Quantifying strategies to minimize aerosol dispersion in dental clinics

Strategies for preventing aerosol-generated microbial contamination in dental procedures: A systematic review and meta-analysis

BACKGROUND

Aerosol generation in dental practice is a significant concern in infection control. This study aimed to investigate the strategies for controlling and preventing aerosol-generated microbes during dental procedures.

METHODS

A systematic search was performed using PRISMA guidelines through electronic databases (PubMed, ScienceDirect, Cochrane Library, Google Scholar, and Scopus) using specific keywords, like "aerosol generation" AND "dental procedures" AND "prevention" for studies reporting interventions, including mouthwash and suction devices, that were effective against pathogens generated during dental procedures. Eligible studies were included based on predefined criteria. Pooled effectiveness was calculated using a random-effects model in RevMan 5.4 software. Quality assessments were performed using RoB-2.0 and the Robvis web application.

RESULTS

Nineteen studies were included in this systematic review and meta-analysis. Different interventions, including cetylpyridinium chloride, chlorhexidine, chlorine dioxide, hydrogen peroxide, herbal formulated products, and suction devices, have been identified as the most utilized interventions to reduce microbial contamination during dental procedures. Overall, these interventions were found to be effective, with a pooled effectiveness of -46.64 (95% CI: -60.89 to -32.38, I2=100%, p<0.00001).

CONCLUSIONS

This study underscores the importance of a multifaceted approach that integrates antiseptic mouthwash and suction devices to minimize the risk of cross-contamination and infection transmission during aerosol-generated dental procedures, thereby safeguarding the health and safety of both patients and dental healthcare workers.

DATA AVAILABILITY STATEMENT

The data presented in this study are available on request from the corresponding author.

Aerosol mitigation in upper airway surgery

BACKGROUND

Aerosol generating procedures pose a risk for SARS-CoV-2 transmission, and comprise a large percentage of cases performed in otolaryngology. An optimal method to mitigate this hazard does not currently exist. This study examined methods to mitigate surgical aerosols from the operating room.

METHODS

Utilizing an intubation manikin (Nasco Healthcare) and particle counter (Sensirion SPS30), a series of electrocautery-induced aerosols containing particles 0.5-10 μm in diameter were measured. Three different mitigation strategies were tested: intraoral (Yankauer, suction Bovie pencil (SBP)), extraoral (smoke evacuator system (SES)), and their combinations.

RESULTS

SES was effective compared to controls, but inferior to intraoral mitigation strategies (p < 0.0001). Combining SES with any intraoral mitigation strategy did not enhance mitigation efficiency, and in some comparisons led to inferior performance (SBP vs SBP-SES, p < 0.05). Comparison of intraoral mitigation strategies found no statistically significant differences between techniques, although SBP was found to have the lowest overall level of particles.

CONCLUSIONS

Intraoral suction techniques are recommended for aerosol mitigation. Extraoral SES use alone is insufficient for aerosol mitigation, and may be counterproductive when used with intraoral suction techniques. Further research is needed to determine the optimal mitigation strategy for intraoperative surgical aerosols.

Study of aerosol dispersion and control in dental practice

OBJECTIVES

In this study, we investigated the dispersion patterns of aerosols and droplets in dental clinics and developed a suction device to evaluate its effectiveness in reducing aerosols during dental procedures.

MATERIALS AND METHODS

Firstly, the continuous images of oral aerosols and droplets were photographed with a high-speed camera, and the trajectories of these particles were recognized and processed by Image J to determine key parameters affecting particle dispersion: diffusion velocity, distance, and angle. Secondly, based on the parameter data, the flow field of aerosol particles around the oral cavity was simulated using computational fluid dynamics (CFD), and the flow field under adsorption conditions was simulated to demonstrate the aerodynamic characteristics and capture efficiencies of the single-channel and three-channel adsorption ports at different pressures. Finally, according to the simulated data, a three-channel suction device was developed, and the capture efficiency of the device was tested by the fluorescein tracer method.

RESULTS

The dispersion experimental data showed that aerosol particles' maximum diffusion velocity, distance, and angle were 6.2 m/s, 0.55 m, and 130°, respectively. The simulated aerosol flow-field distribution was consistent with the aerosol dispersion patterns. The adsorption simulation results showed that the outlet flow rate of single-channel adsorption was 184.5 L/s at - 350 Pa, and the aerosol capture efficiency could reach 79.4%. At - 350 Pa and - 150 Pa, the outlet flow rate of three-channel adsorption was 228.9 L/s, and the capture efficiency was 99.23%. The adsorption experimental data showed that the capture efficiency of three-channel suction device was 97.71%.

CONCLUSIONS

A three-channel suction device was designed by simulations and experiments, which can capture most aerosols in the dental clinic and prevent them from spreading.

CLINICAL RELEVANCE

Using three-channel suction devices during oral treatment effectively reduces the spread of oral aerosols, which is essential to prevent the spread of epidemics and ensure the health and safety of patients and dental staff.