cross contamination, dental assisting, dental hygiene, dentistry, infection control, rdh, Uncategorized

Inconsistency Causes Risk

Recently, Dove Dental learned of another dental breach at a U. S. Dental School.  It was discovered that for nearly 2 years dental handpieces were merely wiped between patients instead of following the mandatory sterilization protocol set forth by the CDC, the dental school and the manufacturer’s instructions for use (IFU).  Given our access to education and technology how can this continue to occur?

Starting in the late 1990’s I spent over 10 years working with accredited teaching programs at dental schools and universities as a school and government regional manager with KaVo Dental.  In those years, there were many infection control inconsistencies ranging from incorrect methodology to simple carelessness.  For example, teaching basic routine dental handpiece maintenance varied between programs and in some cases was not taught at all.  Unfortunately much of this became engrained and passed onto the next generation of dental professionals, as last week’s breach makes clear, this issue is ongoing.

Some of the major problems in the 90’s with improper cleaning were a result of not having enough instruments on hand to ensure proper cleaning; students were typically instructed to purchase just one handpiece (dental offices traditionally contain 3 highspeed handpieces per room).  Additionally, instructions (IFU) were not strictly taught or followed with some instructors relying on central sterilization instead of teaching the student to properly clean the instrument by hand.

From my experience, variations in cleaning, sterilization and performance included:

Variations on handpiece maintenance
*Using incorrect lubricant or wrong nozzle to spray
*Autoclave/reprocess with a sheath/bag
*Autoclave/reprocess with no sheath/bag
*Lubricating with a bur
*Lubricating without a bur
*Lubricating after sterilization
*Purging with a bur
*Purging without a bur
*Not Purging
*Usage of a purge/lubrication machine vs manually
*Disassembly during cleaning (lowspeed components)
*Not disassembling lowspeeds or motors during cleaning
*Reprocessing that never dries
*Too much or too little air pressure PSI
*Dental water line flushing or lack there of
*Shortage of instruments resulting in hurried processes between patients
*Using a hot handpiece immediately out of the autoclave and cooled under water

Naturally, after graduation any bad habits learned persisted and many continue today. When educators conducted due diligence at a dental office we often saw that processes were all over the map, even within a single office: some purged, some lubed, some did not purge and some lubed with odd lubricant/oils not intended for dentists.  Naturally, performance reflected these practices.  For example, a result of not purging was water line biofilm continuously clogged most water ports and electric motors on the market.  Dental offices tended to become defensive about their procedures and quick to blame the manufacturer of handpieces for poor performance rather than focusing on proper cleaning and maintenance.  And while educators noted the inconsistencies around cleaning protocols and resultant risks, much went unnoticed by the industry.

An important note:  handpiece repair service was and continues to be a highly profitable business with direct ties to the inconsistent and incorrect maintenance methods learned early on.

Subsequent to my experience at KaVo Dental, I worked at SciCan and continued to witness inconsistencies in the schools, distributors and hundreds of offices that I examined.  At SciCan we specialized in the Statim Sterilizer, a fairly simplistic machine. But again, practices varied resulting in some of the following:

Variations of maintenance on Statim usage
*level machines that drained properly
*machines that dried correctly
*pouches that were dried correctly
*unleveled machines that did not drain
*leaking seals around cassettes resulting in failed cycles
*instruments (handpieces) not disassembled
*pouches that never dried
*some instruments were bagged, others were not in the same cycle
*never using a spore test
*stopping cycles ½ way through hot, because they did not have enough instruments for the next patient
*never cleaning the cassette
*never changing the bacteria filter or not knowing it exists
*using incorrect water in the machine

As I continued to examine the inconsistencies, I understood that the key to proper handpiece performance at the best value is heavily influenced by the processes that maintain the instruments between patients. Patient safety is at its highest level when the dental staff is properly trained consistently on instrument management through schools, teaching programs, Universities and mentors. When instrument management training is poor and inconsistent, the results carry on for years and patient safety risk is tremendous.

Since 2014 I’ve served as the VP of Sales at DOVE Dental Products where I focus on teaching Evacuation Valve maintenance 101. Through hundreds of office visits, trade shows and phone interviews our company listens to how offices maintain HVE and Saliva Ejector Valves.  We discover the same inconsistencies that existed in the 1990s.  The use and maintenance of valves varies widely, resulting in unclean instruments, poor performance and leakage and backflow; major risks to patients, a critical issue that only grows in importance with each passing year.

They include:

Variations of maintenance on Evacuation Valves
* removing the evacuation valve for cleaning frequency, sometimes, rarely, never
*cleaning the interior of valve frequency, sometimes, rarely, never
* reprocessing the valve components, sometimes, rarely, never
*only wiping exterior surfaces only between patients
*wiping, flushing between patients – some do it daily, weekly, monthly or often never
*cleaning the solids collector daily, weekly, monthly, or never
*never changing o-rings (3 in a HVE) and (2 in a Saliva Ejector) – these prevent seepage or leaking
*not knowing the valve is removable (very common)
*using a barrier between patients
*not using a barrier
*inspecting vacuum line condition routinely, sometimes, never
*ignoring leaks and bubbles from the sides of the instrument (very common)
*instructing patients to close around suction straws (very common)
*when patients do close around straws, nothing is mentioned to prevent Backflow
*warning patients to not close around straws


When we examine dental programs today we see many of the same problems with evacuation valves that we’ve seen in the past.  Many students have no idea that the valves are designed to swivel and should routinely be removed and cleaned even though every instruction guide clearly states: remove, scrub, reprocess routinely. Many rely on central sterilization or a person who maintains the chairs to insure clean and sanitary instruments.  As always, patient safety is critical and it is of concern that weekly we are contacted by a dental school or program to explain “backflow,” and to question its importance as related to protecting the patient.

It’s been 20 years since we first raised concerns about water line bacteria, inconsistent maintenance of instruments and the need for consistency in infection control processes.  Last week a U.S dental school had a major breach because dental handpieces were merely wiped and not properly cleaned for two years.  In 1993 researchers provided solid proof that saliva ejector backflow occurs in 1 in 5 patients who close their lips around straws.  However, just yesterday I had a conference call to explain saliva ejector backflow to a team of RDH’s in charge of infection control at 8 locations with nearly 50 chairs, and who did not know it exists.

Dove Dental continues to promote safe and effective dental practices for the benefit of the dental industry and for the patients.  We are confident that our products provide the best solution for both dentists and patients; a simple, cost effective and expedited cleaning and maintenance regime at the dental office which insures a safe and sanitary dental experience for the patient.

For more information on Dove Dental Disposable Evacuation Valves, visit


cross contamination, dental assisting, dental hygiene, dentistry, infection control, rdh

Welcome New DOVE HVE Valves

DOVE Valves were first introduced in 2014 to meet the challenge of providing clean, safe, uncontaminated evacuation valves for each patient.  DOVE Valves are the #1 selling Disposable HVE and Saliva Ejector Replacement Valve on the Market!  Our products range from HVE (High Volume) Valves to Saliva Ejector Valves, to adapter Tailpieces and Tailcap Plug Covers.

Our Newest DOVE innovation is our comfort driven HVE Valve series.  The new line focuses on comfort, optional sizes, color, chair flexibility and cost.

Comfort:  Evacuation Valve Comfort was a key factor of the design.  Our newest valve(s) are contoured to fit into large or small hands.  We’ve removed exterior fluting and softened all edging.  Exterior surfaces are smooth and the end result is a disposable instrument that feels like the traditional valve.


Optional Sizes:  The HVE Valve market has evolved over the years.  Offices use a variety of lengths of HVE Valves dependent on the type of chair in each operatory.  We are excited to offer 2 distinct lengths of Disposable HVE Valves.  Our new disposable long neck option and our short neck option will allow offices to select valves that are similar in size and length compared to traditional valves.


Color:  DOVE Valves are known for their bright aseptic blue color.  We are now excited to offer bright aseptic purple.  This color was hand selected by a group of RDH Dental Professionals and shares the status as the premier color in dental hygiene!  All new style HVE Valves are offered in either blue or purple.

Medium Neck Small Barb_Purple

Chair Flexibility: The HVE market is flooded with connection styles.  Each dental chair will often have its own connector (Tailpiece) or utilize a DCI style.  In the U.S. alone up to 7 variations are available.  We now offer (3) connection sizes that cover nearly 99% of the U.S. Dental Chair Market.  Our small barb HVE Valve allows easy snap on connection to existing Belmont, Forest, Dental EZ and traditional DCI style connections.  Our medium barb HVE Valves allow easy snap on conversion to Royal, Pelton, Marus and DCI Comfort style chair connections.  Our large barb HVE Valve allows easy connection to Adec style valves.


Performance:  DOVE High Volume (HVE) valves are simple to use, providing a seamless transition to disposable.  Each valve snaps into the connection, secures all styles of HVE straws and has a smooth rounded on/off turret that performs just like a metal valve.  No more leaking, sticking, gumming up of parts and no more time consuming cleaning procedures.

metal vs disposable

Cost:  On May 1st, 2018 we reduced by pricing of our DOVE Valves by 20%!  This included our new comfort driven designs!  Better product, better design, better cost!

Conclusion:  Today, more than ever its vital to provide each patient with a safe, clean, good working instrument.  New DOVE Disposable Valves alleviate cross contamination risks between patients and eliminate the need for extensive metal valve maintenance while saving time and money.

Traditional Metal HVE Valves pose many challenges and problems.  They include leaking of the instrument, difficult cleaning processes, parts inventory, degrading performance and most important patient safety is compromised.  Simple wiping has proven ineffective when instruments are not autoclaved and scrubbed.  Intermittent flushing of the lines does not address each patient and instead skyrockets safety concerns for patients who are not first in the chair.  Its no question the New DOVE High Volume (HVE) Valves are the safest, maintenance free, best performing instrument on the market!

cross contamination, dental assisting, dental hygiene, dentistry, infection control, rdh, Uncategorized

Your Evacuation Valves Most Likely Leak

I know what you’re saying, Not My Valves!  And we hope that is the case, however, there’s a very good possibility they do.  Here’s why…

Lets first ask a couple of questions to see how well maintained your office HVE and Saliva Ejector Valves are.

*How often do you disassemble the parts on the HVE and Saliva Ejector?  See image below.  Each manufacturer states you are to disassemble as part of the regular routine and then scrub each part.


*Do you lubricate the o-rings frequently?  All manufacturers state to routinely lubricate the orings.  Specific to the leading chair mfr, they state to remove the orings entirely and lubricate each routinely.

*How often are you replacing the o-rings?  Valve companies state to inspect orings often and routinely.  Most agree to replace all valve orings yearly assuming your offices are already following the above-mentioned disassembly & lubricating routine.  Not following the above routine likely means changing more frequently.

*What is the main purpose of the orings inside the evacuation valves?

  1.  Seal off the liquid debris from leaving the interior of the valve.
  2.  Provide a swivel on the valve and tailpiece coupler
  3.  Provide a smooth easy on/off rotation

With respect to your office.  Visit each room and see if the following is easy to do:

*Pull off the HVE or Saliva Ejector easily.  These are designed to connect similar to a dental handpiece.  They will click into place and should require NO force.

*Swivel at the connection.  Same applies, similar to dental handpiece designs you should have swivel ability.  Dental unit instruments were designed to work with you and not against you to reduce carpel tunnel syndrome.  Also they are designed to reduce tangling of tubings.

*Pull/push out the On/Off lever.  These are designed to push out with relative ease.  This should require very little force.

So why is our article titled “Your Evacuation Valves Most Likely Leak?”

Over the past 3 years we’ve visited 100’s of offices, spoke with countless dental professionals and continue to work with the leading infection control professionals in the industry.  We rarely see valves maintained correctly.

When orings are not maintained, they will not work properly.  Our experience is based on the following:


1.  It very rare when we offices disassemble the valves.  Our last poll consisted of a few hundred dental professionals resulting in less than 1% following the IFU (instructions for use).  Most valves we encounter are never removed off the lines and never lubricated.

2.  Many offices we visit require a pair of pliers to remove the valves.  It is a sure indicator the orings do not work.  In these situations, the orings have become dry and brittle.  Blood, saliva and other debris leak into the areas where the oring was designed to seal.  These valves most often seap (leak) out the sides.

3.  We speak to dental professionals and ask them if they have ever seen a bubble on the side of the valve during a procedure.  More often we hear YES as opposed to NO as the response.

We’ve personally viewed leaking blood, saliva, water and bubbles.  The cause for concern is where these leaks end up.  Many of the leaks end up on the patients!  To quote one RDH, “I quickly wiped the bubble off of my patients ear in horror”.

leaking valve

Finally, just because you cannot see the leak does not mean it’s not occurring.  Bubbles and blood are obvious indicators.  However, when orings are compromised and no longer function as they were designed, they will leak air and faint fluid because they will take the path least resistance when suction is on.


cross contamination, dental assisting, dental hygiene, dentistry, infection control, rdh, Uncategorized

A Peek into POOR Dental Device Maintenance & Why

At a recent trade show, we questioned 100’s of Dental Professionals (including DDS, Hygienists and Assistants) about standard maintenance between patients.  We also questioned if the office addresses backflow.  The cleaning method between patient’s responses include:

  • wiping only the exterior surfaces between patients (100+ of respondents)
  • wiping the exterior and sheathing the valve between patients (25+ respondents)
  • autoclave the valve components between patients (2 responses)

Flushing the evacuation lines frequency responses include:

  • flushing at the end of day (50+ responses)
  • flushing weekly (50+ responses)
  • flushing between patients (2 responses)
  • flushing?  (1 response)

How do you prevent Backflow risk from Saliva Ejectors to your patients?

  • 0 respondents used any device to alleviate patient backflow
  • An estimated 5 respondents warned patients to not close around suction straws
  • 100+ respondents had no idea about backflow risk

Where and how were you taught valve maintenance?

  • An estimated 20 respondents learned maintenance in school
  • 100+ respondents did not learn valve maintenance or the risks of backflow in school
  • 100+ respondents learned on their own or from their predecessor.

Evacuation Valve IFU’s (Instruction for use) instruct users to disassemble parts routinely, flush daily or between patients and the CDC states DHCP should not advise patients to close their lips around the tip of the saliva ejector to evacuate oral fluids.
We should be concerned when 99% of respondents do not follow the Instructions for Use and are unaware about backflow risks.

If you would like a copy of your existing IFU for evacuation valves, you can contact the Dental Chair Mfr or find them online.  Most can be found in the Dental Assistants Instrumentation Packets.

Do you do this for EVERY Patient?  The IFU recommends it.



cross contamination, dental assisting, dental hygiene, dentistry, infection control, rdh

Prioritize Patient Safety

When we visit the dentist, we place our trust in the dental professional(s) who is treating us.  As patients, we also expect the dental instruments to be clean, safe and in good working order.  Also we listen to our dental professionals instructions (open wide, swallow, bite, close, etc) during our visit.

However, patients instructed to “Close” during routine suctioning, unknowingly put themselves at great risk of cross contamination from the last patients fluids, blood, bacteria and chemicals in the line.  The concern, Saliva Ejector Backflow, has been proven to potentially occur in an estimated 21-25% of patients who close around suction straws, or 1 in 5 patients receive the junk in their mouth from the last patient. (1a)patientclose

Originally discovered in the 1990’s, research proved backflow occurs from low-volume saliva ejectors when the pressure in the patient’s mouth is less than that in the evacuator.  Simply closing around the suction straw forms a seal around the tip of the ejector that creates a partial vacuum. That vacuum can cause the last patients fluids, blood, bacteria, chemicals in the line, etc. to go back into the patients mouth.

Why hasn’t the industry made it mandatory to prevent Saliva Ejector Backflow?

Until now, alleviating the backflow risk has been reliant on teaching and educating dental professionals to instruct patients to not close.

Unfortunately, it occurs much too often.  At a recent tradeshow we questioned 100+ Hygiene and Assisting Professionals about backflow prevention.  Responses were as follows:meeting pic

Q&A:  How do you prevent the potential Saliva Ejector Backflow risk to you patients: responses

  • 0 respondents used any device to alleviate patient backflow
  • An estimated 5 respondents warned patients to not close around suction straws
  • 100+ respondents had no idea about backflow risk

What is the reason for the lack of education or prevention?

This answer will vary dependent on the following: where and how dental professionals were trained / your particular dentist & office expectations or lack thereof / habits / and the office or space lacks the necessary tools and devices to manage patient care properly.

Dental Schools and teaching facilities set the tone early on.  We’ve spoken with numerous programs that only wipe the exterior surfaces between patients and state it’s too expensive to clean the valves properly.  While other programs have a instrument manager in charge of maintaining suction components.  In these situations the students, unfortunately, do not learn valves pose a risk and why.

Finally, in many private offices, strict budgets are set on infection control products.  In other offices, the doctor sets the tone that it’s not important to offer patients clean evacuation valves because he or she never experienced it and its not mandatory.  Therefore, do the bare minimum.  While in others, efficient patient turnover is the priority so the room needs to be turned over quickly vs correctly.

What does the CDC say?

Backflow occurs when previously suctioned fluids present in the suction tubing flow back into the patient’s mouth. Backflow can occur when:

  • There is pressure in a patient’s mouth (a result of closing their lips and forming a seal around the tip of the ejector) that is less than in the saliva ejector (similar to how liquid flows back into a cup after drinking through a straw).
  • The suction tubing attached to the ejector is positioned above the patient’s mouth.
  • A saliva ejector is used at the same time as other evacuation (high-volume) equipment.

Although no adverse health effects associated with the saliva ejector have been reported, dental health care personnel (DHCP) should be aware that backflow could occur when they use a saliva ejector. DHCP should not advise patients to close their lips tightly around the tip of the saliva ejector to evacuate oral fluids. DHCP should contact the manufacturer of the dental unit to review proper use and maintenance procedures, including appropriate cleaning and disinfection methods.

Our view…

We believe patient safety should be the #1 priority.  The dental industry and the CDC take valve backflow too lightly.  Every day we view valves that leak and are filled with debris.
We are hopeful the CDC and the Dental Industry reassess the risk involved.  In the past, it was not possible to alleviate backflow easily and cost-effectively.  Instead, we relied on dental professional to warn patients.  This strategy is not working.
DOVE Dental Products introduced Disposable Backflow Prevention Saliva Ejectors in 2017.  They eliminate any potential risk.
Our original founder, a Dentist, stated about backflow “its not a matter of if a breach will occur, its a matter of when”.  Backflow is real, its proven.  We are 100% confident dental patients would want protection against it.




cross contamination, dental assisting, dental hygiene, dentistry, infection control, rdh

The Dental Device IFU – Are You Putting Patients at Risk?

Last month at the Hinman Dental Convention in Atlanta, GA we introduced our newly designed Disposable DOVE evacuation valves.

Over the 3-day meeting, we held 100’s of conversations with Dental Professionals.  We also sponsored a leading Infection Control Workshop with 60+ attendees.  When conversing, we inquire how their office manages maintenance of both HVE and Saliva Ejector Valves between patients and ask if the office addresses backflow?  The protocol for cleaning varies from 1 respondent to another, responses include:

  • wiping the exterior surfaces between patients (100+ of respondents)
  • wiping the exterior and sheathing the valve between patients (25+ respondents)
  • autoclave the valve components between patients (2 responses)

We always note when we hear anything besides the typical “wiping only” response.  Flushing frequency receives a variety of responses as well:

  • flushing at the end of day (50+ responses)
  • flushing weekly (50+ responses)
  • flushing between patients (2 responses)
  • flushing?  (1 response)

Lastly, Saliva Ejector Backflow responses were all similar:

  • 0 respondents use any device to alleviate patient backflow
  • An estimated 5 respondents stated they warn patients to not close around suction straws

So what is the correct way to clean a valve or is the evacuation valve left up to the discrepancy of the user?  Why is there such a variation of responses?  Do all evacuation valves have an IFU?

Whats the correct way to clean a valve?

DOVE believes patient safety should be the #1 priority.  Regardless of the dental device, if there is the potential risk of cross contamination to a patient or dental professional, the IFU (Instructions for Use) should always be followed.  Metal Evacuation Valve IFU’s in the N. American market instruct users to reprocess routinely.  Some companies are more detailed in the instruction process stating to disassemble each part, scrub each part and reprocess each part routinely.  Finally, a few metal valve manufacturers have checklists instructing flushing & reprocessing to be a routine part room turnover process.

Why is there such a variation of cleaning suction devices?

This answer will vary dependent on the following:  where and how you were trained / your particular dentist & office expectations or lack there of / habits / and the office or space lacks the necessary tools and devices to manage patient care properly.

We’ve spoken with many dental school programs who only wipe the exterior surfaces between patients and state its too expensive to remove the valves.  While other programs have a instrument manager in charge of maintaining the valve components.  Many of these students, unfortunately, never learn the correct valve maintenance.  Many attendees at the Hinman Dental Meeting were unaware valves disconnect from the swivel adapters and its part of the IFU – every usage.

Often in private offices, strict budgets are set on infection control products.  In other offices, the doctor sets the tone that its not important to offer patients clean evacuation valves.  While in others, efficient patient turnover is the priority so the room needs to be turned over quickly vs correctly.  Proper valve maintenance requires patience and time.  Backflow is a proven risk from numerous studies and the CDC.  As evidenced from our conversations, less than 1% offer a backflow preventative device less than 1% warn patients of the potential risk.

Lastly, maintenance requires multiple parts because valve components can breakdown when they are cleaned and reprocessed.  Many offices have 1 valve per chair. Ultimately the room could not function if the valve were to be reprocessed.

All Traditional Dental Evacuation Valves sold legally in N. America contain IFU’s that were prepared by the manufacturer.  These can be found in Assistants Instrumentation Packets if sold with the chair or online at the respective dental chair unit manufacturer.  Or, if the valve(s) were sold separately, IFU’s most likely are included in the original packaging and or online.
Instructions for use (IFU) are based on:
-in most cases they are required or in accordance of FDA Guidelines to provide a clean safe product
-the manufacturer has validated the steps necessary to prepare a device that is
safe for patient use
-The Centers for Disease Control CDC recommends following device IFU’s
-the manufacturers’ IFU is necessary to deliver a safe product for surgery
Not following the Manufacturers’ IFU puts patient safety at risk because the devices may be cleaned improperly, wrapped improperly, and or loaded into sterilizer improperly.  Most common valve risks are backflow, leakage and unclean parts coming into patient contact.
Why the conversation needs to start?
The below chart displays the leading N. American metal valve companies IFU recommendations.  Given the recent meeting conversations, dental offices are failing to deliver clean safe HVE Valves, clean safe Saliva Ejector Valves, do not address backflow and do not effectively manage the flushing of suction systems.  When 99% respond that they do not follow the IFU, something needs to be said.
cross contamination, dental hygiene, dentistry, infection control, rdh

Introducing NEWLY Designed DOVE Disposable Evacuation Valves at Hinman

March 10, 2018

DOVE Dental Products will exhibit in booth #11 at the upcoming 106th Annual Thomas P. Hinman Dental Meeting, March 22-24, 2018.  We will introduce NEWLY Designed DOVE Disposable Evacuation Valves that will include:

  • DOVE Disposable Saliva Ejector with Backflow Prevention offered now in Purple! Dental patient backflow risks occur when patients close their lips around suction straws. Prior patient backwash (or backflow) goes back into the mouth.  Only a backflow prevention device can eliminate this risk.
  • Our NEW High Volume Evacuation (HVE) is now offered in 2 comfort-driven designs! Valve comfort for Hygiene and Assisting is of the utmost importance.  Our 2 designs provide the greatest selection in the disposable market.
  • 2 NEW Connections for the HVE Valves! The current dental chair marketplace has many HVE connections.  Our new adaptors allow us to connect to over 95% of N. American Dental Chair units.

Providing a clean and safe evacuation valve is not possible when dental professionals only wipe the exterior surfaces and intermittently flush dental suction lines.

DOVE will also sponsor Ms. Nancy Dewhirst Infection Control Workshop on March 23 from 1- 4:00 PM.

For more, please inquire at