Eight reasons to ditch the cuspidor
by Allan Wright
Allan Wright explores the history of the cuspidor or spittoon and the advantages of working without one in dental practice.
Some people call it a cuspidor, others a spittoon, but whatever term you use, what you have at the side of your patient is a receptacle for spitting in.
Or, as the Oxford Dictionary of Dentistry puts it rather more eloquently: ‘A form of bowl… into which patients can expectorate.’
Either way, it is clear that it may be time for the cuspidor to retire gracefully from the realms of the dental practice.
This became even more apparent during and after the COVID-19 pandemic, when aerosols were designated the main infectious culprit.
In fact, the cuspidor has been found to have one of the highest concentrations of bacteria in the dental practice, with Yun, Park and Son (2014) demonstrating that the bacterial contamination levels of cuspidor surfaces were 44.9×103 CFU/ml (colony forming units).
Furthermore, the researchers found: ‘The mean bacterial cell count of cuspidors using water from waterlines was also 70.16×103 CFU/ml in at least 11-year-old establishments, statistically significantly higher among in one- to five-year-old (4.61×103 CFU/ml) and six- to 10-year-old clinics (47.89×103 CFU/mL) (p<0.05)’ (Yun, Park and Son, 2014).
So, while the cuspidor will still have its claim to fame helping Pixar’s Nemo to find his way home, perhaps that should now be its only use!
With that in mind, here we consider the current situation, what may constitute best practice, and the pros and cons of having a bowl to spit in right next to you and your patient.
Failure to progress
Before we look to the future, perhaps it would be prudent to look to the past, and the evolution of this rather ubiquitous piece of dental equipment.
According to the Melnick Medical Museum: ‘In the 1800s, most dental offices lacked not only electricity but plumbing as well. Patients rinsed their mouths and spat into an old-fashioned brass bowl that was usually attached to the chair arm.
Even when the spittoon was enclosed in an attractive cabinet, it still had to be emptied by hand.
‘The first self-cleaning cuspidor (the Whitcomb Fountain Spittoon) was introduced in 1867, but was not widely used because it required modern plumbing.’
Of course, plumbing eventually caught up with dental practices, but with the Whitcomb spittoon described as ‘beautifully enamelled in imitation of rosewood’ with smaller particles entering a dedicated waste pipe and a receptacle to catch larger items such as gold and ‘other valuable fillings’, it doesn’t take much imagination to consider the pathogenic horrors here.
Time moved on, of course, as did the technology available and cross-infection control knowledge.
However, as truthfully stated by Ijaz (2021), with a cuspidor there has never been a 100% effective and safe way to circumvent ‘saliva, blood, pieces of calculus, etc, just sitting there staring up at you’.
Reasons to move on
When looking into why so many dental professionals are now moving away from working with cuspidors, it became clear that there are eight main reasons why (Grison, 2015; Olive, 2021):
1. Hygiene
Reduce the risk of cross-contamination by removing the need for the patient to rinse. Instead, you could try to rinse for the patient with a 3:1 and high quality HVE suction from the treatment position. If the patient expresses a desire to rinse at the end of an appointment, consider a funnel attached to the HVE suction system, which the patient can hold close to their mouth
2. Cost reduction
Save costs on consumables such as plastic cups and detergents whilst reducing your environmental impact, as well as reducing the overall price of your equipment, allowing you to invest elsewhere or save costs. Indeed, it has been estimated that removing the dental spittoon could save you around 10% of the RRP of your equipment
3. Minimise effort
Reduce the steps and effort spent resetting the room between patients. After all, if you do not have a cuspidor, no one needs to clean it
4. Improve efficiency
Save time for more appointments by reducing cleaning times and removing the need to rinse. It has been suggested that it takes about 90 seconds to stop a procedure, raise the patient for a rinse and spit, and return to treatment. If you multiply that by the number of patients you see per day, you may be surprised at how much time you lose doing that
5. Improve ergonomics
Improve ergonomics for the dental team by reducing unnecessary movements when adjusting the cuspidor during patient entry and exit. In a blind survey of dentists (who may or may not work with a cuspidor), 80% said working without a spittoon improves ergonomics in a surgery. Every single respondent reported that asepsis is improved, while three-quarters stated patient comfort is improved
6. Better access
Improve access for the dental nurse to get closer while creating space for better patient entry and exit, as the chair can be accessed by them from either side. In addition, dual sided access is beneficial for the dentist, especially, for example, if performing implant treatment while standing
7. Reduce maintenance
Fewer parts to your dental chair reduces both service cost and time. Without a cuspidor, dental chairs have less tubing, solenoids, and circuit boards, making them easier and quicker to install, plus there is less that can go wrong
8. Aesthetics
Improved aesthetics allow for a cleaner, less-intimidating look, allowing the patient to feel more relaxed.
Nothing on the chair
As my colleague Nick Olive once wrote so succinctly on this subject, the so-called ‘nothing on the chair’ set up has many merits in terms of patient comfort.
There are some dental chairs that are designed specifically to allow for this type of configuration.
Delivery systems, for example, can be supplied as a tidy side garage system, with an airbrake on most systems for optimum flexibility.
Another alternative is a 12 o’clock system that can be mounted on a nurse’s table at the rear of the chair to remain out of sight of the patient.
When combined with a ceiling or wall mounted light and no spittoon, a dental chair quickly loses its intimidating appearance and is simply a comfortable piece of furniture in the middle of a room.
This will certainly help nervous patients – but it may also prove to be a way of effectively future proofing a practice as well.
Since they are designed to be clinically flexible and easily adapted, they can be changed to suit the needs of different clinicians quickly and simply.
Ambidextrousness is one important consideration, and a chair that can easily facilitate both left- and right-handed users will certainly provide a variety of useful options well into the future.
Of course, the more options there are to choose from, the more difficult it is for practitioners to decide precisely what it is they need and want.
Therefore, it is important to get the advice of the experts, and to consider all your options before ordering a chair with what you think are the standard options.
Flexibility and adaptability come generally as standard with certain high-quality chairs, so it is undoubtedly worth your while considering all the options.
References
Grison S (2015) Sondage, Le crachoir au cabinet dentaire. EDP Dentaire 52-54
Ijaz S (2021) Seven things dental hygienists are thankful for. Today’s RDH
Olive N (2021) Why I think the world is rejecting the dental spittoon. Dental Tribune
Yun K, Park H, Son B (2014) A study on bacterial concentrations in dental offices. Journal of Environmental Health Sciences 40(6): 469-476
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