Effects of mechanical ventilation and portable air cleaner on aerosol removal from dental treatment rooms

Ren, Yanfang; Huang, Qirong; Marzouk, Tamer; Richard, R. J.; Pembroke, Karen; Martone, Pat; Venner, Tom; Malmström, Hans; Eliav, Eli

doi:10.1016/j.jdent.2020.103576

Cited by 52 publications

(44 citation statements)

References 49 publications

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“…Ventilation rates varied greatly between rooms on the same air handling system due to variations in their sizes and locations and the addition of separate air exhaust fans in some rooms designated for nitrous oxide conscious sedation ( Ren et al 2021 ). Accurate measurements of ventilation rate in dental settings are important for risk assessment and for risk mitigation planning in an era of frequent infectious disease pandemics.…”

Section: Discussionmentioning

confidence: 99%

“…While in theory the most effective measure for air quality improvement in dental offices is to increase outdoor airflow rate through the ventilation system or through natural ventilation by opening doors and windows, such measures are severely limited by the weather or climate conditions. An effective alternative is to improve air filtration using upgraded filters in the ventilation system and portable air cleaners (PACs) equipped with high-efficiency particulate air (HEPA) filters ( Ren et al 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…Mechanical ventilation in air change per hour (ACH VENT ) was measured with an air velocity sensor integrated in an airflow balancing hood (ADM-850L Airdata Multimeter with CFM-850L FlowHood; Shortridge Instruments) as described elsewhere ( Ren et al 2021 ).…”

Section: Methodsmentioning

confidence: 99%

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Ventilation Assessment by Carbon Dioxide Levels in Dental Treatment Rooms

et al. 2021

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It is important for dental care professionals to reliably assess carbon dioxide (CO2) levels and ventilation rates in their offices in the era of frequent infectious disease pandemics. This study was to evaluate CO2 levels in dental operatories and determine the accuracy of using CO2 levels to assess ventilation rate in dental clinics. Mechanical ventilation rate in air change per hour (ACHVENT) was measured with an air velocity sensor and airflow balancing hood. CO2 levels were measured in these rooms to analyze factors that contributed to CO2 accumulation. Ventilation rates were estimated using natural steady-state CO2 levels during dental treatments and experimental CO2 concentration decays by dry ice or mixing baking soda and vinegar. We compared the differences and assessed the correlations between ACHVENT and ventilation rates estimated by the steady-state CO2 model with low (0.3 L/min, ACHSS30) or high (0.46 L/min, ACHSS46) CO2 generation rates, by CO2 decay constants using dry ice (ACHDI) or baking soda (ACHBV), and by time needed to remove 63% of excess CO2 generated by dry ice (ACHDI63%) or baking soda (ACHBV63%). We found that ACHVENT varied from 3.9 to 35.0 in dental operatories. CO2 accumulation occurred in rooms with low ventilation (ACHVENT ≤6) and overcrowding but not in those with higher ventilation. ACHSS30 and ACHSS46 correlated well with ACHVENT ( r = 0.83, P = 0.003), but ACHSS30 was more accurate for rooms with low ACHVENT. Ventilation rates could be reliably estimated using CO2 released from dry ice or baking soda. ACHVENT was highly correlated with ACHDI ( r = 0.99), ACHBV ( r = 0.98), ACHDI63% ( r = 0.98), and ACHBV63% ( r = 0.98). There were no statistically significant differences between ACHVENT and ACHDI63% or ACHBV63%. We conclude that ventilation rates could be conveniently and accurately assessed by observing the changes in CO2 levels after a simple mixing of household baking soda and vinegar in dental settings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ventilation Assessment by Carbon Dioxide Levels in Dental Treatment Rooms

et al. 2021

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“…Large dental treatment rooms have shown certain effects in terms of bioaerosol distribution [ 28 ]. As proposed by several authors, cross ventilation using the opening of windows and air purification devices were shown to be highly effective methods to reduce the risk of airborne transmission of COVID virus containing particles [ 29 , 30 , 31 , 32 ]. The course room (326.2 sqm) in contrast is equipped with 20 windows in total, each measuring 4 sqm and thanks to the fact that they can be opened this allows a rapid ventilation of the complete course room.…”

Section: Discussionmentioning

confidence: 99%

Dental Education during the COVID-19 Pandemic in a German Dental Hospital

Winter

Frankenberger

Günther

et al. 2021

IJERPH

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Due to the SARS-CoV-2 pandemic, dental treatment performed by undergraduate students at the University of Marburg/Germany was immediately stopped in spring 2020 and stepwise reinstalled under a new hygiene concept until full recovery in winter 2020/21. Patient treatment in the student courses was evaluated based on three aspects: (1) Testing of patients with a SARS-CoV-2 Rapid Antigen (SCRA) Test applied by student assistants (SA); (2) Improved hygiene regimen, with separated treatment units, cross-ventilation, pre-operative mouth rinse and rubber dam application wherever possible; (3) Recruitment of patients: 735 patients were pre-registered for the two courses; 384 patients were treated and a total of 699 tests with the SCRA test were performed by SAs. While half of the patients treated in the course were healthy, over 40% of the patients that were pre-registered but not treated in the course revealed a disease being relevant to COVID (p < 0.001). 46 patients had concerns to visit the dental hospital due to the increase of COVID incidence levels, 14 persons refused to be tested. The presented concept was suitable to enable patient treatment in the student course during the SARS-CoV-2 pandemic.

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“…Contaminated air from the area of the dental chair should not spread or circulate in the area that is not subject to treatment. It is also recommended to use portable NERA filters during the treatment of patients, which can be placed near the patient's chair to reduce the level of aerosol infection [16].…”

Section: Mouthmentioning

confidence: 99%

Improvement of Infection Control Measures during Dental Manipulations

Fundovnaya

Noskova

Dorofeev

et al. 2021

JPRI

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When performing dental manipulations, infection control plays a special role, since its violation will negate all the efforts of the dentist, as well as allow various infectious and bacterial complications to develop in the body, as a result of which the patient's health will be significantly harmed. Infection control in dentistry is especially important at the present stage, when the spread of coronavirus infection has not yet been stopped, and the world is already experiencing the third wave of COVID-19. So, today it is very important to evaluate the existing infection control measures taken in dental health organizations, both private and public, and to investigate the measures proposed in the literature to reduce the transmission of both the new coronavirus and other infectious diseases to patients. Infection control measures in dentistry are aimed at minimizing the cross-transmission of mainly blood-borne pathogens. However, the high degree of contagion of the new coronavirus, as well as the possibility of the appearance of such viruses in the future, makes specialists already think about the need to improve infection control measures in order to preserve the health of patients and make dental manipulations as safe as possible for them. This is especially important for elderly patients, in whom complications from coronavirus-like infectious diseases can be fatal. In dental practice, many people are at risk, such as the practitioner, assistants, patients, administrative staff, cleaners, and possibly accompanying people. Standard precautions are usually not sufficient during the active spread of infections, so it is important to use proper PPE and follow hand hygiene. The sequence of consultations and scheduling of appointments with patients, as well as making changes to the waiting area, are also important. To minimize aerosol contamination, mouthwash should be performed before treatment. It should be taken into account that fans with NERA filters can significantly reduce the number of aerosols and, accordingly, reduce the level of pathogenicity of viruses. The aim of the work is to consider the measures proposed in the publications aimed at improving the measures of infection control during dental manipulations.

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Effects of mechanical ventilation and portable air cleaner on aerosol removal from dental treatment rooms

Cited by 52 publications

References 49 publications

Ventilation Assessment by Carbon Dioxide Levels in Dental Treatment Rooms

Ventilation Assessment by Carbon Dioxide Levels in Dental Treatment Rooms

Dental Education during the COVID-19 Pandemic in a German Dental Hospital

Improvement of Infection Control Measures during Dental Manipulations

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