A clinical study measuring dental aerosols with and without a high-volume extraction device

Nulty, Adam; Lefkaditis, Chris; Zachrisson, Patrik; Tonder, Quintus Van; Yar, Riaz

doi:10.1038/s41415-020-2274-3

Cited by 42 publications

(41 citation statements)

References 43 publications

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“…Exclusion criteria were age <18 y, current pregnancy, requirement for antibiotics prior to dental therapy, self-reported HIV or COVID-19 history, COVID-19–like symptoms since January 2020, and antibiotic therapy within 3 mo of sample collection. The sample size was based on previous evidence from in vitro and clinical studies on aerosol spread ( King et al 1997 ; Muzzin et al 1999 ; Nulty et al 2020 ; Allison et al 2021 ) during scaling and restorative procedures.…”

Section: Methodsmentioning

confidence: 99%

Sources of SARS-CoV-2 and Other Microorganisms in Dental Aerosols

et al. 2021

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On March 16, 2020, 198,000 dentists in the United States closed their doors to patients, fueled by concerns that aerosols generated during dental procedures are potential vehicles for transmission of respiratory pathogens through saliva. Our knowledge of these aerosol constituents is sparse and gleaned from case reports and poorly controlled studies. Therefore, we tracked the origins of microbiota in aerosols generated during ultrasonic scaling, implant osteotomy, and restorative procedures by combining reverse transcriptase quantitative polymerase chain reaction (to identify and quantify SARS-CoV-2) and 16S sequencing (to characterize the entire microbiome) with fine-scale enumeration and source tracking. Linear discriminant analysis of Bray-Curtis dissimilarity distances revealed significant class separation between the salivary microbiome and aerosol microbiota deposited on the operator, patient, assistant, or the environment ( P < 0.01, analysis of similarities). We also discovered that 78% of the microbiota in condensate could be traced to the dental irrigant, while saliva contributed to a median of 0% of aerosol microbiota. We also identified low copy numbers of SARS-CoV-2 virus in the saliva of several asymptomatic patients but none in aerosols generated from these patients. Together, the bacterial and viral data encourage us to conclude that when infection control measures are used, such as preoperative mouth rinses and intraoral high-volume evacuation, dental treatment is not a factor in increasing the risk for transmission of SARS-CoV-2 in asymptomatic patients and that standard infection control practices are sufficiently capable of protecting personnel and patients from exposure to potential pathogens. This information is of immediate urgency, not only for safe resumption of dental treatment during the ongoing COVID-19 pandemic, but also to inform evidence-based selection of personal protection equipment and infection control practices at a time when resources are stretched and personal protection equipment needs to be prioritized.

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Section: Methodsmentioning

confidence: 99%

Sources of SARS-CoV-2 and Other Microorganisms in Dental Aerosols

et al. 2021

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“…Previously, the use of EOS has demonstrated reduction of splatter (intensity of contamination and frequency) during most of the simulated procedures in both open clinic bays and closed bays in the same mechanically ventilated setting as used in this study (Din et al 2020; Shahdad et al 2020). In another recent study, EOS was found to statistically significantly reduce the aerosol particulate levels during various AGPs (Nulty et al 2020).…”

Section: Discussionmentioning

confidence: 94%

Fallow time determination in dentistry using aerosol measurement

Shahdad

Hindocha

Patel

et al. 2021

Preprint

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AimTo calculate fallow time (FT) required following dental aerosol generating procedures (AGPs) in both a dental hospital (mechanically ventilated) and primary care (non-mechanically ventilated). Secondary outcomes were to identify spread and persistence of aerosol in open clinics compared to closed surgeries (mechanically ventilated environment), and identify if extra-oral scavenging (EOS) reduces production of aerosol and FT.MethodsIn vitro simulation of fast handpiece (FHP) cavity preparations using a manikin was conducted in a mechanically and non-mechanically ventilated environment using Optical Particle Sizer™ and NanoScan™ at baseline, during the procedure and fallow period.ResultsAGPs carried out in the non-mechanically, non-ventilated environment failed to achieve baseline particle levels after one hour. In contrast, when windows were opened after AGP, there was an immediate reduction in all particle sizes.In mechanically ventilated environments the baseline levels of particles were very low and particle count returned to baseline within 10 minutes following AGP. There was no detectable difference between particles in mechanically ventilated open bays and closed surgeries.The effect of the EOS was greater in non-mechanically ventilated environment on reducing the particle count; additionally, it also reduced the spikes in particle counts in mechanically ventilated environments.ConclusionHigh-efficiency particulate air filtered mechanical ventilation along with mitigating factors (high-volume suction) resulted in reduction of FT (10 minutes). Non-ventilated rooms failed to reach baseline level even after one hour of FT. There was no difference in particle counts in open bay or closed surgeries in mechanically ventilated settings. The use of an EOS device can reduce the particulate spikes during procedures in both mechanical and non-mechanical environments.This study confirms that AGPs are not recommended in dental surgeries where no ventilation is possible. No difference was demonstrated in FT required in open bays and closed surgeries in mechanically ventilated settings.Clinical significanceAGPs should not be carried out in surgeries where ventilation is not possible. Mechanical ventilation for AGPs should be gold standard; where not available or practical then the use of natural ventilation with EOS helps reduce FT. AGPs can be carried out in open bay environment with a minimum of 6 air changes per hour of mechanical ventilation. Four-handed dentistry with high-volume suction and saliva ejector are essential mitigating factors during AGPs.

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“…Moreover, Rupf et al [ 28 ] recommended HVE to reduce patients’ and dental staffs’ exposure to fine and ultrafine airborne particles when using scanning sprays. Furthermore, Naulty et al [ 29 ] and Matys and Grzech-Leśniak [ 30 ], in their studies, recorded aerosol particulate at statistically significantly increased levels during dental procedures. Our study also found an average 2- to 3-fold reduction in aerosol quantity when using HVE compared to SE, which confirms the importance of the proper suction system during tooth preparation (treatment of Black’s class I caries) in order to increase microbial safety in the dental office.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Er:YAG Lasers on the Reduction of Aerosol Formation for Dental Workers

Grzech‐Leśniak¹,

Matys²

2021

Materials

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Infection prevention in dental practice plays a major role, especially during the COVID-19 pandemic. This study aimed to measure the quantity of aerosol released during various dental procedures (caries and prosthetic treatment, debonding of orthodontic brackets, root canal irrigation) while employing the Er:YAG lasers combined with a high-volume evacuator, HVE or salivary ejector, SE. The mandibular second premolar was extracted due to standard orthodontic therapy and placed in a dental manikin, to simulate typical treatment conditions. The particle counter was used to measure the aerosol particles (0.3–10.0 μm) at three different sites: dental manikin and operator’s and assistant’s mouth area. The study results showed that caries’ treatment and dental crown removal with a high-speed handpiece and the use of the SE generated the highest aerosol quantity at each measured site. All three tested Er:YAG lasers significantly reduced the number of aerosol particles during caries’ treatment and ceramic crown debonding compared the conventional handpieces, p < 0.05. Furthermore, the Er:YAG lasers generated less aerosol during orthodontic bracket debonding and root canal irrigation in contrast to the initial aerosol quantity measured in the dental office. The use of the Er:YAG lasers during dental treatments significantly generates less aerosol in the dental office setting, which reduces the risk of transmission of viruses or bacteria.

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A clinical study measuring dental aerosols with and without a high-volume extraction device

Cited by 42 publications

References 43 publications

Sources of SARS-CoV-2 and Other Microorganisms in Dental Aerosols

Sources of SARS-CoV-2 and Other Microorganisms in Dental Aerosols

Fallow time determination in dentistry using aerosol measurement

The Effect of Er:YAG Lasers on the Reduction of Aerosol Formation for Dental Workers

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