Oral Hygiene Mar/Apr2022

oral hygiene , therapy , infection control , management and more ...

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VOL.32 NO.2

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VOLUME 32 | NUMBER 2 MARCH/APRIL 2022

OH | CONTENTS

On the cover...

Colgate’s new Optic White Light Up Pen and matching LED device in a take-home whitening kit will make your teeth “up to 7 shades whiter in 5 days”

READ ME FOR

CPD

4 6 16 20

BRIEFS NEWS & EVENTS CPD CENTRE ABSTRACTS

14 28

A-DEC OFFERS DENTAL UNIT BIOFILM TESTING SERVICES

INCREASING PATIENT COMFORT WITH ADVANCED TECHNOLOGY

With the heightened focus on infection control within the dental practice, A-dec has introduced a useful new product to test the microbiological quality of dental unit water lines

How to deliver the best care while keeping your patients relaxed with relative analgesia

READ ME FOR

CPD

22 32

UNRAVELLING THE MYSTERY OF LONG COVID

Emer. Prof. Laurie Walsh explores some of the implications for patients who develop “long COVID”

facebook.com/auxiliarynow

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SUBSCRIBE ONLINE at http://shop.dentalpractice.com.au

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CPD

twitter.com/auxiliarynow Publisher & Editor: Joseph Allbeury

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HARMONY ERGONOMIC SCALERS AND CURETTES Combining TrueFit technology with EverEdge 2.0 sharpness for state-of-the-art ergonomics and performance that work in harmony

instagram.com/dentevents www.oralhygiene.com.au

Oral Hygiene (formerly Auxiliary) ISSN 1323-4919 is printed in Australia and published six times per year by Main Street Publishing P/L ABN 74 065 490 655 • PO Box 586, Cammeray 2062

Telephone: (02) 9929-1900 Facsimile: (02) 9929-1999 Email: info@dentist.com.au © 2022. All rights reserved. The contents of this magazine are copyright and must not be reproduced without the written permission of the publisher. Permission to reprint may be obtained upon application. Correspondence and manuscripts for publication are welcome. Although all care is taken, the editor and publisher will not accept responsibility for the opinions expressed by contributors to this magazine, or for loss or damage to material submitted for publication.

news | EVENTS

in | BRIEF

SDI launches Pola For Aligners

Current infection control measures reduce COVID

ew Pola For Aligners from SDI utilises Pola Night 10% carbamide peroxide gel that has been carefully selected as the ideal whitening agent to suit any aligner system. The neutral pH gel ensures the greatest patient comfort in a whitening kit and the high-water content gel contains potassium nitrate and fluoride to reduce sensitivity and increase patient compliance. The pleasantly flavoured spearmint gel is both fresh and long lasting. Available from SDI Ltd on 1800-337-003 or visit www.sdi.com.au.

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Opalescence™ Quick PF 45% CP ow part of the Opalescence PF whitening family, Ultradent’s Opalescence Quick PF is the fastest take-home whitener used in a custom tray. The 45% Carbamide Peroxide formulation is available in a Mint flavour with a wear time of only 15 to 30 minutes a day.

Opalescence tooth whitening gel contains PF (potassium nitrate and fluoride) and the waterbased gel helps prevent dehydration and shade relapse. The sticky, viscous gel also won’t migrate to soft tissues and ensures tray stays securely in place. Available from Dentavision - 1800-806-640; Gunz Dental 1800-025-300; and Henry Schein - 1300-658-822.

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Umbrella lip, cheek & tongue retractor ffering beautiful access and practical isolation in a comfortable way, Ultradent’s Umbrella soft tissue retractor provides clear access to all areas of the mouth while prioritising patient comfort. Rather than pulling or stretching the lips, it gently and naturally keeps a patient’s mouth open thanks to its durable, yet flexible, spring-like design.

Its innovative tongue guard allows the tongue to comfortably remain out of the way, prevents triggering the gag reflex for most patients, all while channelling saliva for efficient evacuation. It is easy to place and features anatomically positioned bumpers to rest a hand without causing pain to the patient. These benefits combine to make the procedure easier and provide a better overall experience for both clinician and patient. Available from Dentavision - 1800-806-640; Gunz Dental 1800-025-300; and Henry Schein - 1300-658-822.

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4 oral|hygiene

This study examined the risk of SARSCoV-2 transmission among dentists and their team members by sampling 2784 participants across Germany, using questionnaires and blood samples, to detect IgG antibodies against SARS-CoV-2. The staff used dental dam and surgical respirators during treatment when performing AGPs and patients used pre-procedural mouthwashes. The continuous high use of PPE, mouthwash and ventilation procedures during the wave of cases occurred because teams were very well prepared and appropriate supplies were available in sufficient quantities and knowledge was widely disseminated on how to mitigate SARS-CoV-2 exposure. The questionnaires were analysed to investigate demographic data and working conditions during the pandemic. There were 146 participants with positive SARS-CoV-2 IgG antibodies (5.2%) and 30 subjects with a borderline finding (1.1%). Some 74 out of the 146 participants with SARS-CoV-2 IgG antibodies did not report a positive SARS-CoV-2 PCR test (50.7%), while 27 participants without SARS-CoV-2 IgG antibodies reported a positive SARSCoV-2 PCR test (1.1%). Combining the laboratory and self-reported information, the number of participants with a SARSCoV-2 infection was 179 (6.5%). The risk of SARS-CoV-2 transmission was not higher among the dental team compared to the general population of Germany.

The findings contrast with those of a study with over 1500 dental team members which was performed in May 2020 in the UK during the first wave, when PPE shortages existed and other control measures were not used. The UK infection rate was twice as high for dental staff as for the general population (16.3% vs 6-7%).

Hence, these results show that following hygienic regulations and infection control measures ensures the safety of the dental team and their patients and provides confidence that dentists and their team members are not at higher risk for patientdentist transmission of SARS-CoV-2.

Mksoud M et al. Prevalence of SARS‑CoV‑2 IgG antibodies among dental teams in Germany.

Clinical Oral Investigations 2022 https://doi.org/10.1007/s00784-021-04363-z

March/April 2022

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news | EVENTS

Dental Economics 2022 designed to help you and your practice grow

D

ental Economics is a brand new major event for 2022 that is designed to help your private dental practice GROW.

The event is perfect for principal dentists, employed dentists, new graduates, senior clinicians, practice managers, dental hygienists, oral health therapists and clinical and business support team members.

After two years of uncertainty, 2022 and beyond is the time to start getting back on track - growing your practice, starting a new practice, building your revenue, honing your systems, adding more chairs or opening in new locations.

Whatever your plan, Dental Economics 2022 will provide you with the tools, ideas and inspiration from the absolute best in the business to go to the next level.

Dental Economics 2022 is a 2-day multi-stream event that allows you to create your own program - on the fly.

The event is staged at the Novotel Sydney Brighton Beach - close to Sydney Airport with ample parking and easy access.

Throughout the two days, you can choose from over 50 different lectures, workshops and forums to tailor a program to meet your exact requirements (or bring your entire team to cover all the bases).

Dental Economics 2022 offers a total of 12 hours of CPD organised into six concurrent education streams under the topics of:

Leadership n this interactive forum, hear Australian practitioners who are running large private practices over multiple locations, group practices and a range of unique business models and concepts be interviewed on stage, give insight and answer your questions.

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6 oral|hygiene

Gain first hand insight into how large successful dental practices have overcome challenges to grow, evolve and prosper.

Practice Management articipate in lectures, workshops and forums with the best dental management consultants in Australia who will offer advice from decades of experience working with private dental practices in Australia.

P

Finance nderstand how to navigate the unique financial and legal requirements of dental practices from legal, accounting and financial advisers who create dental practice structures for large group and corporate practices. Sessions on trusts, insurances, superannuation, buying and selling practices and premises and more will be featured.

U

Marketing arketing your dental practice successfully is a key driver for growth.

Hear from clinicians, business owners and consultants about what works and what doesn’t. Sessions on websites, social media, video marketing, advertising and more will all be incorporated into a range of fun and interactive educational sessions.

M

Hygiene Department or the first time in Australia, this program for dental hygienists, oral health therapists and hygiene coordinators will present a range of sessions from inspiring clinicians and consultants that will change the way you view your career and your clinical practice. From looking at concepts for growing hygiene revenue and clinical engagement, to the exploration of the dental spa concept to mobile dentistry and domicillary care models, a broad range of topics will be covered designed to help dental hygienists and oral health therapists rethink their role in the practice and their overall dental career.

F

Communications ommunication is the key to starting and growing a practice. This stream will offer insight, tips and advice on a range of techniques and technologies that can help your practice grow, increase your efficiency and reduce your overheads.

Dental Economics 2022 will deliver unprecedented access to the most knowledgeable and entrepreneurial clinicians, business owners and consultants in Australia today.

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The lecture program will feature over 60 education sessions and the program is evolving on a daily basis at www.dentaleconomics.com.au.

Attention entrepreneurial dental hygienists and oral health therapists ental Economics 2022 is looking for dental hygienists and oral health therapists who are taking advantage of independent practice and want to share their story with their colleagues. Or if you have a business model that your peers can participate in or have ideas on how to take the hygiene department to the next level, then please contact Joseph Allbeury at joseph@dentist.com.au to start a conversation about presenting at Dental Economic 2022.

D

March/April 2022

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news | EVENTS

review

New Colgate Optic White Light Up

By Emeritus Professor Laurence J. Walsh AO

T

oday there are quite a few different options available in the at-home tooth whitening space.

Using carbamide peroxide or hydrogen peroxide gels in custommade vacuum formed trays has been the norm in dental practice since the 1980s. Every so often, something comes along which represents a significant improvement in that overall approach.

Colgate, who revolutionised the consumer tooth whitening market with the first paint on product (Simply White) have now come up with a clever way to extend the concept of a paint on product and combine it with an LED array to boost the overall effect.

Click and go licking the Optic White pen twice gives enough serum to do up to 4 teeth. After using the pen, a simple wipe of the bristles using a dry tissue is sufficient to keep them in shape before replacing the cap on the pen.

To make sure there is no saliva on the teeth to be bleached, immediately after brushing, I used tissue paper to blot dry both the enamel surface and the labial gingiva.

After one or two clicks from the pen, the serum appeared as a droplet that was trapped in the fine bristles at the end.

I then just simply painted the serum directly onto the enamel surface of the teeth. As the solvent evaporates, which takes around 10 to 15 seconds, I could see a thin clear coating was left behind.

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8 oral|hygiene

The binding agents in the serum localise the hydrogen peroxide against the tooth surface and also protect it from inactivation and dilution by saliva. This is quite an important technical improvement over the early paint on products.

Painting the serum on allows selective treatment of different teeth to be done.

Some patients will have uneven shades of their teeth and may only want to paint the serum onto certain teeth that have darker shades in order to bring them to a shade that is more consistent with the other teeth.

I did notice that the colour of the light produced by the LED array in the Colgate unit was different from that of other LED oral lamps that I have seen.

The wavelength was shorter (more towards the indigo end of the spectrum, rather than towards the light blue region).

Shorter wavelengths of light carry more energy and are better for activating photochemical processes.

In the normal use protocol, after the LED illuminator is removed, the dried layer of whitening serum is left on the teeth overnight. As it doesn’t dissolve in water, you can still have a drink of water before you go to sleep. The dried serum comes off easily when the teeth are brushed the next morning. Leaving the whitening serum to sit on the teeth overnight improves the overall outcome because it gains exposure time, which allows the radicals from the peroxide to penetrate into the enamel.

I found that it was easy to control the serum as it comes out from the bristles of the pen because it is moderately viscous in nature and binds well to the dried tooth surface.

Reflections overall

Let there be light nce the serum had dried, it was then time to use the next component from the system, which is the LED illuminator.

This LED array gives an even distribution of light around the anterior teeth because of the diffuser that it uses.

When using the LED light, I did not experience any heat sensations on my gingival soft tissues or in my teeth. After use, the LED device is simply rinsed off in running tap water and left to dry, ready for a recharge or for its next use.

Visible light can improve the results of bleaching through a range of different mechanisms including photochemical and photothermal processes.

O

n using this new system for some time, I found it very easy to use and quite convenient. As there is no vacuum form tray involved, the overall approach is very simple, as there are no impression or laboratory fabrication steps.

This system seems to breach the principle of “no pain, no gain” which has often been the case with tooth whitening products in the past. Freedom from sensitivity is something that all patients will value.

I did not notice any discomfort from the teeth or the soft tissues during the treatment. There were no unpleasant tastes from the tooth whitening serum.

The total package seems to be a very nice way of achieving effectiveness and safety with minimum hassle, with only a few minutes work involved. It certainly deserves a big thumbs up to the design team who were responsible for this product.

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news | EVENTS

Enter the Ultimate Practice Makeover

E

ntries are now open for the Ultimate Practice Makeover 2022 and we talk to host and co-producer, Angus Pryor, about the upcoming dental reality TV show called.

Q A

Hi Angus, so what exactly is the Ultimate Practice Makeover?

It’s basically everything we could think of that would maximise the chance for a practice to dramatically grow in the shortest possible time rolled up as a prize for the winner.

This means a really broad range of just about every kind of help we could give.

We have a very generous group of sponsors donating their wares and time and the total package is unbelievable - totalling over $90,000. There’s a full suite of marketing help, software, training, coaching, uniforms, patient communication tools and a $40,000 fit out of the reception area to take a practice from good to great in the shortest possible time.

Q A

How does it work?

Practices enter the competition.

Once the winner has been selected, we start the makeover process on 1 July 2022. The winner will receive a large range of help to take their practice to the next level.

In the process, we record the journey of the practice to turn it into a reality TV show available on Dentevents.TV. This will allow viewers to learn from the makeover experience and to think about how they can apply those elements to their own practice. Apart from that, our overwhelming desire is to create what will be compelling viewing. As far as I know, this has never been done before!

Q

Who should enter the Ultimate Practice Makeover?

10 oral|hygiene

There are a few elements to this.

It’s open to privately owned dental practices in Australia. People can apply if their practice would benefit from a $40,000 reception area fitout - generously provided by Medifit. Secondly, we want an openness to work with the various coaches and trainers to not just transform the look of the practice but also the behaviour of the practice, so we can get the maximum return.

Bottom line, if the practice needs a bit of a pick-me-up and the owners are open to learning new things and implementing them, they should definitely apply.

A

Q A

Why are you doing the Ultimate Practice Makeover?

Any excuse to get in front of a camera [laughs]! No, it just sounded like a fun project. As far as I know, no one has ever done a reality style TV show in the dental industry like this. The beauty of UPM is that we can take viewers on the journey as a practice goes through the makeover process, while the practice gets the benefit of a $90,000 makeover.

Q A

Who is involved in delivering the makeover?

We’re very lucky. Because I’ve been in the dental industry for quite a long time, I’ve been able to lean on a bunch of other businesses to come and join the project. The typical reaction has been one of great enthusiasm.

As I said earlier, I really can’t think of what else we could do to grow a practice faster in a shorter time... unless maybe we get Justin Beiber to do a concert out the front of the practice [laughs].

We have Medifit doing the fit-out, Dental4windows providing software, Jesse Green helping with consulting, Jayne Bandy helping with phone skills and Simon Palmer helping guide the process in terms of building the value of the practice. Channel D is being installed and there’s some neat tools from Erskine Dental. Then there’s an upgrade on www.dentist.com.au.

For my company, Dental Marketing Solutions, we’re basically throwing the kitchen sink at it - a new website, SEO, social media, branding, logos, consulting and so on.

With all these sponsors on board, won’t the TV show just be like one giant infomercial?

Q

No way! My number one goal is for it to be fun and educational.

The reality is that all of the sponsors involved really just wanted to help and weren’t even too worried about what kind of recognition they get for their involvement. The project only works if the final product (a reality TV show) is great viewing.

My hope is that it becomes a series that is binge-watched for years to come because of the compelling mix of the dramatic practice transformation with a good dose of storytelling. We’re hoping to do this every year although it’s pretty full on producing the show - I might need to wine and dine my wife [laughs].

A

Q A

What is the criteria to determine who wins?

Q A

How can someone enter the Ultimate Practice Makeover?

It’s a combination of the answers that we get from the entrants, plus the practice that we think we can generate the best results for within a six-month period. For example, if someone had a brand-new, immaculate practice, that would restrict our options from the fit-out point of view.

It’s quite simple, just head to ultimatepracticemakeover.com.au and enter your details. From there, if you make it through to the next round, you will receive an email asking for some more information. If you make it to the next round, there will be a zoom interview before the successful practice is selected.

Visit ultimatepracticemakeover.com.au

March/April 2022

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WIN! TheUltimate...

Practice Makeover 2022 WIN a complete public image update valued at over $90,000!

If you love being a dentist but recognise that your practice is not where it needs to be, then take heart!

For the first time ever, you could win the “Ultimate Practice Makeover” valued at over $90,000!

This package of products and services will completely update the public image of your dental practice and get you and your staff trained and on track for business success over a 6-month journey.

Hurry! Entries close on 31 May 2022.

ENTRY REQUIREMENTS To be eligible to enter, all you need is a dental practice in Australia.

Visit www.ultimatepracticemakeover.com.au (takes 2 minutes to apply) and look out for an email from us with the next steps.

Plus, if you win, you’ll need to be ready for a fun adventure as your practice is transformed from wallflower to sunflower.

Your practice’s journey will be documented on video and your results published for other practices to see – and follow along – so be prepared for some fun in the spirit of reality television as your practice is tuned for maximum success.

Visit www.ultimatepracticemakeover.com.au and apply now!

PRIZE PRIZEINCLUDES… INCLUDES… Refresh Refreshofofyour yourwaiting waitingarea areaand andsignage signage PRIZE INCLUDES… valued at up to $40,000 valued at up to $40,000 A review practice Refresh of your waiting area and signage Afull fullmarketing marketing reviewof ofyour your practice with valued at up to style $40,000 withaa“SWOT” “SWOT” styleanalysis analysis($3500 ($3500value value AA12 Channel DDplus full marketing review oftoto your practice 12month monthsubscription subscription Channel plus a your area with “SWOT” style analysis ($3500 value aTV TVafor for yourreception reception area($3100 ($3100value) value) Development ofofaamarketing strategy ADevelopment 12 month subscription to Channel D for plus marketing strategy for July 2021 ($2000 value) aJuly TVto for your reception ($3100 value) toDecember December 2021area ($2000 value) Full - -logo, colours, style Development of a marketing Fullbranding brandingpackage package logo,strategy colours,for style guide value) July toand December 2021 ($2000 guide andmore... more...($1000 ($1000 value)value) New website Full branding package logo, colours, style New websiteand andSEO SEO-package package ($12,000 guide andvalue) more... ($1000 value) ($12,000 value) Refresh ofofyour waiting area New website and SEO package Refresh your waiting areaand andsignage signage valued up ($12,000 valuedatatvalue) uptoto$40,000 $40,000 Online including Refresh of your waiting areadentist.com.au and signage Onlinemarketing marketing including dentist.com.au premium ($2000 valued at upgrade up to $40,000 premium upgrade ($2000value) value) New patient welcome packs Online marketing including dentist.com.au Newuniforms, uniforms, patient welcome packsand and more... value) premium upgrade ($2000 value) more...($2500 ($2500 value) Tablet with loaded New uniforms, patient welcome packs and Tablet withSpeedPixTM SpeedPixTM loadedfor forbetter better case conversion ($1500 value) more... ($2500 value) case conversion ($1500 value) Marketing 66months toto Tablet withconsultancy SpeedPixTM loaded for better Marketing consultancyfor for months help you “stay on plan” ($10,000 value) case ($1500 helpconversion you “stay on plan” value) ($10,000 value) Training you Marketing consultancy forteam 6 months to Trainingfor for youand andyour your team ($2000 value) help you value) “stay on plan” ($10,000 value) ($2000 Telephone training Training foranswering you and your team Telephone answering training ($3500 value) ($2000 ($3500 value) Treatment coaching Telephone answering training Treatmentpresentation presentation coaching ($2000 ($3500 ($2000value) value) New management software Treatment presentation coaching Newpractice practice management software (if ($5000 ($2000 value) (ifrequired) required) ($5000value) value) A roadmap for success New practice management software Aclear clear roadmap foryour yourfuture future success- Priceless! (ifPriceless! required) ($5000 value) A clear roadmap for your future success Priceless!

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infection | CONTROL

READ ME FOR CPD

A-dec offers dental unit biofilm testing service

W

ith the heightened focus on infection control within the dental practice, A-dec has introduced a useful new product to test the microbiological quality of dental unit water lines and surfaces accurately and easily in dental clinics.

The 2-Min Water Control System rapidly and accurately determines the presence of biofilm in dental unit waterlines in just two minutes, to enable

monitoring and action as required. It provides accurate results, eliminating incubation periods or the need to send samples to a laboratory.

A water sample is taken from the dental unit waterline and by adding a few drops of reagents, produces a result which is immediately interpreted and displayed on a Lumitester Smart device.

In the case of microbiological shifts, the dental team can then use the results to implement A-dec’s recommended maintain, monitor and shock waterline maintenance guide to ensure infection control protocols are maintained.

The advantage of this digital test device is rapid and accurate chairside results, without the long wait times and inaccurate manual verification methods of commonly used bacteria swab test kits.

14 oral|hygiene

The Lumitester uses ATP-metry – which measures the presence of Adenosine triphosphate (ATP). ATP is present in all living organisms, providing early warning of biofilm build-up at small concentrations. By counting the number of photons emitted by the bioluminescence reaction, it displays the results in RLU (Relative Light Units). This technology is widely used in the food industry and medical settings to test for harmful biofilms.

When used with the 2-Min Water Control reagent kit, ATP is converted to colony forming units (CFU) to determine the bacterial load of the water sample.

The ADA guidelines state it is good

practice to test water lines on a regular basis, for example six-monthly or annually. There has been no change in the ADA’s target level of 200 CFU/mL in dental unit waterlines, however, clinics often set their own levels such as 100 CFU/mL as a trigger point for action.

When high counts are found, the waterlines will need to undergo additional shock or sanitising treatments.

Dental unit waterlines are susceptible to biofilm build-up because of the narrow water passages in dental equipment and the slow movement of water through the water lines. The problem is greatly exacerbated if equipment has been left idle.

According to A-dec product manager, Angie Wong, this risk is reduced by using a self-contained dental unit waterline system such as that found on A-dec

chairs, treated with ICX infection control tablets. She said the patented design of the A-dec pneumatic control block also eliminated stagnant water, by circulating fresh water through the control block each time a handpiece is used.

To optimise the quality of your dental unit water, be sure to use a fresh ICX tablet and follow these steps every time you refill a self-contained water bottle: 1. Empty any water left in the bottle; 2. Drop the tablet into an empty dental unit water bottle (0.7L tablet in 0.7 litre bottle, 2L tablet in 2 litre). Avoid touching the tablet with skin; 3. Fill the bottle with water, then install it on the dental unit; and 4. Wait two minutes for the tablet to fully dissolve before using the system.

Mrs Wong said now is an ideal time to conduct a 2-minute water test to determine the status of your waterlines.

The exclusive 2-minute testing technology is available as a service on a scheduled basis by authorised and qualified A-dec dealers - similar to annual autoclave testing and validation.

For more info on the 2-minute water testing service, contact your local A-dec dealer. Dealer and A-dec Territory Manager details are available on the A-dec website or by phoning 1800-225-010.

March/April 2022

A-DEC Optimal Infection Control

GET YOUR DENTAL WATERLINE CHECKED IN 2 MINS A-dec 2-minute DWL Digital Tester and Surface Swabs Kit A-dec’s chairside solution for instant dental unit water and surface swab test result. It is rapid, reliable, easy to use and economical to help improve health risk management.

“

It is good practice to test microbial levels in water from dental unit waterlines on a regular basis, for example, six-monthly or annually

”

ADA Guidelines for Infection Prevention and Control, Fourth Edition

Contact us about checking your dental waterline today

For more information a-dec@a-dec.com.au I 1800 225 010 I australia.a-dec.com @A_decAust

@A-dec AUS

© 2021 A-dec Inc. All rights reserved.

Chairs Delivery Systems Lights Monitor Mounts Cabinets Maintenance Imaging

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A-dec offers dental unit biofilm testing service

W

ith the heightened focus on infection control within the dental practice, A-dec has introduced a useful new product to test the microbiological quality of dental unit water lines and surfaces accurately and easily in dental clinics.

The 2-Min Water Control System rapidly and accurately determines the presence of biofilm in dental unit waterlines in just two minutes, to enable

monitoring and action as required. It provides accurate results, eliminating incubation periods or the need to send samples to a laboratory.

A water sample is taken from the dental unit waterline and by adding a few drops of reagents, produces a result which is immediately interpreted and displayed on a Lumitester Smart device.

In the case of microbiological shifts, the dental team can then use the results to implement A-dec’s recommended maintain, monitor and shock waterline maintenance guide to ensure infection control protocols are maintained.

The advantage of this digital test device is rapid and accurate chairside results, without the long wait times and inaccurate manual verification methods of commonly used bacteria swab test kits.

CPD

The Lumitester uses ATP-metry – which measures the presence of Adenosine triphosphate (ATP). ATP is present in all living organisms, providing early warning of biofilm build-up at small concentrations. By counting the number of photons emitted by the bioluminescence reaction, it displays the results in RLU (Relative Light Units). This technology is widely used in the food industry and medical settings to test for harmful biofilms.

When used with the 2-Min Water Control reagent kit, ATP is converted to colony forming units (CFU) to determine the bacterial load of the water sample.

The ADA guidelines state it is good

practice to test water lines on a regular basis, for example six-monthly or annually. There has been no change in the ADA’s target level of 200 CFU/mL in dental unit waterlines, however, clinics often set their own levels such as 100 CFU/mL as a trigger point for action.

When high counts are found, the waterlines will need to undergo additional shock or sanitising treatments.

Dental unit waterlines are susceptible to biofilm build-up because of the narrow water passages in dental equipment and the slow movement of water through the water lines. The problem is greatly exacerbated if equipment has been left idle.

According to A-dec product manager, Angie Wong, this risk is reduced by using a self-contained dental unit waterline system such as that found on A-dec

14 oral|hygiene

chairs, treated with ICX infection control tablets. She said the patented design of the A-dec pneumatic control block also eliminated stagnant water, by circulating fresh water through the control block each time a handpiece is used.

To optimise the quality of your dental unit water, be sure to use a fresh ICX tablet and follow these steps every time you refill a self-contained water bottle: 1. Empty any water left in the bottle; 2. Drop the tablet into an empty dental unit water bottle (0.7L tablet in 0.7 litre bottle, 2L tablet in 2 litre). Avoid touching the tablet with skin; 3. Fill the bottle with water, then install it on the dental unit; and 4. Wait two minutes for the tablet to fully dissolve before using the system.

Mrs Wong said now is an ideal time to conduct a 2-minute water test to determine the status of your waterlines.

The exclusive 2-minute testing technology is available as a service on a scheduled basis by authorised and qualified A-dec dealers - similar to annual autoclave testing and validation.

For more info on the 2-minute water testing service, contact your local A-dec dealer. Dealer and A-dec Territory Manager details are available on the A-dec website or by phoning 1800-225-010.

Unravelling the mystery of long COVID

By Emeritus Professor Laurence J. Walsh AO

T

his article explores some of the implications for patients who develop “long COVID”, also known as “long haul COVID”, which refers to new health problems that develop 3 or more months after infection. The information presented below has been put together from reading through some 265 papers on long COVID and is designed to highlight key points of relevance for every dental professionals.

Disease trajectory fter becoming infected with SARS-CoV-2, around 40% of people will have an asymptomatic infection, while another 40% will have a mild infection and will convalesce at home. In most cases with asymptomatic or mild infections, the person will clear the virus as they recover and inflammation will subside, with little or no persisting effects over the following months - and hence there is only a low probability of long COVID (6% or less). Around 20% of people have a more severe acute illness and of those, around 1 in 4 will need to be hospitalised. More severe acute illness means there has been a larger disturbance to the host immune system and more inflammation and together these factors elevate the likelihood of having long COVID, with health issues extending from 3 months after the acute infection and not seeing a return to good health. Those patients who are in ICU and the subset who are ventilated experience a range of issues, known as post-ICU syndrome and ventilator with-

A

22 oral|hygiene

March/April 2022

March/April 2022

Question 1. The Water Control System analyses DUWL biofilm in:

Question 6. People with long COVID may experience:

a. 60 seconds b. 2 minutes c. 5 minutes d. 15 minutes

a. Fatigue and shortness of breath b. Fever c. Pneumonia and acute respiratory failure d. Delirium e. All of the above

Question 2. The Lumitester measures the presence of: a. Polysaccharides b. Lipids and nucleic acids c. Extracellular polymeric substances d. Adenosine triphosphate e. All of the above Question 3. ADA guidelines recommend action when the bacterial load in dental unit water reaches: a. 100 CFU/mL b. 200 CFU/mL c. 300 CFU/mL d. 400 CFU/mL Question 4. When high bacterial counts are found, waterlines need to undergo shock and sanitising treatments: a. True b. False Question 5. Dental unit waterlines are susceptible to biofilm build-up because of the narrow water passages in dental equipment and the slow movement of water through the water lines: a. True b. False

Question 7. Reductions in smell and taste are common with which variant of COVID: a. Only Alpha b. Only Delta c. Only Omicron d. Alpha and Delta e. Delta and Omicron Question 8. The symptoms associated with long COVID number more than: a. 10 b. 25 c. 50 d. 75 e. 100 Question 9. How many research papers did the author read to formulate the content of the article: a. 45 b. 96 c. 145 d. 265 e. 317 Question 10. Long COVID is more likely to affect women than men: a. True b. False

INSTRUCTIONS: OralHygiene™ is now offering PAID subscribers the ability to gain 2 Hours CPD credit from reading articles in this edition of the magazine and answering the questions above. To participate, contact OralHygiene for your Username and Password. Then log into the Dental Community website at www.dentalcommunity.com.au and click on the CPD Questionnaires link; select the Oral Hygiene Mar/Apr 2022 questionnaire and then click START. A score greater than 80% is required to PASS and receive CPD.

READ THE ARTICLES BELOW AND ANSWER THE QUESTIONS ONLINE AT WWW.DENTALCOMMUNITY.COM.AU - 2 HOURS OF CPD clinical | EXCELLENCE

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Harmony ergonomic scalers and curettes Combining TrueFit technology with EverEdge 2.0 sharpness for state-of-the-art ergonomics and performance that work in harmony

I

Increasing patient comfort with advanced technology

t’s no secret that most dental professionals experience fatigue, pain, and discomfort of the hand, wrist or arm on a daily basis. But since the COVID pandemic surfaced, many dentists and hygienists have been forced to switch from power instruments to hand instruments, which often exacerbates any previous workrelated discomfort from repetitive motion. “I was getting pain in my thumb joint from having to mostly hand scale since COVID,” described Deborah Deal, RDH.

How to deliver the best care while keeping your patients relaxed

I

n any health care environment, patient comfort is incredibly important. While dental practitioners are highly trained with this in mind, technology can make it even easier to ensure your patients are relaxed when in the chair. In fact, when dental practices stay up-todate on the latest technological advancements, it assures patients they’re getting the highest level of care and comfort.

It also leads to better outcomes for those patients, who are more likely to return for care and to have lifelong and multigenerational relationships with your dental practice.

One excellent use for today’s dental technology has to do with a cause near and dear to all our hearts: relieving patient anxiety safely.

No matter how much you try to make patients feel at ease, some of them will still have tremendous anxiety about dental care. You can focus on how comfortable the chair and neck support are,

28 oral|hygiene

Hoping to relieve fatigue and discomfort for clinicians, Hu-Friedy developed an innovative and ergonomic handscaling solution, the new Harmony Ergonomic Scalers and Curettes.

Combining Hu-Friedy’s proprietary TrueFit technology with its EverEdge 2.0 blade sharpness technology, the Harmony instruments provide an ergonomic solution that reduces a clinician’s pinch force grasp, improves grip, and requires less pressure on the tooth—perhaps extending the length of a dental professional’s career.

give them sunglasses to block out the harsh lighting and even create ambience with lighting and music, but they’re still tense and uncomfortable.

And the tenser your patients are, the more likely they will jolt and jump during the procedure, which makes it hard to work with instruments, drills and other equipment. This is a real concern.

For Ms Deal and many other dentists and hygienists who evaluated the Harmony scalers and curettes for DPS, these instruments provide much-needed relief from daily discomfort. “The Harmony design allows me to use a lighter grip to remove deposits and it is less stressful on my finger joints.”

TrueFit Technology & reduced hand fatigue he Harmony ergonomic scalers and curettes are designed with HuFriedy’s proprietary TrueFit technology, a sensor-based system derived by measuring millions of data points for pinch force in the finger and pressure applied to the tooth when scaling. Reducing pinch force by up to 65% and requiring less pressure to the tooth when scaling, Hu-Friedy says the instrument’s design helps to alleviate hand fatigue and injury risk due to repetitive motion. With EverEdge 2.0 technology, the working ends of the Harmony instruments are 72% sharper than others, according to Hu-Friedy, enabling calculus removal with less pressure and biomechanical stress on fingers and hands.

“The ergonomics [of the Harmony instrument] helped remove deposits easier and with less hand fatigue,” said Mary Aigeldinger, RDH and hygienist Kim Attanasi agreed. “The design allowed me to scale without using too much pressure, which, in turn, prevented fatigue.”

T

For Maureen Curran, RDH, “the instrument allows for lighter grasp, therefore reducing hand fatigue,” and Michaela Popa, DMD, said the instruments are very sturdy, precise and cause less hand fatigue. “Due to COVID, many patients have neglected their oral health; a majority had some type of periodontal disease and subgingival calculus. Hand and wrist fatigue has been a major problem,” said Lydia Pope, RDH. “This scaler worked effortlessly. I used much less pressure when scaling and it reduced my hand and wrist fatigue,” she explained. “I really like the design of the scaler combined with the EverEdge 2.0 technology,” said Jennifer Porter, RDH.

Grasp/grip and tactile sensitivity he Harmony handle easily adapts to each clinician’s individual grasp, while the optimised shape and extended silicone grip are well balanced, providing a secure and nimble grasp with optimal tactile sensitivity. “I like the shape and feel in my hand that enables a light grip,” said Ms Deal and Lauren Dennis, RDH, said, “The new ergonomic shape compared to the original handle provides more comfort, a noticeable difference in pinch force reduction.” Pamela Emard, RDH, stated, “At the end of the day when my hands are beginning to fatigue, I didn’t have to worry about the instrument slipping from my grasp.”

T

32 oral|hygiene

March/April 2022

March/April 2022

Question 11. Nasal masks are beneficial to patients in the age of COVID because:

Question 16. With EverEdge 2.0 technology, compared to others, the working ends of the Harmony instruments are sharper by:

a. Everyone is stressed and likes to relax at the dentist. b. Nitrous oxide gas kills any COVID virus in your nose. c. Patients have to breathe through their nose which lessens their exposure to respiratory droplets. d. Sedated patients can be treated faster.

a. 51% b. 65% c. 72% d. 48% e. 34%

Question 12. Five minutes of 100% oxygen eliminates nitrous oxide from the bloodstream:

Question 17. TrueFit technology reduces pinch force when scaling by:

a. True b. False Question 13. According to the article, the best way to relieve tension in a patient is to: a. Ensure they are comfortable in the chair and have neck support. b. Give them sunglasses to block out harsh lighting. c. Create ambience with lighting and music. d. Administer nitrous oxide sedation.

Question 14. Using nitrous oxide is beneficial for your practice because: a. More cooperative and relaxed patients create a less stressful environment for clinicians. b. Higher patient satisfaction can lead to more referrals. c. Higher patient satisfaction can lead to better Google reviews. d. All of the above.

Question 15. Features of the ClearView Nasal Mask include: a. Mask-in-mask design reduces ambient N2O. b. Clear outer mask that shows the patient “breathing through nose”. c. Low profile provides easier access to the patient’s mouth. d. All of the above.

To retrieve your FREE Dental Community Login:

Call (02) 9929 1900 or Email info@dentist.com.au

a. 51% b. 65% c. 72% d. 48% e. 34% Question 18. EverEdge 2.0: a. Alleviates hand fatigue and injury risk due to repetitive motion b. Creates an ergonomic handle shape compared. c. Allows a reduction in pinch force during scaling. d. Is a Blade sharpness technology e. All of the above Question 19. Harmony performed nest when assessed for: a. Pinch force reduction b. Tactile sensitivity c. Sharpness of blade d. Balance e. Overall comfort for clinician Question 20. Harmony includes an extended silicone grip provides a secure and nimble grasp and optimal tactile sensitivity: a. True b. False

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26 VIDEOS - 6+ HOURS OF EDUCATION INTERACTIVE Q&A SUPPORT WEBINARS Presented by Professor Laurence J. Walsh AO

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Learn firsthand from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control that have come in over the past 12 months, including the new guidelines from NHMRC (May 2019), Hand Hygiene Australia HOURS CPD (Sept 2019) and the CDNA (Dec 2018) as well as recent changes in Australian Standards and TGA regulations that are relevant to infection control. The course will provide a summary of how those changes interlink with one another.

The course will cover practical implementation of the new requirements and what it means for everyday dental practice. Hear about the why and the how and keep up-to-date with the changes that are happening. Bring along your questions in writing or in person for one of the Q&A sessions that will be held during the day.

COURSE TOPICS This one day course will cover changes in regulations and guidelines from 2018 to 2020 including: n n Risk-based precautions.

Hand hygiene and hand care practices. n n Addressing common errors in personal protective equipment. n n

Biofilm reduction strategies. n n Efficiency-based measures to improve workflow in instrument reprocessing and patient changeover. n n

Correct operation of mechanical cleaners and steam sterilisers. n n Wrapping and batch control identification. n n

Requirements for record keeping for instrument reprocessing. n n Correct use of chemical and biological indicators. n n

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FULL UPDATE! All the changes to Infection Control Guidelines in 2020

Professor Laurence Walsh AO is a clinically active specialist in special needs dentistry who is based at the University of Queensland in Brisbane. Laurie has been teaching infection control and clinical microbiology for over 25 years at postgraduate level and has been the chief examiner in microbiology for the RACDS for the past 20 years. He has presented invited courses and lectures on infection control across Australia and internationally. Laurie has written over 60 articles on infection control and in addition published over 320 journal papers and a further 190 technical reports and literature reviews. He serves on two committees of Standards Australia (personal protecting equipment; and instrument reprocessing) and in recent years has been an adviser to the Communicable Diseases Network of Australia and the Australian Commission on Safety and Quality in Health Care.

Laurie has been a member of the ADA Infection Control Committee since 1998. He has contributed to various protocols, guidelines and checklists and manuals used in Australia.

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by Dentevents, Dentevents, aa division division of of Main Main Street Street Publishing Publishing Pty Pty Ltd Ltd ABN ABN 74 74 065 065 490 490 655 655 •• www.dentevents.com www.dentevents.com •• info@dentist.com.au info@dentist.com.au ™ ™ and Dentevents™ ™ are trademarks of Main Street Publishing P/L © 2020 Main Street Publishing Pty Ltd Tel: (02) 9929 1900 • Fax: (02) 9929 1999 • Infection Contol Boot Camp Tel: (02) 9929 1900 • Fax: (02) 9929 1999 • Infection Contol Boot Camp and Dentevents are trademarks of Main Street Publishing P/L © 2020 Main Street Publishing Pty Ltd

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abstracts | 2022

Oral Hygiene Abstracts 2022

By Emer. Prof. Laurence Walsh AO

Preprocedural rinsing and suction attenuate risk for symptomatic COVID-19 cases

This study at the Ohio State University College of Dentistry tracked the origins of microbiota in aerosol generating procedures (AGPs): osteotomies for dental implants, tooth preparation for restorations and scaling and root planing using ultrasonic scalers. All treatment was delivered in two enclosed dental operatories measuring 10.5 × 10 × 12 feet each, with a ventilation system that allowed 6 air exchanges per hour. Subjects were recruited from the outpatient population seeking dental care and not from a COVID-19 ward. Five operators and assistants carried out the clinical procedures and at any given time, no more than 3 individuals occupied the room. Operators and assistants wore N95 masks with singleuse face shields and high-volume intraoral evacuators (HVE) were used during AGP. Patients used 1% hydrogen peroxide preprocedural rinses, in line with current CDC/AmDA guidelines.

Viruses and bacteria in aerosols were quantified by combining reverse transcriptase quantitative polymerase chain reaction (to identify and quantify SARS-CoV-2) and 16S sequencing (to characterise the entire microbiome) with fine-scale enumeration and source tracking. Linear discriminant analysis revealed significant class separation between the salivary microbiome and aerosol microbiota deposited on the operator, patient, assistant or the environment. Some 78% of the microbiota in condensate could be traced to the dental irrigant, while saliva contributed to a median of 0% of aerosol microbiota. They also identified low copy numbers of SARS-CoV-2 virus in the saliva of several asymptomatic patients but none in aerosols generated from these patients. Undetectable viral levels in the aerosol were most likely due to low salivary loads, coupled with dilution of the saliva by the irrigant and at-source aerosol mitigation with a high-volume suction device. Together, the bacterial and viral data encourage us to conclude that when infection control measures (pre-procedural rinsing and high volume evacuation) are used, such as preoperative mouth rinses and intraoral high-volume evacuation, dental treatment is not a factor in increasing the risk for transmission of SARS-CoV-2 in asymptomatic patients and that infection control practices are sufficiently capable of protecting personnel and patients from exposure to potential pathogens.

Meethill AP et al. Sources of SARS-CoV-2 and other microorganisms in dental aerosols. J. Dent. Res. 2021, 100(8): 817-823.

A trusted source of accurate advice for infection prevention and control

Like other frontline healthcare workers, a major challenge faced by dentists was having to adjust their services and workflows to ensure patient safety and minimise risk of transmission during the COVID pandemic. Unfortunately, a “disinfodemic” of poor quality or inaccurate advice driven by social media has plagued health advice to the public and to professionals, causing problems for clinicians seeking quality and timely advice. This study examined dentists’ knowledge, preparedness and experiences of managing COVID-19 in Australia. A cross-sectional online survey of dentists with a current membership with The Australian Dental Association (ADA) was conducted between March and April 2021. Practising dentists holding a current ADA membership were invited to participate. At the time the study was conducted, ADA had 11,173 registered practising dentists. Participation was voluntary. An online survey was developed on the Research Electronic Data Capture (REDcap) platform. The survey questions were developed by a panel of experts from dentistry and infection prevention and disease control. COVID-19 had a significant impact in oral healthcare in Australia. Of the 368 survey responses, most dentists (72.3%) reported having a good level of knowledge about COVID-19, with most visiting the ADA Federal COVID-19 (74.7%) and state/territory department of health websites (62.8%), respectively to source up-todate information. The ADA COVID microsite and its resources were used heavily as an authoritative source of information to inform procedures and protocols for clinical practice. Most dentists (87.6%) felt prepared to manage COVID-19 into the future, although 66% reported not receiving training or certification in the use of PPE. Over half (58.7%) reported not being concerned about contracting SARS-CoV-2 at work, with some (28.9%, n = 98/339) feeling more stressed than usual and having heavier workloads. Overall, dentistry in Australia has adapted to the varied challenges raised by the pandemic. Comprehensive training and detailed guidelines, especially those provided by the ADA’s national Infection Control Committee, were fundamental for successful patient management during the COVID-19 outbreak. Australian dentists reported constructive, beneficial and productive experiential learnings and changes amid the pandemic and gained benefit from multiple modes of support for the current pandemic.

Castillo CS et al. Australian dentists’ knowledge, preparedness and experiences during the COVID-19 pandemic.

Infection, Disease and Health. 2021;27(1):49-57.

Note: A qualitative analysis of the experiences of dentists from the previous study has also been published as a separate article: Nahidi S et al: “We will have to learn to live with it”: Australian dentists’ experiences during the COVID-19 pandemic. Infection, Disease & Health 2021 https://doi.org/10.1016/j.idh.2021.11.001

20 oral|hygiene

March/April 2022

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infection | CONTROL

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Unravelling the mystery of long COVID

By Emeritus Professor Laurence J. Walsh AO

T

his article explores some of the implications for patients who develop “long COVID”, also known as “long haul COVID”, which refers to new health problems that develop 3 or more months after infection. The information presented below has been put together from reading through some 265 papers on long COVID and is designed to highlight key points of relevance for every dental professionals.

22 oral|hygiene

Disease trajectory fter becoming infected with SARS-CoV-2, around 40% of people will have an asymptomatic infection, while another 40% will have a mild infection and will convalesce at home. In most cases with asymptomatic or mild infections, the person will clear the virus as they recover and inflammation will subside, with little or no persisting effects over the following months - and hence there is only a low probability of long COVID (6% or less). Around 20% of people have a more severe acute illness and of those, around 1 in 4 will need to be hospitalised. More severe acute illness means there has been a larger disturbance to the host immune system and more inflammation and together these factors elevate the likelihood of having long COVID, with health issues extending from 3 months after the acute infection and not seeing a return to good health. Those patients who are in ICU and the subset who are ventilated experience a range of issues, known as post-ICU syndrome and ventilator withdrawal,

A

March/April 2022

infection | CONTROL Table 1.

Risk factors for Long COVID

Female gender

Table 2.

Common symptoms during long COVID

Central nervous system

Older age (being elderly)

Fatigue

Acute infection

“Brain fog” (comprehension and memory issues)

More severe initial symptoms

Dizziness

More symptoms

Low energy levels

Hospitalisation

Headache

Elevated C-reactive protein

Loss of smell

Elevated IL-6

Loss of taste

Pre-existing disease

Loss of hearing

Obesity

Ear pain

Diabetes mellitus

Orofacial pain

Hypertension

Sleep problems

Ischaemic heart disease

Anxiety

Chronic obstructive pulmonary disease

PTSD

Chronic kidney disease

Depression

Psychiatric illness

Respiratory system Shortness of breath

respectively. These follow after the acute infection and after those subside, long COVID is then likely to follow.

Post-ICU hen someone has been in deep sedation in the ICU, they will experience a range of impairments that relates to the medicines used (especially those for paralysis and sedation) and their lack of mobility. Memory loss, problems with maintaining attention and reduced executive function are common issues after being in deep sedation for several weeks. Likewise, due to being immobile, reduced joint mobility, muscle weakness and muscle wasting occur. Changes in a person’s cognitive status and physical status from their time in intensive care ripple on over time, despite the fact the person has now been discharged back home. Other issues include the fear of infecting others and of being reinfected. These may be a significant mental burden that continues for some months.

Lack of appetite can arise because the person has not had an oral intake for a prolonged period. This can be associated with some atrophy of the masticatory muscles due to reduced oral activity.

W

Risk factors for long COVID hile hospitalisation for the acute infection is a major risk factor for having long COVID, raising the probability to around 30%, it is not clear how it effects the duration of long COVID and information about the longevity of long COVID is limited (less than 2 years of follow-up to date).

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March/April 2022

Change in voice Lower voice volume GIT Nausea Diarrhoea Gut flora dysbiosis Lack of appetite Acid reflux Abdominal pain Musculoskeletal Weakness Joint pain Skin and appendages Skin hypo- or hyper-pigmentation Nail abnormalities Hair loss Telogen effluvium Androgenic alopecia Alopecia areata

oral|hygiene

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Image courtesy British Medical Journal

The risk of developing long Covid is enhanced when certain risk factors are present (Table 1). The risk factors that related to pre-existing disease also make the initial infection more severe and more likely to lead to hospitalisation, with an accompanying sustained and intense “cytokine storm”. Of note, males will typically get worse acute COVID than females, but males are less likely to develop long COVID.

Aetiology of long COVID he basic cause of what is going wrong in patients with long COVID is lingering disease and persisting inflammation. There may be hidden reservoirs of virus, as well as secondary effects of acute infection with SARS-CoV-2 on the

T

24 oral|hygiene

gut microbiome and this then influences other body systems. There is certainly good evidence for significance immune and inflammatory perturbations in long COVID, with dysfunction and dysregulation of normal endocrine systems such as the pituitary-adrenal axis and the thyroid.

In a similar way, within the lungs, areas where the virus has not been cleared may go on to become isolated foci of fibrosis, with neutrophil extracellular traps.

There is dysregulation of immune responses, with autoimmunity and excessive inflammation within the central nervous system. The heightened inflammation can be thought of as a less severe version of the cytokine storm from the acute illness. Any persisting virus will drive an associated host immune response against the pathogen. The presence of the

spike protein in the brain and associated inflammation could be responsible for chronic inflammation, that then manifests clinically as fatigue and “brain fog”.

Common symptoms during long COVID here are over 100 documented symptoms that can develop in long COVID and most people (80%) with the condition will have 2 or more symptoms that require attention. These symptoms affect multiple systems of the body and are not contained purely to the respiratory tract.

They also vary according to which strain of the virus caused the infection. Reductions in smell and taste are very common with Alpha and Delta variants, but not with Omicron variants.

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infection | CONTROL Differences in symptoms: Acute COVID vs long COVID ypically, people with long COVID suffer from fatigue and shortness of breath, but they usually do not show fever which is a classic sign seen during the acute infection. In acute COVID, pneumonia and acute respiratory failure occur, while in long COVID a persist shortness of breath may be caused by progressive fibrosis of the lungs. In long COVID, people can suffer from a range of heart problems including myocarditis, cardiomyopathy and arrhythmias and they can experience chest pain due to cardiac issues.

They can develop joint pain and stiffness, which do not occur in acute COVID. In terms of mental health issues, in acute COVID the infection can trigger delirium, while in long COVID people experience disturbed sleep, depression, anxiety and PTSD. There are many other ways in which the anomalies seen differ between acute COVID and long COVID. Hence, long COVID is not merely an attenuation or persistence of the acute phase of the infection.

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Long COVID and dental care epending on the pattern of symptoms, a range of modifications to care may be needed. Those with fatigue will be less able to withstand treatment, so the length of the appointment and also the timing will need to be adjusted. A patient with joint pain or muscle weakness will struggle getting into and out of the chair (or hoist), so we will need to take additional care with the patient’s ingress and egress procedures. Patients with long COVID often develop postural orthostatic tachycardia and this can be exacerbated when there are rapid changes in their body position, so any changes in the position of the dental chair need to be made slowly to make sure the patient is comfortable. Likewise, in patients with arthralgia or chronic pain, we need to be aware of what they can tolerate and ensure that are kept in a comfortable position during their appointment.

If the patient has had significant coagulopathy during their COVID illness, they may taking antiplatelet and anticoagulant medicines and hence excessive bleeding needs to be prevented using local measures. Those with shortness of breath will

D

26 oral|hygiene

be less mobile and may struggle using stairs. Using a pulse oximeter to monitor the oxygen saturation would be prudent and would inform decisions about whether the patient needs supplemental oxygen support. If a patient with long COVID reports chest pain, that could reflect a range of underlying problems, including heart disease which has been worsened by their COVID illness.

Patients with long COVID can develop new psychiatric illnesses, particularly those related to anxiety and this may lead to them being medicated with antianxiety and anti-depressive medicines and in turn to salivary gland hypofunction. This problem has been noted to occur in about 25% of individuals with long COVID in over 6 studies. More aggressive prevention will be needed because of the resulting increased risks for dental caries and non-carious loss of tooth structure and the use of home care products will need to be adjusted to maximise oral comfort.

When patients are experiencing brain fog and have major issues with memory, their ability to make decisions and reduced executive power, we need to consider whether they still have capacity to consent. If they lack capacity, we will then need to then involve other decisionmakers for the patient.

Long term health care hose with long COVID will need closer monitoring for health issues.

Often, new health issues will require surveillance at the community general medical practice level and those with more severe disease patterns will be seeing additional medical specialists and also attending hospitals. Hence, it is essential to make sure the medical history information for these patients is updated at each visit.

Those who have developed coronary damage, lung fibrosis or diabetes are particularly likely to need specialist medical care for the foreseeable future and this could be a significant burden in their life going forward. As time passes, more will be known about the various presentations of long COVID and it is likely that the list of the more than 100 persistent symptoms of long COVID that have been documented in the literature will continue to grow. Hence, these patients need to be watched closely for new oral health problems, since some conditions may develop

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that are yet to be documented. At the same time, we need to maintain a watching brief for these patients and recognise the need to refer them for urgent care if they develop symptoms that are life-threatening.

About the author Emeritus Professor Laurence J. Walsh AO is a specialist in special needs den‑ tistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Dentistry, including 21 years as Professor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical microbiology. Laurie has served as Chief Examiner in Microbiology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years. His published research work includes over 330 journal papers, with a citation count of over 15,400 citations in the literature. Laurie holds patents in 7 families of dental technologies. He is cur‑ rently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020.

Recommended reading 1. Crook H et al. Long covid- mechanisms, risk factors and management. BMJ 2021;374:n1648. doi: 10.1136/bmj.n1648.

2. Garg M et al. The conundrum of ‘Long-COVID-19’: a narrative review. Int J Gen Med 2021;14:2491-2506. doi: 10.2147/ IJGM.S316708.

3. Hayes LD et al. More Than 100 persistent symptoms of SARS-CoV-2 (Long COVID): a scoping review. Front Med 2021;8:750378. doi: 10.3389/fmed.2021.750378.

4. Iqbal FM et al. Characteristics and predictors of acute and chronic post-COVID syndrome: A systematic review and metaanalysis. doi: 10.1016/j.eclinm.2021.100899 5. Marchesan JT et al. The “oral” history of COVID-19: Primary infection, salivary transmission, and post-acute implications. J Periodontol 2021;92(10):1357-1367. doi: 10.1002/JPER.21-0277.

6. Minblit D et al. Legacy of COVID-19 infection in children: long-COVID will have a lifelong health/economic impact.

Arch Dis Child 2021 doi: 10.1136/archdischild-2021-321882.

7. Pavli A et al. Post-COVID syndrome: incidence, clinical spectrum, and challenges for primary healthcare professionals. Arch Med Res 2021;52(6):575-581. doi: 10.1016/j.arcmed.2021.03.010.

8. Renaud-Charest O et al. Onset and frequency of depression in post-COVID-19 syndrome: A systematic review. J Psychiatr Res 2021;144:129-137. doi: 10.1016/j.jpsychires.2021.09.054.

9. Yan Z et al. Long COVID-19 syndrome: a comprehensive review of Its effect on various organ systems and recommendation on rehabilitation plans. Biomedicines 2021;9(8):966. doi: 10.3390/biomedicines9080966.

10. Yong S, Liu S. Proposed subtypes of post-COVID-19 syndrome (or long-COVID) and their respective potential therapies. Rev Med Virol 2021 DOI: 10.1002/rmv.2315.

March/April 2022

clinical | EXCELLENCE

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CPD

Increasing patient comfort with advanced technology How to deliver the best care while keeping your patients relaxed

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n any health care environment, patient comfort is incredibly important. While dental practitioners are highly trained with this in mind, technology can make it even easier to ensure your patients are relaxed when in the chair. In fact, when dental practices stay up-todate on the latest technological advancements, it assures patients they’re getting the highest level of care and comfort.

It also leads to better outcomes for those patients, who are more likely to return for care and to have lifelong and multigenerational relationships with your dental practice.

28 oral|hygiene

One excellent use for today’s dental technology has to do with a cause near and dear to all our hearts: relieving patient anxiety safely.

No matter how much you try to make patients feel at ease, some of them will still have tremendous anxiety about dental care. You can focus on how comfortable the chair and neck support are,

give them sunglasses to block out the harsh lighting and even create ambience with lighting and music, but they’re still tense and uncomfortable.

And the tenser your patients are, the more likely they will jolt and jump during the procedure, which makes it hard to work with instruments, drills and other equipment. This is a real concern.

March/April 2022

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clinical | EXCELLENCE In those situations, one way to deliver treatment safely is to use nitrous oxide/oxygen sedation (relative analgesia), which can make the patient experience much less stressful. It keeps them calm throughout the procedure, while actually helping them feel as if the time has passed faster. This happens with minimal side effects - just five minutes of 100% oxygen eliminates nitrous oxide from the bloodstream.

Using nitrous oxide is also beneficial for the practice. More cooperative and relaxed patients create a less stressful environment for clinicians. Higher patient satisfaction can then also lead to more referrals and better reviews for the practice.

Nitrous oxide and oxygen delivery is easily adjustable so you can provide the right mix for each patient. While analogue and digital technology accomplish the same job, the Accutron™ Digital Ultra™ Flowmeter actually has more safety features than other models. Plus, its completely flat surface allows for easy disinfection or barrier protection.

“There’s no doubt that patient comfort is among the top priorities amongst dental practices today. Combining best practices with technology is the most effective way to ensure patient comfort while providing a superior patient experience...”

Best practice for using nitrous oxide dictates that practices use a single-use nasal mask and tubing that is sterilised per the manufacturer’s recommendations.

Nasal masks are beneficial to patients in the age of COVID in that they require patients to breathe through their nose and lessen their exposure to respiratory droplets.

The ClearView™ Nasal Mask uses a patient demand system for administering gas, which is designed to match the patient’s flow of breathing. And the soft inner mask creates a better seal against the patient’s face for better administration of gas.

Features of the ClearView Nasal Mask include: • Mask-in-mask design to reduce ambient N2O; • Clear outer mask that shows the patient “breathing through nose”; and • Low profile that provides easier access to the patient’s mouth.

The Axess™ Low Profile Nasal Mask is a single-use mask that works with positive flow systems. Its low profile offers better visibility and better access to a patient’s mouth. The nasal mask fits comfortably and snug and its lightweight circuit tubing makes it easier for patients to move without displacing the mask.

To help make patients even more comfortable and relaxed, both the ClearView and the Axess Nasal Masks come in scents and colous that appeal to patients.

There’s no doubt that patient comfort is among the top priorities amongst dental practices today. Combining best practices with technology is the most effective way to ensure patient comfort while providing a superior patient experience.

30 oral|hygiene

March/April 2022

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clinical | EXCELLENCE

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Harmony ergonomic scalers and curettes Combining TrueFit technology with EverEdge 2.0 sharpness for state-of-the-art ergonomics and performance that work in harmony

I

t’s no secret that most dental professionals experience fatigue, pain, and discomfort of the hand, wrist or arm on a daily basis. But since the COVID pandemic surfaced, many dentists and hygienists have been forced to switch from power instruments to hand instruments, which often exacerbates any previous workrelated discomfort from repetitive motion. “I was getting pain in my thumb joint from having to mostly hand scale since COVID,” described Deborah Deal, RDH. Hoping to relieve fatigue and discomfort for clinicians, Hu-Friedy developed an innovative and ergonomic handscaling solution, the new Harmony Ergonomic Scalers and Curettes.

Combining Hu-Friedy’s proprietary TrueFit technology with its EverEdge 2.0 blade sharpness technology, the Harmony instruments provide an ergonomic solution that reduces a clinician’s pinch force grasp, improves grip, and requires less pressure on the tooth—perhaps extending the length of a dental professional’s career.

32 oral|hygiene

For Ms Deal and many other dentists and hygienists who evaluated the Harmony scalers and curettes for DPS, these instruments provide much-needed relief from daily discomfort. “The Harmony design allows me to use a lighter grip to remove deposits and it is less stressful on my finger joints.”

TrueFit Technology & reduced hand fatigue he Harmony ergonomic scalers and curettes are designed with HuFriedy’s proprietary TrueFit technology, a sensor-based system derived by measuring millions of data points for pinch force in the finger and pressure applied to the tooth when scaling. Reducing pinch force by up to 65% and requiring less pressure to the tooth when scaling, Hu-Friedy says the instrument’s design helps to alleviate hand fatigue and injury risk due to repetitive motion. With EverEdge 2.0 technology, the working ends of the Harmony instruments are 72% sharper than others, according to Hu-Friedy, enabling calculus removal with less pressure and biomechanical stress on fingers and hands.

“The ergonomics [of the Harmony instrument] helped remove deposits easier and with less hand fatigue,” said Mary Aigeldinger, RDH and hygienist Kim Attanasi agreed. “The design allowed me to scale without using too much pressure, which, in turn, prevented fatigue.”

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For Maureen Curran, RDH, “the instrument allows for lighter grasp, therefore reducing hand fatigue,” and Michaela Popa, DMD, said the instruments are very sturdy, precise and cause less hand fatigue. “Due to COVID, many patients have neglected their oral health; a majority had some type of periodontal disease and subgingival calculus. Hand and wrist fatigue has been a major problem,” said Lydia Pope, RDH. “This scaler worked effortlessly. I used much less pressure when scaling and it reduced my hand and wrist fatigue,” she explained. “I really like the design of the scaler combined with the EverEdge 2.0 technology,” said Jennifer Porter, RDH.

Grasp/grip and tactile sensitivity he Harmony handle easily adapts to each clinician’s individual grasp, while the optimised shape and extended silicone grip are well balanced, providing a secure and nimble grasp with optimal tactile sensitivity. “I like the shape and feel in my hand that enables a light grip,” said Ms Deal and Lauren Dennis, RDH, said, “The new ergonomic shape compared to the original handle provides more comfort, a noticeable difference in pinch force reduction.” Pamela Emard, RDH, stated, “At the end of the day when my hands are beginning to fatigue, I didn’t have to worry about the instrument slipping from my grasp.”

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March/April 2022

YOUYOU REQUIRE MAXIMUM EFFICIENCY. YOU REQUIRE MAXIMUM EFFIC REQUIRE MAXIMUM EFFICIENCY. YOUYOU DEMAND COMPLETE ORGANIZATION. YOU DEMAND COMPLETE DEMAND COMPLETE ORGANIZATION. HUFRIEDYGROUP INTRODUCES HUFRIEDYG YOUYOU NEED ENSURED SAFETY. HUFRIEDYGROUP YOU NEED ENSURED S NEED ENSURED SAFETY. INTRODUCES ™ ™ YOU DESERVE INFINITE CONFIDENCE. YOU DESERVE HUFRIEDYGROUP INTRODUCES YOU DESERVE INFINITE CONFIDENCE. HUFRIEDYG HUFRIEDYGROUP INTRODUCES

HARMONY HAR HARMONY ™™ HARMONY HAR HARMONY

YOU REQUIRE MAXIMUM EFFICIENCY. SCIENTIFICALLY PROVEN ERGONOMIC SCIENTIFICA SCIENTIFICALLY PROVEN ERGONOMIC YOU DEMAND COMPLETE ORGANIZ SCALERS AND CURETTES SCALERS AN SCALERS AND CURETTES HUFRIEDYGROUP YOU NEED ENSURED SAFETY. SCIENTIFICALLY PROVEN ERGONOMIC SCIENTIFICA SCIENTIFICALLY PROVEN ERGONOMIC DESERVE INFIN HUFRIEDYGROUP SCALERS AND CURETTES YOU SCALERS AN SCALERS AND CURETTES

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To more about how IMS can Hu-Friedy Mfg. LLC, 1666 E. Touhy Ave., Desenhance Plaines, IL 60018 | Hu-Friedy.com VISIT USCo., ONLINE AT about HU-FRIEDY.COM/PerfectFit To learn learn more about how IMS enhance VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit To learn more howcan IMS can enhance All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit your practice visit Hu-Friedy.com/Infinity ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. your practice visit ©2016 Hu-Fried y Mfg. Co., LLC. All Hu-Friedy.com/Infinity rights reserved. its affiliates or related companies, unless otherwise noted. your practice visit Hu-Friedy.com/Infinity ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. ©2017 Mfg. Co., rights reserved. ©2021 Hu-Friedy Co.,All rights reserved. ©2017 Hu-Friedy Hu-Friedy Mfg.Mfg. Co., LLC. LLC. AllLLC. rightsAll reserved.

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clinical | EXCELLENCE Ms Curran said, “Angled lower anterior teeth from the lingual were a breeze to clean without pinching my handle firmly.” Ms Pope said the handle’s shape allowed her to apply a looser, more relaxed grip while removing deposits and it was easy to feel and remove subgingival calculus. “Tactile sensitivity was off the charts,” she added.

“The instrument’s design allowed me to scale without using too much pressure, which, in turn, prevented fatigue...”

Increased efficiency armony Ergonomic Scalers and Curettes “make my job easier and quicker!” exclaimed Laura Inman, RDH and hygienist Brooke McCorvey said she “loves the way it adapts. Ease and efficiency are pretty awesome.” Ms Pope used a Harmony scaler on subgingival

H

Harmony Instruments • Designed with TrueFit technology to maximize ergonomics and reduce pinch force.

• Scaler blade is 72% sharper to enable calculus removal with less pressure.

• Harmony handle adapts to each clinician’s individual grasp.

• Extended silicone grip provides a secure and nimble grasp and optimal tactile sensitivity. calculus and said, “Less strokes were used per tooth. Calculus was removed with ease [and there was] less pain and discomfort for the patient.” The Harmony design allowed Ms Curran “to save time during appointments and have less aches at the end of the day,” and Ms Aigeldinger said she wanted to use the instrument frequently, especially when a patient had heavy, hard deposits.

Overall satisfaction oting that proper instrumentation “makes our jobs more efficient with less stress,” Ms Curran said, “I really like the overall Harmony design and plan to order more.” Ms Pope said she likes everything about the Harmony instruments and “wouldn’t change a thing,” while Ms Inman concluded, “I am already recommending these instruments and am planning on ordering more.”

N

This article originally appeared in Dental Product Shopper. Reprinted with permission.

34 oral|hygiene

Product Evaluation Snapshot Criteria based on average score (out of 5)

Pinch force reduction Reduction in pressure applied to tooth Balance

Tactile sensitivity Secure and nimble grasp with extended silicone grips Sharpness of blade (EverEdge 2.0) Overall comfort for clinician SECTION A AVERAGE SECTION B OVERALL SATISFACTION

HARMONY ERGONOMIC SCALERS AND CURETTES

FINAL SCORE

AVERAGE OF SECTIONS A AND B

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