Corded

Along with our desire to produce excellent dentistry comes the need to be able to see what we are doing more clearly. Without a doubt, the most important vision enhancement aid is a pair of high quality magnification loupes. When you can see a magnified image of a tooth through a pair of loupes, your ability to render precision care rises tremendously.

Using a headlight is just another step beyond loupes. Headlights eliminate most shadows, since your head can never get between the source of the light and the object being illuminated. And, with the light following your eyes, the object you are viewing is always maximally illuminated.

This can be especially advantageous when viewing and/or treating different areas of the mouth during the same visit. Usually, as you move from one area to another, you have to readjust your overhead light repeatedly. Hygienists would also benefit from using a headlight, since they typically start at one corner of the mouth and progress to the opposite one. This requires constant readjustment of the treatment room light.

Not only is a headlight an aid intraorally, but it is also valuable when contouring provisionals, since we usually move away from the patient for protection against grinding debris. This movement usually requires that we move the overhead light to illuminate our new work area. Then we have to move it back to the patient when we try in the provisional. We may have to do this jockeying of the light several times, a real nuisance. A headlight eliminates this problem.

Fiber Optic vs. LED

Fiber optic headlights, with their control boxes sitting on a cabinet top and umbilical transmitting the light, have been the de facto leaders for providing unmatched illumination over the years. However, LED technology has definitely taken over this market, rendering the halogen/metal halide models obsolete.

Corded vs. Cordless

LED headlights are available in both corded and cordless models. Corded versions typically have a higher level of illumination and longer battery life, while cordless models eliminate the control unit and the annoying cord running from the headlight to the control unit. This subcategory compares corded models.

Components

Control unit With LEDs, this is typically a small unit that clips onto your belt, trousers, or scrubs. It contains the battery (internal or removable) and either a simple on-off switch or rheostat allowing you to increase or decrease the light being emitted.

Umbilical With LEDs, this is the cord from the headlight itself to the control box. This is merely an electrical connection as no light is transmitted in this cord.

Headlight Sometimes called the lamphead. Includes the lens and a flip-up mechanism. All of our tested units are very small and lightweight.

Headband vs. Magnification Lenses Mount

Headbands distribute the weight of headlights and cords so that there is minimal pressure on your neck muscles. In addition, using a headband-mounted headlight allows you to separate the functions of your loupes and headlight more easily. For example, when you are treating anterior teeth, you may not need the extra illumination provided by a headlight. However, headbands certainly do not blend with creative coiffures. And, unless the headbands are reasonably snug, even slight movement can move the light beam away from the operative field.

As an alternative, the headlight can be mounted on the frame of the magnification loupes. While this style does not involve having to wear a headband, it does add weight to the loupes. However, the current generation of LED headlights have minimal weight, making this the most popular method of using a headlight. 

Therefore, no matter what type of headlight you choose, the mounting is critical to your comfort. If you try one type and it does not work for you, try the other option.

Illumination Level/Iris Control

With any headlight, you want to choose a level of light that gives you the amount of illumination you need to complete the procedure as effectively as possible. The illumination level is usually controlled by a setting on the control unit.

However, another setting that plays a role in the level of light as well as the coverage area is the iris adjustment, which controls the diameter of the spot produced. While this was a feature on most halogen headlights, LEDs usually do not even have this feature.

NOTE The power readings from manufacturers may not match our readings, since manufacturers may be using a different distance from the headlight to the light meter. The distance we use (14.0in/35.6cm) was confirmed clinically.

Premature Polymerization of Composite

Most LEDs come with a removable filter that mounts on the end of the headlight itself on some type of hinge mechanism. However, rotating the filter on an LED is difficult without contaminating it with your gloves.

Therefore, we tested most of our CHOICES by illuminating a standard flowable composite at the highest setting. For the control group, the flowable was dispensed on flattened dentin and immediately covered by a glass slide with a 230g weigh on it. After 1.0 minute, the weight was removed and the material was light cured for 40 seconds. The polymerized disc of flowable was then measured for thickness.

Then the procedure was repeated after exposing the flowable to the headlight for 30-second intervals at 14.0in/35.6cm, which again simulates the distance your head would probably be from the mouth clinically. Polymerized discs of flowable were then measured and compared to the control. When the thickness of the disc exposed to the headlight differed from the control by 10%, the test was stopped and that time was recorded. This increase in thickness indicates the composite was prematurely polymerizing under the headlight.

The results are listed in the commentary for each light. However, it would still be prudent to test your headlight at your chosen illumination level on a small amount of composite to see what effect it will have on premature polymerization.

Do LED Headlights Emit Dangerous Levels of Blue Light?

The rapid acceptance of LED headlights has been a major leap forward in allowing us to see better intraorally. Due to their low power consumption, corded LED headlights are powered by a small and lightweight battery pack that typically clips to our belts.

In either rendition, LED headlights allow us to have maximum mobility while giving us the needed illumination to perform at an optimal level. However, one manufacturer of these lights has challenged the profession to look critically at the danger of excessive blue light being emitted from these products. As the caution goes, this blue light can be deleterious to our eyes.

This blue light hazard to eyes is nothing new. It is the reason we use various types of orange shields to protect our eyes when we activate a curing light to polymerize composites, cements, and other light-cured materials. There is even a blue light hazard specific website dealing with this issue along with a host of eye care professionals researching the issue and industrial hygienists who are charged with providing a safe workplace for many different types of workers. In this regard, even the safety of open fluorescent fixtures without diffusers has been questioned.

These open fixtures could be a particular concern to dentists since we probably have patients starring directly into them when they are reclined in your treatment rooms. While it seems highly unlikely that a patient could suffer any eye damage from the relatively short exposure during a dental procedure, it is also obvious that patients should be given protective lenses not just for physical hazards (e.g., dropping an instrument), but also from the light going directly into their eyes. This means the lenses need to be tinted to filter out blue light as well as glare.

In addition, the white light emitted by most LED headlights has been implicated as being too harsh, which could result in more eye strain and glare. This white light is much different than the softer, more yellowish light emitted by the previous generation of the aforementioned fiber optic headlights powered by halogen bulbs. One LED headlight, however, produces what is described as a neutral beam that is presumably safer on the eyes and, as a bonus, is stated to render color more naturally. See below for our description of this neutral beam.

The white light produced by LEDs has been compared to the so-called full spectrum or daylite fluorescent bulbs that typically are supposed to emulate sunlight. This type of light has not only been recommended for shade-matching in dentistry and other fields, but it also has been stated to promote better health with John Ott being the most famous advocate in this field.

Confused? Well, that is not the end of the story. Besides the blue light having a potential adverse effect on your eyes, excessively high illumination levels have also been implicated. After all, that is one of the reasons we squint when we are exposed to bright light and why we wear sunglasses on clear, sunny days. So, with all this in mind, should you go back to the yellow halogen days?

We set out to determine the truth since we only get one pair of eyes and no one wants to ruin them by using the wrong type of headlight. Note: Even though headlights are the main subject of this project, the current generation of treatment room lights, which utilize LEDs, could also be part of this discussion since it is the cumulative effect of blue light that really matters.

For the first part of this investigation, we tested the following LED headlights:

SurgiTel High Intensity Mini LED Neutral (SurgiTel/General Scientific)

SurgiTel High Intensity Mini LED Cool (SurgiTel/General Scientific)

SurgiTel Micro LED Neutral (SurgiTel/General Scientific)

Solaris (Perioptix/DenMat)

DayLite UltraMini (Designs for Vision)

Feather Light LED (Ultralight Optics)

Ergolux (Halm Ergotechnology)

TESTS 

Size of Spot @ 14in/35.6cm

Headlight
Size
SurgiTel Mini Neutral
3.2in/8.2cm
SurgiTel Mini Cool
2.8in/7.1cm
SurgiTel Micro Neutral
2.6in/6.6cm
Solaris
2.6in/6.7cm
DayLite UltraMini
3.1in/8.0cm
Feather Light LED
3.4in/8.6cm
Ergolux
2.9in/7.3cm

  

BOTTOM LINE Even though there are some differences in the sizes of the spots, it is unlikely these differences will be an issue if you also wear loupes, since your field of view will probably be well within the size of these spots.

 

Shape of Spot

Headlight
Shape
SurgiTel Mini Neutral
Round
SurgiTel Mini Cool
Round
SurgiTel Micro Neutral
Round
Solaris
Square
DayLite UltraMini
Square
Feather Light LED
Square
Ergolux
Square

  

BOTTOM LINE For those of you that used a fiber optic, corded headlight of yesteryear, you may remember that it produced a typical round spot that mimicked the actual lens. When LEDs hit the market, it was somewhat surprising to discover that they had a square beam. Now, with the SurgiTel offerings, the round beam is back and it is better defined compared to the products with square beams, which tend to have a more indistinct border. However, similar to the spot size issue, it is unlikely that you will notice the beam shape if you are using loupes.

 

Hotspot (Yes or No)

Headlight
Hotspot
SurgiTel Mini Neutral
Yes, but minimal
SurgiTel Mini Cool
Yes, but minimal
SurgiTel Micro Neutral
Yes, but minimal
Solaris
Yes
DayLite UltraMini
Yes
Feather Light LED
Yes
Ergolux
Yes

  

BOTTOM LINE If a headlight has a hotspot, the center of its beam will be brighter than its periphery. Other than the SurgiTel products, all other headlights have a definitive hotspot in the middle of their beams. (The latest HDi offerings from Designs for Vision, which were not included in this report, does not have hotspots.) With the SurgiTel headlights, the illumination is relatively uniform from the center out to the periphery of the beam, with only a faint hotspot that is barely noticeable. If you are wearing loupes with minimal magnification (2x), you may be able to notice the hotspots since your field of vision will probably be wider compared to loupes with higher levels of magnification. Nevertheless, it is uncertain whether these hotspots will affect your vision clinically. In our evaluations of LED headlights, no evaluator has commented on hotspots.

 

Color of Spot

Headlight
Color
SurgiTel Mini Neutral
Warm white
SurgiTel Mini Cool
Cool white
SurgiTel Micro Neutral
Warm white
Solaris
Cool white
DayLite UltraMini
Cool white
Feather Light LED
Cool white
Ergolux
White w/pinkish hue

  

BOTTOM LINE The two SurgiTel products with Neutral in their names definitely have a warmer, less stark color than the other headlights. As noted previously, this warmer color is somewhat closer to the more yellowish beam produced by the fiber optic, corded headlights of yesteryear, which were powered by halogen bulbs. However, the warmer white produced by the neutral offerings from SurgiTel is still white and, when we compared them side-by-side to a halogen light, there were still significant differences in color.

While the more neutral beam from the SurgiTel products could provide more pleasant illumination, no evaluator has commented on the whiter light of the LEDs we have already evaluated. On the other hand, we have not had a warmer LED for comparison sake. This warmer LED could just be a preference item or it could be easier on the eyes. A complete evaluation, which has not yet been done, will need to determine the importance of this property.

 

Power at highest setting (Lux)

Headlight
Lux 
SurgiTel Mini Neutral
30,400
SurgiTel Mini Cool
31,200
SurgiTel Micro Neutral
14,110
Solaris
87,300
DayLite UltraMini
37,100
Feather Light LED
22,500
Ergolux
21,300

  

BOTTOM LINE If you want maximum illumination, the Solaris is by far the product of choice. None of the other headlights even come close. On the other hand, the SurgiTel Micro Neutral, which is extremely small, was the least powerful and may not provide an adequate illumination level.

 

Power at lowest setting (Lux)

Headlight
Lux
SurgiTel Mini Neutral
1,495
SurgiTel Mini Cool
1,623
SurgiTel Micro Neutral
1,070
Solaris
17,000
DayLite UltraMini
13,100
Feather Light LED
1,890
Ergolux
N/A (only one setting)

  

BOTTOM LINE If the maximum power from the Solaris is just plain excessive for your eyes, you have the option of lowering it to a more moderate level. The lowest setting on the other lights probably will not provide enough illumination to be of much help clinically. This is especially true of the SurgiTel trio and the Feather Light.

 

Blue light emitted (mW/cm2) using the Coltolux digital light meter

Headlight
mW/cm2
SurgiTel Mini Neutral
0
SurgiTel Mini Cool
1
SurgiTel Micro Neutral
0
Solaris
12
DayLite UltraMini
0
Feather Light LED
0
Ergolux
0

  

BOTTOM LINE Dental radiometers such as the Coltolux light meter are basically designed to measure blue light peaking around 470 nm, while the blue light wavelength range stated to be harmful to eyes is 430-440 nm. Nevertheless, even blue light at 470 nm can be dangerous to our eyes. After all, many LED curing lights emit blue light in the 470 nm peak and we still need to protect our eyes. Therefore, it seemed logical to perform this test.

However, all the headlights either produced no measurable blue light or, in the case of the Solaris, an extremely small amount. And when we reduced the intensity level on the Solaris to approximately half power, its reading on the light meter was negligible. On the other hand, since the light meter is designed for testing curing lights, it may not be sensitive and/or sophisticated enough to measure blue light from a headlight.

 

Blue light emission determined by composite hardness

Since the validity of the readings from the light meter was questionable, we tested whether there were any differences in hardness when the lights were used to illuminate a test restorative composite. As noted previously, even though the most dangerous blue light wavelength range (430-440 nm) is somewhat shorter than those required to cure most composites, we still believe this is a valid test to compare individual lights.

We use hardness as a reliable parameter for measuring the degree of cure of a composite. A higher composite hardness could indicate more blue light is being emitted from a specific headlight compared to other headlights that produce lower hardness values.

This test consisted of illuminating a test specimen of composite for either one hour (a typical operative procedure) or six hours (a typical workday when you could be using the headlight on most patients). In addition, the two LED models included in this part of the overall project were tested at 30 minutes to simulate a shorter procedure. Each headlight was used at its highest power level from our normal testing distance of 14.0in/35.6cm. The two LED headlights were also compared to a fiber optic halogen type (Zeon Illuminator) and to an LED treatment room light (Helios 3000), the latter of which was positioned 30.0in/76.2cm from the composite. The control was a curing light (VALO Cordless) used in the standard mode for 20s.

Headlight
Time
Hardness (KHN)
VALO Cordless
20s
93.1
Solaris
30m
77.2
Solaris
1h
95.0
Solaris
6h
94.1
SurgiTel Mini Neutral
30m
75.2
SurgiTel Mini Neutral
1h
94.8
SurgiTel Mini Neutral
6h
97.2
Zeon Illuminator
1h
88.0
Zeon Illuminator
6h
84.6
Helios 3000
1h
77.9

  

BOTTOM LINE The hardness produced by the two LED headlights at one hour and six hours was virtually the same as that from the curing light. The fiber optic halogen headlight produced a composite hardness slightly lower, while the treatment room LED and the LED headlights used for 30 minutes trailed the pack, but not by much. The results of these tests indicate that all the lights produce enough blue light to polymerize composite. Of course, this is certainly not breaking news since even the headlight manufacturers acknowledge this fact since virtually all of them provide orange filters to block the blue light during the time you are manipulating a light-sensitive material intraorally.

 

REALITY

We do not think it is prudent to be cavalier about blue light damage to our eyes and believe large shields like the type sold by Premier offer the best protection when using a curing light, which, depending on the position of the restoration you are placing, could actually shine directly into your eyes.

On the other hand, it is uncertain whether the reflected blue light from a headlight has the same deleterious effects. Since fiber optic headlights like the one we tested also produce blue light, their use by all types of healthcare professionals for many years without any apparent dangers to the your eyes would seem to indicate the same conclusion could be reached about LEDs. In other words, other than prematurely polymerizing a light-sensitive material, there does not seem to be an eminent danger from blue light with LED headlights.

Nevertheless, other than having your eyes examined annually by an eye care professional, you can also use an Amsler grid to check your own eyes periodically. There is also evidence to support taking antioxidant supplements such as carotenoids (zeaxanthin and lutein), vitamins C and E, and zinc to help stymie retinal decline as we age.

As far as illumination levels are concerned, we believe you need to use a headlight that provides enough light to accomplish your task. You may be able to accomplish intraoral procedures perfectly well using a headlight at 20,000 Lux or even less, while others may need 40,000 Lux or even higher.

Obviously, being able to regulate the light levels is an important feature for a headlight since you may require more light for posterior procedures and less for those anteriorly. Or you may be able to dispense entirely with the headlight in certain circumstances. And, if you are using a headlight with a stark white beam that is bothersome, you have a warmer option from SurgiTel.

Note: This is a dynamic area and updates, as usual, will be posted when appropriate.

We are grateful to Dr. Richard Price for providing much of the reference material used in this article.

 

Consumer-Oriented Headlights

Along with professional models, you can walk into virtually any home improvement or hardware store and find consumer LED versions. Compared to professional headlights that typically cost $500+, consumer models can be a veritable bargain. So will an inexpensive consumer model work as well as a more expensive professional version?

To find an answer to that question, we tested a simple headlight purchased from Restoration Hardware for the princely sum of $35.00. It features a black elastic headband, is activated merely be turning the black rubber-coated knob encircling the beam, has a ratchet-type hinge to adjust its downward angle, and gets its power from three AAA batteries housed in a metallic silver plastic enclosure. All in all, it does not look cheap.

Unfortunately, that is where the good news stops. We measured the power of this light at only 1,563 lux compared to professional versions that emit over 20,000 lux. Now we understand that this is just one model as other consumer versions may provide more serious light. But it appears a professional version is still your best bet to illuminate the oral cavity to a level that will make your job easier and your dentistry more precise, which, of course, is the whole point to these lights.

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