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.