For this weeks TIPisode we talk about products and best practice ideas for Intraoral and Extraoral suction. Covid-19 has people reeling and we are here to help!
Here are several of the products mentioned in the episode
More TIPisodes: https://ataleoftwohygienists.com/tipisodes/
This TIPisode has been transcribed for your viewing pleasure:
Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: Quick and easy tips to keep you up to date and presented by the experts in the profession. Now, get ready for your unofficial TIPisode.
So, y’all, we’re back with a TIPisode. Andrew and I don’t do this super often, but we are really excited about a lot of products that are coming out from all this craziness right now and the pandemic and the shutdown, and we thought we’d kind of tell you some of the things that we are finding pretty interesting. This is not an all encompassing —
Andrew Johnston: — All inclusive. Yeah.
Michelle Strange: — I guess, list. All inclusive maybe? Yeah. It’s not — this is just the things that we’ve seen. And today we’re going to start with high-volume evacuation or extraoral evacuation. Yeah?
Andrew Johnston: Yeah. I mean, I think the funny thing about all of this is we’ve been talking about this for years and year and years. And, on the back of this pandemic, now we’re finally going to be able to — I hope to be able to do the right thing, finally, by our patients, by us, by the other people in the room, family members, whatever. So this is really exciting for me to talk about.
Michelle Strange: Yeah. You know, I’ve been a big fan of AIRFLOW for years now. I’ve always been a user of, you know, back in the day, the prophy jet, and then once, you know, I got other options for powder, I kind of migrated to AIRFLOW. But you know what? It’s been — it creates a ton of aerosols. And you know what the one moment — because we’re going to talk face shields and masks and all this stuff later on — but the one time where I was like, “I think I need to get a better handle on my aerosols,” is because, well, one, I was wearing the wrong mask, but I could taste the mintiness of the powder.
Andrew Johnston: Ah. Gross.
Michelle Strange: And it was — it was super gross. And, you know, I was using glycine. Glycine’s a little bit of a smaller powder. I wasn’t even using — when I went to go look at the box — and this is where, you know, now I’m obsessed with masks and stuff, but before, I didn’t know the level of the mask, and I didn’t even realize that it was a box of masks that wasn’t rated by ASTM or ATMS. I always get those confused. But, anywho, we’re not going to go down mask. But that was when I was like, “Well, one, I got to get ahead of this on the mask side, but maybe I need to embrace my high-volume evacuation.”
And then Washington, tell me about Washington and high-volume.
Andrew Johnston: Well, it’s funny because for years they’ve been trying to also pass this in the legislation that it’s mandatory for any procedure that creates any sort of aerosol or splatter is supposed to be using a high-volume evacuation. Now, it hasn’t actually made it into the rules yet, but I think this is going to push it right in really quick. It was already going to be on the cusp. Like, we’ve been talking about it for years, and it had got to the point of, like, okay this might be the year to do it.
Michelle Strange: It’s time.
Andrew Johnston: It is time.
And so one thing I what to kind of pivot towards a little bit — and hopefully you can answer this because you’re pretty good at all of this information — is as we’re talking today about the suction units, there’s different reasons to use different ones.
So, for example, The Blue Boa versus the Isolite versus the high-volume evacuation. And so there’s droplets and aerosols, and there’s water reduction, and there’s all these different reasons to have different tools. Can you talk a little bit more about that, though, because I feel like people just think that we’re just trying to pull water out of people’s mouths.
Michelle Strange: You know, I think I said on the phone with you the other day, I was like, “Well, that product looks great if I was only worried about aerosols. But I am drowning the patient in addition to it, and it doesn’t get all of the pooling water in the back.”
And, you know, I’ve been testing a lot of different high volumes. It’s probably been a strong year and a half, and I got all kinds, you know? I’ve got Mr. Thirsty. I have Isolite. I have Isovac. I have Purevac. I have the regular one with the CordEze. I have ReLeaf. I have — I’m trying to think. I feel like there’s one more.
Andrew Johnston: Have you tried the Nu-Bird yet?
Michelle Strange: The Nu-Bird. That’s on my list.
Andrew Johnston: Okay.
Michelle Strange: I want to try it. But I just haven’t bit the bullet and paid for it and — because I was trying all these other ones — and I’m trying to think. There’s a few more out there — and then I realized that, at the end of the day, I have not found one that works for everything.
Andrew Johnston: Right.
Michelle Strange: It doesn’t work for every procedure, it doesn’t work for every patient, and it doesn’t work for every clinician because there’s one other hygienist that will volunteer with me sometimes, and she’s like, “I just can’t get this to work.” And I’m like, “I get it. It’s not for everyone.” So — and not anything specific, but just whatever she was trying.
And I just — I have been begging the world to find something for, you know, mainly us hygienists because we’re in there doing it by ourselves a lot of times that can control the aerosols and also not drown the patient at the same time but without having 47 parts because, at this point, what I do [laughing] — my two setups are either Isolite or Isovac depending on the room I’m in. That’s going to get all the pooling water for me, and it actually does a really good job of aerosols when I’m in the posterior of the mouth. But, if I’m using AIRFLOW and I’m blasting from lingual to facial in the anterior, I’m like, you know, I can’t even — I’m just asking it to do something it just can’t manage, right?
Andrew Johnston: Sure. Sure, sure.
Michelle Strange: So then I have to have a second high-volume evacuation to grab all of those. So then I’m like, “Okay, there’s two things that I have to have now.” And not everybody has two high-volumes in their operatories. I’m lucky that I do.
And so, if I’m not using that particular system, then I am using something like — well, maybe a combination. I’m always using a high-volume evacuator, but because I can’t stay on top of the pooling water and the splatter and the spray and all the stuff happening in the back of the mouth and I’m trying to either focus on one or the aerosols, I have to have that low volume.
So I did do ReLeaf. ReLeaf was good, but that’s also two high-volume evacuations I was going to have to have, so then, again, if you don’t have that, that’s a problem. And then I ended up with Pink Petal on a saliva ejector with a back-flow preventer, and then my CordEze, which is a bracelet to take the drag off my high volume, which is — Oh, my God. It’s like night and day. It’s like I barely have anything in my hand.
Andrew Johnston: And I think that we agree with, like, we’re not really necessarily going to recommend all of these products for everyone, but CordEze is something you and I both believe in as far as if you are having any sort of fatigue or any sort of pull on it, like, that — it just works. There’s just no getting around it. It works 100 percent of the time.
Michelle Strange: Yeah. It’s so funny because when I first started high-volume, I — have you — do you do high volume pretty routinely by yourself?
Andrew Johnston: Yeah. Mm-hmm. Mm-hmm.
Michelle Strange: By yourself?
Andrew Johnston: Yeah.
Michelle Strange: I mean, I’ve slapped the patient in the face probably a dozen times if I don’t — I’m so bad with it [laughing] because I’m focused —
Andrew Johnston: I learned it in school though from —
Michelle Strange: — Yeah. And I didn’t.
Andrew Johnston: — and so from school, I’ve used it regularly.
Michelle Strange: Mm-hmm. I didn’t.
Andrew Johnston: So it wasn’t a weird thing.
Michelle Strange: And I have always retracted with my suction because, again, my — from day one graduating going into perio, my flow was prophy jet, Cavitron, hand scale. Boom, boom, boom. I’ve never done in any other way. And so everybody got, like, blasted with water.
And so I’ve taken my low volume, and I’ve used it as a retraction tool. So I got — I mean, but that’s horrible ergonomics because I got rid of, like, my mirror, and then I was doing a lot of, like, “Turn your head all the way over to the other side,” —
Andrew Johnston: [Laughing].
Michelle Strange: — and putting my head at a weird angle to see some areas. And so none of it’s been good for me.
I can’t find — and — but, you know, this is also a good time where if you guys have something, tell us. I will try it because I need a solution.
Andrew Johnston: Right. Right.
Michelle Strange: But, anywho. Point of it. CordEze is great because I wasn’t slapping my patients in the face with the tubing because it was coming across, and, I mean, I was trying to — I didn’t know how to use it. And I am still not great at it because mostly because I didn’t learn because I got CordEze, and problem solved.
Andrew Johnston: So should we run through some products just —
Michelle Strange: — Okay. Let’s do it.
Andrew Johnston: — generally of — and what they’re for?
Michelle Strange: Mm-hmm.
Andrew Johnston: So obviously number one on the list is CordEze. That was the one for me for all of these things. But let’s talk about Isolite, Mr. Thirsty, and all of those. I know we’ve talked about them on the podcast before, so if you guys haven’t listened to our full episodes, we’ve talked about them multiple times. But these ones are going to be more for the pooling of water and, in my opinion — and you’re, again, the expert on infection control out of the two of us at least —
Michelle Strange: Yeah. [Laughing]. Out of the two of us.
Andrew Johnston: — if we’re working — so you think about the Isolite, right? So, if we’re working on a patient who has some sort of respiratory issue and they’re exhaling through their mouth, my thought is it’s going to capture a lot that. Not all of it. It’s going to capture a lot of that because it’s a constant vacuum, and it’s occluding the back. True or False?
Michelle Strange: True.
Andrew Johnston: Fix me on these things.
Michelle Strange: Well, I mean, of course. I don’t know — like, I would be very curious how much breathing they’re doing through their mouth. Probably occasional when they can’t take good breath with their nose and they might try to get some in with their mouth. But it does occlude. And it’s quite nice because it blocks the airway, so if you did drop anything in a procedure or something like that, that would grab it. And it’s a bite block, too, so patients find it super comfortable.
Now, when —
Andrew Johnston: — It retracts the cheek and the tongue also.
Michelle Strange: It retracts the cheek, the tongue. And I will say, though — and you can confirm because you used it more than I did years ago, and then I just within the year got it — you have to change your sequence a little bit if you’re doing full mouth, right?
Andrew Johnston: Right.
Michelle Strange: Like, if we’re doing full mouth perio maintenance or whatever it is, you have to change your sequence, and you might have to change your grip.
Andrew Johnston: Let me —
Michelle Strange: — And this is something they actually teach.
Andrew Johnston: — think about that for a second.
Michelle Strange: They teach it in their training. So — which I’m really glad.
So the thing about Isolite which I enjoyed is that they went through a whole training session with me, and they were like, “You’re going to have to modify your grip just a little bit depending on where you are in the mouth.” So, if you’re trying to get that next-to-the-tooth fulcrum on number 13/14, it just ain’t going to happen. So you got to —
Andrew Johnston: — I see what you’re saying.
Michelle Strange: — yeah. You just got to change it.
Andrew Johnston: Yeah. I mean, it’s nothing significant. Like, your modified pen grasp isn’t going to be like — it’s not going to be like you’re going to be using just now two fingers to get this thing done. It’s just — yeah. It’s just very slight manipulations.
Michelle Strange: You got to come back on the — whatever you’re using, right?
Andrew Johnston: Mm-hmm. Mm-hmm.
Michelle Strange: Come back on the — towards the cord of it —
Andrew Johnston: — Yeah. For sure, for sure.
Michelle Strange: — if that makes any sense.
Andrew Johnston: Yeah.
Michelle Strange: So we’re already at, like, 11 minutes, so what else do you want to talk about?
Andrew Johnston: Well, I think I want to talk about — so that is good for, again, pooling water and things like that. You can have a Blue Boa does a good job of kind of sitting on the side of the cheek getting some of that pooled water as well.
Then the other thing that we have to look at is when we’re creating these aerosols and creating these droplets. What do we use for that particular procedure? Because it’s — the Isolite’s great, but like you mentioned earlier, if you are spraying right on the facials of eight and nine, it’s just going to bounce off and get into the — everywhere.
Michelle Strange: Mm-hmm.
Andrew Johnston: So, if you don’t want to use that high-volume evac right there also, what else is out there that we could use?
Michelle Strange: Mm-hmm. So — well, there’s — the thing that’s going around a lot are the extraoral high-volume evacuation systems. And it was just like a unit you push up to the patient, and it’s got a cone that sits right at their face.
You know, I keep joking that all of the holistic dentists that did these safer removal of mercury and everybody gave them a hard time with all of their devices and PPE, they going to be the real winners of all of this. [Laughing].
Andrew Johnston: [Laughing].
Michelle Strange: They are set up like champions for anything, so [cross talk] model a lot of it. [Laughing].
Andrew Johnston: I honestly think that they actually developed COVID, put it in Wuhan, and then did all this just so they could get more business. That’s my conspiracy theory.
Michelle Strange: You heard it here. Conspiracy theory by Andrew. [Laughing].
But they got a lot of good products that we might want to imitate. And so that is one that you actually do see in a holistic dentist.
A~flexX Assist is — which we can put that in the show notes because I misspell it every time, but it’s A-F-L-E-X-Xassistarm.com. And so it was something that was for low volume so you didn’t have to fishhook the patient, but now she came out with new tubing for your high volume so it’s not so heavy, and then she also came out with a cone that’s going to be autoclavable. So it’s going to be, essentially, that extraoral, but it’s coming from yours.
And she’s doing a lot of research because some of the questions I had was like, “Well, what does that — does it drain your evacuation system? Like, the whole system? Like, if I run it and you’re running it and the doctor’s running it, can your vacuum system hold up to that?” So there’s just a lot of things that they’re going to still have to figure out, but I was like, “What a cool device.”
Andrew Johnston: Yeah.
Michelle Strange: I’m super excited for it.
Andrew Johnston: Yeah. For sure.
Similarly, another extraoral one that we ran across is from ADS Dental Systems. It’s called “Extraoral Dental Suction System.” Its buy-line is “Droplets & Aerosols Terminator.”
Michelle Strange: [Laughing].
Andrew Johnston: And it’s the same thing. It’s just like — it’s this cone that it opens up a little bit more as it goes towards the mouth almost like a funnel where it’s wider then it gets a little bit more narrow, and then the whole cone is just like your tubehead for your xray machine, like that kind of cylinder that you’re looking at. And this is also a different unit that you’d push up as well. There are some filters and things like that in the bottom of it, and it’s just really — again, if you guys have never ever paid attention to our show notes, this is the TIPisode to start paying attention to show notes.
Michelle Strange: Yeah. It’s going to have some links.
Andrew Johnston: We’ll have links to all of this stuff in there, so.
Michelle Strange: Mm-hmm.
And just remember, everyone, that your personal protective equipment is the last barrier, and it’s the least effective. What really matters — and this is according to NIOSH and CDC — that you eliminate the risk of exposure, you substitute if you can during a risk of exposure, you have engineering controls, and that’s where high-volume evacuation falls in. So it is one of the better controls to reduce your risk. It’s essentially a device that’s created that either removes the risk or puts a barrier between you and your risk. Like, your sharps container’s considered an engineering control. Your needle devices —
Andrew Johnston: — Recapping device.
Michelle Strange: — recapping devices, thank you, those are all engineering controls. Super important. And then your work-practice controls meaning you got to do it. You got to use it. You got to be trained on it. And then your PPE comes out.
So these engineering controls are going to be super important. We’ve put a lot of weight on that PPE and asked it to carry a burden that it was never meant to carry, and I think we need to just reassess and get innovative and get creative and also curious about some of these products. And, remember, not one’s going to work for every single person, and you got to train on it. And training to competency is going to be a huge part of it.
Andrew Johnston: That was a great wrap-up.
Michelle Strange: Perfect. Well, thanks, everybody, for hanging out with us for this TIPisode. Remember, you can follow us on Facebook and Instagram, and we love reviews.
Andrew Johnston: All right. Bye, everyone.
Michelle Strange: Bye, y’all.
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