Correspondence Address:
Dr. Rajagopal Athmarao Thennukonda
Department of Dentistry, Madurai Medical College and Hospital, Madurai, Tamil Nadu
India

Full Text

Human is capable of hearing vibrations in the range of 20 Hz to 20 KHz. Any sound wave above this frequency is referred to as ultrasonic. [1],[2] It was proposed in the early 1950s that ultrasonic sound waves can be used to disintegrate dental calcified tissues. With the introduction of high-speed rotary devices, interest in ultrasonic application waned. In mid-1950s, it was demonstrated that ultrasonics can be efficiently used to dislodge deposits from dental surfaces. Several other studies that followed confirmed the efficiency of ultrasonic in removing calculus. With such proof, widespread use of ultrasonics in dental clinic begin to emerge. It was since 1957, use of ultrasonics in endodontics began to materialize. [2]

Currently, ultrasonics use in dentistry has grown to large proportions. All dental clinics in affordable settings have at least one type of ultrasonic scaler units (USU). The application of ultrasonic scaler units is found in dental scaling, has wide applications in endodontics, and oral surgical procedure. In a typical USU, ultrasonic is produced by "magnetostriction" (a mechanism which converts electromagnetic energy into mechanical energy) or based on "Piezoelectric principle" (crystal is used that changes dimension in an electrical field. Subsequent deformation of crystal results in a mechanical oscillation without producing heat). [2] The older units use the former principle while that newer units rely on piezoelectric principle. The newer USU have been used as a scaler, an endodontic retreatment application or as a piezo-surgical unit.

Currently, ultrasonic scaler unit is a Class 2 device, without exempt as per the Food and Drug Administration (FDA). As compared to the widespread use of USU, very little is known about adverse, deleterious effects, or hazards associated with its use. Only a very few case reports have been known to be reported in literature [3] and up to 2% of all adverse events (AEs) associated with dental devices and equipment were reported to involve scalers. [4] The FDA of the United States of American Government defines AEs as "any undesirable experience associated with the use of a medical product in a patient." [4] There is a paucity of literature on the quantum of such adverse effects associated with USU, with last one such report's qualitatively discussing the subject [5] and another not detailing into scalers. [4]

Reports containing such warnings may help the users and even government officials to recall the potentially dangerous materials from the market. To cite an example, the recall of a denture cream with excess zinc leading to a downstream of events such as hypocupremia and neurological disease in a young individual who was using a partial denture and denture cream with high zinc content. Such seemingly unrelated correlations is often missed in general practice. [6],[7],[8] Database such as manufacturer and user facility device experience (MAUDE) could be collection of such events, providing strong large-scale collective evidence for knowledge of AE as well as practice.

General dentistry, especially seemingly harmless equipment such as an ultrasonic scaler, over these years of usage have poor patient safety literature baring very few isolated case report unlike in medical field. [3],[9] Probably, this could emanate from the fact that most of the dental devices being Class 1 and 2 devices, the possibility/probability of injury arising from the use of such materials might be less severe, follow-up is rare or fear of lengthy, costlier legal proceeding or the inherent gap in patient safety culture. [9] The aim of this manuscript is to list possible AE associated with USU usage in dental clinics in the past 10 years.

 Materials and Methods

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