Recent studies conducted on prohibiting the spread of COVID-19 through aerosols are highlighting the importance of personal protective equipment, reduced treatment time, and one of endodontists most reliable tools, which I’ll discuss more in detail below. I think we can all agree that reducing aerosols is paramount… the question of the day is HOW?
I’ve been brainstorming with my husband, a general dentist, on ways that he can reduce aerosols when doing restorative procedures (among other things). Being a good wife, I brought him some of my favorite products to try out and thought that I would share them with you, too.
The Rubber Dam: Our Hero
First, let’s start out with the star of the aerosol-reducing show: your rubber dam. Endodontists everywhere are probably rejoicing right now because the rubber dam is finally getting the respect that it deserves — it’s never been so important! And, believe it or not, the rubber dam will make your life easier.
What Clamps Should You Use?
If you are doing restorative procedures with the rubber dam, you may have to get creative with your clamps and the overall placement. I have a standard set of clamps that I keep in all of my cassettes. I typically use a #14 or #14A for my molars and a #2A or #1 for my premolars and anteriors and a #9 for my tiny anteriors.
For my broken down teeth, I sometimes need to use a #12A or #13A, and I can usually make those clamps work for anything. Do keep in mind that, over time, your clamps will start to stretch out and get loose, so you will need to replace them. (If you’re going to be a stickler about reducing aerosols, then you can’t omit this part!)
The Silker-Glickman Clamp
We typically use the Silker-Glickman clamp for teeth that are badly broken down, but I can see a use for it in restorative dentistry too. You could clamp a posterior tooth and then split the dam and carry it over to a more anterior tooth. However, if you don’t want to invest in this one, you can also use two clamps on either end to achieve the same thing (split-dam technique).
The Split Dam Technique for Reducing Aerosols
The split dam technique goes a little something like this: You clamp one tooth and stretch the dam across a few teeth over. The dam is split in between the two hole punches. Place the holes close together like this and then make a slit in the dam connecting the two holes.
Wedgets for Securing the Rubber Dam
Now, you may find it hard to do a crown preparation here, but you can certainly drop a box when doing a Class 2 restoration. You can either secure the anterior part of the dam with another clamp or use a wedget.
Wedgets are great to secure your dam down any time it starts to creep up on you (kind of like a real wedgie, lol).
Clamping the Tissue
The next thing you can do is clamp the tissue. This is not my favorite thing to do, but sometimes it has to be done, especially when the tooth is just too short to clamp. Don’t be afraid to do it — the tissue will be a little sore at first (so let your patient know), but it will heal just fine.
OpalDam for Reducing Aerosols
Adding something like OpalDam can also be a huge help in reducing aerosols. In fact, I won’t do a root canal without it — it has now become a part of my standard operating procedure. Before I place it, though, I will soak a cotton pellet in some sodium hypochlorite, wipe down the tooth, and let it sit there for a minute.
You can even use Opaldam when you are doing the split dam technique. Once the tooth is sealed with the OpalDam, I am ready to start using my high speed handpiece, and it’s so much safer than before.
Reduce Air Pressure from Syringe
If you want to take it even further, make sure you start using a stropko irrigator. I use my stropko to avoid air emphysemas, but you can also use this guy in your restorative procedures. The stropko reduces the pressure of the air that comes out of the syringe, which keeps you from blowing air, saliva, or water all over your operating field (or you). When it comes to reducing aerosols, this is huge!
Another benefit to using the stropko irrigator is that it helps thin out your bonding agent to give it that saran wrap look. The irrigator (air only) simply takes the place of your normal air water syringe, and then you place a flowable composite tip on the end. Trust me — this guy will become your new best friend!
An Invaluable Tool
I know that using a rubber dam in doing restorative dentistry can sometimes be tricky. If you’re doing a DO composite on a second molar, I don’t really have a great solution for you (because that’s just hard!), but if you are doing a root canal, there is never a reason why you shouldn’t use a rubber dam. It makes such a difference!
Over the next few weeks and months, as we find our “new normal”, a big part of our job will be rethinking how we do things. (I actually recently held a free webinar on teledentistry and how we can adjust our thinking and our processes to protect our patients, our teams, and ourselves in these uncertain times. If you missed it, you can access that webinar on my media page, along with other great resources.)
I am a huge proponent of working with the tools we already have in our toolbox as we look to the future and find the best ways to keep everyone safe in the process. These tips and tricks for reducing aerosols are just another piece in the puzzle of saving lives while we’re saving teeth. We’re all in this together!