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HIGH-VOLUME EVACUATOR

The third precaution for oral health professionals is the proper use of the HVE during ultrasonic scaling. Using the HVE is recommended because employing the saliva ejector alone is not enough to effectively remove dental aerosols—although it may be used in conjunction with the HVE.8 Utilizing an HVE during ultrasonic dental instruments helps to protect the dental team and operatory environment from contaminated aerosols.
During ultrasonic instrumentation, the HVE may be used manually or hands-free. When a manual HVE is used, the ideal clinical scenario is to have a dental assistant help control the aerosol. Most dental practices, however, do not have the luxury of staffing each operatory with both a dental assistant and a dental hygienist. When delivering treatment solo, clinicians may wish to use a hands-free system—with the current market offering a variety of options. Clinicians should carefully evaluate each system, as many hands-free HVE devices require a special attachment that must be professionally installed on the dental unit prior to use. If a hands-free device is not available, the clinician must use a handheld HVE.
 
PROPER HVE TECHNIQUE

The proper technique for utilizing the manual HVE requires practice but is necessary to ensure its effective use. Choosing a half-length HVE tip, as opposed to a full-length HVE tip, will ease manipulation and retraction during calculus and biofilm removal. HVE tips may be purchased in short, half-length, or standard full-length versions, or clinicians may cut a standard tip in half. Shorter tips allow clinicians to use the tip as a retractor while still maintaining proper body ergonomics. The saliva ejector should be placed in the patient's mouth at the beginning of the procedure. The use of a precurved mandibular saliva ejector may help to keep the ejector positioned in the lower corner of the patient's mouth. A conventional saliva ejector can be shaped to hug the patient's cheek so it will not move during the procedure. Recommended for patient comfort, the primary function of the saliva ejector is to remove water that falls to the back of the patient's throat, while the HVE removes aerosolized water generated by the ultrasonic device.

Oral health professionals should always hold the HVE in their nondominant hand with a palm grasp. This type of grasp allows the dental hygienist to maintain a straight wrist while retracting the tissue. Placing the tip so the bevel faces the teeth will prevent trapping the patient's buccal mucosa with the HVE. The end of the HVE should gently push back on the buccal mucosa with a cupping motion and be guided toward the most distal tooth in the area being scaled. Figure 3 illustrates how the placed at the distal-most area and not rest on the gingiva. The HVE can be stabilized when working on the lingual aspect by resting it on the corner of the mouth. Clinicians should be aware of their body ergonomics through out the appointment, and be willing to move from the 9 o'clock to the 12 o'clock seated position to prevent strain or twisting of their spine. As with any new technique, continued practice will help to make the HVE a practical addition to the ultrasonic scaling process.

CONCLUSION
In summary, oral health professionals should take steps to protect themselves, their patients, and the dental equipment environment during ultrasonic instrumentation. Protection protocol includes donning proper PPE, asking patients to use a preprocedural mouthrinse, and using an HVE. The HVE is most effectively utilized with the help of a dental assistant or by implementing a hands-free version. If these options are not available, then clinicians should use ergonomically correct body and hand positioning while holding the HVE in their nondominant hand. Oral health professionals, whether using ultrasonic scalers on every patient or periodically, can protect themselves and their patients from potentially harmful bacteria found in the clinical setting by following these infection control protocols.

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