Your handpiece works extremely hard, making its maintenance critically important.
The dental handpiece is one of the most used instruments in the entire dental armamentarium, and it is one of the most costly instruments as well. Dentists use handpieces in every restorative, periodontic, endodontic, and surgical procedure, and dental hygienists use them in every hygiene procedure. Because of the wide range of uses and the frequency and duration of those uses in a typical dental practice, keeping handpieces clean, disinfected, and running smoothly directly impacts a practice’s bottom line in many ways. Whether you choose to use an electric or an air-driven handpiece, both of which are classified as Class 1 medical devices by the Food and Drug Administration (FDA),1 there are a number of maintenance steps that every dental practice needs to follow to keep its handpieces running at optimum capacity and maximum safety.
In electric handpieces, the motor is so powerful that even after bearings and gears begin to fail and disintegrate, the handpiece will continue to deliver the same amount of torque to the attachment, all the while increasing friction to the point that the attachment can become hot enough to burn a patient.2 When using an electric handpiece, the practitioner must be aware throughout every procedure of any sensation of heat in the handpiece or the attachment being used. If the handpiece begins to feel hot, its use should be discontinued immediately. Not only will this prevent further damage to the unit, more importantly it will prevent injuring the patient.3 While this was more of a problem with the introduction of the first electric handpieces over a decade ago and many improvements to the electric motors have been made since then, it is still incumbent upon the operator to monitor electric handpieces for increased levels of heat during each and every procedure.
With air-driven handpieces, controlling the level of air pressure entering the unit is critical. Too much air pressure can cause the bearings inside the handpiece to fail, and it can also reduce speed as air accumulates around the turbine, creating resistance to slow the turbine down.2 Likewise, the quality of the air being driven into the handpiece is important when it comes to extending the life of the turbine. If a handpiece is not properly cleaned and maintained, oil particles and water droplets can accumulate in the compressor. When the handpiece is turned on, the oil and water travel through the air lines and bounce against the turbine at high speed, damaging it—at possibly great cost to the practice.2
The FDA, the Centers for Disease Control and Prevention (CDC), and the American Dental Association (ADA) all have specific policies, guidelines, and requirements for the disinfection and sterilization of dental handpieces. The FDA mandates that all dental handpieces used in the United States be designed so that they can be sterilized by an accepted methodology, such as the CDC guidelines for infection control in dental healthcare settings, and also that those devices can withstand repeated sterilization cycles.1,4 The CDC classifies dental handpieces as “critical” items, the highest category of risk to patient safety, because the attachments can penetrate both soft and hard tissues and make contact with the bloodstream to generate blood and debris spatter, which creates the most significant risk of transmitting infection from instrument to patient.4 Therefore, according to CDC guidelines, dental handpieces must be sterilized by autoclave, dry heat, or a heat and chemical vapor combination after every single use.4 The ADA recommends strict adherence to these sterilization principles as well.5
Separate from infection control procedures, dental handpieces are machines that need to be maintained and, from time to time, repaired. Maintenance schedules and tasks rely mainly on whether the handpiece is electric or air-driven. Regardless of the source of power, handpiece maintenance needs to be followed rigorously and routinely to prevent this critical tool from being out of commission for any length of time.
There are three general principles to follow in maintenance, and they apply to all handpieces: clean, lubricate, and sterilize.2 All handpieces, regardless of type or function, should be cleaned of debris and blood, lubricated according to the manufacturer’s instructions, and then sterilized according to the CDC and ADA guidelines. Because the specific process steps to fulfill each of these three principles varies according to the type of handpiece, always consult the manufacturer’s instruction manual and follow the recommended techniques.
When a handpiece is in need of repair, time and cost are major considerations for most dentists. If the handpiece is still under warranty, the most cost-effective option is to return it to the manufacturer. However, if the handpiece is older, dentists may opt to send the handpiece out to a repair service. In this case, if the repair service is not carefully researched, the work could end up costing dentists even more in terms of time and money.
There are several criteria that any potential repair service should be able to offer.2 First, choose a reliable service where you can communicate directly with the technician who will be performing the repair, and make sure that technician is highly trained and qualified. Make sure the repair service uses genuine parts from the handpiece’s manufacturer, performs all repairs in-house, and can prove both with original documentation. Finally, never send out a handpiece for repair without getting an estimate or a warranty for the work. Both can save you a significant amount of money at the outset.
Because nearly every dental procedure relies on the dental handpiece at some point, these tools are among the most critically important to a practice’s productivity and bottom line. They also carry a significant risk if they are not cleaned and maintained properly. At best, an improperly cleaned or maintained handpiece can disrupt a practice, and at worst, it can harm a patient. Following the infection control guidelines and policies set by the regulatory agencies and the maintenance instructions and schedules set by the handpiece manufacturers should ensure many years of efficient and safe operation.
References
1. US Food and Drug Administration. Guidance for Industry and FDA Staff: Dental Handpieces: Premarket Notification [510(k)] Submissions. May 2007. https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm071411.htm. Accessed September 2, 2014.
2. Williams G. Anatomy of a Handpiece: Understanding Handpiece Maintenance and Repairs. 2010; The Academy of Dental Therapeutics and Stomatology. https://www.ineedce.com/courses/2000/PDF/1012cei_handpiece_rev9.pdf. Accessed September 2, 2014.
3. US Food and Drug Administration. Available at: https://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm226995.htm. Accessed September 2, 2014.
4. Centers for Disease Control and Prevention (CDC). Guidelines for infection control in dental health care settings—2003. MMWR Morb Mortal Wkly Rep. 2003 Dec 19;52(RR-17):1-68. https://www.cdc.gov/oralhealth/infectioncontrol/guidelines/index.htm. Accessed September 2, 2014.
5. Kohn WG, Harte JA, Malvitz DM, et al. Guidelines for infection control in dental health care settings—2003. J Am Dent Assoc. 2004;135(1):33-47.
