Optimizing high-volume evacuator usage: A quantitative analysis of aerosol control in dental procedures

Dental aerosols pose a risk to dental healthcare workers (DHCWs). High-volume evacuators (HVE) are commonly recommended to efficiently eliminate dental aerosols. However, there are limited objective recommendations concerning the operating distance and angle of HVE. This study investigated the contamination of dental aerosol particles during dental drilling, rinsing, and polishing, with and without HVE. The primary objective was to evaluate the efficiency of HVE with various operating parameters both qualitatively and quantitatively. A dental manikin with a complete oral cavity simulated the patient, and aerosol dispersion represented by condensed droplets was visualized by a green laser. A laser particle counter (AeroTrak 9303, TSI) was used to measure particle size. We also employed aerosol monitors (DustTrak II 8530 & 8532, TSI) to determine aerosol mass concentrations. Our results showed that HVE has limited effectiveness in managing large particles (5.0–25.0 μm). Furthermore, we found a significant negative correlation between the reduction rate of HVE and the operation distance (ρ < 0, p < 0.05, Spearman's correlation test), highlighting the necessity of placing the suction nozzle as close as possible to the patient's oral cavity. The maximum effective distance should not exceed 10 cm. Notably, increasing the angle had a substantial negative impact on reducing particle concentration in the breathing zone of the operator, showing the recommendation for parallel positioning of the suction nozzle. These results underscore the importance of optimizing HVE usage to enhance aerosol management during dental procedures, thereby reducing potential health risks.