NU-BIRD DENTAL BLOG

Dentistry, Technology & HVEvolution

Thu, 01 May 2025 16:56:25 GMT

The Idea HVE has to have 8mm bore opening is scientifically FLAWED!

Dentistry Technology & HVEvolution

Written by Laura Emmons RDH 2015

In recent years, the dental industry has experienced many changes. The evolution of dentistry has

caused a quiet revolution with those who tend to resist change. Post 2020 due to Covid 19 outbreak, New State health regulation mandates and CDC compliance have been adopted in many states and provinces in the USA and Canada. Clinicians who have worked in dentistry for years are being challenged to “bite the bullet” to leave old outdated methods of practice and use advanced technology devices. Many clinics are feeling pressure to evolve just to keep up and comply with the new standards of care.

There are now new HVE hybrid evacuation devices available to help dental professionals perform procedures with better health and safety along with improved ergonomics.

Many decades ago, In order to manage pooling water in the oral cavity during dental procedures, patients use to swish with water and spit in a round shaped bowl called a Cuspidor. As the years passed, air evacuation systems came along. The dentist used a long strait evacuator tube to suction out the water in the mouth during procedures. Later, dental hygienists expanded the dental profession who were specially trained to clean a patients teeth using hand scaling instrumentation. The process of cleaning teeth by hand was found to be very labor intensive. Magneto restrictive devices came out in the 1950s which helped speed up scaling procedures in removing deposits on teeth. These new scaling devices were used mainly for patients with heavy stain and calculus.

Back then, many hygiene operatories were not plumbed for HVE or highspeed handpieces. Hygienists were forced to work in a operatory which usually only had basicially a chair and light, cuspidor a slow speed prophy angle and a low-volume evacuator (LVE) for evacuation of their paitents mouth. Use of a saliva ejector was easy to bend and adapt to the patient’s mouth and usually was hung inside the cheek allowing evacuation to be “hands free” while the hygienist used a mouth mirror in one hand and a scaler in the other.

Often, the hygienist required help from a dental assistant to use High volume evacuation to suction the water during ultrasonic scaling procedures where a high volume of water spray was occuring. When no assistant was available or if the operatory was not plumbed for HVE, the hygienist had to resort to using a

saliva ejector to manage all the excess waterspray.

Technology advanced quickly with improvements. Advanced magnetorestrictive) devices came on the

market along with air polishers and lasers. These devices were found beneficial and time saving for providers to use. Some clinicians who used standard HVE by themselves had ergonomic issues which cause repetitve strain injuries in the hand, wrist,arm, neck and back thus the thought of using HVE became a barrier to its use. The main complaint was the hose felt too heavy and stiff to angle in

the mouth. Due to the ease-of-use and convenience, hygienists gravitated to just using saliva ejectors and hands free apparatus for water management.

Photo above; Dentsply Cavitron (1)

Due to the 2020 outbreak of Covid 19, new health concerns awakened the dental community to a higher awareness of aerosols and the need for better protecting providers as well as patients. While illnesses are commonly shared in the workplace, the risk of exposure increases significantly for hygienists using powered instrumentation such as ultrasonic and air polishing devices. Some studies have shown bacteria and viruses can rapidly spread through spatter and aerosols generated from dental procedures and while it can’t be proven that a viral infection can spread via contaminated aerosols resulting from powered instrumentation it’s certainly offers one possible explanation for office wide epidemic’s that commonly occur. (6)

Powered instrumentation is in widespread use in North America, yet safety standards and regulations

concerning the use has not sufficiently evolved. Currently 35 out of the 50 states in the USA claim to have

adopted CDC infection control guidelines for dental infection control standards. 15 of these states have

adopted the guidelines within the last two years starting what appears to be a new trend. In the CDC

guidelines under (PPE)personal protective equipment it clearly states : “Aerosols can remain airborne for long

extended periods of time and may be inhaled. Aerosols should not be confused with the large particles that makes up the bulk of the

spray from hand-pieces and ultrasonic scaler‘s. The spray might contain certain aerosols (ie. particles of respirable size <10um).

“Appropriate work practices including use of dental dams (172) and high velocity air evacuation should minimize dissemination

of droplets, spatter and aerosols.(1)

In the CDC guidelines section under the Blood-borne pathogen‘s and aerosols section it also states: “To

prevent contact with splashes and spatter dental healthcare personnel should position patients properly and make appropriate use

of barriers (eg.,Face shields surgical masks gowns,rubber dams and high-volume evacuators. ” (2)

Some clinicians are unaware and or ignorant where aerosol management is concerned. Few agencies

enforce compliance. Infection control guidelines and regulations are currently under review in the few

remaining states. We anticipate these reviews will result in new updated rule changes to include

Manditory use of HVE.

While HVE is a top recommended solution for controlling aerosols and reducing risk of contamination

by the ADA (2) and CDC,(1) some clinicians still at their own risk, use saliva ejectors. Isolation devices are also a common choice even though many have been scientifically proven to offer no safety protection from contaminated aerosols.

So what exactly is high volume/velocity evacuation(HVE)?

Definitions of Terms:

HVE: High Volume Evacuator: Device which can remove a large volume of cubic feet air in a short

amount of time.

CFM : Air volume measured in Cubic feet of air per minute.

InHg: Static pressure meassurement in inches of mercury.

Velocity : A speed function of cubic feet per minute and inches of mercury in air flow.

Velocity equals the speed of which air travels through a device.

High Velocity Evacuation: A function of a given amount of cubic feet per minute(CFM) and a measured

amount of inches of mercury (inmg), usually with an increase in air speed near a port or opening.

Terminus end point : The very tip or end of the device being used a the user end.

LVE: Low volume evacuator is a device with low cubic feet per minute.

In the article “Aerosols and Splatter in Dentistry” by Stephen K. Harrel and John Molinari,(2) For a suction system To

be classified as an HVE, it must remove a large volume of air within a short period.” (7)

Air volume is measured in cubic feet per minute (CFM). While both HVE and LVE maintain the same

static vacuum pressure (InHg) using the same vacuum system, the difference in air volume and velocity perfomance is due to device design. Saliva ejectors cannot remove enough air volume to be classified as HVE due to the small diameter of the tubing and not effective against aerosols because it pulls a significantly lower volume of air. * An HVE can remove airborne contamination as long as it can pull a large volume of air and offer a wide air path footprint.

So why do we need to be using HVE ?

As discussed earlier, research shows that aerosols and splatter produced during dental procedures do

contain saliva, blood, bacteria and pathogen’s. This risks the spread of illnesses such as common cold,

Flu, influenza, herpes,SARS, Hep C, Candida Aures,TB and Covid 19 virus which especially is a concern for dental providers who work on patients with undiagnosed or undetected cases. Many clinicians have been duped into believing it is OK to only use a saliva ejector to manage the aerosolized water spray. From an infection control standpoint, providers don’t realize what is invisibly going on when generating aerosols. HVE offers the best solution for controlling aerosolized particles before they leave the mouth and studies have shown HVE to reduce over 90% of aerosols. (7)

Dental clinics have air compressors and a separate vacuum system.

The compressor runs by an electric motor which has pistons that pressurize air for the air water syringe and air motors such as high and low speed handpieces.

The vacuum system unit has its own electric motor which drives an impeller in order to create a vacuum. If a vacuum pump does not have enough inches of mercury (inhg)( Velocity) regardless of CFM

capacity, it can lower evacuation performance. Also when there are more users on the suction system, it tends to lower CFM and InHg. Dental maintence/repair technicians normally set the pressure switch to 10 to 12 InHg level of performance. Some larger vacuum units were set around 18-20 Hg and designed to be used in larger offices with several operatories with multiple HVE suctions were in use at the same time. I worked in an office where the vacuum system was rated for only six users. Currently, the office has 12 operatories and up to 12 users at any given point. The system is completely inadequate in suction performance when there are several clinicians using their HV evacuators at the same time.

In the article “ Aerosols and Splatter In Dentistry “ by Harrell and Molinary, it

states, “The usual HVE used in dentistry has a large opening (usually 8 mm or greater) and is attached to an evacuation system that will remove a large volume of air (up to 100 cubic ft per minute).”(7)

This article was written in 2004 twenty years ago. Back then, a straight HVE tip plugged into the valve/tubing was the only main apparatus used at the terminus end point. There were really no other options available for clinicans to use. So, when they mentioned “ evacuation system pulling 100 cubic feet per minute” and that it had to be “ 8mm or greater ,” with all due respect the reference has to be about the strength of the vacuum motor and size of tubing used in installation to the on/off valve! 100 cubic feet per minute? Are you serious? This is an extreme exaggeration as most units would only be capable of 1/10th of that level of performance.

A simple math equation for calculating airflow measurments and speed is shown in the box on the left.

To simplify the equation in laymans terms,

1 cubic foot of air is equal to about 7.5 gallons.

100 cubic feet of air is approximately 748 gallons. A visual example would be to take two of the largest lawn and leaf garbage bags which are 42 gallons each and fill them with air. and then extract all the air from both bags in 1 minute! Hmmm… That is a task I don’t believe even NASA could accomplish. I have questions and concerns for any company which would base a claim like this using inacurate information in an attempt to bring credibility in the promotion of a product. The statement that an HVE has to have 8mm bore or larger is scientifically flawed.

I checked a healthy new evacuation system in the dental office where I work and it performed at a range of 9-10 cubic ft per minute with a static reading of 12 InHg at the valve opening terminus end!

100 CFM per minute may be the evacuation motor’s capacity but when airflow travels through long plumbed lines and through the hose tubing reaching to the terminus end of a device, it can be quite a different story especially if the system is not new, has a long way to travel through the plumbing and hoses, and has clogged lines.

In order to determine what the mean level for adequate HVE requires more research.

For now, providers should be using systems and devices which maximize air flow performance.

So what would one do to accurately measure cubic feet per minute (CFM)?

Cubic feet per minute of airflow is a difficult task to measure and this type of testing requires very

specialized equipment. Dental office repair technicians usually only check for inches of mercury (inhg).

This is only half the equation. To be more acurate, they would need to go into each clinical operatory and

actually check cubic feet per minute (CFM) at each station. Measuring cubic feet per minute at each

station is a necessity in order to determine the health of the system.

**Combinations of both static (InHg) and cubic feet per minute (CFM) is necessary to have a

healthy vacuum system.

A elementary timed water test can reveal a range of suction volume performance in devices

at their terminus end point. Use a stop watch and 1 cup of water and

measure the speed of how long it takes to suck up that water using a

straight HVE tip, then use the same procedure with a saliva ejector to set

the high and low benchmarks. One can then test other suction devices in

order to measure their performance.

Another scientific way to test air path width at the terminus end point is to

spread 1/4 cup salt or talc on a table and drag and evacuation device

through it in order to view the width of the air pathway through the device.

Analysis with this test can reveal a device with design flaws.

Today, technology has produced hybrid HVE devices with multiple hole patterns at the terminus end point. They offer a wider air path foot print which can capture more aerosolized water and spatter.

(Left: Air path foot print of HVE mirror compared to saliva ejector and standard HVE tip)

Photos of Air path ways demonstrated using Shark vacuum.

Note the vacuum hose wand air path width which parallels the large vacuum pathway.

The added brush head attachment contacts the floor with a broader surface area than just the hose end path enabling it to inhale

a wider air path of particles.

A television infomercial for the popular “Shark”vacuum cleaner compared it’s features against a competitor. Their demonstration was similar to what is needed for dental evacuation devices. Performance was tested to show how well the vacuum picked up particles on the carpet and floor and its wide air path which makes vacuuming a room faster. Mobility of the vacuum offered easy turning manuverability and access to difficult to reach places like under tables. The vacuum unit was more Ergonomic than other models when lifted up showing how light in weight it was to use.

Plain common sense would tell one to take a look at their home vacuum. The large diameter hose is a type of “ high volume”. If one were to just use the hose to clean, it would take a long time to suck up

all the dirt and dust particles. This is due to how the liner air pathway is channeled at

the terminus end point of the tube. Yet if one puts on a wider floor attachment, cleaning

can be completed much faster because of a wider “surface area foot print” or “air pathway” which can pull in a broader path of particulate! Aerosols are similar to small dust particles on the floor only they are alot less visible to the eye. Use of a uni-directional evacuator (like just using the straight vacuum hose ) only offers the diameters given width of an air pathway. Using a device with wider surface area /air path foot print at the terminus end point, can broaden the amount of particles picked up.

As demonstraited by the Shark vacuum example, design features allow cleaning tasks to be faster and easier. This is true for some newer dental evacuation devices as well.

Just having high inches of mercury (InHg) and high cubic feet per minute (CFM) does not mean great aerosol protection. A wider air path foot print at the terminus end point is also necessary.

**High volume, high port velocity and wide air pathway in dental evacuation is what is needed for proper management of water and aerosols.

Choosing the right device:

It is very surprising to find products on the market labeled as HVE but actually perform lower than the level of a saliva ejector. Remember when suctioning up water, it is approximately 1000 times more dense

than air. Most of the time in dentistry we are working with a mixture of mostly air with water and when

combined, produces spatter and aerosols.

Is there a solution? How do we address these problems and encourage more clinicians to use HVE as a safety standard? One way is dental clinicians need to be educated and learn more about a device’s design features in order to know what to look for. Device design is extremely important . A straight HVE tip has high volume and a given width of air pathway foot print. Another device may perform with slightly less air volume (CFM) but have higher port velocity and wider air path foot print enabling it to capture a broader pathway of aerosols.

Below: Examples of hand-held devices which offer high volume evacuation with wide hole pattern and wide air pathways. These can be purchased on the market. Many are ergonomic, lightweight and can be easily used in the mouth.

(1)Ergo Vac. (2)Purevac (3)multiaxis spiral suction (4) Angle Ease (5)Nu-bird integrated valve, “Banchi’

Below: Examples of hands-free stationary devices and adapters which utilize the HVE port. hands-free

evacuators were designed to collect water in the back of the mouth. Some designs have smaller tubing and hole size which cause limitations in the design, could restrict airflow and lower air volume (CFM) and air velocity. The balance of airflow is extremely important in order to keep the holes from getting plugged with tissue and become ineffective. These devices work for pooling water but according some studies,(4) not adequate for aerosol management.

(9) The Leaf. (10) LVE adapted to HVE (11) Blu Boa (12) Isolite

Evacuation is the Secondary Task to most dental procedures being performed, clinicians are more

likely to choose a device which offers the greatest convenience and comfort so they can focus on their

P rimary Task.

Inverse Relationship:

Easy Secondary tasks increase efficiency of Primary tasks.

The more Complex the device design, Increased ease of use.

Difficulty with Secondary tasks reduce efficiency of Primary tasks.

The more Simple the device design, Decreased ease of use.

In the “Shark” vacuum cleaner demo, the three same factors which directly impact its use are Performance, Mobility and Ergonomics. These factors apply to dental use of HVE as well.

Performance: Clinicians need to know whether the power/static pressure (InHg), airflow volume

(CFM) and port velocity of their HVE performs to adequate safety levels. Clinicians need should rely on

data from independent and manufacture tests to determine the effectiveness of the devices they use, not just the word of a salesman representative. * J ust because an evacuator plugs into an HVE suction port does not mean it is operating at an acceptable suction volume level on the terminus/end point. Vacuum performance can vary greatly from office to office. Clinicians need to look for devices which have high port velocity and wide air path foot print for good aerosol reduction.

Mobility: In order to work safer and efficiently, an HVE device needs to be light in weight and with the ability to be hand held approximately 6 mm to 15 mm away from the active aerosol generating tip. For example a stationary hands free device cannot be placed in the posterior of the mouth when the clinician works in the anterior area of the mouth. This is where more of the aerosols and splatter escape the evacuator eject into the air. Mobility is key and there are at least a dozen locations within the mouth

that clinicians need to access with HVE. Clinicians should look for designs that offer full range of mobility,

hand held and easy to manuver in all areas of the mouth. Broad air path evacuation with multiple ports

help enables the device to capture a wider area of particulate and water the problem is however that many of the designs have holes that just plug with tissue and render it ineffective. The long straight

tube of a standard HVE tip can be awkward to angle and handle. Clinicians have to pay careful attention to tip angulation to avoid getting the suction locked onto their patients cheek or tongue. A shorter length of this type of suction tip offers easier access and more acurate angulation to help stay close to the aerosol generating tip. Ultimately one needs to be able to move their suction device within the patient’s mouth without risking discomfort to patients while keeping focus on performing their primary task .

Ergonomics: This important factor can make the clinicians job more time consuming,

difficult to perform and cause injury. An average HVE hose weighs

approximately one pound and feels very stiff to manage. Hygienists complain of too much

pull and hose drag on the wrist and arm which can lead to repetitive strain injury. Because the usual

standard HVE units are hand held, clinicians are unable to use their mouth mirror for

indirect vision so they have to rely on direct vision only which can cause excess strain on

the neck and shoulders. New lighter weight designs have features that eliminate hose

twist and drag which can reduce the risk of repetitive strain injury. The HVE device needs

to have multi functional capability eliminating the need to switch devices mid procedure

(ie.. laying down the suction to pick up the mouth mirror to view.)

New hybrid device technology for HVE now come with more complex features that offer innovative solutions to the performance, mobiliity and ergonomic challenges of the standard straight HVE tip model.

One new HVE system on the market is the Purevac by Dentsply International. It performs with a wide air pathway. The opening offers aerosol reduction during ultrasonic scaling procedures. The hose is ergonomic with free rotation and is light weight making it easy to use.

Another example of a new complex design hybrid is the Nu-Bird HVE Mirror System. The mirror head looks like a lollipop that has 10 multi-directional ports positioned around the periphery. These ports are very specific in size allowing the air pathway foot print to be approximately one inch in diameter. The patented design pulls air from both sides, front and back, versas a single-directional device like a standard HVE tip. As air flows through each of the ports, acceleration occurs while simultaneously pressure drops. That drop in pressure is the additional vacuum which helps quickly grab and capture aerosols and water in the mouth.

This is another example of “Bernoulli’s principle” at work and how high port velocity supplies a

“Venturi effect” that provides additional vacuum. The reason planes fly is the air rushing over the top of the wing creates a low pressure causing the wing to lift.

above Nu-bird mirror showing additional vacuum created due to Bernoulli’s principle” Photo on left of “Bernoulli’s principle’ and increased vacuum. (10)

There are several reasons dental clinicians would benefit from using the newer technology of an HVE/mirror system combo.

1) Higher accuracy with clear indirect vision.

2) Easier access and mobility in all areas of the mouth.

3) Ergonomic design features that reduce strain on hand and arm

4) Better water management and capture of generated aerosols

In the past, main stream dental clinicians have not had access to evacuation devices which

ergonomically utilized HVE but now can. Dental professionals should apply themselves to evolve in

learning to use some of these newer technology systems so they can benefit from the better

performance, health and safety and improved ergonomics and thus prolong their careers.

Laura Emmons, a graduate of Lake Washington Institute of Technology, works full time as a clinical hygienist. She and her husband own and operate a design and manufacturing company called Nu-Bird which

pioneered new technology of a mirror system which is combined with HVE for dental clinicians. You can reach Laura at info@nu-bird.com or visit nu-bird.com and face book. 5/24/2019

References:

1) Centers for Disease Control and Prevention. Guideline for infection Control in Dental Health-Care settings-2003

2) Aerosol and splatter Contamination from the Operative Site During Ultrasonic Scaling Sept 1998, volume 129, Issue 9 JADA,Pages 1241-1249

3). Aerosol and splatter. (J Am Dent Assoc. 1998) PMID: 9766105 (Pubmed-Indexed for MEDLINE) CDC guidelines: Bloodborne Pathogens anbd Aerosols

4) Holloman, J. L., Mauriello, S.M.,& Arnold,R.R. (2015) Comparison of suction device with saliva ejector for aerosol and spatter reduction during ultrasonic scaling. JADA,27-33

5) Avasth, A. 2018 “High Volume Evacuator (HVE) in reducing aerosol-an exploration worth by clinicians” Dental Health Oral disord The. 2018; 9 (3):165-166

6) Emmons, L.., Wu, C., Shutter,T., High-Volume evacuation: Aerosols- Its what you can’t see that can hurt you. RDH mag. July Issue 2017

7) Harrel,S.K.,&Mollinari,J.P.“Aerosols and Splatter in dentistry”JADA, Vol.135 April 2004,435

8) Kenyon TA, Valway SE,Ihle WW.Onorato IM, Castro KG. Transmission of multidrug-resistant Mycobacterium tuberculosis during a long airplane flight. N. Engl J Med 1996:334(15):933-8

9) Jacks, M. (2011) Protecting Yourself. Dimensions of Dental Hygiene. 9(8):26-29

10) youtu.be Creative Learning Bernoulli’s principle 3d animation Published on Oct 24, 2015

Conflict of Interest

The Author declares that there is no conflict of interest.

Photos 1,2,3,4,5,6,8,9,10,11,12 were from Google product websites.

5) Photo of Purevac Dentsply Professional from Dentsply International google website

6) Nu-bird HVE systems HV valve and short HV tip.

6) Nu-bird HVE Adapter with short HVE tip Dentistry, The Evolution Revolution

The Worlds Best Ergonomic HVE

Mon, 30 Jan 2023 20:19:55 GMT

Finally, there is Ergonomic Easy HVE!

One of a kind, we are first to introduce a small compact ergonomic HVE VALVE.

LIGHTER IN WEIGHT and more ergonomic to use then standard HVE valve units.

Standard clinical aluminum HVE valves, WEIGH approx. 2oz and stainless steel versions weigh up to 4 oz. !! this is not including the weight of the standard HVE hose attached which can weigh up to 1lb!

The Nu-Bird HVE Valve only weighs 1/2 oz!! Our HVE hose weighs approx. 4 oz.

These are extremely important features and make it easy for clinicians to use who normally avoid using standard HVE because of the weight on the wrist and hand and repetitive strain it can cause.

NU-bird’s New HVE Valve unit adapts directly to our Ergonomic HVE hose, allows clinicians to easily switch from Hygiene to restorative procedures which require a standard HVE tip in a snap. A must have for all dental procedures.

Introducing the Nu-Bird SR Banchi Series

Mon, 30 Jan 2023 20:07:57 GMT

We've got an exciting new product for you!

We call it the SR Banchi Series! On this new model, the valve is integrated directly into the handle of a suction mirror for easy ON/OFF control of suction. Your efficiency improves because with it, you don’t have to reach over to the delivery system to turn the suction on or off thus making it more ergonomic to use. It's a must for clinicians who work without an assistant performing both restorative and hygiene procedures. Check out our Store for more details.

NuBird "Silver Raven" received the 2022 Cellerent "Best of Class" Hygiene Award!

Tue, 20 Sep 2022 17:48:01 GMT

Photo taken at RDH Under One Roof 2022

We are honored to receive the Best of Class Award for hygiene products. We have worked many years to perfect our products to allow hygienists to perform their tasks with better accuracy, ergonomics all at an economical cost.

Aerosols: Science Using Common sense...

Fri, 24 Apr 2020 15:44:18 GMT

There Are several dental suction mirror devices on the market claiming to be HVE but are really simply just plug into the HVE and really don't perform at the level necessary and in some cases are at the level of a saliva ejector or less. Simply having a large bore device used in an office having a weak suction system could be a recipe for disaster and backwash. Port velocity the right ratio to volume is key to multi factor issues encountered in dental offices. To answer your questions requires in-depth understanding of how this all works in regards to all the variables and if they can be controlled ie variable vs invariables in the testing process. I understand what CDC mentions in the webinar. In reality, this would suggest all dental offices use the exact same vacuum system, layout, line size, number of op's and the exact same number of clinicians using the exact same devices at the same time. I believe my point is understood. Device design is extremely important and how clinically it is used. Simple designed devices often become complicated to use. NuBird dental evacuation mirror is designed to meet the needs of the clinicians by allowing focus on primary tasks while the mirror design will handle the aerosols provided the clinicians are using the device, office vacuum system is in working order (9-14 mmhm static pressure reading at the HVE valve end and the traps and lines are not clogged up with Fl varnish. 250 NL/min. (may be from CDC?) is referring to the dental office vacuum motor itself as devices themselves cannot "self" create vacuum and are connected to a vacuum motor to work. Being 98% in aerosol reduction starts first at the vacuum motor then the supply lines and ends at the terminus end point (device being used) Let's be realistic...My point, an unpowered device plugged into a dental office vacuum system cannot achieve more than what that system is performing at. Terminus end point is where the patented NuBird evacuation Mirror system performs above all others from start to finish. Simple tests can be performed by anyone to actually see the difference in device design as I have demonstrated and have suggested in articles published in magazines. I encourage and strongly suggest these tests be performed by the users of HVE devices. There are so many variables to address I could write a book about this and may in the future. Read the article on our Blog called Technology, Dentistry and HV Evolution. This will help explain more in detail the science and give more understanding. Be informed and STAY SAFE.
Lee Emmons RDH
President Nu-Bird Inc.

Aerosols may be a concern, but not if you are using a Nu-bird HVE Mirror..

Thu, 16 Apr 2020 15:23:17 GMT

Nu-bird Mirrors have multidirectional ports which utilize Bernoulli's Principal for increased high Volume/ Velocity suction power in the Mirror's head design.

Multi directional ports have continuous air flow even when the mirror is pressed against mucosal tissue so the mirror won't fog and you will have plenty of power to remove water and aerosols (KEY) before they leave the mouth!

Dental Economics "Dental Pearls" Author Joshua Austin, DDS, FAGD

Thu, 24 Oct 2019 16:47:26 GMT

Nu-Bird HVE Mirror System

If I could have any superpower that would affect my dentistry, I think x-ray vision would be the best, for obvious reasons. After that, laser vision, hypnosis, time control, and superspeed would be on the list. Right in there with those would be a third hand. How great would that be? Having an extra hand for suction or to keep a mirror clean would be a game changer for dentists and dental hygienists. The Nu-Bird HVE Mirror System can give you that third hand superpower very economically.

The Nu-Bird HVE Mirror System marries the mouth mirror and high-volume evacuator (HVE) for several great benefits. First, Nu-Bird provides a clear, fog-free view. Nothing is as annoying as a mouth-breathing patient who constantly fogs up the mouth mirror. Nu-Bird’s air pathway ports on the front and back of the mirror will prevent the dreaded fog. Even when the mirror is placed against the mucosa, air flow is constant, and the mirror remains fog-free.

Aside from keeping your mirror fog-free, the Nu-Bird operates as a high-volume evacuator. The design of the Nu-Bird allows the air ports around the mirror to efficiently and effectively suction fluids without impeding the clinician’s vision. This makes the Nu-Bird great for the hygiene department. Having a mirror and HVE in one makes scaling and root planing procedures faster and easier.

Installation of the Nu-Bird HVE Mirror System is easy. Simply plug the metal Nu-Bird adapter into the HVE port. Loop the hose around toward the patient and insert the Nu-Bird mirror into the other end of the hose. Turn on the HVE, and you’re ready to roll. The Nu Bird suction mirror handpiece can be autoclaved after each use, so having a few of the suction mirrors will help keep the Nu-Bird sucking all day. ne of my hygienists used the Nu-Bird in her operatory for a few days. She thought the Nu-Bird was easy to set up and maintain, and she liked that it gave her an extra hand, making procedures such as scaling and sealant application much easier. She also thought the Nu-Bird suction mirror was great for retraction on patients with strong cheeks and tongues. She did say that the extra bulk of the suction mirror takes a little getting used to, as does the extra sound. Her exact words were “ . . . but that’s a small price to pay!”

Nu-Bird can give you or your hygienist an extra hand when it’s needed most. Whether it be keeping your mirror fog-free or suctioning without requiring you to hold a standalone high-volume evacuation tip, Nu-Bird can make procedures easier on both clinicians and patients. Line-drive double into the right field corner for Nu-Bird!

High Volume Evacuation in Dental Hygiene, the Time is Now!

Tue, 01 Aug 2017 00:00:00 GMT

IT’S WHAT YOU CAN’T SEE THAT CAN HURT YOUIT’S WHAT YOU CAN’T SEE THAT CAN HURT YOU

Recently, when a hygienist contracted a virus at work, it came on so quickly and aggressively that she ended up taking a whole month off at home to recover. Eventually, all of the other staff at her dental office, including front desk and clinicians, also came down with the same virus. After a month-long recovery, another hygienist described it as “the worst virus I had ever experienced”. She was concerned. The dentist office required that clinicians use personal protective equipment (PPE) such as masks, gloves, eye protection, and proper lab coats; however, they did not require a High Volume Evacuator (HVE) as a part of their safety protocol when working with powered instruments. Making matters worse, the vacuum pump lines were clogged with build-up that inhibited the air flow and limited the performance of the evacuation equipment at that office.

Illnesses are commonly shared in the workplace but the risk of exposure increases significantly for hygienists using powered instrumentation such as ultrasonic and air polishing . Bacteria and viruses can rapidly spread through splatter and aerosols produced by these types of treatments. The anecdote above given by the firsthand experience of one of the hygienists at the clinic described. While it can’t be proven that the viral infection was spread via contaminated aerosols resulting from powered instrumentation, it certainly offers a possible explanation for the office-wide epidemic. Powered instrumentation technologies have steadily increased to widespread use in North America ; however, safety standards and regulations concerning their use have not sufficiently evolved along with them. Only 24 out of 50 states in the U.S. claim they follow CDC infection control guidelines. While HVE is a top recommended solution for controlling aerosols and reducing the risk of contamination , many clinicians are still allowed to choose any suction device they prefer in order to perform their work. Saliva ejectors and isolation devices are a common choice even though they offer no safety protection from contaminated aerosols.

Dental healthcare professionals, educators and governments are faced with increasing urgency to change and improve health safety in dentistry. Some U.S. states and Canadian provinces have already mandated that HVE be used with all ultrasonic and air polishing procedures. Infection control guidelines, standards and regulations are currently under review by the Department of Health. We anticipate that these reviews will result in new, updated, and modified rule changes to include a mandate requiring the use of HVE across many more states. This needs to be a universal requirement and publicized with the same rigor as the anti-smoking campaigns that achieved bans on smoking in public places in the 1990’s.

WHAT IS HVE?

A High Volume Evacuator (HVE) is a suction device that draws a large volume of air over a period of time. This differs from a Low Volume Evacuator (LVE) which pulls a significantly lower volume of air. Air volume is measured in cubic feet per minute (CFM) and while both HVE and LVE maintain the same static vacuum pressure; the difference in air volume is due to the borehole size or number of holes in the evacuator tip. HVE devices typically have large, single bore or multiple openings, whereas LVE devices have a much smaller bore size. The standard HVE device commonly used in dentistry has a large opening and is attached to an evacuation system that will remove a volume of air up to 100 cubic feet per minute.

WHY DO WE NEED HVE?

Research shows that aerosols and splatter produced by ultrasonic and air polishing treatments contain saliva, blood, bacteria, and pathogens . Once airborne, aerosol particles can remain for an hour or more, lingering in the clinician’s breathing space and in the operatory, while splatter lands on the surfaces immediately surrounding the treatment area. This risks the spread of illnesses such as the common cold and influenza viruses, herpes viruses, pathogenic Streptococci or Staphylococci, the severe acute respiratory syndrome (SARS), and tuberculosis (TB).

While vaccinations for diseases such as the flu and H1N1 are available, neither the United States Centers for Disease Control and Prevention (CDC) nor the American Dental Association (ADA) mandate the use of these vaccines as a preventative safety measure. For illnesses such as TB or SARS, these agencies recommend that patients avoid elective dental procedures altogether, or have treatment done in a hospital. In Washington State, recent outbreaks of active TB have been reported by The Today file, and by the Washington Post. This is especially a concern with undiagnosed or undetected cases. A mandate for using HVE as a preventative safety measure is now more than ever, urgently needed.

HVE offers the best solution for controlling aerosolized particles before they leave the mouth. Studies have shown HVE to reduce over 90%-98% of aerosols regardless of source As there is no single solution that will provide complete protection, a combination of protective measures such as PPE, pre-procedural rinses, pre-polishing, and advanced air filtration systems, when used together with HVE offer the most effective and practical method of reducing the overall risk of infection.

HVE also offers better assurance against potential liability claims and a compromised public perception of the dental industry as a whole. From epidemics to fatalities, a single infection can lead to disastrous results. Until such a time when regulations and monitoring are implemented and enforced, the burden lies with individual dental teams to ensure that they are taking every measure necessary to maintain a safe and sanitary working environment.

WHAT TYPES OF EVACUATION DEVICES ARE CURRENTLY AVAILABLE ON THE MARKET?

HVE instruments have been shown to universally reduce airborne contamination, no matter what the dental source by 90% to 98%. Using an HVE is a mandatory infection control precaution during the use of an ultrasonic scaler. Harrel “Contaminated Dental Aerosols”

Evacuation devices on the market today vary by function according to the purpose for which they are designed. For ultrasonic scaling or air-polishing, the goal is not just water management; it is aerosol containment and controlling the risk of disease transmission . Saliva ejectors, isolation devices and standard HVE are among the most commonly used evacuation devices on the market today. Each of these has been studied for its effectiveness in reducing aerosols produced by powered instrumentation.

In a study by the ADA comparing HVE and a saliva ejector, results showed the HVE device to reduce up to 90% of particles reaching the clinician’s breathing space over the saliva ejector alone . The diameter of the saliva ejector is too small to be effective in removing aerosols and according to Stephen Harrel,“does not qualify as a high volume evacuator” . A JADA research report compared a saliva ejector to an isolation device for aerosol and splatter reduction during and after ultrasonic scaling. The findings of this study showed neither device to effectively reduce aerosols and splatter, nor was there a significant difference in the reduction of aerosols and splatter between the two devices . On the other hand, through his extensive research, Stephen Harrel concludes that a standard HVE tip removes 90-98% of aerosols regardless of the source and proves an effective solution to aerosol containment and reducing the risks of contamination.

While the results on the HVE studies are impressive, the conditions when operating in a clinical environment can be quite different from the test environment. In the field, hygienists must not only be able to efficiently use the device in the patient’s mouth but they also depend on the vacuum system and equipment provided at their dental clinic where age and other conditions may impact performance. They also need to work steadily in the patient’s mouth, ensuring their comfort, often while performing precision treatment with a powered instrument for a prolonged period of time. These are variables that may challenge the performance of an HVE device in ways that are not available in a test environment.

Above: Kona Adapter and Isolite Pooled Water management using hands free systems commonly used in dental offices.
Kona Adapter and Isolite Pooled Water management using hands free systems commonly used in dental offices.

Above: Aerosol and water management using standard HVE tip and the new technology HVE Mirror System

HOW IS HVE MEASURED?

Vacuum gauges on evacuation equipment show the level of airflow (CFM) that was set by the manufacturer or service technician. The setting range depends on the size of the evacuation motor, the clinic, and how far the air has to travel from the motor to the user end; however, the only way to know whether an HVE device is working properly, is to test the volume of air flow coming out at the terminus or user end. Conditions such as age/strength of the equipment, build-up in the evacuation line, and number of users on the system can significantly impact the air flow at the user end; unfortunately, these variables are often overlooked . Currently there are no testing standards to measure airflow at the user end.

So how can we as clinicians tell if the power and volume of the HVE suction system are performing to adequate levels?
A simple timed water test is an easy way to test a device for suction performance at the user end:

TIMED WATER TEST

Start with a straight HVE tip and use a timer to measure how long it takes to pull up eight ounces of water. This will establish a control suction rate. Then measure the other devices against the control rate to gain an idea of how different devices compare against the standard HVE device.

SCIENTIFIC TESTS

To compare breadth of suction between instruments, we performed tests using both salt and equal amounts of sifted talc powder to simulate small particles and how different suction devices perform as they draw in the mediums.

In fig. 1 we placed salt evenly across a smooth flat surface. Using the straight tip HVE device, a saliva ejector (LVE), and an HV suction mirror to draw up the salt, we pulled each device through the salt at the same speed.

The wider footprint and hole port design allows the device to draw up a wider air path of particles.

In fig. 2 we used talc powder with standard HV, saliva ejector, HV Suction Mirror and a saliva ejector adapted to HV. The results were impressive. Due to the wider footprint of the hole placement around the suction mirror head, the HV mirror was able to inhale a swath of particles that were two times wider than a straight tip HVE device.

THREE KEY CHALLENGES WITH USING HVE

As suction is often the secondary function to the dental procedure being performed, clinicians are more likely to choose a device which offers the greatest convenience and comfort so that they can more easily focus on their primary task. Since saliva ejectors are widely used as hand held and hands free, they are typically an easy option and first choice for managing pooling water. However, as studies have shown that they are not effective in reducing aerosols, saliva ejectors are a poor choice for use with powered instruments. While on the other hand, HVE is the best option, factors which can directly impact acceptance and clinical application of this technology include: performance, mobility, and ergonomics.

1. Performance

Clinicians need to know whether the power and airflow volume of their HVE suction system is performing to adequate safety levels. There are many devices on the market today that fit HVE ports but perform as LVE. As there is not standard safety measurement of air quality and vacuum performance, clinicians must rely on existing data from independent and manufacturer tests to determine the effectiveness of the devices they use.

As previously noted, vacuum performance can vary depending on the conditions of the system. A system can have clean lines and exhibit adequate airflow yet have extremely low static measurement of vacuum pressure (mmHg). This is where backflow could be experienced. In another example, an evacuation system might show a high static reading but have clogged lines resulting in low volume (CFM). When there are more users on the suction system loop, it tends to lower the volume and pressure. This may be experienced in larger offices. Most office suction systems have enough strength to remove pooling water but the lines can get clogged reducing suction volume performance.

[Just because an evacuation tip can be used on an HVE suction port to evacuate water and aerosols, does not mean it is operating at an acceptable suction level at the terminate or user end.]

2. Mobility
In order to work properly, HVE devices need to be hand held approximately 6mm-15mm away from the active ultrasonic tip or air polisher. For example, the device cannot be placed in the back of the mouth, like stationary devices, when the clinician works in the front of the mouth and vice-versa. Mobility is the key and there are at least a dozen locations within the mouth that clinicians need to access with HVE. The straight long shape of the standard HVE tip can be awkward to handle. Clinicians also need to pay careful attention to tip angulation to avoid getting the suction locked on their patient’s cheek or tongue. Ultimately, clinicians need to be able to move their suction device within their patient’s mouth without risking discomfort, all the while keeping focus on the treatment they are performing.

3. Ergonomics
Ergonomic limitations can make the clinician’s job more time-consuming, difficult to perform, or cause long term injury:

A normal HVE hose weighs approximately one pound and feels very stiff to manage. Hygienists complain of too much pull on the wrist and arm, which can lead to repetitive strain injury.
Because HVE devices are handheld, clinicians are unable to use their mouth mirror for indirect viewing. Reliance on direct vision only can cause excess strain on the neck by stretching over the patient to see what they are doing as they work.
Due to limited visibility, clinicians typically have to take extra time to lay down the HVE device and check all areas with the mouth mirror and then rescale the spots they missed. Better functionality and efficiency is important for completing tasks within allotted time.

Ultimately, the question should be "which HVE system is most effective for aerosol reduction while maintaining clinician ergonomics, ease of use, and patient comfort?”

IS THERE A SOLUTION?

How do we address these problems and encourage hygienists to use HVE as a safety standard for all ultrasonic treatments?
In order to get hygienists to embrace HVE for safety and efficiency with powered instrumentation, the following concerns must be addressed:

DEVICE DESIGN: WHAT DO CLINICIANS NEED TO LOOK FOR?

New HVE devices are available on the market with practical features that offer innovative solutions to the ergonomic and mobility challenges of the standard straight tip model. Beginning with performance, clinicians need to look for devices that operate at higher velocity evacuation levels for reducing aerosols and splatter. From an ergonomics and mobility perspective, clinicians need to look for design elements that offer:

Full mobility that is easy to handle in all areas of the mouth
Broad sweep suction that inhibits the device from sucking up tissue
Lightweight design that reduces the risk of injury
Multifunctional capability that eliminates the need to switch devices mid-procedure

One example of an HVE solution that meets the criteria listed above is the HV Suction Mirror System by Nu-Bird Inc.

REGULATION STANDARDS, TESTING, AND CERTIFICATION

Currently, the health and safety of clinicians, office staff, dentists and their patients are too loosely guarded; tighter controls are needed. Dental health-care professionals must be made aware of the risks associated with aerosols and splatter produced by ultrasonic and other devices. With so much at risk, governments and the dental industry must take immediate action towards regulation and standards requiring the use of HVE as a preventative safety measure with powered instrumentation:

Mandatory use of HVE during ultrasonic, laser, and air polishing procedures should be universally enforced.
Measurements for air quality and safe suction levels must also be defined, benchmarked, and standardized.
Clinicians also need to know if the power and airflow volume of the HVE suction system is performing to adequate safety levels chairside at the user end. In the same way that water lines and sterilization units are monitored at user end, evacuation air flow measurements should be so too.
Dental office equipment should also be tested and certified to ensure that they perform as required for reducing aerosols and splatter. An annual user end vacuum airflow and static pressure certification program would ensure that these systems are performing effectively.

TRAINING

Today’s hygienists need to apply themselves to learn about and utilize new technology systems which can offer better HVE performance and improved ergonomic benefits. It is imperative that HVE be taught at the fundamental level in dental hygiene and dental schools, and enforced in general dental practice. Dental schools, manufacturers, and regulation enforcement agencies need to take steps to provide programs and material to advance clinical skills and compliance with upcoming changes in dental care safety.

CONCLUSION

It is vitally important for clinicians to utilize ultrasonic, air polishing and laser technologies and so positive steps have been taken to support the evolving health safety needs in dentistry. A few U.S. states and Canadian provinces have mandated the use of HVE with powered instrumentation . Dental hygiene schools have also taken steps to advance the clinical skills of their students in health and safety practices. However, there is still a road ahead for changes in industry regulations and standards for the health and safety of dental health-care professionals and their patients. Programs for testing, monitoring and maintaining performance of vacuum systems in dental offices and HVE devices at the user end are still needed. The time is now to take necessary steps to do better to manage aerosols for preventing the spread of disease in dental offices and to provide a safe and healthy environment for us all.

Article By Laura Emmons, Cheri Wu and Tia Shutter

REFERENCES

Changing The Way Dental Professionals See

Tue, 28 Mar 2017 00:00:00 GMT

Nu-Bird HV Suction Mirrors Are Changing The Way Dental Professionals See

The Nu-Bird HVE suction mirror is the ultimate suction/viewing/retraction instrument for dentists, hygienists and assistants. The strong suction capacity performs high volume evacuation very efficiently and better manages the generated aerosols and water debris allowing clear view of all areas in the mouth. The Nu-Bird Mirror easily plugs into a standard HV using a special designed hose adapter which is very lightweight and allows the mirror to swivel and held with modified pen grasp like a standard mouth mirror. This helps clinicians to move about in the mouth with easier access to follow closely the water generating device. The mirror face is replaceable when it becomes scratched. Perfect for use during ultrasonic scaling, air polishing, laser and sealant placement procedures.

Nu-Bird Suction Mirrors are changing the way professionals practice dentistry allowing clinicians to achieve a higher standard of care.

FEATURES AND BENEFITS

Nu-Bird Suction Mirrors are changing the way professionals practice dentistry and allow clinicians to achieve a higher standard of care.

PATENTED DESIGN IS GUARANTEED TO OUTPERFORM ALL OTHERS IN ITS CLASS

Clear fog free view during ultrasonic scaling therapy
Efficiently removes aerosols and pooling liquid on the mirror face and in the mouth
Perfect companion for water Laser therapy and Air polishing
Strong and steady retraction device for thick tongues, cheeks and difficult patients
Long life, eco-friendly, stainless steel, fully sterilizable
Design deflects oral tissue away from plugging suction ports maintaining suction level
Adapter hose allows free rotation; ergonomic design eliminates body fatigue
Promotes career longevity.
Replaceable #4 front surface rhodium coated mirror
Adapts to both a standard HVE or LVE suction systems.
Suction performance is approximately 80% the level of a high volume suction
Reduce aerosols better due to wide airflow pattern
Can cut SRP appointment time in half
Accurately place sealants in 1/3rd the time over traditional methods
Saves chair time and extra appointments with increased production
Patient comfort
Made in America

When trying other similar devices on the market, don’t settle for an imitation because quantity can never substitute for efficient performance. The Nu-Bird Suction Mirror, formally known as the “Hammer Head’, has a patented design guaranteed to outperform all others in its class.