry in Canberra. Michael said “when I found out that I’d won, I was really, really excited. It’s an opportu nity to lean on experts who have an area of expertise where I do not... it’s a great opportunity to tap into something that I wouldn’t otherwise do.”

Dental Marketing Solution’s CEO and the show’s host, Angus Pryor, shares Michael’s enthusiasm for the project.

n 12 month subscription to Channel D to engage your patients in the waiting area including a TV valued at $3,100

The Ultimate Practice Makeover begins!

GET LISTED 1 million visitors a year... 9,675 dental practices... 27,690 clinicians... And counting... Get listed today! easiestThedentalmarketingyouwilleverdo! ™ www.dentist.com.au SCAN to Add or Update Your Practice

M r Hafiz said daily waterline maintenance was easy with a proven solution like A-dec ICX tablets for self-contained waterline bottles, however, it was also important to monitor water quality and apply a periodic shock treatment as per“A-decguidelines.ICX Renew shock treatment, launched in May this year, is the perfect complement to A-dec’s self-contained waterline system to ensure the highest quality water is delivered to ICXpatients.”Renew is an odourless formula that clears deposits and contamination which can build up over time, without harming plastic tubing or corroding dental unit components, unlike some harshThetreatments.latestADA Infection Control Guidelines suggest a shock treatment if CFU (colony forming units) reach 200 CFU/mL.

A

Shock treatment

He said dental unit waterlines needed periodic maintenance to ensure they met ADA guidelines and that a systematic approach was the only way of ensuring ongoing dental unit waterline quality.

12 oral|hygiene July/August 2022

“Recently, more A-dec dealers have begun offering water line testing as part of A-dec’s recommended ‘Maintain / Monitor / Shock’ regime, which provides peace of mind to all dental practices that their waterlines are kept within safe limits.”

A-dec’s dental unit waterline testing service can provide accurate results in just minutes.

-dec dealers have stepped in to help dental practices with a new end-toend waterline maintenance approach and routine waterline testing service.

CPDMEREADFOR

The rapid and accurate water testing system uses state-of-theart equipment to detect contamination at very low levels, so that the required treatment regime can be implemented to maintain or correct water quality issues.

infection | CONTROL

By David Petrikas

A-dec Product Marketing Manager, Shal Hafiz, said it was important to ensure dental unit waterlines remained uncontaminated to avoid unpleasant experiences with poor water quality in clinics and potential health risks for patients and staff.

The testing is part of the “A-dec 360 Maintenance” approach which includes regular waterline maintenance, backed up by waterline quality monitoring and periodic shock treatment.

Test now to protect dental waterlines

.

To

For complete trademark information, visit a-dec.com/legal/trademarks.

When you SHOCK, let ICX RENEW

Unwanted guests in your waterlines?

Unwanted visitors like bacteria love to colonise in your dental unit waterlines. A daily waterline maintenance protocol with A-dec ICX® waterline treatment tablets, along with periodic ICX Renew™ shock treatments, will help reduce these nasty microorganisms. find

n Non-corrosive and gentle on equipment

Contact A-dec on 1800 225 010 or visit: australia.a-dec.com to find your nearest authorised A-dec dealer to arrange a dental unit waterline test today.

n Eliminates odour and foul-tasting bacteria

n Remains active in water up to two weeks during periods of equipment non-use

ICX Renew Shock Treatment

Fast-acting ICX Renew liquid shock treatment removes odour and foul-tasting bacteria in dental unit waterlines. Just mix the two solutions together into an empty water bottle, run through the lines and soak overnight. After completing the shock treatment, flush the lines with water and resume your regular use.

n Continuously present in water as a preventive, proactive solution

n Blue colour lets you know the solution is hard at work in the waterlines

“Some testing systems are tedious and inaccurate and take up to 72 hours to produce a result, which could mean you are using contaminated water on patients while awaiting your test results. A-dec’s water testing system produces an accurate result in 2 minutes, without the need for cumbersome and potentially inaccurate manual counts. If your test triggers an action level, simply treat your dental units with ICX Renew liquid shock treatment.”

ICX Renew has a visual indicator which turns the dental unit waterline water blue, indicating the shock treat ment is at work in the waterline. After the prescribed sitting time, the lines are flushed until they are clear and are then ready to be refilled with clean water and an ICX tablet matching the size of the self-contained water bottle for ongoing daily maintenance.

n Odourless formula

The effervescing ICX formula does the work for you, preventing the accumulation of odour and foul-tasting bacteria. Simply add one tablet to an empty selfcontained water bottle before each filling. ICX continues working in the system with each treatment, protecting the waterlines from further contamination and reducing the need for frequent shock treatments

n Maintains dental unit waterline effluent ≤ 10 CFU/mL

Mr Hafiz said both ICX and ICX Renew are non-corrosive and will not corrode or clog waterlines or harm dental tubing, diaphragms, ‘O’ rings and other softHecomponents.saidthedigital waterline testing

“Monitoring requirements will depend on your area’s water quality and the clin ic’s individual requirements. Initially, test water once a month. If the results pass your specified action level (i.e. 200 CFU/ mL), then reduce the testing protocol to at least every six months.”

ICX Waterline Treatment Tablets

n Reduces buildup of deposits

Mr Hafiz said the A-dec 360 Mainte nance system took the uncertainty out of waterline maintenance, ensuring water quality, staff and patient safety was main tained, and that equipment was protected.

“It is good practice to test microbial levels in water lines regularly - at least every six months, as this is a good pro tocol to ensure dental unit waterline quality is not forgotten,” Mr Hafiz said.

14 oral|hygiene July/August 2022 infection | CONTROL

service should be implemented as part of a regular service call. “The digital waterline test, A-dec ICX tablets and ICX Renew shock treatment are all available from your local A-dec dealer for complete endto-end care of your dental unit waterlines.”

n Eliminates the need to purge waterlines at night

n Gentle on your dental equipment

n Will not corrode or clog waterlines

“Shock treatments are required periodi cally to clean dental unit waterlines and more often if dental units have been left unused for any period, such as over a holiday break,” Mr Hafiz said.

n Compatible for use with restorative bonding materials

n Penetrates and removes the buildup of odour and foul-tasting bacteria

• Powder-water suppression for patient comfort

X16+ Dual-wavelength laser

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• Pure-sine scaler transducer for patient comfort

• Rechargeable and completely wireless

• Includes all photomodulation therapy tips

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Question 1. The Water Control System analyses DUWL biofilm in: a. 60 seconds b. 2 minutes c. 5 minutes d. 15 minutes

Question 6. Which wavelength of light causes significant cellular and molecular injury, including damage to DNA?:

INSTRUCTIONS: OralHygiene™ is now offering PAID subscribers the ability to gain 2 Hours CPD credit from reading articles in this edition of the magazine and answering the questions above. To participate, contact OralHygiene for your Username and Password. Then log into the Dental Community website at www.dentalcommunity.com.au and click on the CPD Questionnaires link; select the Oral Hygiene Jul/Aug 2022 questionnaire and then click START. A score greater than 80% is required to PASS and receive CPD.

a. Unable to penetrate through the stratum corneum of the skin. b. Unable to penetrate through the cell membrane of a human cell. c. Readily able to penetrate bacteria and viruses because of their much smaller size. d. All of the above.

a. Clear b. Blue c. Pink d. Cloudy white

UVC light from 200-230 nm: A new way to improve air quality?

Question 2. Once mixed, the ICX Renew solution is:

he problems of contamination of the dental working environ ment with particles of patient origin are well-known and similar concerns exist for oper ating theatres, especially when more complex procedures such as organ transplantation and the placement of joint prostheses are being undertaken.

Test now to protect dental waterlines

The literature indicates that particular problems around contaminated material in the air occur during procedures such as ultrasonic scaling and the use of air powder polishing devices and high-speed air turbine drills. These problems are magnified when the oper atory is small in size and has limited fresh air exchange through the air-conditioning system, hence allowing concentrations of particulates in the air to increase over time in bursts, as various procedures are undertaken.

Question 10. UVC light at 222 nm has been shown to kill:

a. Light in this spectral range can be generated cheaply by LEDs. b. Elemental mercury is not required in the light source. c. It can kill bacteria without causing harm to living tissue in humans. d. All of the above.

a. Is carcinogenic. b. Causes keratitis. c. Causes cataracts. d. Damages your DNA. e. All of the above.

As well as aerosols generated during procedures, there are also issues with the movement of people in and out of rooms. This issue has been well docu mented in operating theatres, where the movement of personnel and the associated opening and closing of doors greatly increases aerosol concentrations. While common sense would suggest that a simple approach using high efficiency particle air filtration may be highly effective at reducing the concentration of aerosols, to date the literature around this has reported mixed results, with real world studies involving aerosol sensors showing no benefit from area HEPA filters in the dental operatory. On the other hand, recent literature supports the value of high volume evacuation (HVE) as an effective mitigation strategy that reduces aerosol concentrations, particularly when used with a wide bore tip and especially when that tip has a conical end that increases the surface area at the collecting end.2-4

infection CONTROL A-dec’s dental unit waterline testing service can provide accurate

a. 200 nm b. 207 nm c. 222 nm d. 254 nm e. 289 nm

Question 7. Particular wavelengths of light that are of interest in infection control are 207 nm and 222 nm because:

Question 8. Ultraviolet lamps emit light that...

Question 4. When high bacterial counts are found, waterlines need to undergo shock treatments using: a. ICX Renew b. ICX c. Distilled water d. Chlorhexidine gluconate

a. Influenza viruses. b. Coronaviruses including SARS-CoV-2. c. Multi-drug resistant bacteria. d. All of the above.

CPDMEREADFOR 22 ora hygiene July/August 2022

-dec dealers have stepped in to help dental practices with a new end-toend waterline maintenance approach and routine waterline testing service. A-dec Product Marketing Manager, Shal Hafiz, said it was important to ensure dental unit waterlines remained uncontaminated to avoid unpleasant experiences with poor water quality in clinics and potential health risks for patients and staff. He said dental unit waterlines needed periodic maintenance to ensure they met ADA guidelines and that a systematic approach was the only way of ensuring ongoing dental unit waterline quality. “Recently, more A-dec dealers have begun offering water line testing as part of A-dec’s recommended ‘Maintain Monitor Shock’ regime, which provides peace of mind to all dental practices that their waterlines are kept within safe limits.” The rapid and accurate water testing system uses state-of-theart equipment to detect contamination at very low levels, so that the required treatment regime can be implemented to maintain or correct water quality issues. The testing is part of the “A-dec 360 Maintenance” approach which includes regular waterline maintenance, backed up by waterline quality monitoring and periodic shock treatment. Shock treatment Mr Hafiz said daily waterline maintenance was easy with a proven solution like A-dec ICX tablets for self-contained waterline bottles, however, it was also important to monitor water quality and apply a periodic shock treatment as per“A-decguidelines.ICX Renew shock treatment, launched in May this year, is the perfect complement to A-dec’s self-contained waterline system to ensure the highest quality water is delivered to ICXpatients.”Renew is an odourless formula that clears deposits and contamination which can build up over time, without harming plastic tubing or corroding dental unit components, unlike some harshThetreatments.latestADA Infection Control Guidelines suggest a shock treatment if CFU (colony forming units) reach 200 CFU/mL.

By Emeritus Professor Laurence J. Walsh AO

Question 3. ADA guidelines recommend action when the bacterial load in dental unit water reaches: a. 100 CFU/mL b. 200 CFU/mL c. 300 CFU/mL d. 400 CFU/mL

T

infection CONTROL CPDMEREADFOR

Question 5. ICX and ICX Renew are non-corrosive and will not corrode or clog waterlines or harm dental tubing, diaphragms, ‘O’ rings and other soft components:

a. True b. False

By David Petrikas results in just minutes.

A

oral|hygiene CPD CENTRE 12 ora hygiene July/August 2022

Question 9. Light from 200 to 230 nm is...

a. Trapped air bubbles.

a. True b. False retrieve your FREE Dental Community Login: Call 9929 1900

or Email info@dentist.com.au

his article explores the role of light in dental several

Question 17. A 50% loss of efficiency results from a scaler tip that is worn by...

e. 50-62%

a. From visible green through to the near infrared region. b. In the far ultraviolet range. c. In the mid ultraviolet range. d. All of the above.

a. HiSmile Vio 405 nm violet light. b. Smartbleach™ 535 nm visible green LED array. c. Deka Smartlite™ 532 nm KTP laser. d. All of the above.

a. 0.5 mm b. 1 mm c. 1.5 mm d. 2 mm

id you know an hygienist spends 2 hours per day on average power scaling? With so much usage and often a different insert for many procedures, you must regularly evaluate your inserts to ensure they con tinue functioning properly. Ultrasonic inserts combine the power, efficiency and comfort you need to treat a wide range of patients, but they can also be delicate. This article provides a checklist to help you properly use, care for, maintain and therefore extend the useful life of your Ultrasonic Inserts.

When an insert tip is worn, the “sweep” of the instrument is reduced. The insert tip doesn’t travel as far on its optimal path. When using a worn tip, generally more pressure is applied, or generator power is increased, to compensate for the efficiency loss—often leading to patient discomfort and increasing the possibility of tip bending/breakage. When using a worn insert tip, the clinician will likely feel the need to increase the power setting on the generator to facilitate debris removal. However, scaling efficiency will not increase and more heat will be gener ated, especially if the power setting exceeds the recommendation for the insert tip.

(02)

a. Voids the warranty. b. Reduces performance. c. Makes them susceptible to breakage. d. Disrupts the vibration pattern and reduces debris removal. e. All of the above.

Question 11. Using an LED array in combination with a suitable whitening gel shows a gain in the effectiveness of the treatment in the order of:

Question 20. Applying too much pressure...

b. 12-20%

T

D

Question 13. Warming a bleaching gel with light facilitates the breakdown of hydrogen peroxide and can improve the overall bleaching effect that is gained:

different perspectives, emphasising the translation from the scientific principles to the explanation given to patients. Clinicians typically learn information about bleaching techniques and the role of light both from continuing professional education courses and from training materials provided by manufacturers for their individual systems. This represents the beginning of a journey rather than its entirety. Let us begin with the dental clinician’s perspective (from Oral Health Therapist Maria Lucas).

Maintenance checklist for ultrasonic inserts

Question 15. Studies show that violet light has no effect in reducing yellow stains unless an intervening oxidant is used like hydrogen peroxide...

Question 16. How many days on average does an hygienist spend power scaling?

that

a light An

c. 24-28%

Question 14. Examples of whitening systems which use photodegradation are the...

1. Check tip condition

a. 1 hour b. 2 hours c. 3 hours d. 4 hours

CPDMEREADFOR

b. A clog in the waterline filter.

How to properly care for your ultrasonic inserts

Why clinicians choose to use a system also has important EXCELLENCE

a. 8-10%

c. Using more power than is recommended to compensate for worn tips. d. All of the above.

Question 19. Bending or reshaping insert tips...

a. Dampens tip vibration. b. Leads to poor deposit removal.

reason why some clinicians may choose to use a light is to remain comparable and on trend with what patients are asking for and what patients feel may work best for them. Patient perception is important to consider when running a successful dental practice; The introduction of initial “in office” power bleaching methods Zoom, the old “BriteSmile” and other laser or LED devices were sold to dentists/business owners on the presumption that the “light” did the work to lighten and brighten the teeth; READ ME FOR CPD clinical EXCELLENCE 32 ora hygiene July/August 2022 clinical

d. Causes patient discomfort. e. All of the above.

bleaching from

READ THE ARTICLES BELOW AND ANSWER THE QUESTIONS ONLINE AT WWW.DENTALCOMMUNITY.COM.AU - 2 HOURS OF CPD 26 ora hygiene July/August 2022

d. 30-45%

POWEREDBYTHETo

Just like your hand scalers, ultrasonic insert tips wear with use. Worn insert tips can significantly diminish your scaling efficiency. One millimeter of tip loss results in a 25% loss of efficiency. Two millimeters? That’s a 50% loss of efficiency.

Question 18. Handpiece overheating can occur because of...

Shining light on common misconceptions about the role of light in dental bleaching

c. Causes operator hand fatigue

Question 12. Teeth are relatively transparent to wavelengths...

By Maria Lucas and Laurence J. Walsh AO

a. True b. False

CPD Register Now: www.boosterinjection.com.au ON DEMAND ONLINE LEARNING PROGRAMME

HOURS

6

n Correct operation of mechanical cleaners and steam sterilisers.

dentevents presents...

n Biofilm reduction strategies.

Presented by Professor Laurence J. Walsh AO

n Hand hygiene and hand care practices.

6+

n Biofilm reduction strategies.

The course will cover practical implementation of the new requirements and what it means for everyday dental practice. Hear about the why and the how and keep up-to-date with the changes that are happening. Bring along your questions in writing or in person for one of the Q&A sessions that will be held during the day.

n Efficiency-based measures to improve workflow in instrument reprocessing and patient changeover.

n Correct use of chemical and biological indicators.

6 HOURS CPD Register Now: www.boosterinjection.com.au

n Requirements for record keeping for instrument reprocessing.

The course will cover practical implementation of the new requirements and what it means for everyday dental practice. Hear about the why and the how and keep up-to-date with the changes that are happening. Bring along your questions in writing or in person for one of the Q&A sessions that will be held during the day.

Learn firsthand from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control that have come in over the past 12 months, including the new guidelines from NHMRC (May 2019), Hand Hygiene Australia (Sept 2019) and the CDNA (Dec 2018) as well as recent changes in Australian Standards and TGA regulations that are relevant to infection control. The course will provide a summary of how those changes interlink with one another.

COURSE TOPICS

n Risk-based precautions.

n Wrapping and batch control identification.

n Correct operation of mechanical cleaners and steam sterilisers.

INTERACTIVE Q&A SUPPORT WEBINARS

n Hand hygiene and hand care practices.

n Efficiency-based measures to improve workflow in instrument reprocessing and patient changeover.

BOOT CAMP 2020

n Correct use of chemical and biological indicators.

26 VIDEOS - 6+ HOURS OF EDUCATION

This one day course will cover changes in regulations and guidelines from 2018 to 2020 including:

ON DEMAND ONLINE LEARNING PROGRAMME BOOT CAMP Infection Control BOOT CAMP 2020 - HOURS OF EDUCATION

n Wrapping and batch control identification.

This one day course will cover changes in regulations and guidelines from 2018 to 2020 including:

dentevents presents...

COURSE TOPICS

Learn firsthand from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control that have come in over the past 12 months, including the new guidelines from NHMRC (May 2019), Hand Hygiene Australia (Sept 2019) and the CDNA (Dec 2018) as well as recent changes in Australian Standards and TGA regulations that are relevant to infection control. The course will provide a summary of how those changes interlink with one another.

INTERACTIVE Q&A SUPPORT WEBINARS

26 VIDEOS

Infection Control

n Addressing common errors in personal protective equipment.

n Risk-based precautions.

n Requirements for record keeping for instrument reprocessing.

Presented by Professor Laurence J. Walsh AO

n Addressing common errors in personal protective equipment.

Register Now: www.boosterinjection.com.au REGISTRATION FEES Dentists $660 inc gst Others $330 inc gst REGISTRATION INCLUDES n On-Demand access to 26 Online Learning Videos (Over 6 hours of education). n Online Learning Companion Booklet. n Suggested Reading Material Booklet. n Access to regular Q&A Webinar(s). n Online Questionnaire to earn 6 Hours of CPD. Infection Contol Boot Camp is presented by Dentevents, a division of Main Street Publishing Pty Ltd ABN 74 065 490 655 • www.dentevents.com • info@dentist.com.au Tel: (02) 9929 1900 • Fax: (02) 9929 1999 • Infection Contol Boot Camp™ and Dentevents™ are trademarks of Main Street Publishing P/L © 2020 Main Street Publishing Pty Ltd dentevents.tv

Professor Laurence Walsh AO is a clinically active specialist in special needs den tistry who is based at the University of Queensland in Brisbane. Laurie has been teaching infection control and clinical microbiology for over 25 years at postgrad uate level and has been the chief examiner in microbiology for the RACDS for the past 20 years. He has presented invited courses and lectures on infection control across Australia and internationally. Laurie has written over 60 articles on infection control and in addition published over 320 journal papers and a further 190 technical reports and literature reviews. He serves on two committees of Standards Australia (personal protecting equip ment; and instrument reprocessing) and in recent years has been an adviser to the Communicable Diseases Network of Australia and the Australian Commission on Safety and Quality in Health Care. Laurie has been a member of the ADA Infection Control Committee since 1998. He has contributed to various protocols, guidelines and checklists and manuals used in Australia.

Register Now: www.boosterinjection.com.au REGISTRATION FEES Dentists $660 inc gst Others $330 inc gst REGISTRATION INCLUDES n On-Demand access to 26 Online Learning Videos (Over 6 hours of education). n Online Learning Companion Booklet. n Suggested Reading Material Booklet. n Access to regular Q&A Webinar(s). n Online Questionnaire to earn 6 Hours of CPD. Infection Contol Boot Camp is presented by Dentevents, a division of Main Street Publishing Pty Ltd ABN 74 065 490 655 • www.dentevents.com • info@dentist.com.au Tel: (02) 9929 1900 • Fax: (02) 9929 1999 • Infection Contol Boot Camp™ and Dentevents™ are trademarks of Main Street Publishing P/L © 2020 Main Street Publishing Pty Ltd UPDATE!FULL All the changes to InfectionGuidelinesControlin2020 dentevents.tv

By Emer. Prof. Laurence Walsh AO

20 oral|hygiene July/August 2022 abstracts | 2022

Makhsous S et al. Methodology for addressing infectious aerosol persistence in real-time using sensor network. Sensors 2021; 21: 3928.

Oral Hygiene Abstracts 2022

Real time monitoring of aerosols

Choudhary S et al. Comparison of aerosol mitigation strategies and aerosol persistence in dental environments. Infect Control Hosp Epidemiol. 2022, 1–6. doi:10.1017/ice.2022.26

Human exposure to infectious aerosols results in the transmission of diseases such as influenza, tuberculosis and COVID-19. Most dental procedures generate a significant number of aerosolised particles, increasing transmission risk in dental settings. Since the generation of aerosols in dentistry is unavoidable, some clinics have started using intervention strategies such as area-filtration units and extraoral evacuation equipment, especially under the recent constraints of the COVID-19 pandemic. However, the effectiveness of these devices in dental operatories has not been studied. Therefore, the ability of dental personnel to efficiently position and operate such instruments is also limited. To address these challenges, this study utilised a real-time sensor network for assessment of aerosol dynamics during dental restoration and cleaning procedures with and without intervention. The strategies tested during the procedures were (i) local area High-Efficiency Particle Air (HEPA) filters and (ii) Extra-Oral Suction Devices (EOSD). The study was conducted at the University of Washington School of Dentistry in Seattle USA using a network of 13 fixed sensors positioned within the operatory and one wearable sensor worn by the dental operator. The sensor network provided time and space-resolved particulate matter (PM) data. Three-dimensional (3D) visualisation informed aerosol persistence in the operatory. It was found that area filters did not lower the overall aerosol con centration in dental offices in a significant way. A decrease in PM concentration by an average of 16% was observed when EOSD equipment was used during the procedures. The combination of real-time sensors and 3D visualisation can provide dental personnel and facility managers with actionable feedback to effectively assess aerosol transmission in medical settings and develop evidencebased intervention strategies.

The aim of this study was to determine the impact of various aerosol miti gation interventions and to establish duration of aerosol persistence in a variety of dental clinic configurations. Aerosol measurement studies were performed in endodontic, orthodontic, periodontic, paediatric and general dentistry clinics in St. Louis, Missouri from July to October 2020. Aerosol sensors in the form of an optical aerosol spectrometer, the inlet of which was positioned 20 cm in front of and 10 cm above the patient’s mouth without interruption of the procedures performed by the dentist. Wearable particulate matter sensors were to measure real-time aerosol concentration from the vantage point of the dentist during routine care in a variety of clinic configurations (e.g. open bay, single room, partitioned operatories). It compared the impact of aerosol mitigation strategies (e.g. ventilation and high-volume evacuation (HVE) and prevalence of particulate matter) in the dental clinic environment before, during and after high-speed drilling, slow-speed drilling and ultrasonic scaling procedures. Dental suction was used in all configurations with an 8.2 mm tip with aflow rate 74 standard cubic feet per minute at 7.0 Hg (2095.44 LPM). The concentration of aerosol was highest when using a high-speed drill in a dental operatory space with little ventilation. The largest aerosol concentrations were generated by ultrasonic scaling and high-speed drilling of anterior teeth. Conical HVE had higher effi ciency for removing aerosol plumes than the standard-tip HVE. When aerosols were detected in the environment, they were rapidly dispersed within minutes of completing the aerosol-generating procedure. Few aerosols were detected in dental clinics, regardless of configuration, when conical HVE was used. Thus suggests that fallow time can be reduced to 5 minutes, which likely occurs during routine patient care. Dentists should consider using conical HVE rather than standard-tip evacuators to reduce aerosols generated during routine clinical practice. Conical HVE is likely more efficient in reducing emissions from high-speed drilling than standardtip HVE because of the relatively large surface area available for conical HVE to evacuate aerosols from the dental environment. Furthermore, when such effective aerosol mitigation strategies are employed, dentists need not leave dental chairs fallow between patients because aerosols are rapidly dispersed.

Aerosol mitigation: Suction tip shapes matter

• Opening Breakfast • Free childcare • Free business growth seminars • Latest technology & innovations • Women in Dentistry Breakfast • Australian Dental Association Queensland professional CPD program Brisbane Convention & Exhibition Centre Highlights include: REGISTER NOW AUSTRALIA’S PREMIER DENTAL EVENT See you at 27 - 29 October 2022 @ausdental / ADX expo @ ad x expo adxbrisbane.org.auFREEENTRY #ADXexpo #ADXBrisbane

UVC light from 200-230 nm: A new way to improve air quality?

T

On the other hand, recent literature supports the value of high volume evacuation (HVE) as an effective mitigation strategy that reduces aerosol concentrations, particularly when used with a wide bore tip and especially when that tip has a conical end that increases the surface area at the collecting end.2-4

he problems of contamination of the dental working environ ment with particles of patient origin are well-known and similar concerns exist for oper ating theatres, especially when more complex procedures such as organ transplantation and the placement of joint prostheses are being undertaken.

infection | CONTROL CPDMEREADFOR

By Emeritus Professor Laurence J. Walsh AO

The literature indicates that particular problems around contaminated material in the air occur during procedures such as ultrasonic scaling and the use of air powder polishing devices and high-speed air turbine drills.1-3 These problems are magnified when the oper atory is small in size and has limited fresh air exchange through the air-conditioning system, hence allowing concentrations of particulates in the air to increase over time in bursts, as various procedures are undertaken.

22 oral|hygiene July/August 2022

As well as aerosols generated during procedures, there are also issues with the movement of people in and out of rooms. This issue has been well docu mented in operating theatres, where the movement of personnel and the associated opening and closing of doors greatly increases aerosol concentrations.

While common sense would suggest that a simple approach using high efficiency particle air filtration may be highly effective at reducing the concentration of aerosols, to date the literature around this has reported mixed results, with real world studies involving aerosol sensors showing no benefit from area HEPA filters in the dental operatory.4

M

avelengths of light from 200 to 230 nm have been shown to kill bacteria without causing harm to living tissue in animals or humans.8-16 The light is unable to penetrate through the stratum corneum of the skin (which has a thickness of between 5 and 20 µm). Likewise, the light is unable to penetrate through the cell membrane of a human cell, since the light inten sity is reduced by half a distance of approximately 0.3 microns, which means that it is unable to penetrate through the membrane of a human cell (typically 10 to 25 µm in diameter). On the other hand, it is readily able to penetrate bacteria and viruses because of their much smaller size.

The ability of ultraviolet light to kill viruses and resistant bac teria is similar for 254 nm light and for the wavelengths from 200 to 230 nm. From a practical standpoint, having a light which is not dangerous to humans changes the way that one could deploy such a light source in a work environment. There has been particular interest in using such light sources in operating theatres16 to reduce the incidence of surgical site infections, including the concept of continuous irradiation of the germicidal wavelengths of light during the surgical procedures. The underlying rationale is that the majority of surgical site infections result from bacteria that fall directly onto the surgical wound from the air. If there was contin uous exposure of germicidal UVC light during surgical procedures, this should inactivate pathogens that fall onto the wound area.

W

ecent studies have shown that UVC light at 222 nm is highly effective against a range of viruses including human influenza viruses17 and endemic strains of coronaviruses as well as SARS-CoV-2,18 as well as against bacteria including those with multi-drug resistance. Adding to this, recent clinical trials conducted on either healthy volunteers or patients with pressure ulcers have shown no indications of skin inflammation or DNA damage, but a large reduction in the number of bacteria recov ered from swabbing the surface of the skin.20

There is now considerable interest in using ultraviolet C (UVC) light for area disinfection, as a replacement for the older and more dangerous 254 nm ultraviolet lamps which emit light that is both carcinogenic and also readily able to cause keratitis and the generation of cataracts.

While the use of germicidal ultraviolet lamps is well known historically, their use has not been popular because of the inherent problems of 254 nm ultraviolet light, which causes significant cellular and molecular injury, including damage to DNA. As a result, such light sources can only be used when no people are in the area that is being treated. Light at this wave length is absorbed strongly into DNA, causing strand breakages and hence having mutagenic effects.5

Suggested applications for 200-230 nm light currently include health care facilities, operating theatres and occupied public spaces where large numbers of people may be found and where airborne transmission of coronaviruses can be expected to occur.15,18 Suggestions have also been made to include airports, schools, restaurants and public transportation vehicles as an inexpensive and safe way of reducing the spread of airborne mediated viruses. Based on current regulatory limits, which for this range is an energy density of 23 mJ per square centimetre over 8 hours,19 achieving 90% inactivation of viruses would require approxi mately 8 minutes, 99% in 16 minutes and 99.9% inactivation in 25 minutes. Such exposure times are practical for these types of environments and would also align with the timing of typical dental appointments, if such light sources were to be deployed in a waiting room or in a dental operatory.

Effects on pathogens

Application to the COVID-19 pandemic

Friendly photons

This is a rapidly evolving topic and it will be interesting to follow the pathway by which UVC light sources operating in the range of 200 to 230 nm gain approval from the Therapeutic Goods Administration for claims that are made regarding their disinfecting actions.

R

Particular wavelengths of interest are 207 nm and 222 nm.8 Light in this spectral range can be generated by LEDs or by filtration from a more broad-spectrum light source such as a krypton-bromine or krypton-chlorine excimer lamp (excilamp), which is relatively inexpensive and does not contain elemental mercury, which is a common ingredient in lamps that generate longer ultraviolet light wavelengths.

oving to a shorter wavelength of light is a useful strategy because it then falls outside the absorption spectrum of DNA, but instead into the absorption spectrum of proteins. The extremely strong absorption of light from the 190-230 nm range into human tissues is well-known6,7 and it is responsible for the extreme safety of laser vision correction surgery, where laser light with a wavelength around 200 nm is used to selectively ablate cells on the surface of the eye, without any risk of penetration into deeper structures (and thus no risk of damage to the retina).

July/August 2022 oral|hygiene 23 infection | CONTROL

In oral surgical procedures undertaken in office-based prac tice settings, the physical set up is, of course, different from the operating theatre of a major hospital, but nevertheless the concept of using a continuously running invisible light source may merit further exploration. A powerful feature supporting its use is that it would not be necessary to shield the eyes or the skin from the light source when it is in operation.

16. Fukui T et al. Safety of 222 nm UVC irradiation to the surgical site in a rabbit model. Photochem Photo biol. 14 March 2022, DOI: 10.1111/php.13620

18. Buonanno M et al. Far-UVC light (222 nm) efficiently and safely inactivates airborne human coro naviruses. Sci Rep 2020;10:10285.

24 oral|hygiene July/August 2022

|

3. Makhsous S et al. Methodology for addressing infectious aerosol persistence in real-time using sensor network. Sensors 2021; 21: 3928.

6. Goldfarb AR, Saidel LJ. Ultraviolet absorption spectra of proteins. Science 1951; 114(2954):156–

5. Pfeifer GP, Besaratinia A. UV wavelengthdependent DNA damage and human non-melanoma and melanoma skin cancer. Photochem Photobiol Sci. 2012; 11(1): 90-97.

17. McDevitt JJ et al. Aerosol susceptibility of influ enza virus to UV-C light. Appl Environ Microbiol. 2012; 78(6):1666–1669.

References

15. Welch D et al. Far-UVC light: A new tool to control the spread of airborne-mediated microbial dis eases. Sci Rep. 2018; 8(1): 2752.

7.157.Kreusch S. et al. UV measurements in microplates suitable for high-throughput protein determination. Anal Biochem. 2003;313(2): 208–215.

19. ICNRP. The International Commission on NonIonizing Radiation Protection, Guidelines on limits of exposure to ultraviolet radiation of wavelengths between 180 nm and 400 nm (incoherent optical radia tion). Health Phys 2004; 87(2), 171-186.

20. Fukui T et al. Exploratory clinical trial on the safety and bactericidal effect of 222-nm ultraviolet C irradiation in healthy humans. PLoS ONE 2020;15(8): e0235948.

8. Welch D. et al. Far-UVC light: A new tool to control the spread of airborne-mediated microbial dis eases. Sci Rep. 2018; 8(1):2752.

10. Buonanno M. et al. 207-nm UV light-a prom ising tool for safe low-cost reduction of surgical site infections. II: In-vivo safety studies. PLoS One 2016; 11(6): e0138418.

14. Narita K. et al. Chronic irradiation with 222-nm UVC light induces neither DNA damage nor epi dermal lesions in mouse skin, even at high doses. PLoS One 2018; 13(7):e0201259.

infection CONTROL

11. Buonanno M. et al. Germicidal efficacy and mam malian skin safety of 222-nm UV light. Radiat Res. 2017; 187(4): 483-491.

Emeritus Professor Laurence J. Walsh AO is a specialist in special needs den tistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Dentistry, including 21 years as Pro fessor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical microbiology. Laurie has served as Chief Examiner in Microbi ology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years. His published research work includes over 330 journal papers, with a citation count of over 15,400 citations in the literature. Laurie holds patents in 7 families of dental tech nologies. He is currently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recognition of his con tributions to dentistry.

2. Pulich A et al. Simulated and clinical aerosol spread in common periodontal aerosol generating proce dures. Clin Oral Invest 2022 https://doi.org/10.1007/ s00784-022-04532-8 1 June 2022

4. Choudhary S et al. Comparison of aerosol miti gation strategies and aerosol persistence in dental environments. Infect Control Hosp Epidemiol. 2022, 1–6. doi:10.1017/ice.2022.26

1. Han P et al. Splatters and aerosols contamination in dental aerosol generating procedures. Appl Sci. 2021; 11(4):1914.

About the author

12. Ponnaiya B. et al. Far-UVC light prevents MRSA infection of superficial wounds in vivo. Plos One 2018; 13(2): e0192053.

13. Narita, K et al. Disinfection and healing effects of 222-nm UVC light on methicillin-resistant Staph ylococcus aureus infection in mouse wounds. J Photochem Photobiol. B 2018; 178(Suppl C): 10-18.

9. Buonanno M. et al. 207-nm UV light - a promising tool for safe low-cost reduction of surgical site infec tions. I: in vitro studies. Plos One 2013; 8(10): e76968.

MANAGEMENTINSTRUMENT

1) Compared to other leading scaler designs. Data on file. Available upon request.

rights reserved. working ends, ensuring blades to efficiently less pinch force when Learn How to Scale Hu-Friedy.com/Harmony Hu-Friedy is now a proud member of All company and product names are trademarks 1) Compared to other leading scaler designs. Data ©2020 Hu-Friedy Mfg. Co., LLC.

less pinch force

• on file. Available upon request.

• An open hole pattern that promotes water flow throughout the cassette

The most sophisticated solution for instrument management That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include: • An open hole pattern that promotes water flow throughout the cassette • Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing • Easy-to-use, ergonomic latch that allows for one-handed opening Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment. VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right. WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: • Ideal height and mesio-distal width • Pre-trimmed and pre-crimped for simple placement • Accurate occlusal anatomy that matches the natural tooth FIT IS EVERYTHING Find the right one with Hu-Friedy Orders 1300 65 88 22 www.henryschein.com.auOrders 0800 808 855 www.henryschein.co.nz To learn more about how IMS can enhance your practice visit Hu-Friedy.com/Infinity ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. Hu-Friedy is now a proud member of All company and product names are trademarks 1) Compared to other leading scaler designs. Data ©2020 Hu-Friedy Mfg.

silicone rail

That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include:

efficiency

working ends, ensuring you have sharp, long lasting blades to efficiently remove calculus while applying less pinch force when holding the handle. Learn How to Scale in Perfect Harmony at Hu-Friedy.com/Harmony Hu-Friedy is now a proud member of

The most sophisticated solution for instrument management

Ideal height and mesio-distal width • Pre-trimmed and pre-crimped for simple placement • Accurate occlusal anatomy that matches the natural tooth FIT IS EVERYTHING Find the right one with Hu-Friedy Orders 1300 65 88 22 www.henryschein.com.auOrders 0800 808 855 www.henryschein.co.nz To learn more about how IMS can enhance your practice visit Hu-Friedy.com/Infinity ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. Hu-Friedy Mfg. Co., LLC, 1666 E. Touhy Ave., Des Plaines, IL 60018 | Hu-Friedy.com All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. ©2021 Hu-Friedy Mfg. Co., LLC. All rights reserved. Hu-Friedy is now a proud member of All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. 1) Compared to other leading scaler designs. Data

outcomes

WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:

INFINITY SERIES™ CASSETTES

reserved. less pinch force when Learn How to Scale Hu-Friedy.com/Harmony PER-Harmony-PrintAd-HFG-Introduces-HFL-482AUS-A4-2012.indd 1 YOU DESERVE MANAGEMENTINSTRUMENT INFINITY SERIES™ CASSETTES The most sophisticated solution for instrument That’s right, you deserve it. You deserve the peace that you are employing the most contemporary method innovator of the cassette-based instrument management you the modern design and functionality of the Infinity • An open hole pattern that promotes water flow throughout • Color-coded silicone rail system that significantly for more water flow while protecting the instruments • Easy-to-use, ergonomic latch that allows for one-handed Performing at your best means having confidence in the efficiency of your practice, while helping protect VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless You’ll quickly discover why dentists favor our impeccable fit. Perfect for your Because when it comes to the perfect fit, Hu-Friedy is just right. WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: • Ideal height and mesio-distal width • Pre-trimmed and pre-crimped for simple placement • Accurate occlusal anatomy that matches the natural tooth FIT IS EVERYTHING Find the right one with Hu-Friedy Orders 0800 808 855 www.henryschein.co.nz To learn more about how IMS can enhance your practice visit Hu-Friedy.com/Infinity ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved.

holding

• Color-coded system that significantly reduces instrument contact and allows for water protecting the instruments during reprocessing

more

Easy-to-use, ergonomic latch

handle. Learn How to Scale in Perfect Harmony at Hu-Friedy.com/Harmony PER-Harmony-PrintAd-HFG-Introduces-HFL-482AUS-A4-2012.indd 1 12/11/20 11:53 YOU DESERVE INFINITE CONFIDENCE. MANAGEMENTINSTRUMENT INFINITY SERIES™ CASSETTES The most sophisticated solution for instrument management That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include: • An open hole pattern that promotes water flow throughout the cassette • Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing • Easy-to-use, ergonomic latch that allows for one-handed opening Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment. VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right. WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: • Ideal height and mesio-distal width • Pre-trimmed and pre-crimped for simple placement • Accurate occlusal anatomy that matches the natural tooth FIT IS EVERYTHING Find the right one with Hu-Friedy Orders 1300 65 88 22 www.henryschein.com.auOrders 0800 808 855 www.henryschein.co.nz To learn more about how IMS can enhance your practice visit Hu-Friedy.com/Infinity ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. Hu-Friedy is now a proud member of All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, 1) Compared to other leading scaler designs. Data on file. Available upon request. ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 working ends, ensuring you blades to efficiently remove less pinch force when holding Learn How to Scale in Perfect Hu-Friedy.com/Harmony PER-Harmony-PrintAd-HFG-Introduces-HFL-482AUS-A4-2012.indd 1 Hu-Friedy is now a proud member of All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, 1) Compared to other leading scaler designs. Data on file. Available upon request. ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 less pinch force when holding Learn How to Scale in Perfect Hu-Friedy.com/Harmony PER-Harmony-PrintAd-HFG-Introduces-HFL-482AUS-A4-2012.indd 1 MANAGEMENTINSTRUMENT INFINITY SERIES™ CASSETTES The most sophisticated solution for instrument management That’s right, you deserve it. You deserve the peace of mind and confidence that you are employing the most contemporary method of processing instruments. innovator of the cassette-based instrument management system, Hu-Friedy you the modern design and functionality of the Infinity Series Cassettes An open hole pattern that promotes water flow throughout the cassette • Color-coded silicone rail system that significantly reduces instrument for more water flow while protecting the instruments during reprocessing • Easy-to-use, ergonomic latch that allows for one-handed opening Performing at your best means having confidence in what you do. Experience the efficiency of your practice, while helping protect your patients, your VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right. WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: • Ideal height and mesio-distal width • Pre-trimmed and pre-crimped for simple placement • Accurate occlusal anatomy that matches the natural tooth FIT IS EVERYTHING Find the right one with Hu-Friedy OrdersOrders 0800 808 855 www.henryschein.co.nz To learn more about how IMS can enhance your practice visit Hu-Friedy.com/Infinity ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. Hu-Friedy is now a proud member of All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. 1) Compared to other leading scaler designs. Data on file. Available upon request. ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 working ends, ensuring you have sharp, long lasting blades to efficiently remove calculus while applying less pinch force when holding the handle. Learn How to Scale in Perfect Harmony at Hu-Friedy.com/Harmony Hu-Friedy is now a proud member of All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. 1) Compared to other leading scaler designs. Data on

Performing at your

handle. Learn How to Scale in Perfect Harmony at Hu-Friedy.com/Harmony PER-Harmony-PrintAd-HFG-Introduces-HFL-482AUS-A4-2012.indd 1 12/11/20 11:53 AM YOU DESERVE INFINITE CONFIDENCE. MANAGEMENTINSTRUMENT INFINITY

LLC.

• that allows for one-handed opening best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the of your practice, while helping protect your patients, your staff and your instrument investment. predictable for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right.

less pinch force

flow while

All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted.

his article explores the role of light in dental bleaching from several different perspectives, emphasising the translation from the scientific principles to the explanation given to patients.

Let us begin with the dental clinician’s perspective (from Oral Health Therapist Maria Lucas).

• An important reason why some clinicians may choose to use a light is to remain comparable and on trend with what patients are asking for and what patients feel may work best for them. Patient perception is important to consider when running a successful dental practice;

By Maria Lucas and Laurence J. Walsh AO

Clinicians typically learn information about bleaching techniques and the role of light both from continuing professional education courses and from training materials provided by manufacturers for their individual systems. This represents the beginning of a journey rather than its entirety.

Shining light on common misconceptions about the role of light in dental bleaching

Why clinicians choose to use a system that also has a light

READ ME FOR CPD

26 oral|hygiene July/August 2022

clinical | EXCELLENCE

T

• The introduction of initial “in office” power bleaching methods - Zoom, the old “BriteSmile” and other laser or LED devices were sold to dentists/business owners on the presumption that the “light” did the work to lighten and brighten the teeth;

All of these basic phenomena share a common causal pathway, which is that of photodegradation. What is happening here is that short wavelength light is being absorbed into the substrate, where it is causing the decomposition of the molecules that absorb the light. Short wavelengths of light (such as visible violet) carry more photon energy than long wavelengths (such as visible red), which is why they are better at breaking chemical bonds in the target.1

T his is the starting example because it is the form of interaction which we all see in our everyday lives. We notice that the curtains and fabrics that hang in windows positioned on the western side of our house become brittle and fade in colour over time. When our car is parked in an open-air car park for most of its life, we notice how the paint colour fades. We notice the same thing on the painted areas of our house, especially on the northern and western sides which get more direct sun exposure. When we buy certain med icines, we notice that they are provided in brown glass bottles to prevent ambient light from degrading them.

• Clinicians often consider both the actual effectiveness of the treatment that is being offered, as well as what patients want and expect, in order to keep chairs booked up.

July/August 2022 oral|hygiene 27

What manufacturersthe told users about the role of light

• Clinicians follow manufacturer’s instructions for appropriate use of the product they are using. Both light intensity and light exposure time are also based on the manufacturer’s instructions;

It is sometimes amusing when one sees commentary in dental publications questioning the role of light in dental bleaching. If one was to train in photo biology or attend classes for chemical engineering (both of which I have done), one would soon discover that the major processes by which light can alter dental bleaching are standard foundation knowl edge in chemical engineering.

The second part of this article helps to explain how the various ways that light can interact with different substrates in a way that is relevant to dental bleaching. Note that some products and systems may use several of these processes in par allel. It all comes down to the selection of the wavelength of the light source and the formulation of the gel.

In the case of coloured light, the absorbing molecule will be opposite the colour wheel from the incident light source. For example, visible violet and visible blue light absorb most strongly in molecules that are yellow.2,3 This is why tetracycline antibiotics are stored in a brown glass bottle. There is a consid erable literature showing the impact of different wavelengths of light on tetracy clines, which reveals the potent influence of violet and cyan light, while green and red light have little, if any, effect.

The use of violet light for photodeg radation has been the subject of many studies on the dental literature. A key take-home message from the studies is that violet light can reduce yellow stains without an intervening oxidant (such as hydrogen peroxide).4,5

How ofexplainclinicianstheuselighttopatients

• The typical information coming to cli nicians from manufacturers is that the light or light source activates the initia tors in bleaching gel and also helps to catalyse (speed up) the chemical reac tions of hydrogen peroxide to make the process of whitening occur faster;

Photodegradation

clinical | EXCELLENCE

• My personal experience with Zoom is based on using 4 x 15 minute light intervals with the option of changing the light intensity. The exposure time period is set, but can be varied in terms of “sessions” based on the level of comfort of the patient and how much sensitivity they are experiencing; and

• Advice can sometimes be that the process of bleaching from the gel will work without a light, but that applying light speeds up the process; and

ow let us move on to explore the science of photochemistry (from Laurie Walsh).

When we attend an art gallery, we notice a sign that says that flash photog raphy is not permitted and paintings are positioned to prevent direct exposure to sunlight (Light-induced fading of paint ings was reported in 50 BC by Vitruvius. In 1782, the first comprehensive and successful book on the effect of solar light on pigments and dyes in paintings is written by Senebier).

N

What the science says

• Patients often affiliate “the light” with a procedure that works or is well known. The question could be asked as to whether they have become accus tomed to what they see in the cosmetic area outside dentistry and in online social media; and

How we ensure the appropriate light intensity and exposure time

• Clinicians often repeat to patients what has been told to them by the manufac turers of the product they are using. In my experience, clinicians adhere to the manufacturer’s instructions for the product they are using on patients and don’t stray from what has been advised.

• It is common to inform patients that the “light source” helps to activate and speed up the chemical reaction which occurs as a result of the hydrogen peroxide breaking down to whiten and lighten the discoloured molecules in the tooth.

• It is common knowledge Zoom bleaching will induce sensitivity but that it is transient. The manufacturer recommends using fewer intervals or to reduce the light intensity if the patient is experiencing sensitivity. Hence light intensity and exposure time are chosen based on the features of the patient, e.g. Do they suffer from generalised tooth sensitivity? Are they taking photosensitive medications that may render them inappropriate for the procedure? Do they have underlying medical conditions we need to be aware of?, etc.

• Typically, some emphasis will be placed on the fact that the light is not ultraviolet (this is always emphasised) and hence not harmful and that the energy and warmth from the light heats the gel up and this speeds up chemical reactions that occurs;

• Manufacturers sometimes say that patients perceive that using light helps the process work faster.

T

Given that hydrogen peroxide bleaching gels have water as a major com ponent, it makes sense to also consider

improvement can be gained using a broad wavelength light source (such as a lamp with appropriate filtration) or a narrow spectrum light source such as an LED), or a monochromatic light source (a laser).

“Light causes the decomposition of the molecules that absorb the light. Short wavelengths of light carry more photon energy than long wavelengths, which is why they are better at breaking chemical bonds...”

Manufacturers have learnt the hard way that light sources operating in the short wavelength ultraviolet spectrum are highly problematic in terms of direct heating of enamel and also causing prob lems such as photo-eruptive lesions and sunburn to the oral tissues and perioral facial skin. This is why current systems typically use visible light wavelengths.

clinical | EXCELLENCE

bleaching gels, with orange or red colours that will absorb strongly light from a conventional 470 nm dental curing light. Some gels use various forms of titanium dioxide microparticles to alter their light absorbing properties. An example of the effective absorption of light over a range of visible light wavelengths is shown in Figure 1. Note in this example, the strong absorption of light by the coloured bleaching gel at a range of wavelengths in the visible and near infrared region.

Examples of current systems which use photodegradation are the Vio 405 nm violet light which is part of the HiSmile™ PAP+™ in office bleaching system, and Smartbleach™, where the light source can be a 535 nm visible green LED array (Smartbleach 3LT®) or a 532 nm KTP laser such as the Deka Smartlite™

he chemistry of bleaching using hydrogen peroxide is oxidation and this process is enhanced when tempera tures are elevated. An everyday example of a photothermal process is the increase in temperature which occurs in a car with black exterior paint, as compared to a car with white exterior paint. The white paint is highly effective at reflecting all visible light wavelengths, whereas the opposite is true for the black exterior paint, which absorbs all visible light wavelengths. The absorbed energy causes increased molec ular vibrations, which means that the object gets hotter. The same phenomenon occurs when standing in bright sunshine wearing a black shirt, versus wearing white clothing. A photothermal process does not require a short wavelength of light and will work with longer wave lengths such as near infrared light.

intense energy sources that can absorb strongly into water, such as lasers in the middle and far infrared regions. Histori cally, photothermal processes were the first way that intense light was used to accelerate bleaching reactions. The

Provided that suitable absorbing col oured molecules (chromophores) are present, an intense light source will warm a bleaching gel. This facilitates the break down of hydrogen peroxide10-12 and can improve the overall bleaching effect that is gained.14-17Fromadesign perspective, it is essen tial to match the light source to absorbing molecules in the gel. To the water base of the gel, various pigments can be added. This explains why some commercial bleaching products have highly coloured

A classic example of this process is seen in the way that visible green light interacts with the red coloured quinone complex that forms when tetracycline molecules are bound strongly into tooth structure. This explains both why intense green light from an array of LEDs or from a KTP laser is highly effective at degrading this quinone molecule and like wise, why ambient sunlight in patients who were exposed to first-generation tet racyclines during tooth development and developed marked discolouration of their teeth as a result, causes the incisal half of their anterior teeth to become lighter over time.6-8 The same lightning effect is not seen on posterior teeth and the same indi viduals. A recent 27 month study tracked the colour of tetracycline stained teeth and showed that ambient light alone was able to cause substantial beneficial colour change.9 When one uses filters to remove the green component, this beneficial effect no longer occurs.2

Photothermal reactions

28 oral|hygiene July/August 2022

The key limitation of the photothermal approach is that excessive heating of the gel or direct absorption of light that is transmitted through the gel into the enamel will heat the tooth surface and this in turn can cause thermal stress to the dental pulp leaving the patient to experience a poorly localised C fiber pain response. Note from Figure 1 that this direct absorption of light by enamel is very low for visible and near infrared light, but is very high for short wave length ultraviolet light. Overall, it is important to avoid excessive light expo sure (prolonged time at high intensity) as this will cause heat-related stress to the dental pulp18-21 and increase pain sensa tions during in-office bleaching.22,23

Figure 1. Percentage absorption of light passing through 1 mm of enamel or 1 mm of Ultradent Opalescence Boost™ bleaching gel. Calculated from references 37-39.

The concept of using photochemical processes for degrading coloured mol ecules is a standard approach within chemical engineering for the treatment of highly coloured wastewater. A particular chemical process developed for such an

Photodynamic processes

that into adjacent molecular diatomic oxygen, creating reactive oxygen species. As this energy transfer occurs, the photosensitiser molecule relaxes back to its ground state. Depending on the pH, there are several pathways by which it may do this, including pathways which generate light (such as luminescence andAnphosphorescence).6-8everydayexample of a photo dynamic process is the activation of curcumin (turmeric) by blue and violet light that is present in ordinary sunlight. It has been known since antiquity that turmeric applied to skin wounds had a potent disinfecting action, which was greatly enhanced when the turmeric prep aration on the wound was also exposed to visible light. The chemistry of this involves a classic photodynamic activa tion process, with the short wavelength light causing the molecular excitation of the turmeric, with the resulting release of reactive oxygen species.30 The feeder molecule for the reactive oxygen species is normal atmospheric oxygen dissolved in the water used in the turmeric paste.

An example of a commercial in office bleaching gel that is based on photody namic processes is Smartbleach™.6-8,31,32 The photosensitiser is rhodamine B, which has a maroon to magenta colour and the corresponding light sources are in the visible green region, such as a laser (argon ion 514.5 nm or KTP 532 nm) or LEDs (535 nm).

clinical | EXCELLENCE

Using a broad spectrum photocatalyst, the choice of light source becomes less important, although as already discussed, using a shorter wavelength will bring more energy from absorption as each photon carries greater energy. An example of a bleaching gel which uses a titanium dioxide photocatalyst is GC Tion™.

A s the Greek derivation of the term “dynamos” would suggest, in these processes the light plays a critical role in empowering (pushing) the reaction. A specific photosensitiser is used, in combi nation with a light source that is absorbed very strongly in that photosensitiser. Careful attention is paid to the pH of the environment, since this influences what happens after the light is absorbed. At the molecular level, the photosensitiser molecules become electronically excited and then undergo a decay process. The process is not inherently damaging to the photosensitiser molecules, which basi cally absorb the energy and then couple

Concurrent irradiation

application is the photo-Fenton reaction, where iron ions and short wavelength (blue, violet or ultraviolet) light combine together to give much greater breakdown of highly coloured molecules.

The photo-Fenton reaction forms the fundamental basis for what happens when an LED array is used in combination with a suitable gel in current versions of Zoom! dental bleaching systems. A range of clin ical and laboratory studies have assessed the added value of the photo-Fenton reaction above the fundamental Fenton reaction driven by the same gel, which is not light dependent. Across all the literature, the improvement gained in the effectiveness is in the order of 24-28%.29

A typical bleaching product that can undergo photothermal activation will also work without exposure to the light and the user instructions will indicate that applying light will enhance the effect of the agent, but is not a critical requirement.

In dental bleaching products, to enhance the supply of molecular oxygen, a feeder reaction may be used for local generation of oxygen, such as the cata lytic breakdown of hydrogen peroxide into oxygen and water.

Examples of photothermal activa tion include SDI Pola Office Plus™ and Ultradent Opalescence Boost™. The ben efits of photothermal enhancement vary between products depending on which light-absorbing agents have been included in the gel. This explains why variations in the role and importance of light have been reported in the literature.24-28

July/August 2022 oral|hygiene 29

“Provided that suitable light-absorbing coloured molecules (chromophores) are present, an intense light source will warm a bleaching gel. On the other hand, in a photodynamic process, where light pushes the reaction, a inphotosensitiserspecificisused,combinationwithalightsourcethatisabsorbedverystronglyinthatphotosensitiser...”

Photochemical processes

C

S ome light sources designed for bleaching may contain more than one light source. The rationale behind this is that the secondary light source is not designed to contribute to the bleaching process, but rather to attenuate pulpal responses of the patient from hydrogen peroxide and its derivatives during the treatment. To achieve this, the secondary light source needs to have a wavelength that can cause photobio modulation (PBM) effects by absorbing in cytochrome oxidase enzymes within mitochondria.33-35

Photocatalytic processes

B ecause this technology is not deployed in bleaching systems sold in Australia, some readers will be unfamiliar with the broad concept involved. As the name suggests, a light-sensitive catalyst is used. When exposed to the relevant wavelengths of light, reactive oxygen species are generated, which then are the active components for bleaching. Tita nium dioxide is a widely used material in photocatalytic processes in industry, as it has a wide absorption pattern in the visible spectrum and in the adjacent near infrared and ultraviolet regions. In fact, the absorption spectrum can be altered by the introduction of various changes in the titanium dioxide, such as doping with nitrogen atoms.

olour vision and photosynthesis are perhaps the best-known examples in everyday life of photochemical processes. In such reactions, the light wavelength triggers a specific chemical reaction and is a critical requirement for it to occur.

clinical | EXCELLENCE

I f one uses an incorrect light source that is not absorbed in the target, then one cannot expect to see any beneficial actions. On the other hand, if one uses a powerful light source for an extended period that is fixed in position over the teeth, it is self-evident that some heating of the teeth could occur, both through absorption in the gel, as well as by absorption within the tooth structure itself. This is where consideration around how well the light is absorbed within the structure of the tooth is very important.

n Check that products are used well within their expiry date.

30 oral|hygiene July/August 2022

Suitable wavelengths occur from the visible red region (from 630 nm) through to the near infrared region (to around 1100 nm). These wavelengths alter the behaviour of neurons and revers ibly impair neural transmission without causing damage.36 A secondary light source can be an LED or a diode laser.

Get the photochemistry right!

All methods of light activation of bleaching products need to use pathways that are effective for improving the final result from the procedure...”

n Follow manufacturer advice regarding limits for light intensity and exposure time. Use separate additional timers if these are not built into the system.

As can be seen in Figure 1, teeth are relatively transparent to wavelengths from the visible green through to the near infrared region. However, teeth absorb strongly in the far and middle ultraviolet range, due to absorption into apatite mineral.37,38 Not surprisingly, when an intense UVC or UVB lamp is applied to teeth for a prolonged period, the enamel becomes hot and there is thermal stress at the level of the pulp. This was the cause of problems with the first generation of Zoom! and one of the reasons why there was subsequently a change in the light source used with this particular bleaching

Why should there be controversy about the role of light in bleaching?

A s explained above, the fundamental photochemistry behind light in bleaching processes is well known. The observation of chemical effects of light is as old as humanity itself and pho tochemical processes are the subjects

erature and in the patent literature and the occurrence of everyday examples such as those mentioned above, there are those who deny any value to using light to enhance bleaching. Perhaps their core knowledge of photochemistry is limited.

The comment can also be made that some manufacturers of various light systems could have better informed clini cians regarding the mechanisms at play and in particular provided information about how their system is designed to maximise the interaction between light and the relevant target. Armed with that information, clinicians could have greater confidence that there is a worthwhile ben efit in using the light source provided by the manufacturer.

n Protect the patient’s eyes from intense light using the recommended protective eyewear, retractors, etc as supplied by the manufacturers.

“There are some cases of poorly whichphotothermallaboratoryconductedstudiesofbleachinglackrelevantcontrols...Awell-designedstudyshouldexploretheeffectofthegelusedalone,lightusedaloneandthecombinationofthegelwiththeappropriatelight,atasufficientintensityfortheappropriatetime...”

of multiple recent standard chemistry texts.40,41 From a pure chemistry per spective, the electronic excitations that are required to trigger photochemical, photodynamic and photophysical events (including photodegradation) require energies roughly in the interval 100-1000 kJ/mol (1 to 10 eV) as this is sufficient to break bonds or cause other major molecular rearrangements. Hence, the corresponding wavelengths go from the ultraviolet region right through the visible spectrum (400-700 nm) and extend as far as 1200 nm in the near infrared region.40 This aligns with wavelengths used with contemporary dental bleaching systems.

In some cases, they have drawn upon the results of poorly conducted laboratory studies of photothermal bleaching which lack relevant controls and so they are unable to properly distinguish between the effect of light versus no light. A welldesigned study should explore the effect of the gel used alone, light used alone and the combination of the gel with the appropriate light, at a sufficient intensity for the appropriate time. As well, some authors have only looked at studies using photothermal processes (where improve ments will be small if the gel lacks the appropriate absorbing molecules) and have ignored literature on the other mechanisms discussed above. A narra tive review or a systematic review is only as good as the selection process that is used for the included papers. Excluding papers on processes other than photo thermal systems is a common error in such reviews on the question of light and dental bleaching.

Despite the wealth of material on the topic of photochemistry in the dental literature as well as in the industrial lit

n Become informed of what mechanisms bleaching systems are using light to achieve.

Table 1. Key clinical take home messages

n Use the supplied positioning devices to locate the light source at the proper working distance.

7. Verheyen P, Walsh LJ. Bleaching using the laser.

30. Walsh LJ. Back to the roots: applications of curcumin (turmeric) in dentistry. Auxiliary. 2015; 25 (3): 26-28.

July/August 2022 oral|hygiene 31

41. Persico M, Granucci G. Photochemistry: A Modern Theoretical Perspective. Springer: New York, 2018.

18. Zach L, Cohen G. Pulp response to externally applied heat. Oral Surgery Oral Medicine Oral Pathology 19.1965;19:515-530.SealeNS,etal. Pulpal reaction to bleaching of teeth in dogs. Journal of Dental Research 1981;60:948-953.

17. Ziemba SL, et al. Clinical evaluation of a novel dental whitening lamp and light-catalyzed peroxide gel. Journal of Clinical Dentistry 2005;16:123-127.

38. Li R et al. Optical properties of enamel and trans lucent composites by diffuse reflectance measurements. Journal of Dentistry 2012; 40S: e40-e47.

11. Garcia Einschlag F, et al. Effect of temperature on hydrogen peroxide photolysis in aqueous solution. Journal of Photochemistry and Photobiology, Part A Chemistry. 1997;110:235-242

24. Marson FC, et al. Clinical evaluation of in office dental bleaching treatments with and without the use of light-activation sources. Operative Dentistry 2008;33:15-22.

25. Calatayud JO, et al. Clinical efficacy of a bleaching system based on hydrogen peroxide with or without light activation. European Journal of Esthetic Dentistry 26.2010;5:216-224.BuchallaW,

Maria Lucas is an oral health therapist in full time private practice. She completed her OHT training at the University of Adelaide in 2007 and later undertook the Adult Restorative Course at the Uni versity of Sydney. Maria has a special interest in tooth whitening and is a codirector of the Institute of Aesthetic Teeth Whitening, a training company devoted to education in tooth whitening. She has a keen interest in business development and in supporting not for profit entities that provide health care for disadvantaged communities in the Asia Pacific region.

6. Walsh LJ, Liu JY, Verheyen P. Tooth discolouration and its treatment using KTP laser-assisted tooth whit ening. Journal of Oral Laser Applications 2004;4(1):7-20

22. Kossatz S, et al. Effect of light activation on tooth sensitivity after in-office bleaching. Operative Dentistry 23.2011;36:251-257.HeL-B,etal.

21. Eldeniz AU, et al. Pulpal temperature rise during lightactivated bleaching. Journal of Biomedical Materials Research,Part B: Applied Biomaterials 2005; 72:254-259.

20. Baik JW, et al. Effect of light enhanced bleaching on in vitro surface and intrapulpal temperature rise. Journal of Esthetic and Restorative Dentistry 2001;13:370-378.

10. Baxendale J, Wilson J. The photolysis of hydrogen peroxide at high light intensities. Transactions of the Faraday Society 1957;52:344-356.

33. Walsh LJ. Laser analgesia with pulsed infrared lasers: theory and practice. Journal of Oral Laser Appli cations 2008;8(1):1-10.

34. Liang R, George R, Walsh LJ. Pulpal response fol lowing photo-biomodulation with a 904-nm diode laser: a double-blind clinical study. Lasers in Medical Science 2016;31(9):1811-1817.

37. Spitzer D, Ten Bosch JJ. The absorption and scat tering of light in bovine and human dental enamel. Calcified Tissue Research 1975;17;129-137.

36. Chan A, Punnia-Moorthy A, Armati P. Low-power pulsed Nd:YAG laser irradiation for pre-emptive anaes thesia: A morphological and histological study. Laser Therapy 2014;23(4):255-62.

Attin T. External bleaching therapy with activation by heat, light or laser – a systematic review. Dental Materials 2007;23:586-596.

1. Coluzzi DJ, Convissar RA, Roshkind DM, Walsh LJ. Laser Fundamentals. In: Convissar RA (ed) Principles of Laser Dentistry, 3rd edition, 2022. St Louis: Elsevier

system. Other reasons included photoeruptive lesions within the mouth and around the oral tissues and UVB-induced erythema (sunburn) caused by ultraviolet B and C light exposure.

In: Moritz A, Beer F, Verheyen P, Wernisch J, Schoop U, Blum R, Walsh LJ. Oral Laser Application. Berlin: Quintessence, 2006

28. Gurgan S, et al. Different light-activated in-office bleaching systems: a clinical evaluation. Lasers in Med ical Science 2010;25:817-822.

3. Athanassiadis B, Abbott PV, Walsh LJ. A critical analysis of research methods and experimental models to study tooth discolouration from endodontic materials. International Endodontic Journal, 2022; 55 (Suppl.2):

29. Bennett ZY, Walsh LJ. Effect of photo-Fenton bleaching on tetracycline stained dentin in vitro. Journal of Contemporary Dental Practice. 2015;16(2):126-129.

Referencesclinical

2.Mosby.Bennett ZY, Walsh LJ. Factors affecting the rate of oxidation and resultant discolouration of tetracyclines contained in endodontic medicaments and irrigants. International Endodontic Journal. 2015; 48(4):373-379.

9. Athanassiadis B, Abbott PV, Walsh LJ. Develop ment and reversal of discolouration in roots filled with Ledermix or Doxymix pastes stored in the dark for three months then daylight for twenty four months. European Endodontic Journal 2022, in press.

Emeritus Professor Laurence J. Walsh AO is a specialist in special needs dentistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Den tistry, including 21 years as Professor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical micro biology. Laurie has served as Chief Examiner in Microbiology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years. His published research work includes over 330 journal papers, with a citation count of over 15,400 citations in the lit erature. Laurie holds patents in 7 families of dental technologies. He is currently ranked in the top 0.25% of world scien tists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recogni tion of his contributions to dentistry.

In summary, all methods of light activation of bleaching products need to use pathways that are both effective for improving the final result, while at the same time considering the complexity and cost of the light source and the rel evant safety implications for staff and patients. Key points for safety and effec tiveness are listed in Table 1.

12. Haywood VB. In-office bleaching: lights applica tions, and outcomes. Current Practice 2009;16:3-6.

The effects of light on bleaching and tooth sensitivity during in-office vital bleaching: A sys tematic review and meta-analysis. Journal of Dentistry 2012;40:644-653.

40. Albini A. Photochemistry: Past, Present and Future. Springer: New York, 2016.

15. Luk K, et al. Effect of light energy on peroxide tooth bleaching. Journal of the American Dental Association 16.2004;135:194-201.SuliemanM,et al. Comparison of three in office bleaching systems based on 35% hydrogen peroxide with different light activators. American Journal of Den tistry 2005;18:194-197.

35. Walsh LJ. Clinical applications of low level laser therapy: current use and future potential. Australasian Dental Practice 2015 May-June 26 (3): 82-84.

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4.370–383.Zanin F. Recent advances in dental bleaching with laser and LEDs. Photomedicine and Laser Surgery 5.2016;34:135-136.KuryM,et al. Effect of violet LED light on in office bleaching protocols: a randomized con trolled clinical trial. Journal of Applied Oral Science 2020;28:e20190720

13. Ontiveros JC. In-office vital bleaching with adjunct light. Dental Clinics of North America 2011;55:24114.253.Tavares M, et al. Light augments tooth whitening with peroxide. Journal of the American Dental Associa tion 2003;134:167-175.

8. DeMoor RJG, Verheyen J, Diachuk A, Verheyen P, Meire MA, De Coster PJ, Keulemans F, De Bruyne M, Walsh LJ. Insight into the chemistry of laser-activated bleaching. The Scientific World Journal. 2015: 650492.

31. Kuzekanani M, Walsh LJ. Quantitative analysis of KTP laser photodynamic bleaching of tetracycline-dis coloured teeth. Photomedicine and Laser Surgery 2009; 27(3):1-5.

39. Anagnostaki E et al. A Spectrophotometric study on light attenuation properties of dental bleaching gels: potential relevance to irradiation parameters. Dentistry Journal 2020;8:137.

32. Bennett ZY, Walsh LJ. Efficacy of LED versus KTP laser activation of photodynamic bleaching of tetracycline-stained dentine. Lasers in Medical Science 2015;30(7):1823-8. doi: 10.1007/s10103-014-1675-4.

About the authors

27. Alomari Q, El Daraa E. A randomised clinical trial of in-office dental bleaching with or without light activation. Journal of Contemporary Dental Practice 2010;11:E017-024.

When an insert tip is worn, the “sweep” of the instrument is reduced. The insert tip doesn’t travel as far on its optimal path. When using a worn tip, generally more pressure is applied, or generator power is increased, to compensate for the efficiency loss—often leading to patient discomfort and increasing the possibility of tip bending/breakage. When using a worn insert tip, the clinician will likely feel the need to increase the power setting on the generator to facilitate debris removal. However, scaling efficiency will not increase and more heat will be gener ated, especially if the power setting exceeds the recommendation for the insert tip.

id you know an hygienist spends 2 hours per day on average power scaling? With so much usage and often a different insert for many procedures, you must regularly evaluate your inserts to ensure they con tinue functioning properly. Ultrasonic inserts combine the power, efficiency and comfort you need to treat a wide range of patients, but they can also be delicate. This article provides a checklist to help you properly use, care for, maintain and therefore extend the useful life of your Ultrasonic Inserts.

Just like your hand scalers, ultrasonic insert tips wear with use. Worn insert tips can significantly diminish your scaling efficiency. One millimeter of tip loss results in a 25% loss of efficiency. Two millimeters? That’s a 50% loss of efficiency.

32 oral|hygiene July/August 2022 clinical | EXCELLENCE

How to properly care for your ultrasonic inserts ME FOR

Maintenance checklist for ultrasonic inserts

1. Check tip condition

CPDMEREADFOR

D

Hu-Friedy is now a proud member of All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. 1) Compared to other leading scaler designs. Data on file. Available upon request. ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 working ends, ensuring you have sharp, long lasting blades to efficiently remove calculus while applying less pinch force when holding the handle. Learn How to Scale in Perfect Harmony at Hu-Friedy.com/Harmony Hu-Friedy is now a proud member of All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. 1) Compared to other leading scaler designs. Data on file. Available upon request. ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 less pinch force when holding the handle. Learn How to Scale in Perfect Harmony at Hu-Friedy.com/Harmony PER-Harmony-PrintAd-HFG-Introduces-HFL-482AUS-A4-2012.indd 1 12/11/20 11:53 AM MANAGEMENTINSTRUMENT INFINITY SERIES™ CASSETTES The most sophisticated solution for instrument management That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include: • An open hole pattern that promotes water flow throughout the cassette • Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing • Easy-to-use, ergonomic latch that allows for one-handed opening Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment. VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right. WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: • Ideal height and mesio-distal width • Pre-trimmed and pre-crimped for simple placement • Accurate occlusal anatomy that matches the natural tooth FIT IS EVERYTHING Find the right one with Hu-Friedy Orders 1300 65 88 22 www.henryschein.com.auOrders 0800 808 855 www.henryschein.co.nz To learn more about how IMS can enhance your practice visit Hu-Friedy.com/Infinity ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. Hu-Friedy Mfg. Co., LLC, 1666 E. Touhy Ave., Des Plaines, IL 60018 | Hu-Friedy.com All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. ©2021 Hu-Friedy Mfg. Co., LLC. All rights reserved. Hu-Friedy is now a proud member of All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. 1) Compared to other leading scaler designs. Data on file. Available upon request. ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 working ends, ensuring you have sharp, long lasting blades to efficiently remove calculus while applying less pinch force when holding the handle. Learn How to Scale in Perfect Harmony at Hu-Friedy.com/Harmony Hu-Friedy is now a proud member of All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. 1) Compared to other leading scaler designs. Data on file. Available upon request. ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 less pinch force when holding the handle. Learn How to Scale in Perfect Harmony at Hu-Friedy.com/Harmony PER-Harmony-PrintAd-HFG-Introduces-HFL-482AUS-A4-2012.indd 1 12/11/20 11:53 YOU DESERVE INFINITE CONFIDENCE. MANAGEMENTINSTRUMENT INFINITY SERIES™ CASSETTES The most sophisticated solution for instrument management That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include: • An open hole pattern that promotes water flow throughout the cassette • Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing • Easy-to-use, ergonomic latch that allows for one-handed opening Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment. VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right. WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: • Ideal height and mesio-distal width • Pre-trimmed and pre-crimped for simple placement • Accurate occlusal anatomy that matches the natural tooth FIT IS EVERYTHING Find the right one with Hu-Friedy Orders 1300 65 88 22 www.henryschein.com.auOrders 0800 808 855 www.henryschein.co.nz To learn more about how IMS can enhance your practice visit Hu-Friedy.com/Infinity ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. Hu-Friedy is now a proud member of All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, 1) Compared to other leading scaler designs. Data on file. Available upon request. ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 working ends, ensuring you blades to efficiently remove less pinch force when holding Learn How to Scale in Perfect Hu-Friedy.com/Harmony PER-Harmony-PrintAd-HFG-Introduces-HFL-482AUS-A4-2012.indd 1 Hu-Friedy is now a proud member of All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, 1) Compared to other leading scaler designs. Data on file. Available upon request. ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 less pinch force when holding Learn How to Scale in Perfect Hu-Friedy.com/Harmony PER-Harmony-PrintAd-HFG-Introduces-HFL-482AUS-A4-2012.indd 1 MANAGEMENTINSTRUMENT INFINITY SERIES™ CASSETTES The most sophisticated solution for instrument management That’s right, you deserve it. You deserve the peace of mind and confidence that you are employing the most contemporary method of processing instruments. innovator of the cassette-based instrument management system, Hu-Friedy you the modern design and functionality of the Infinity Series Cassettes An open hole pattern that promotes water flow throughout the cassette • Color-coded silicone rail system that significantly reduces instrument for more water flow while protecting the instruments during reprocessing • Easy-to-use, ergonomic latch that allows for one-handed opening Performing at your best means having confidence in what you do. Experience the efficiency of your practice, while helping protect your patients, your VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right. WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: • Ideal height and mesio-distal width • Pre-trimmed and pre-crimped for simple placement • Accurate occlusal anatomy that matches the natural tooth FIT IS EVERYTHING Find the right one with Hu-Friedy OrdersOrders 0800 808 855 www.henryschein.co.nz To learn more about how IMS can enhance your practice visit Hu-Friedy.com/Infinity ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. Hu-Friedy is now a proud member of All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. 1) Compared to other leading scaler designs. Data on file. Available upon request. ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 working ends, ensuring you have sharp, long lasting blades to efficiently remove calculus while applying less pinch force when holding the handle. Learn How to Scale in Perfect Harmony at Hu-Friedy.com/Harmony Hu-Friedy is now a proud member of All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. 1) Compared to other leading scaler designs. Data on file. Available upon request. ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 less pinch force when holding the handle. Learn How to Scale in Perfect Harmony at Hu-Friedy.com/Harmony PER-Harmony-PrintAd-HFG-Introduces-HFL-482AUS-A4-2012.indd 1 12/11/20 11:53 AM YOU DESERVE INFINITE CONFIDENCE. MANAGEMENTINSTRUMENT INFINITY SERIES™ CASSETTES The most sophisticated solution for instrument management That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include: • An open hole pattern that promotes water flow throughout the cassette • Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing • Easy-to-use, ergonomic latch that allows for one-handed opening Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment. VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right. WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: • Ideal height and mesio-distal width • Pre-trimmed and pre-crimped for simple placement • Accurate occlusal anatomy that matches the natural tooth FIT IS EVERYTHING Find the right one with Hu-Friedy Orders 1300 65 88 22 www.henryschein.com.auOrders 0800 808 855 www.henryschein.co.nz To learn more about how IMS can enhance your practice visit Hu-Friedy.com/Infinity ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. Hu-Friedy is now a proud member of All company and product names are trademarks 1) Compared to other leading scaler designs. Data ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. working ends, ensuring blades to efficiently less pinch force when Learn How to Scale Hu-Friedy.com/Harmony Hu-Friedy is now a proud member of All company and product names are trademarks 1) Compared to other leading scaler designs. Data ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. less pinch force when Learn How to Scale Hu-Friedy.com/Harmony PER-Harmony-PrintAd-HFG-Introduces-HFL-482AUS-A4-2012.indd 1 YOU DESERVE MANAGEMENTINSTRUMENT INFINITY SERIES™ CASSETTES The most sophisticated solution for instrument That’s right, you deserve it. You deserve the peace that you are employing the most contemporary method innovator of the cassette-based instrument management you the modern design and functionality of the Infinity • An open hole pattern that promotes water flow throughout • Color-coded silicone rail system that significantly for more water flow while protecting the instruments • Easy-to-use, ergonomic latch that allows for one-handed Performing at your best means having confidence in the efficiency of your practice, while helping protect VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless You’ll quickly discover why dentists favor our impeccable fit. Perfect for your Because when it comes to the perfect fit, Hu-Friedy is just right. WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: • Ideal height and mesio-distal width • Pre-trimmed and pre-crimped for simple placement • Accurate occlusal anatomy that matches the natural tooth FIT IS EVERYTHING Find the right one with Hu-Friedy Orders 0800 808 855 www.henryschein.co.nz To learn more about how IMS can enhance your practice visit Hu-Friedy.com/Infinity ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved.

U

clinical | EXCELLENCE

34 oral|hygiene July/August 2022

7. Prevent overheating

Your practice makes an investment in its ultrasonic inserts. Any investment needs to be kept up to continue producing an ROI. If properly used and shown the proper care, your ultrasonic inserts will help keep you the best in practice no matter the patient or procedure.

terilising inserts in a cassette will protect them and extend their useful life. If your office uses sterilisation pouches instead, always use caution when placing the insert in the ultra sonic bath or autoclave, as heavier instruments placed on top can cause bending/breakage of the tip and/or stack. Cassettes provide the best long-term protection for your ultrasonic inserts.

E

Using worn tips can result in inefficient scaling, inferior tip performance, handpiece overheating and more discomfort for you and your patient. So be sure to measure tip wear on a weekly basis and replace inserts as they wear and lose efficiency.

ometimes your handpiece can begin to feel warm. You may want to believe that it may cool down on its own, but some times it doesn’t. You may reach the point where you need to put it down to either change the ultrasonic insert or switch to hand instrumentation. Overheating can happen and in addition to a couple of points mentioned earlier, there is more you can do to prevent such occurrences.

3. Double check power settings

2. Evaluate pressure applied

hen it comes to the amount of pressure one should use when ultrasonic scaling, light pressure is all you need to allow the tip of the insert to vibrate efficiently, this results in fracture or removal of deposits. Applying more pressure dampens the tip vibration, leading to poor deposit removal, operator hand fatigue, and patient discomfort. Ultrasonic inserts are designed to work with a light grasp and light lateral pressure - let the insert do the work for you.

ltrasonic inserts are designed for specific applications since complex oral anatomy and debris type/location prohibit an effective “universal” insert. Robust inserts are for moderate to heavy/tenacious deposits and stains in supragingival and accessible subgingival areas. Thin inserts allow enhanced access to narrow subgingival areas, tight pockets, interproximal concavities and other difficult-to-access areas. Using thin inserts as “universal” inserts—particularly on moderate/heavy suprag ingival deposits—can result in excessive tip wear, inefficient deposit removal and tip bending/breakage. Much like using the correct power setting, matching the right insert to each clinical application is vital. And remember, more than one type of insert may be needed for each clinical procedure.

5. Don’t compromise instrument shape

Bending or reshaping insert tips is not recommended. Aside from voiding the warranty, reshaping the tip can result in poor tip performance and make the tip susceptible to breakage. Insert tips are designed with precise bends to optimise the elliptical vibration path—bending the tips disrupts this vibration pattern, rendering the tip inefficient at debris removal.

S

4. Match insert type to clinical application

ach ultrasonic insert has a recommended power range for optimal performance. Robust tips, such as the HuFriedy Group #10, #1000 and Beavertail inserts, are intended to remove heavy debris and can be used on higher power settings. It is recommended that thinner tips, designed for effective deposit removal, be used on low to medium power. Thin inserts with water flow to the tip have narrower water flow channels. If used on high power, the water flow rate may not be enough to cool the insert tip—resulting in handpiece overheating. Use the lowest effective power settings for each insert for maximum scaling and patient comfort. It is highly recommended to adhere to the power ranges specified on the insert packaging for optimal effectiveness.

6. Proper sterilisation and maintenance

You may experience overheating due to air bubbles trapped in the handpiece. Trapped air can prevent water from contacting the vibrating stack—resulting in heat build-up. The entire insert stack must be completely submerged in water to operate efficiently. To eliminate/minimise trapped air, be sure the handpiece is filled to the top with water and held vertically when placing the insert. To further prevent trapped air, it is advisable to run water through the handpiece for at least 2 minutes at the start of each day and for 45 seconds each time you seat an insert into the handpiece.

W

Another reason for overheating may be that your waterline filter is clogged. Check the waterline that extends from the generator to the wall connection or the operatory unit. This waterline typically has a filter that should be monitored and changed routinely. A clogged filter will disrupt the water flow through the generator and result in less flow to the insert tip. Regularly changing the filter is an inexpensive, quick mainte nance procedure that can help ensure unobstructed water flow.

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