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Brain function monitors have improved safety and efficiency in general anesthesia; however, they have not been adequately tested for guiding conscious sedation for periodontal surgical procedures. This study evaluated the patient state index (PSI) obtained from the SEDline monitor (Sedline Inc., San Diego, CA) to determine its capacity to improve the safety and efficiency of intravenous conscious sedation during outpatient periodontal surgery. Twenty-one patients at the periodontics clinic of Baylor College of Dentistry were admitted to the study in 2009 and sedated to a moderate level using midazolam and fentanyl during periodontal surgery. The PSI monitoring was blinded from the clinician, and the following data were collected: vital signs, Ramsay sedation scale (RSS), medications administered, adverse events, PSI, electroencephalography, and the patients' perspective through visual analogue scales. The data were correlated to evaluate the PSI's ability to assess the level of sedation. Results showed that the RSS and PSI did not correlate (r= −0.25) unless high values associated with electromyographical (EMG) activity were corrected (r= −0.47). Oxygen desaturation did not correlate with the PSI (r= −0.08). Satisfaction (r= −0.57) and amnesia (r= −0.55) both increased as the average PSI decreased. In conclusion, within the limits of this study, PSI appears to correlate with amnesia, allowing a practitioner to titrate medications to that effect. It did not provide advance warning of adverse events and had inherent inaccuracies due to EMG activity during oral surgery. The PSI has the potential to increase safety and efficiency in conscious sedation but requires further development to eliminate EMG activity from confounding the score.

Background:Control of contamination in the dental office has sometimes deterred practitioners from using ultrasonic scalers. Recent studies point to the aerosol and splatter produced during ultrasonic scaling as a vehicle for the possible transmission of bloodborne pathogens. A recently introduced ultrasonic insert that focuses the spray produced during scaling may reduce this aerosol contamination. An aerosol reduction device (ARD) that is attached to the ultrasonic handpiece has been shown to reduce the contamination cloud by placing suction in close proximity to the ultrasonic tip. The purpose of this study was to compare the contamination produced by a standard insert (S) and the new focused spray (F) insert with and without the use of the aerosol reduction device (ARD). Methods:The testing was conducted in vitro within a plastic enclosure using a dye in the coolant spray. After mock scaling of a dentoform model, the number of contaminated squares on the enclosure was counted and recorded. Results:Analysis of the data indicated no significant difference (P>0.05, Mann‐Whitney U test) between the S or F inserts in the amount of contamination produced. When the aerosol reduction device was used, there was a significant reduction (P<0.05, Mann‐Whitney U test) in the amount of contamination for both inserts with a greater reduction for the standard insert. Conclusions:The traditional style of ultrasonic insert (S) and the newer focused coolant water insert (F) produce an equal amount of aerosol contamination. The amount of aerosol contamination produced by both inserts is copious. The ARD significantly reduced contamination with both styles of inserts. These findings support the use of a large bore high‐volume evacuator whenever an ultrasonic scaler is used. J Periodontol 1999;70:473‐477.

As concern about indoor air quality increases, attention is being placed on the aerosol and splatter produced during dental procedures. This study quantifies the contamination produced by ultrasonic scalers during in vitro scaling without coolant water. When compared with the handheld curette used as a control, all ultrasonic scalers and tips tested produced significant aerosol and splatter regardless of the type of scaler, the power level or the insert. The ADA-recommended method for controlling contaminated aerosol and splatter is the use of a large-bore high-volume evacuator. This study supports the ADA recommendation of use of a high-volume evacuator whenever ultrasonic scaling is performed.

There is concern with decreasedair quality and potential aerosol contamination in the dental operatory. This problem has been addressed by the Centers for Disease Control and Prevention, which recommends that all sources of blood‐contaminated splatter and aerosols be minimized. One of the major sources of potential aerosol contamination in the dental setting is the ultrasonic sealer. This study looks at the use of a high volume evacuator attachment for the ultrasonic sealer handpiece. Artificial teeth were mock‐scaled for 1 minute with and without the evacuator attachment. The mock scaling was performed within a plastic enclosure that had a 1 cm grid laid out on 4 sides. Scaling was performed 10 times each by 2 operators. An erythrosin solution was used for the ultrasonic sealer coolant with a coolant volume of 17.5 ml/min. The number of squares containing a red erythrosin spot were counted and considered to represent aerosol contamination. The high volume evacuator attachment produced a 93% reduction in the number of contaminated squares (chi squared significant at P< 0.05). There was no increase in heat transfer to a tooth analogue when the high volume evacuator attachment was used with the ultrasonic sealer as compared to the sealer without the evacuator attachment. It is felt that the high volume evacuator attachment is capable of significantly reducing the amount of aerosol contamination produced within the test system without increased heat transfer to the tooth. J Periodontol 1996;67:28–32.

As concern about indoor air quality increases, attention is being placed on the aerosol and splatter produced during dental procedures. This study quantifies the contamination produced by ultrasonic scalers during in vitro scaling without coolant water. When compared with the handheld curette used as a control, all ultrasonic scalers and tips tested produced significant aerosol and splatter regardless of the type of scaler, the power level or the insert. The ADA-recommended method for controlling contaminated aerosol and splatter is the use of a large-bore high-volume evacuator. This study supports the ADA recommendation of use of a high-volume evacuator whenever ultrasonic scaling is performed.

Disease transmission and barrier techniquesduring dental treatment have been areas of recent concern in dentistry. Ultrasonic sealers are known to produce aerosols, and these aerosols are often produced from areas of significant disease activity, including bleeding. This study was performed to determine if these aerosols contain blood from the gingival sulcus. Forty areas consisting of two contiguous periodontally involved teeth (probing depth of at least 5 mm on one site of each tooth) were scaled subgingivally with an ultrasonic sealer for 30 seconds. A high volume evacuator (HVE) tip was positioned 3 to 5 cm away from the operating site and utilized to capture the aerosols produced. The water remaining in and on the HVE tube was tested for occult blood by the guiac resin method. Gingival index, mean probing depth, presence of bleeding with scaling, and presence of visible blood in the HVE tip were recorded. All 40 test sites showed a positive result for blood in the captured aerosols despite the wide variation in the measured parameters. It may be concluded that subgingival scaling on periodontally involved teeth with ultrasonic sealers would be expected to produce aerosols containing blood. J Periodontol 1998;69:434–438.