E2 ◊Page E1 hygienist must employ language capable of engaging that specific pa- tient, targeting his or her indi- vidual cognitive and clinical characteristics. This task is far from simple and is the primary example of proactive therapy, defined as such by Geno- vesi and Marconcini et al.,10 in which the patient is placed at the centre of the dialogue and becomes part of the therapeutic path. The attribution of responsibility generates a positive change that will hopefully lead to a long-term oral disease prevention and oral health maintenance regime. During the motivation session, the microbiological principles of the oral microbiota, the formation of bio- film, and the important interaction between oral health and systemic health are explained to the patient. Mechanical procedure The patient is instructed on correct at-home oral hygiene, supported by using the appropriate mechanical cleaning tools. In our experience, the sonic toothbrush represents the gold standard of home care for the patient because, owing to the dynamic fluid action, it is able to re- move plaque and effects a change to the microbiota that corresponds to health. For interdental cleaning, we recommend silicone-bristle brushes or air and water cleaning aids for interdental spaces. These aids are easy to use without any particular manual ability, even where access is more difficult, and unlike dental floss, these tools are less harmful to the gingivae and more effective. Toothpastes and mouthwashes The choice of toothpaste and mouth- wash is essential for optimising the clinical effectiveness of mechanical instruments and to promote a state of eubiosis. There are a very large number of products dedicated to oral home care on the market. Each product has its indications and char- acteristics. Normally, chlorhexidine is administered only for a very short period of use—in the acute phase HYGIENE TRIBUNE Dental Tribune Middle East & Africa Edition | 6/2020 or, more precisely, in the first phase of MFMD. Later, it will be replaced with proactive products. In the ini- tial reactive phase, NitrAdine tablets (PerioTabs; bonyf) or zinc- based antimicrobial products can also be suggested to patients. In the proac- tive phase, the products are based on ozone, in the form of toothpastes and gels with higher concentra- tions or ozonated water, or, in less problematic situations, products containing natural antiseptics; and nanohydroxyapatite, propolis gel, GLIC toothpaste and GLIC mouth- wash (Polifarma Benessere) in dia- betic patients; or other biomimetic products.11 Operative session During the operative session of MFMD, the following operational precautions must be considered. Ultrasonic instrumentation Aerosols generated by ultrasound are an intrinsic feature of the de- vices.12 Therefore, in this situation of high transmissibility of the virus, it is preferable to limit the use of ul- trasound in favour of manual tools. If there are biofilm and non-calcified deposits, it is also recommended to reduce the level of irrigation and power of the ultra- sonic devices. In this scenario, it is highly recom- mended to use devices with which one can better regulate the water supply and reduce the amplitude of movement of the insert, minimising cavitation (Fig. 1). In situations where the use of ultrasound at a higher power is needed, it is important to increase the safety precautions indi- cated by scientific societies, such as PPE or efficient aspirators. Sonic instruments By nature, the sonic insert has a re- duced aerosol production. It would thus be useful to apply this technol- ogy wherever possible. Vector technology This technology exploits the shock wave produced in the periodontal pocket by cavitation. It eliminates uncontrolled oscillating move- ments and mechanical vibrations and requires a reduced flow of water. Therefore, the water is not sprayed and aerosol production will be al- most completely eliminated. For this reason, this technology should also be employed when possible in order to reduce the generation of aerosols.13 Use of prophylaxis powders The powders have literally revolu- tionised the therapeutic approach to the patient. We know that aerosol produced during this kind of thera- py is significant in terms of quantity and waste. It is therefore important, when there is a need, to modulate their use, reducing the time of ap- plication, choosing powders suitable for the clinical situation and prefer- ably using trolley devices that opti- mise the effectiveness of the jet. The reduction of aerosols is also favoured by intermittent use of the device. Periodontal cleaning It is preferable to use subgingival tips (Fig. 2), normally indicated for peri- odontal sites over 5mm deep. These allow us to limit excesses of the jet by directing it entirely into the peri- odontal pocket. Supragingival cleaning Micronised sodium bicarbonates and calcium carbonates satisfy all types of supragingival needs (re- storative mate- rials, erosion, brack- ets, pigments, plaque and exposed implant surfaces) and reduce the duration of application. In this case, choosing powders dedicated to the sub- gingival area can be wrong be- cause powders with lower abrasive indices increase spraying duration and therefore aerosols (and costs). General use The pedal should be used intermit- tently and never in a continuous jet, greatly reducing waste and nebulisa- tion caused by continuous spray of the jet. Of course, we must not for- get that it will be necessary to have powerful aspirators that reduce the spread of potentially contaminated aerosols, the retractor connected to the suction side and positioned near the patient’s oral cavity. instruments, Manual instruments There is no doubt that, even if for a short period, we must come back to manual instrumentation, limiting the use of ultrasound. In manual instrumentation, it is important to choose instruments that allow us to be effective but also ergonomic. Universal including DSS1/ DSS2 curettes (with graduated rod) or DS1/DS2 curettes (without graduated rod) with a double work- ing blade with perio-anatomical ad- aptations for anterior or posterior sites, and M23 and M23F scalers, are excellent tools. In this way, we can meet the need to reduce the instru- mentation time by optimising the performance of non-surgical peri- odontal therapy (Fig. 3). Ozone therapy, laser therapy and probiotics Periodontal therapy can and must also be supported on a professional level by proactive agents and de- vices.14 For example, the efficacy of professional use of ozone or probi- otics has been highlighted by sev- eral publications by our institute, and these substances may provide a further therapeutic opportunity in the hands of the dental hygienist to preserve the patient’s periodontal health,15,16 especially in this historic time in which we must reduce aero- sols, but still keep the oral cavity of our patients healthy. In addition, ozone is known to be non-specific and broadly effective on bacteria, fungi and viruses owing to its oxidis- ing properties.17,18 tion of airborne infections, analysing the surface near the working area using microbial cultures. The results showed that ozone therapy might be considered useful as a preopera- tive rinse for decontamination pur- poses, as well as to reduce airborne contamination. Ozone therapy has been reported as being effective for a range of different virus types, includ- ing SARS-CoV.19 Editorial note: A list of references can be obtained from the publisher. This article was originally published in prevention-international magazine for oral health, Vol. 4, Issue 2/2020. About The Istituto Stomatologico Toscano is a foundation for clinical, research and advanced training in dentistry in Lido di Camaiore in Italy. It offers continu- ing and further education courses, as well as conferences (currently postponed or made available online). Its masters’ courses are provided in collaboration with Saint Camillus International University of Health and Medical Sciences in Rome in Italy. A master’s degree in non-surgical periodontal treatment for dental hygien- ists starts in January every year. It consists of theoretical and practical lessons on one weekend per month and individual study for a final thesis, which is supported by tutors. In addition, an international post- graduate programme is available for den- tists (one- or two-year master’s degree). More information can be found at www. istitutostomatologicotoscano.it. Courses are being conducted online on the insti- tute’s own education platform currently in order to guarantee students continuity of training and pursuit of the educational assessments, including thesis drafting and research. In a recent study, we evaluated the effectiveness of pre-surgical rinsing with ozonated water in the reduc- The institute also organises free-of-charge webinarswith Dr Simone Marconcini and Prof. Ugo Covani. DAC Universal wins Red Dot Design Award 2020 By Dentsply Sirona Dentsply Sirona’s DAC Universal was awarded with a Red Dot Award for Product Design. The product im- pressed the jury with an intuitive and visually appealing user interface. With DAC Universal, Dentsply Sirona offers an infection control system with a fully automatic reprocess- ing workflow. Due to COVID-19, this year’s award winners were honoured during the Red Dot Design Week. With DAC Universal, Dentsply Sirona adds a Red Dot Award to the com- pany’s portfolio in 2020. Among more than 6,500 product applica- tions, DAC Universal convinced the jury with its high design quality and intuitive user interface. The award- winning product was presented at the Red Dot Design Week, which took place as a virtual event due to COVID-19. Intuitive workflow for a high level of safety The impressed with jury was Dentsply Sirona’s DAC Universal, emphasizing both its “sleek appear- ance that expresses efficiency and a high level of safety for the patient and the practice team. The fully automatic reprocessing allows for cleaning, lubrication (if necessary), and a thermal disinfection of up to six instruments within approx. 15 minutes – by simply pressing a sin- gle button. “For me DAC Universal is the best solution on the market today for fast reprocessing of contra angles and turbines. Information given by the display is easy to understand as well as cycle time remaining,” explains dental assistant Jane Mik- kelsen in Hinnerup, Denmark, who had the opportunity to assist Dent- sply Sirona with early testing of the product. “The design of the lids of the new DAC are excellent and help to minimize direct contact with hot surfaces. When removing the lid, it is no longer possible to come into contact with hot metal, as the lid has been redesigned.” “The award confirms our key objec- tives as a leading dental company in the global market: Bringing together excellent functionality and premi- um design in products that meet all requirements of dental professionals and continuously improve the ex- perience for patients,” said Michael Geil, Group Vice President Equip- ment and Instruments at Dentsply Sirona. For more information about the full Dentsply Sirona portfolio please contact your local representative. Dentsply Sirona 21st Floor, The Bay Gate Tower Business Bay, Al Sa’ada Street Dubai, United Arab Emirates Tel.: +971 (0)4 523 0600 Web: www.dentsplysirona.com/en E-mail: MEA-Marketing@dentsplysirona.com a n o r i S y l p s t n e D © cleanliness” and the “thoughtful functionality, [which] saves dental practices a lot of time in terms of everyday tasks.” DAC Universal was launched in 2019 with a complete facelift and numerous changes, including a touch display with in- tuitive user interface and a guided maintenance workflow. With DAC Universal, Dentsply Sirona offers an infection control system with a clear and effective workflow that ensures