Ergonomics is one of the top concerns when dental practitioners are selecting a handpiece. That's not surprising. The repetitive movements involved in dentistry make musculoskeletal disorders (MSDs) a major occupational challenge for the field and an essential factor to consider when making almost any equipment decision.
Infection control is another area of concern when it comes to selecting a handpiece. Mitigating the spread of infectious agents has, of course, long been an issue for dentists and hygienists. More recently, the COVID-19 pandemic has further heightened concerns and awareness around how dental procedures can potentially spread disease, and recent research indicates that handpieces — cordless handpieces, in particular — can play a major role in tamping down that spread.
No matter how clean a person's mouth is, it is home to a variety of microorganisms, including bacteria, viruses, fungi and even parasites. It is never a sterile environment. The moment a piece of dental equipment comes into contact with a patient's saliva, it is contaminated. That's only the beginning, though. As a dentist or hygienist works on a patient's teeth, they generate particles that spread the microorganisms from that patient's mouth to the wider office environment. That means potentially spreading infectious agents from the patient to the provider, from the provider to other providers, patients or office staff — or even to people like mail carriers or sales representatives who may be visiting the office.
These infectious agents come in two categories: splatter and aerosols. Splatter involves large droplets (greater than 50 microns) that typically travel a short distance from the patient's mouth and then settle on surfaces like countertops, floors or a person's skin or hair. While splatter doesn't travel far during its initial flight, it can then move from surface to surface as it is carried on hands, clothing, papers or other materials, allowing it to spread widely.
Aerosols are the other kind of infectious agents that can be generated during dental work. Currently very important to the public due to their role in COVID-19 spread, aerosols consist of very small particles (less than 50 microns in size) that are suspended in air and can travel long distances — as far as 36 feet. Their small size also allows them to travel deep into a person's respiratory system when inhaled, which makes them particularly concerning.
There are a variety of tools aimed at eliminating or capturing the infectious agents that can be spread by dental practices. One of the most commonly used are high-volume evacuators, which draw away saliva and debris from a patient's mouth during a procedure. Others include pre-procedural rinses and laser bacterial reduction, both of which are meant to help reduce the amount of bacteria present in a patient's mouth before the provider starts a procedure, as well as the extent of bacterial contamination in the immediate area.
Handpieces can also play a major role in reducing the production of splatter and aerosols that can spread disease — and it turns out that choosing the right handpiece is essential. In a study supported with funding from Premier Dental and released in 2021, researchers led by Dr. Petra Wilder-Smith, director of dentistry at the University of California, Irvine Beckman Laser Institute & Medical Clinic, evaluated the distribution of aerosol and splatter generated by four different dental hygiene handpieces during simulated coronal polishing, with five licensed hygienists using the four handpieces at low and high speed, with and without high-volume evacuation.
The study found a significant difference in the volume of aerosols generated by the four handpieces, with the Premier AeroPro® cordless handpiece producing the smallest amount of aerosols. One of the keys to the AeroPro's strong performance, Dr. Wilder-Smith found, is that the handpiece does not use a foot-controlled rheostat to ramp the device speed up and down, but instead features a touch button on and off that allows providers to choose between three different constant speeds — low (500 rpm), medium (1,500 rpm) and high (2,800 rpm).
Use of a steady, constant speed is essential to reducing particle production and spread. With a rheostat-based handpiece, each time the operator pushes the rheostat to change the device speed, it creates turbulence as the device accelerates or decelerates against the patient's teeth. That, in turn, creates bursts of splatter and aerosol. By contrast, devices like the AeroPro that operate at a constant speed, produce significantly fewer particles, and the particles they do produce travel a shorter distance, which benefits the clinician and dental team. For teeth polishing, a minimum speed of 1,500 rpm is usually sufficient. Providers should also consider selecting contemporary polish products formulated to deliver amorphous calcium phosphate, which can increase uptake of fluoride in the tooth surface. The goal — from both a patient care and an infection control perspective — is to polish for the least amount of time and with the least amount of polishing agent possible.
Easy to wipe down and keep clean, cordless devices like the AeroPro offer infection control advantages in this regard, as well. The AeroPro motor can be cleaned and disinfected with CaviWipes™, meaning providers can wipe down the handpiece with the same product commonly used to clean the rest of the workspace. For the components of the AeroPro that have direct contact with oral microbes, there are custom-fit disposable barriers and autoclavable sheaths.
Of course, infection control isn't the only consideration when choosing a handpiece. As noted above, ergonomics is perhaps the biggest concern for providers when it comes to choosing equipment. To that end, Dr. Wilder-Smith's research found that the AeroPro also outperformed the other three instruments that her team evaluated in terms of ergonomics. According to a study she and her colleagues published in the Journal of Dental Hygiene in 2020 (also with support from Premier Dental), the AeroPro "used significantly less total muscle work over the entire polishing period" than did the other handpieces. It also "performed significantly better for back, neck and torso posture," allowing hygienists to finish coronal polishing more quickly and with less fatigue, strain on their muscles and postural discomfort.
Those ergonomic considerations are particularly important given that dentists and hygienists are at high risk of developing conditions like carpal tunnel syndrome and other MSDs. And while dentistry has started paying more attention to ergonomic issues, much of this attention has focused on posture and positioning of the upper body. The lower body is at risk, as well, especially when practitioners have to adjust their bodies in awkward ways to work with cords and foot pedals. Ideally, a person's body should be in as neutral a position as possible from head-to-toe. That can be difficult, though, when you need your feet for operating floor pedals and rheostats connected to handpieces and other tools. Cordless handpieces like AeroPro reduce the need for that kind of footwork, allowing providers to more easily maintain a healthy posture across the full length of their body.
The portability of cordless handpieces is also an advantage, especially as trends towards mobile dentistry and tele-dentistry have accelerated during the COVID-19 pandemic. These days, hygienists may find themselves working in a range of settings, including pediatricians' offices, urgent care centers and homeless shelters. The ability to easily pack up their equipment and take it wherever they need to go is increasingly important.
Few aspects of dentistry have remained unchanged from decades ago, and so it only makes sense that equipment would have evolved along with the practice. And while worries about the spread of microorganisms during dental procedures aren't new, the COVID-19 pandemic has brought heightened attention to the issue.
As research led by Dr. Petra Wilder-Smith and supported by Premier Dental shows, cordless handpieces offer advances in a host of areas, ranging from increasingly relevant concerns around infection control to portability, speed and ergonomics. It's an innovative technology that is opening up new and better ways to practice.
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