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The usefulness of the modified extra-oral vacuum aspirator (EOVA) from

household vacuum cleaner in reducing bacteria in dental aerosols

Article  in  International Dental Journal · December 2001

DOI: 10.1002/j.1875-595X.2001.tb00853.x · Source: PubMed

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 The usefulness of the modified
extra-oral vacu u m aspi rator (EOVA)
from household vacuum cleaner in
reducing bacteria in dental aerosols
R. Teanpaisan, M. Taeporamaysamai, P. Rattanachone,
N. Poldoung and S. Srisintorn
Prince of Songkla University, Thailand

Aims and objectives: C!rrenUy, as a preventive.rneasure against air Hospital :rcquired infection has
contamination caused by dental procedures, dust-collecting aspirators been of great concern to both
such as an extra-oral vacuum aspirator (EOVA) are corning into gene€l hcelth care rvorkcrs and prrienrs.
use. ln this study, we iested ihe ability of a modified EOVA that uses ln dentnl clinics, thcre are many
a household vaclum machine. Design and setting: The study was potcntiaL risl(s for rransmission of
conducted in two paris. First, the mod fied EOVAwas tested for lts abiTity
infection dLrring clinical proce
to eliminate an Escher"lchia coli aerosol generated in a manikin. Second,
duresLr. For example, aerosols
the device was lested for ts ability to remove the aerosol generaied by
contajning blood, saliva and minure
denial treatment procedLreg, scaling and drllling a tooth, on human
subjects. Results: There was a stat stically signifrcant reduction n both
particulatc remnants of dental
the E- coll aerosol and the ora bacteria aerosol during denta lreatment
tissuc ot restorarivc materiel rre
procedures. Conclusion: The rnodified EOVA machine is h ghty effective commonly g€nerated, p2rricularlv
in preventing aircontamination by dentalprocedures. lts ma n advaniages v,hen using high speed denral
are that it can eas ly be modified for use w th any dental unit and it is instruments or ultrasonic scalcrs' r.
re atively lnexpens ve. The organisms prcsent in such
aerc,sols can include oral bacteria,
Key wards: Exta-arcl vacuun aspirator, aercsol canlamination, denlal rcspirarory pathogcns and Llood
bornc viruses. Of the respirarorv
p^thoecns, ll)c1bat iatu trbenr/t.ti
is considercd to be of incrersing
importance rvorldrvide, prrtly dLre
to rhe increased incidence of HIV
.lisease. ln Thxiland, tubercrlcxis
has bccn the mosr commonly
rcported opportunistic inlcction,
occurring in 28.9 per cent .,f HIV
infected paticntsir. For thesc rcesons,
rcmoval oI aerosols gcnerated
during dental trearment is an
importanr priorirv and use of
extra'oral vacuum espirarion has
been recommended to prorect
dennl staff and subsequent parients6.
Rccendy, the use ofa poverful
Correspondefce (o: Dr Rawee Teanpaisan, Departmenl ol Stomatotooy, Facullv ot
Denlishy, Prince oi Songkla Univ6rs ty, Fac!lry ofDenlislry, prince of Sonqk a Universiiy vacuurn aspirator set closc to the
l'larYai,Songkha, PO. Aox 17 KhorHong 90112 Thaiand. patient's molrth has proved effec-
E'maii: irawee@ralree.psu.ac.lh tive in preventing polJution caused
O 2001 Fol/l/r'odd Denlal PrBss
Flgure 1a. The werdry blow househod
vacuum cleaner machine before
by dispcrsed contaminants in the
dental clinic. Hower.ct, the pres-
endy available commercial vacuum
aspiretors are vcn, expcnsive and
can only be used with certain q'pes
of dental unit. They rre, therefore,
not commonly used in dcntal clin-
ics in Thailand. To reduce the cost
of this machr,re, $e engrneering udt
in the Facultl- ofDentistry, Prince
of Songkla University, Thailand,
has modified a less expensive
alternative that is bascd upon a
bousehold vacuum cleancr. The
purpose of this study was to
determinc thc effectiveness of dris
modificd extra oral vacuum aspi-
rrtor for ellminating the bactcriAl
aerosols generated during dentrl
Materials and methods
EOVA device
A 1,100 Vlatts vet dry blow
vacuum cleaner machine, whicb
produced a maximum negative
prcssure at T0mmllg was used in
thn study (Fgr, /a). The m,rchine
wes modified by removing the dust
bag and connectlng rbe xir outlet
rvith a rube connected to the dental
unit's drainage system. Thc vacu-
um's flcxible liose rvas teplaccd
\\'itb x 2m long hose (4cm internal
Lnlernaiional Detr{a Journal (2001) VoL 51/No.6
Figrre 'tb. The vaculm machine after modificaiion
diamerer) fitted rvith a cone shaped
plastic cup. Tbe hose was clamped
to an adjusuble stalk to hold the
cup in any desited position (Frgr'?
//). The vacuum cl€anet was
housed in a mobilc cupboard with
thc powcr switch placed in
convedent position on thc ourside.
In use, spxfter and aetosol
contamination was evacurtcrl
througb tbe cooe-shaped p)astic
cup direcdy inro the dental uniCs
waste-water drainage system. Any
residual contamineted watet that
temarncd lnside the vacuum's tank
was treatcd rxith disinfectant to
eliminatc microorganisms.
Exafiination of the efficiency
of EovA
ln order io examine thc efficiency
of the EOVr\ For eliminating
bacteria, the study was conducted
in two phases. First, simr:lated
dental procedurcs werc pet€ormed
on teeth in a manikin using a clim-
caL strxin of Eschertrhia co/i. A.
suspensrrn of E. rallwas introduced
into the water tank of rhc dental
unit to give a final count of 1.0 1.2
x 1{I5CFU/ml. Th€ manikin head
was set up in a dentrl chatu ro simu
late dcntd restorative procedutes
and a cavity prepered in a first
to an exira-oral vacuurn aspirabr nrcd
molar tooth. DrilJingwas conducred
for rwo minutes with the EOVA
device running simultilneousl)'. -^
MacConLey agar culture plate, was
placed on the chest ofrhc manjkrn
to collect any E. ral/ in the aerosol.
a The plates were thcn incubared
aerobically at 37'C for 24h and
resultant colonies werc counted,
The controi was ihe samc proce-
dure as described above but
rvithout operation of tbc LOVA
device. Colonies recovered on the
settle plates were confumed 2s E.
rr, using the API 20 D kit (Bio
Merieux, France).
In the second phase ofthe study,
\ve invcsrigxted rhe production
and removal of aerosols of oral
bacteria during dental trearment
ptoccdures on human subjccts.
Trvcnty four separate procedurcs
were pctfotmed on diffcrent days.
Fourtecn procedures inv.rlved
restorattve work on reeth in differ
ent areas of rhe mourh- ln rhe
other ten procedures, scaling was
performed with an ultrasonic scaler.
Blood agar culture platcs rvere
piaccd oo the chest ofsubjects and
lcfr in position for two minutes
during each procedure. The control
was the same number of pfoce-
dures but without running the
EOVA device. The phtes were
 415

Table 1 The number of oral bacterla counls r€covered during s.€ling Ireatment

Bacle.ial count (CFU) of scaling treahent ior 2 rnin al the d flerent quadranrs
Palent Lower righl Lower lelt Upper right Upper efl Upper arterior Lower anlerior
Withoul With Wilhout With Wlh Wilholl Wilh Withoui Wilh Wilholi With
WithoLrt
EOVA EOVA EOVA EOVA EOVA EOVA EOVA EOVA EOVA EOVA EOVA EOVA
1 45 41 16 6 aT 11 136 49 23 1n 48 45
2 00 86 11 43
3 00 21 1A 42 40 16 6 0 0
10 351 31 82 85 60 40 10
5 62 01 31 13 10 422262
6 o2 12 60 679 2042
'| 31 11 6 126 12 17 1T 3 I
B 21 7 360 240 46 11 71 22 29 23 21 6
9 93 124 7A 10 3 97 32 2607492
t0 274 323 72 74 43 45 17 24 4
z ,2.176 -2.501 -2.a12 -2.549 -2.67A 2176
0 030 0 012 0 011 0 008 0.030
'Wilcoxon S nged Rank tesl

incubated uoder anaerobic condi- Table 2 The numb6r of oral bacteria

counts recovered dLrring lhe resloratile
tions in an anaerobic chamber preparation
(atmosphcre 80 pcr ccnt N,, 10
per cenr CO,, 10 per cent H,) for Toolh Bacleral couil (cFU)
,lBh at 37"C, and resulrant colonies Wilhoul EOVA Wilh EOVA
27 18 T
23 800 159
trftcr
cach expcriment,2ml of
37 24 2
th€ contamlnated residual lvater in 27 2
vacuum's tank u'as collected to 2
2
checl wherher it was conrer:rina&d.
37 22 5
The remaining contaminated water 6 0
rvas then disinfected with Biocidc@ 11 38 i9
1.7s per cen(v/v) for 5min, and 11 334 244
36 37 0
2ml of the sample rvas re-collected 11 272 5-l
to check for Ulling. To control for 17 1

background bxctcrial contamina 22 102 9

tion in the air, culture settle plates
rvere placed approximately 1m
fronr where the test proccdure rvas
being performcd.
Statistical analysis
Quanritrtive dara of L'afterial
counting vere sublected to para-
metric or non paramctric analysis
using t tcst and Wilcoxon Signed
Ranks test, respccli\.ely.
Results
In the first part of thc study,
suspeDsion ofE. ,r/l (1.0 -1.2 x 105
CFU/ml) rvas added to thc cool-
rng rvater ofan air turbine, which
u'as used to drill cavities in teeth in
a manikin. The EOVA dcvice was
uscd to remove the aerosol. A total
of38 esrimetions were madc. There
z 3.300
'Wilcoron S nged Ranks lest
u'as a statistically significant reduc,
tion in the numbcr ofE. rrlilvhen
using the EOVA device compared
with the control (P- 0.01, t-test).
The mean rccovcrable counts of
E. rol/rvithout using EOVA rvere
29.26 ! 19.13 CI]U and wh€n
using IIOVA were 17.26 ! 12.56
CFU,
ln the sccond parr ofthe study,
th€ spxtter of oral bactcria rvas
a cxamined during nctual dental
tr€atment proccdures on human
subiccts. The results are shorvn 1n
Turler / and ?and illusuate thafthe
mean recovetable counrs of ofal
bacterla rvcre g,:nerally slgnificandy
lower when using EOVA.
Bacteria in the rvater ofthe vacu,
0.001
um's tenk horvevcr, rvcre removed
by thc addjtion of a disinfcctanr.
The control pleres showcd only a
small number of environmental
bacterir (mcan number of 2.65 I
0.75 CFU).
Discussion
Bacteria in the mouth and respira-
tory tract trrc
d.islodged durlng
denral procedures and become
aerosol contaminants that may
cause infecLions such as puL-nonary
TBx'0, pneumonia and influcnza.
In addition, blood is thc mosr
important sourcc of HIV, HBV
and HCV and since oral fluids can
becomc contaminared wirh blood,

Teanpaisen or a/: Modiled household vacuumcleanerin reducinq bact€ dal d€nbt aeroso s
416
saliva and ginglval fluici lrom all
dental patienn must be considcted
infectiver tr':. lnfectious aetosols can
be generated when drilling human
reeth containing particles of 0.5-
5.Opm in diameter, some ofwhich
can be irhaled *'ith little difficultl.
ln spite o{ rigorous batriet tech
niques, dcnral petsonnel may be
exposed to such aerosols and
spetter. Carolyn and Nancy':
demonstrated tht conteminated
aerosol cafl penetrated single
Iayered face masks and lace-
shields and thar thc latter werc
substandally infer.ior to masks at
pre\'€nting penetrauon of :riJborne
debris, bccause of their lack of
pcriphetal fit. fherefore, an alter
native to these barriers is required
to prorccr dcntal staff from infec
The EOVA has been manufac
tured by several companies to
pror.ide protection for thc dental
envlronment ag3tnst aerosols. Eech
machine has to be specificalli' us ed
with a recommended meke and
model ofdentd unit but since these
machines are expensive the) hare
not been videly used by th€ dentxl
profession tn developing countries.
Our study pror.ides evidence
that an BOVA cotrstrucred by
lntemalona oenlaL Jo$ial (2001)Vol 51/No.6
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modifying a household vacuum dcnt. I ,4h 3a. Dt"t 1976 6114 11
cleaner wrs effectlve at rectucing HolbrooL W !, I1utr K F. Nlacphee l
aerosol dissemination into the T, r,l B.ctdiologrc.l rnre$igation
oathc rcrosol lrom uniasonic s.ale.s.
dental surgery environment. The tst Dht I 1r)78 144: 245 211.
modified EOVA used in this Chariyalertsal, S, Snisrnthana T,
expcriment is chexp, movable, eas!' S2engwooloey o. rt Clinical pres
to set up and can be mociified 'r
enktion and risl behavio6 orf.tients
to be used with any clental unit wtrh acauned innunodenciency sl.
available. drome i. Thaiiand, 19r4 19r8
iegio.xl warlation and tcnporal trelds.
C/i, Itf.4 Dt 2001 32: 955 962.
'1. Paiw,twrhi A. Tnber.ulosis in Thar
Acknowledgements
l^ad kqitulagr 2001 6: 65-?0.
This study was supported by the 8. Surrora Y, Ozxki T. TrtaL! S, r/ ,1.
grants from the Prince ofSongkla Elin,natins eLects ol a. dr plrifier
University, Thailand and rhe od ,dlectan* during dsf,til pro.e
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inlection br high specd defltal equip