Optimal infection control in the dental operatory is crucial and requires a successful balance between the rigors of sterilization protocols with the growing demand for an efficient workflow. Frequently, this balance is difficult to achieve, placing these two important factors at odds with one another.
For example, the Centers for Disease Control and Prevention (CDC) recommends flushing of saliva ejectors (SE) with a cleaner in between patients and also suggests flushing of high volume evacuation (HVE) tubing regularly. (1, 2) Research shows, however, that more than 75% of dental practices do not adhere to this guidance and widespread inconsistency in infection control protocols exist. (3, 4)
Disposable valves can alleviate variability
To alleviate variability when infection control protocols need to be optimized, a new line of disposable HVE and SE valves may prove instrumental. These new products can be integrated into either a private dental practice or institutional dental setting without any deleterious impact on workflow or staff time.
This new line of DOVE (Disposable Oral Valve Evacuation) disposable valves, manufactured by Stoma Dental, are infused with an antimicrobial to inhibit the growth of organisms on the exterior surface and interior cavity, and are the only disposable alternative to processing metal valves. The DOVE valves are simple to operate: A smooth and easy switch activation by the dental assistant or hygienist operates the opening and closing mechanism. At the end of each procedure, the valves can be pulled off of the vacuum line and discarded.
In our high-volume practice, instrument cross-contamination and patient safety are always a concern. We’ve found that our metal evacuation valves lose performance over time when they’re not consistently cleaned and sterilized. It can be very time-consuming to deal with their multiple parts when cleaning them properly. The option of working with disposable evacuation valves provides us with a very safe and clean valve for each patient.
Even when infection control protocols are implemented as recommended by valve manufacturers, and both the HVE and SE metal valves are disassembled and autoclaved in between patients, challenges remain. It can take more than 10 minutes to complete this process. In addition, metal valves begin to perform inconsistently after repeated heat sterilization, and additional labor costs are incurred when degraded parts, especially O-rings, need to be replaced.
We’ve ordered our fair share of saliva ejector parts, including O-rings, filter traps, and rubber tips, because they either get misplaced or do not hold up well. When we work with the disposable valves, we just need to snap them on before each new patient and dispose of them immediately afterwards. The time saved and assurance that we have a safer product is invaluable.
Reduce backflow risks
The new DOVE HVE and SE valves also respond to concerns caused by the potential for reverse flow, or backflow, which can occur when there is greater negative pressure in the patient’s mouth than in the evacuator tubing. Studies demonstrate that backflow occurs in as many as in 1 in 5 patients who close their lips around the SE tip. (3, 4) When this happens, material from the mouth of a previous patient might remain in the vacuum line of the SE and be aspirated into the mouth of the next patient. In fact, the CDC recommends that patients not be instructed to close their lips around the SE tip during use. (5)
The DOVE system includes HVE and SE valves, tailcaps, and tailpieces. The DOVE valves accommodate a wide range of disposable tips, as their interior chambers narrow to fit large and small tip designs and everything in between. Stoma Dental’s line of tailpieces allows for easy adaptation of DOVE products if adapters are required.
In summary, disposable HVE and SE valves alleviate variability in infection control and optimize patient safety, while also responding to concerns that exist over potential backflow. They also contribute to more efficient workflow and may offset certain labor costs connected to time-consuming infection control procedures associated with metal valves. Use of these new disposable valves is expected to grow, and we’ll likely see more information and data involving their use in the future. Dental health professionals should plan ahead and consider how these devices might be successfully integrated into their practices.
1. Centers for Disease Control and Prevention. Recommended infection-control practices for dentistry, 1993. MMWR Recomm Rep. 1993;42(RR-8):1-12.
2. Kohn WG, Collins AS, Cleveland JL, et al. Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep. 2003;52(RR-17):1-61.
3. Miller C. Back flow in low-volume suction lines may lead to potential cross-contamination. RDH Magazine. 1996;16(1):30.
4. Watson CM, Whitehouse RL. Possibility of cross-contamination by dental patients by means of the saliva ejector. J Am Dent Assoc. 1993;124:77-80.
5. CDC Division of Oral Health. Infection Control: Frequently Asked Questions – Saliva Ejector. CDC website. http://www.cdc.gov/oralhealth/infectioncontrol/faq/saliva.htm. Updated July 10, 2013. Accessed August 20, 2015.
About the author
Timothy M. Talbott, DDS, MS, is an endodontist in private practice in Naples, Florida.
About Stoma Dental
Stoma Dental, the manufacturer of the disposable DOVE valves was recently named an official corporate member of the Organization for Safety, Asepsis, and Prevention. DOVE valves are available for purchase through Henry Schein Dental, Patterson Dental or from Stoma Dental at stomadental.com.