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Li Y, Li J, Hu J, Yu X, Li Z, Cao J. Quantitative evaluation of the impact of indoor relative humidity on deposition of aerosols generated during tooth grinding in a real-world clinical setting. Clin Oral Investig 2024; 28:292. [PMID: 38693418 DOI: 10.1007/s00784-024-05683-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES Exposure to aerosol particles generated from tooth grinding has a negative impact on the health of dental personnel. The aim of this study was to quantitatively analyze the impact of indoor relative humidity (IRH) on the deposition of these suspended particles in a well-controlled dental environment. MATERIALS AND METHODS In this study, a humidity control system was employed to effectively regulate and maintain indoor relative humidity (IRH). A novel computer-assisted numerical control system was developed to pre-treat the molar specimens, and accurately simulate clinical tooth grinding procedures. Each procedure was performed in triplicate, with an online real-time particle counter (ORPC; TR-8301, TongrenCo.) measuring aerosol production. All testing devices were controlled remotely. The data obtained were statistically analyzed using descriptive statistics and non-parametric tests (Kruskal-Wallis/ Dunn's post hoc test with Bonferroni correction, p < 0.05). RESULTS The findings showed that with increasing IRH, the maximum peak concentration of aerosol particles decreased by 397% from 6.51 × 107 particles/m3 at 30% to 1.64 × 107 particles/m3 at 80%. The Kruskal-Wallis test results indicated a statistically significant effect of IRH on the aerosol increment (p < 0.05). CONCLUSIONS Increasing the IRH level can effectively promote the deposition of aerosol particles, with a return to baseline within 15 min after reaching 60% or above. CLINICAL RELEVANCE Our study suggested that maintaining IRH above 70% during the cleaning process, allowing natural recovery to ambient humidity levels within 15 min after cleaning, and taking basic precautions, may lead to an adequate reduction in the possible health risks of aerosol contamination.
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Affiliation(s)
- Yugang Li
- School of Mechanical Engineering, Guizhou University, Guiyang, China
- Guizhou Equipment Manufacturing Polytechnic, Guiyang, China
| | - Jiachun Li
- School of Mechanical Engineering, Guizhou University, Guiyang, China.
| | - Jie Hu
- School of Mechanical Engineering, Guizhou University, Guiyang, China.
| | - Xiaoyan Yu
- Guiyang Hospital of Stomatology, Guiyang, China
| | - Zhe Li
- School of Life Sciences, Guizhou Normal University, Guiyang, China
| | - Jichao Cao
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, China
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Li N, Cai QM, Hu NY, Jiang SL, Chen FQ, Hu QQ, Yang F, He CZ. Pyrosequencing analysis of bacterial community changes in dental unit waterlines after chlorogenic acid treatment. Front Cell Infect Microbiol 2024; 14:1303099. [PMID: 38299116 PMCID: PMC10828043 DOI: 10.3389/fcimb.2024.1303099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024] Open
Abstract
Introduction The contamination of dental unit waterlines (DUWLs) poses a significant risk of cross-infection in dentistry. Although chemical disinfectants have been effective in reducing number of bacteria, they do have limitations. Methods This study aimed to investigate the potential of chlorogenic acid, a natural substance with broadspectrum antibacterial properties, for treating DUWLs. Over a period of three months, we analyzed the microbial communities in 149 DUWLs samples collected from 5 dental units using high-throughput pyrophosphate sequencing. Results The results revealed that chlorogenic acid treatment had a significant impact on the microbial community profile in the DUWLs, with the most significant changes occurring within the first 15 days and stabilization observed in the last 30 days. The predominant genera detected in the samples were Bacteroides, Lactobacillus, Streptococcus, Methylobacterium, and Phreatobacter. Additionally, the relative abundance of certain beneficial bacteria, such as Alloprevotella, Roseburia, and Blautia, increased, while the presence of opportunistic pathogens like Mycobacteria significantly decreased. The functional prediction analysis using the KEGG database indicated a decrease in the pathogenicity of the bacterial community in the DUWLs following chlorogenic acid treatment. Discussion This study introduces a novel approach for the prevention and treatment of infections associated with dental care.
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Affiliation(s)
- Na Li
- Department of Stomatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Nursing School, Nanchang University, Nanchang, China
| | - Qin-Ming Cai
- The First Affiliated Hospital of Nanchang University, School of Public Health, Nanchang University, Nanchang, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ni-Ya Hu
- The First Affiliated Hospital of Nanchang University, School of Public Health, Nanchang University, Nanchang, China
| | - Shu-ling Jiang
- Department of Stomatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Nursing School, Nanchang University, Nanchang, China
| | - Fu-Qing Chen
- Department of Stomatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Qiao-Qiao Hu
- Department of Stomatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Fen Yang
- Department of Stomatology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Chao-Zhu He
- Nursing School, Nanchang University, Nanchang, China
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Koletsi D, Panayi N, Laspos C, Athanasiou AE, Zinelis S, Eliades T. In vivo aging-induced surface roughness alterations of Invisalign ® and 3D-printed aligners. J Orthod 2023; 50:352-360. [PMID: 36573484 PMCID: PMC10693732 DOI: 10.1177/14653125221145948] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To assess the surface roughness of in-house 3D-printed orthodontic aligners compared with Invisalign® appliances, both retrieved as well as in the 'as-received' control status. DESIGN An in vitro study following intra-oral material aging. SETTING AND PARTICIPANTS Twelve clinically used Invisalign® appliances and the same number of 3D-printed aligners, without involvement of attachments, were obtained from a respective number of patients. A similar number of 'as-received' aligners, of each material, were used as control (CON) groups. METHOD Four groups of materials were examined: A = Invisalign® CON; B = Invisalign® used; C = 3D-printed CON; and D = 3D-printed used. Optical profilometry was employed to examine the following surface roughness parameters: amplitude parameters Sa, Sq and Sz and functional parameters Sc and Sv. Descriptive statistics and quantile regression modeling were conducted, and the level of statistical significance was set at α = 0.05. RESULTS Intra-oral exposure of 3D-printed aligners was significantly associated with increase in all tested parameters (P < 0.001 at all occasions). Significant differences were detected in the retrieved 3D-printed aligners compared with Invisalign® retrieved, with the exception of Sz. The respective effect sizes (median differences) were as follows: Sa: 169 nm, 95% confidence interval [CI] = 89-248, P < 0.001; Sq: 315 nm, 95% CI = 152-477, P < 0.001; Sc: 233 nm3/nm2, 95% CI = 131-335, P < 0.001; and Sv: 43 nm3/nm2, 95% CI = 17-68, P = 0.002. CONCLUSION Within the limitations of this study, we concluded that surface roughness differences existed between 3D-printed aligners and Invisalign® in the retrieved status, as well as between the control and retrieved 3D-printed groups.
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Affiliation(s)
- Despina Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Nearchos Panayi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
- Department of Dentistry, School of Medicine, European University Cyprus, Nicosia, Cyprus
- Private practice, Limassol, Cyprus
| | - Christodoulos Laspos
- Department of Dentistry, School of Medicine, European University Cyprus, Nicosia, Cyprus
- Private practice, Limassol, Cyprus
| | | | - Spiros Zinelis
- Department of Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Li YG, Li JC, Yu XY, Hu J, Li Z, Cao JC. Quantitative assessment of aerosol contamination generated during tooth grinding with a speed-increasing handpiece. J Dent 2023; 139:104631. [PMID: 37495202 DOI: 10.1016/j.jdent.2023.104631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/29/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVES Tooth grinding produces a significant amount of aerosol particles. The aim of this study was to quantitatively assess particle contamination produced from tooth grinding with a speed-increasing handpiece across a real-world clinical setting. METHODS All molar crowns were pretreated into cylinders with a uniform size. A novel computer-assisted numerical control system was used to parametrically study the bur speed: from 20,000 (20 K) to 200 K rpm at 20 K rpm intervals. 5-minute tooth grinding was performed in triplicate at each speed setting. Three online real-time particle counters (ORPC; TR-8301, TongrenCo.) were placed at 3 positions (0.5, 1, and 1.5 m) to evaluate particle production. All experimental instruments were controlled remotely. The data obtained were statistically analyzed using descriptive statistics and non-parametric tests (Scheirer-Ray-Hare and Kruskal-Wallis/ Dunn-Bonferroni tests, p < 0.05). RESULTS The concentration level of aerosol particles production during the grinding experiment was elevated above the control group for all conditions, and increased with bur speed at any location (the maximum peak, reaching 5.59 × 107 particles/m3, at 200 K and 1 m), with differences between conditions. The effect of speed on the increment of particles across different channels compared to the control group was statistically significant among locations (p < 0.001). CONCLUSIONS Statistically significant particle contamination was produced using a speed-increasing handpiece, but the contamination level for each experimental condition was reduced to baseline within 30 min, and most particles with a diameter greater than 1üm produced at low speeds (80 K or lower) tended to settle within 1 m. CLINICAL RELEVANCE Our study suggested that the use of a speed-increasing handpiece below 80 K and 30 min of fallow time may lead to an adequate reduction in the health effects of particle contamination.
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Affiliation(s)
- Yu-Gang Li
- School of Mechanical Engineering, Guizhou University, Guiyang, China; Guizhou Equipment Manufacturing Polytechnic, Guiyang, China
| | - Jia-Chun Li
- School of Mechanical Engineering, Guizhou University, Guiyang, China.
| | - Xiao-Yan Yu
- Guiyang Hospital of Stomatology, Guiyang, China
| | - Jie Hu
- School of Mechanical Engineering, Guizhou University, Guiyang, China
| | - Zhe Li
- School of Life Sciences, Guizhou Normal University, Guiyang, China
| | - Ji-Chao Cao
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, China
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Cao R, Qiu P, Xu B, Lin J, Chu D, Fan Z. Effectiveness of interventions to reduce aerosol generation in dental environments: A systematic review. Prev Med Rep 2023; 35:102383. [PMID: 37680854 PMCID: PMC10480641 DOI: 10.1016/j.pmedr.2023.102383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
Certain dental procedures produce high levels of aerosols containing pathogenic microorganisms, posing a risk for the transmission of infections in dental settings. This study aimed to assess the effectiveness of various aerosol mitigation interventions during clinical dental procedures in real-world environments. A systematic literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and Embase for English studies up to March 2023 according to the PRISMA guidelines. Only peer-reviewed controlled clinical trials (CCT) or randomized controlled trials (RCT) studies involving human subjects were included. The risk of bias of selected researches were evaluated by two independent authors using the Cochrane Collaboration tool. The literature search yielded 3491 articles, of which 42 studies met the inclusion criteria and were included in this study. Most studies evaluated bacterial contamination in bio-aerosols, while the viral and fungal contamination was assessed in only three studies. Overall, various approaches have been applied in reducing aerosol contamination in clinical scenarios, including high-volume evacuators (HVE), mouse rinses and rubber dams, air cleaning systems, and high-efficiency particulate air (HEPA) filters. The available evidence suggests that various aerosol mitigation strategies could be implemented to decrease the risk of cross-infection during clinical dental procedures in real-world environments. However, further clinical trials are necessary to establish statistical validity in measuring aerosol contamination and mitigation, as well as to evaluate the risk of infection transmission for viral and fungal contamination.
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Affiliation(s)
- Rongkai Cao
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
| | - Piaopiao Qiu
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
| | - Borui Xu
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
| | - Jingying Lin
- College of Environmental Science and Engineering, Tongji University, Shanghai 200092, PR China
| | - Danna Chu
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
| | - Zhen Fan
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
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Thawaba AA, Albelasy NF, Elsherbini AM, Hafez AM. Evaluation of enamel roughness after orthodontic debonding and clean-up procedures using zirconia, tungsten carbide, and white stone burs: an in vitro study. BMC Oral Health 2023; 23:478. [PMID: 37443027 PMCID: PMC10339551 DOI: 10.1186/s12903-023-03194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The main goal of orthodontic debonding is to restore the enamel surface as closely as possible to its pretreatment condition without iatrogenic damage. This study aimed to compare the effects of different adhesive removal burs; zirconia burs, tungsten carbide burs, and white stone burs on enamel surface roughness. MATERIALS AND METHODS Total sample of 72 extracted premolars was randomly divided into three equal groups (n = 24) depending on the method of adhesive removal: zirconia burs (ZB); tungsten carbide burs (TC); and white stones (WS). The metal brackets were bonded using Transbond XT orthodontic adhesive (3 M Unitek, Monrovia, CA, USA) and debonded after 24 h using a debonding plier, then the ARI was assessed. The adhesive remnants were removed using the different burs and Final polishing was performed using Sof-lex discs and spirals. Thirteen samples from each group were evaluated using a Mitutoyo SJ-210 profilometer to determine average surface roughness (Ra) and three samples from each group were examined under Scanning Electron Microscopy (SEM) to determine EDI score. The evaluations were performed at three time points; before bonding (T0), after adhesive removal (T1) and after polishing (T2) and the time consumed for adhesive removal by burs was recorded in seconds. The data were analyzed statistically by ANOVA, Tukey's test and Kruskal-Wallis H-test. RESULTS Kruskal-Wallis H-test showed no statistically significant difference of ARI in all studied groups (p = 0.845) and two-way mixed ANOVA revealed that all burs significantly increased surface roughness at T1 compared to T0 (p < 0.001) in all groups with the lowest Ra values were observed in the ZB group, followed by the TC group, and WS group. The fastest procedure was performed with WS, followed by ZB, then TC bur (p < 0.001). After polishing (T2), Ra values showed no significant difference in ZB group (P = 0.428) and TC group (P = 1.000) as compared to T0, while it was significant in WS group (p < 0.001). CONCLUSION zirconia bur was comparable to tungsten carbide bur and can be considered as alternative to white stone which caused severe enamel damage. The polishing step created smoother surface regardless of the bur used for resin removal.
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Affiliation(s)
- Ahmed A. Thawaba
- Department of Orthodontic, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Nehal F. Albelasy
- Department of Orthodontic, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Amira M. Elsherbini
- Department of Oral Biology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Ahmad M. Hafez
- Department of Orthodontic, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Pratt A, Eckermann N, Venugopalan SR, Uribe LM, Barlow L, Nonnenmann M. Evaluation of aerosols in a simulated orthodontic debanding procedure. Sci Rep 2023; 13:4826. [PMID: 36964164 PMCID: PMC10036970 DOI: 10.1038/s41598-023-32082-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/22/2023] [Indexed: 03/26/2023] Open
Abstract
Dental practitioners may be at risk for exposure to severe acute respiratory syndrome corona virus 2 when performing aerosol generating procedures. Though recent evidence suggests that coronavirus may be transmitted through aerosol generating procedures, it is unknown whether common procedures performed in dental clinics generate aerosol. The aim of this study was to simultaneously quantify airborne concentrations of the bacteriophage MS2 near the oral cavity of a dental mannequin and behind personal protective equipment (i.e., face shield) of the practitioner during a simulated orthodontic debanding procedure. A deband was performed eight times on a dental mannequin. Optical particle counters and SKC Biosamplers were used to measure particle concentration and to collect virus aerosol generated during the procedure, both near the oral cavity and behind the orthodontists face shield. A plaque assay was used to determine the viable virus airborne concentration. When comparing the two measuring locations, near the oral cavity and behind the clinician's face shield, there was no statistically significant difference of virus concentrations or particle size distribution. This study suggests that debanding under these conditions generates live virus aerosol and a face shield does not provide increased protection from virus aerosol, but does provide some protection against splatter during the procedure.
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Affiliation(s)
- Alessandra Pratt
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA.
- Center for Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa City, IA, USA.
| | - Nile Eckermann
- Department of Orthodontics, University of Iowa, Iowa City, IA, USA
| | | | | | - Lauren Barlow
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA
| | - Matthew Nonnenmann
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, NE, USA
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Choudhary S, Durkin MJ, Stoeckel DC, Steinkamp HM, Thornhill MH, Lockhart PB, Babcock HM, Kwon JH, Liang SY, Biswas P. Comparison of aerosol mitigation strategies and aerosol persistence in dental environments. Infect Control Hosp Epidemiol 2022; 43:1779-1784. [PMID: 35440351 PMCID: PMC10822722 DOI: 10.1017/ice.2022.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To determine the impact of various aerosol mitigation interventions and to establish duration of aerosol persistence in a variety of dental clinic configurations. METHODS We performed aerosol measurement studies in endodontic, orthodontic, periodontic, pediatric, and general dentistry clinics. We used an optical aerosol spectrometer and wearable particulate matter sensors to measure real-time aerosol concentration from the vantage point of the dentist during routine care in a variety of clinic configurations (eg, open bay, single room, partitioned operatories). We compared the impact of aerosol mitigation strategies (eg, ventilation and high-volume evacuation (HVE), and prevalence of particulate matter) in the dental clinic environment before, during, and after high-speed drilling, slow-speed drilling, and ultrasonic scaling procedures. RESULTS Conical and ISOVAC HVE were superior to standard-tip evacuation for aerosol-generating procedures. When aerosols were detected in the environment, they were rapidly dispersed within minutes of completing the aerosol-generating procedure. Few aerosols were detected in dental clinics, regardless of configuration, when conical and ISOVAC HVE were used. CONCLUSIONS Dentists should consider using conical or ISOVAC HVE rather than standard-tip evacuators to reduce aerosols generated during routine clinical practice. Furthermore, when such effective aerosol mitigation strategies are employed, dentists need not leave dental chairs fallow between patients because aerosols are rapidly dispersed.
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Affiliation(s)
- Shruti Choudhary
- Aerosol and Air Quality Research Laboratory, Department of Chemical, Environmental and Material Engineering, University of Miami, Miami, Florida, United States
| | - Michael J. Durkin
- Division of Infectious Disease, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Daniel C. Stoeckel
- St. Louis University Center for Advanced Dental Education, St. Louis University, St. Louis, Missouri, United States
| | - Heidi M. Steinkamp
- St. Louis University Center for Advanced Dental Education, St. Louis University, St. Louis, Missouri, United States
| | - Martin H. Thornhill
- The School of Clinical Dentistry, The University of Sheffield, Sheffield, United Kingdom
- Department of Oral Medicine, Carolinas Medical Center, Atrium Health, North Carolina, United States
| | - Peter B. Lockhart
- Department of Oral Medicine, Carolinas Medical Center, Atrium Health, North Carolina, United States
| | - Hilary M. Babcock
- Division of Infectious Disease, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Jennie H. Kwon
- Division of Infectious Disease, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Stephen Y. Liang
- Division of Infectious Disease, Washington University School of Medicine, St. Louis, Missouri, United States
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Pratim Biswas
- Aerosol and Air Quality Research Laboratory, Department of Chemical, Environmental and Material Engineering, University of Miami, Miami, Florida, United States
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Roy S, Kumar P, Raza M, Sharma P, Shetty D, Jain S. Orthodontic bond strength with the use of non-aerosol producing bonding primers in lieu of conventional primers: An in vitro evaluation. J Orthod Sci 2022; 11:51. [PMID: 36411814 PMCID: PMC9674935 DOI: 10.4103/jos.jos_134_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 12/11/2021] [Accepted: 06/20/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of non-aerosol producing restorative self-etching primers (SEPs) as a substitute for conventional orthodontic bonding primers and to analyze the extent of residual composite on the tooth post-debonding. MATERIALS AND METHODS Eighty-four extracted human premolars were randomly divided into seven groups based on the adhesive and the bonding protocol used. The study comprised Prime and Bond one select (Dentsply), G-Premio Bond (GC), which were each divided into three subgroups based on the method used for moisture control and the control group (Transbond XT conventional total etch). The three methods for moisture control in study groups were: without drying, air-drying with the use of a three-way syringe, and with the use of blotting paper. Shear bond strength (SBS) was tested using a universal testing machine (UTM), and after debonding, the enamel surface of each tooth was examined under 10× magnification to evaluate adhesive remaining index (ARI) scores. RESULTS Groups 2A (Prime and Bond; without drying) & 1 (Transbond XT) had the lowest and highest SBS values, respectively (P = 0.001). Comparison of ARI between the control group and group 2b (Prime and Bond; air-drying with 3 in 1) showed a significant difference (P = 0.041). Comparison of ARI between control group and group 2c (Prime and Bond; blotting paper) showed a significant difference (P = 0.017). Rest all other comparisons were non-significant. CONCLUSIONS Transbond XT had SBS values higher than the self-etch groups. Among the self-etch groups, G-Premio Bond had higher SBS values when the traditional methods of air-drying were followed. Use of blotting paper for drying that produced variable SBS values can be an effective alternative method. G-Premio Bond with its adequate bond strength under manufacturer's instruction seems promising in this regard.
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Affiliation(s)
- Shevani Roy
- Department of Orthodontics and Dentofacial Orthopaedics, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India
| | - Piush Kumar
- Department of Orthodontics and Dentofacial Orthopaedics, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India
| | - Monis Raza
- Department of Orthodontics and Dentofacial Orthopaedics, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India,Address for correspondence: Dr. Monis Raza, Senior Lecturer, Department of Orthodontics and Dentofacial Orthopaedics, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh - 201 206, India. E-mail:
| | - Payal Sharma
- Department of Orthodontics and Dentofacial Orthopaedics, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India
| | - Divya Shetty
- Department of Orthodontics and Dentofacial Orthopaedics, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India
| | - Shubhangi Jain
- Department of Orthodontics and Dentofacial Orthopaedics, I.T.S. Center for Dental Studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India
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Kumbargere Nagraj S, Eachempati P, Paisi M, Nasser M, Sivaramakrishnan G, Francis T, Verbeek JH. Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental healthcare providers. Cochrane Database Syst Rev 2022; 8:CD013826. [PMID: 35994295 PMCID: PMC9394685 DOI: 10.1002/14651858.cd013826.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Aerosols and spatter are generated in a dental clinic during aerosol-generating procedures (AGPs) that use high-speed hand pieces. Dental healthcare providers can be at increased risk of transmission of diseases such as tuberculosis, measles and severe acute respiratory syndrome (SARS) through droplets on mucosae, inhalation of aerosols or through fomites on mucosae, which harbour micro-organisms. There are ways to mitigate and contain spatter and aerosols that may, in turn, reduce any risk of disease transmission. In addition to personal protective equipment (PPE) and aerosol-reducing devices such as high-volume suction, it has been hypothesised that the use of mouth rinse by patients before dental procedures could reduce the microbial load of aerosols that are generated during dental AGPs. OBJECTIVES To assess the effects of preprocedural mouth rinses used in dental clinics to minimise incidence of infection in dental healthcare providers and reduce or neutralise contamination in aerosols. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 4 February 2022. SELECTION CRITERIA We included randomised controlled trials and excluded laboratory-based studies. Study participants were dental patients undergoing AGPs. Studies compared any preprocedural mouth rinse used to reduce contaminated aerosols versus placebo, no mouth rinse or another mouth rinse. Our primary outcome was incidence of infection of dental healthcare providers and secondary outcomes were reduction in the level of contamination of the dental operatory environment, cost, change in mouth microbiota, adverse events, and acceptability and feasibility of the intervention. DATA COLLECTION AND ANALYSIS Two review authors screened search results, extracted data from included studies, assessed the risk of bias in the studies and judged the certainty of the available evidence. We used mean differences (MDs) and 95% confidence intervals (CIs) as the effect estimate for continuous outcomes, and random-effects meta-analysis to combine data MAIN RESULTS: We included 17 studies with 830 participants aged 18 to 70 years. We judged three trials at high risk of bias, two at low risk and 12 at unclear risk of bias. None of the studies measured our primary outcome of the incidence of infection in dental healthcare providers. The primary outcome in the studies was reduction in the level of bacterial contamination measured in colony-forming units (CFUs) at distances of less than 2 m (intended to capture larger droplets) and 2 m or more (to capture droplet nuclei from aerosols arising from the participant's oral cavity). It is unclear what size of CFU reduction represents a clinically significant amount. There is low- to very low-certainty evidence that chlorhexidine (CHX) may reduce bacterial contamination, as measured by CFUs, compared with no rinsing or rinsing with water. There were similar results when comparing cetylpyridinium chloride (CPC) with no rinsing and when comparing CPC, essential oils/herbal mouthwashes or boric acid with water. There is very low-certainty evidence that tempered mouth rinses may provide a greater reduction in CFUs than cold mouth rinses. There is low-certainty evidence that CHX may reduce CFUs more than essential oils/herbal mouthwashes. The evidence for other head-to-head comparisons was limited and inconsistent. The studies did not provide any information on costs, change in micro-organisms in the patient's mouth or adverse events such as temporary discolouration, altered taste, allergic reaction or hypersensitivity. The studies did not assess acceptability of the intervention to patients or feasibility of implementation for dentists. AUTHORS' CONCLUSIONS: None of the included studies measured the incidence of infection among dental healthcare providers. The studies measured only reduction in level of bacterial contamination in aerosols. None of the studies evaluated viral or fungal contamination. We have only low to very low certainty for all findings. We are unable to draw conclusions regarding whether there is a role for preprocedural mouth rinses in reducing infection risk or the possible superiority of one preprocedural rinse over another. Studies are needed that measure the effect of rinses on infectious disease risk among dental healthcare providers and on contaminated aerosols at larger distances with standardised outcome measurement.
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Affiliation(s)
- Sumanth Kumbargere Nagraj
- Professor and Head, Department of Oral Medicine and Oral Radiology, Faculty of Dentistry, Manipal University College Malaysia, Melaka, Malaysia
- Honorary Research Fellow, Division of Surgery and Interventional Science, Department of Surgical Biotechnology, University College London, London, UK
| | - Prashanti Eachempati
- Professor and Head, Department of Prosthodontics, Faculty of Dentistry, Manipal University College Malaysia, Melaka, Malaysia
| | - Martha Paisi
- Peninsula Dental Social Enterprise, Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - Mona Nasser
- Peninsula Dental School, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | - Tony Francis
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Manipal University College Malaysia, Melaka, Malaysia
| | - Jos H Verbeek
- Cochrane Work, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Rathore K, Rathore HS, Singh P, Kumar P. Redefining aerosol in dentistry during COVID-19 pandemic. Dent Res J (Isfahan) 2022; 19:53. [PMID: 36159064 PMCID: PMC9490255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/19/2021] [Accepted: 10/17/2021] [Indexed: 11/15/2022] Open
Abstract
The corona virus malady 2019 (COVID-19) pandemic has rekindled the well established argument regarding the role of dental aerosol in transference of severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). Aerosols and droplets are generated amid innumerable dental procedures. With the commencement of the COVID-19 pandemic droplet, a review of the infection/disease control strategies for aerosols is required. We do not know where this pandemic is directed. We do not have conclusive evidence for an optimal management strategy. Every day brings in varying information, so recognizing the hazard created by aerosols will help diminish the probability of infection transfer at the time of dental procedures. Hence, the author assessed the evidence-based medical and dental literature in relation to "aerosol' that documented the source of transmission of aerosol through various potential routes, addressed the risk potential to patients and the dental team, and assessed the additional measures that might minimize the viral transmission if regularly adopted. In this article, the author evaluated and compiled dental guidelines by various countries and various health-care associations in context to aerosol-generating procedures and has made recommendations for the restriction of dental aerosols and splatter in routine dental practice.
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Affiliation(s)
- Kanupriya Rathore
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India,Address for correspondence: Dr. Kanupriya Rathore, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. E-mail:
| | | | - Pranshu Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pravin Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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12
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Rathore K, Rathore H, Singh P, Kumar P. Redefining aerosol in dentistry during COVID-19 pandemic. Dent Res J (Isfahan) 2022. [DOI: 10.4103/1735-3327.351342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Koletsi D, Iliadi A, Eliades T. Predictability of rotational tooth movement with orthodontic aligners comparing software-based and achieved data: A systematic review and meta-analysis of observational studies. J Orthod 2021; 48:277-287. [PMID: 34176358 PMCID: PMC8385585 DOI: 10.1177/14653125211027266] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate all available evidence on the prediction of rotational tooth movements with aligners. DATA SOURCES Seven databases of published and unpublished literature were searched up to 4 August 2020 for eligible studies. DATA SELECTION Studies were deemed eligible if they included evaluation of rotational tooth movement with any type of aligner, through the comparison of software-based and actually achieved data after patient treatment. DATA EXTRACTION AND DATA SYNTHESIS Data extraction was done independently and in duplicate and risk of bias assessment was performed with the use of the QUADAS-2 tool. Random effects meta-analyses with effect sizes and their 95% confidence intervals (CIs) were performed and the quality of the evidence was assessed through GRADE. RESULTS Seven articles were included in the qualitative synthesis, of which three contributed to meta-analyses. Overall results revealed a non-accurate prediction of the outcome for the software-based data, irrespective of the use of attachments or interproximal enamel reduction (IPR). Maxillary canines demonstrated the lowest percentage accuracy for rotational tooth movement (three studies: effect size = 47.9%; 95% CI = 27.2-69.5; P < 0.001), although high levels of heterogeneity were identified (I2: 86.9%; P < 0.001). Contrary, mandibular incisors presented the highest percentage accuracy for predicted rotational movement (two studies: effect size = 70.7%; 95% CI = 58.9-82.5; P < 0.001; I2: 0.0%; P = 0.48). Risk of bias was unclear to low overall, while quality of the evidence ranged from low to moderate. CONCLUSION Allowing for all identified caveats, prediction of rotational tooth movements with aligner treatment does not appear accurate, especially for canines. Careful selection of patients and malocclusions for aligner treatment decisions remain challenging.
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Affiliation(s)
- Despina Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Anna Iliadi
- Department of Dental Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, Attica, Greece
| | - Theodore Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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14
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Hegde MN, Parmar G, Logani A, Hegde ND, Ballal S, Krithikadatta J, Nawal R, Amalavathy K, Devadiga D, Bhat R. Dental practice management during COVID-19 times-Now and beyond. Int J Clin Pract 2021; 75:e14251. [PMID: 33887076 PMCID: PMC8250248 DOI: 10.1111/ijcp.14251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/16/2021] [Indexed: 12/23/2022] Open
Abstract
AIM Coronavirus disease 2019 (COVID-19) being declared a global public health emergency has become a significant challenge for all healthcare workers, including dentistry, recognised as a high-risk profession during these times. This consensus statement aims to highlight and provide guidelines necessary to be implemented for a clinical dental practice. MATERIALS AND METHODS A total of nine conservative Dentists and Endodontists and one Oral and Maxillofacial Surgeon; with four panelists from government dental colleges, one each from the North, South, East and West India and six resource persons from private colleges in South India, all of them being clinicians and administrators practicing dentistry since the inception of the pandemic, collaborated in this consensus statement. The consensus statement was developed through a symposium conducted on the topics; general dental practice during COVID-19 times, the importance of aerosols in clinical dental practice in the spread of COVID-19, effective standard operating protocols for clinical dental practice and Institutional settings with scientific evidence-based justifications, followed by a panel discussion with to devise mandatory protocols to be followed in clinical and institutional settings. The symposium was attended by 46 practitioners who participated in the deliberation. RESULTS This consensus statement provides clinicians and researchers with protocols for the dental practice, agreed upon by experts in the field. The Consensus Statement has been formulated according to the AGREE Reporting checklist for the formulation of guidelines. CONCLUSION The experts and panelists reached a Consensus on the protocols and guidelines for the safe clinical and institutional dental practice.
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Affiliation(s)
- Mithra N. Hegde
- Department of Conservative Dentistry & Endodontics, Nitte (Deemed to be University)AB Shetty Memorial Institute of Dental Sciences (ABSMIDS)MangaloreKarnatakaIndia
| | - Girish Parmar
- Department of Conservative Dentistry and EndodonticsGovernment Dental College and Hospital AhmedabadAhmedabadIndia
| | - Ajay Logani
- Department of Conservative Dentistry and EndodonticsAll India Institute of Medical SciencesNew DelhiIndia
| | - Nidarsh D. Hegde
- Department of Oral and Maxillofacial SurgeryJawaharlal Nehru Institute of Medical SciencesImphalIndia
| | - Suma Ballal
- Department of Cariology, Department of Conservative Detistry & EndodonticsSaveetha Dental College and Hospitals.ChennaiIndia
| | - Jogikalmat Krithikadatta
- Department of Cariology, Department of Conservative Detistry & EndodonticsSaveetha Dental College and Hospitals.ChennaiIndia
| | - Ruchika Nawal
- Department of Conservative Dentistry and EndodonticsMaulana Azad Dental College and HospitalNew DelhiIndia
| | - Kurunji Amalavathy
- Department of Conservative Dentistry and EndodonticsSathyabama University Dental College and HospitalChennaiIndia
| | - Darshana Devadiga
- Department of Conservative Dentistry & Endodontics, Nitte (Deemed to be University)AB Shetty Memorial Institute of Dental Sciences (ABSMIDS)MangaloreKarnatakaIndia
| | - Raksha Bhat
- Department of Conservative Dentistry & Endodontics, Nitte (Deemed to be University)AB Shetty Memorial Institute of Dental Sciences (ABSMIDS)MangaloreKarnatakaIndia
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15
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Singh H, Maurya RK, Sharma P, Kapoor P, Mittal T. Aerosol generating procedural risks and concomitant mitigation strategies in orthodontics amid COVID-19 pandemic - An updated evidence-based review. Int Orthod 2021; 19:329-345. [PMID: 34088619 PMCID: PMC8141723 DOI: 10.1016/j.ortho.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/26/2022]
Abstract
IMPORTANCE The ongoing COVID-19 pandemic has posed unique challenges to orthodontic profession by adversely impacting provision of in-office orthodontic care due to prevailing uncertainty around risks pertaining to splatter and 'aerosol-generating procedures' (AGPs). This review aims to provide an insight into the prevailing and emerging evidence informing potential risks related to splatter and AGPs, and risk mitigation strategies employed for reducing the potential risk of SARS-CoV-2 transmission from dental bioaerosols. METHODS PubMed, Google Scholar, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, LILACS, WHO COVID-19 databases and preprint databases were searched for eligible English language publications. Citation chasing was undertaken up until the review date of 4 January 2021. Study selection, data extraction and risk of bias assessment was undertaken independently in duplicate, or else by consultation with a third author. RESULTS Following filter application and duplicates removed, a total of 13 articles assessing procedural mitigation measures were included. Seven included studies revealed overall low-risk of bias. The overall risk varied from unclear to high for rest of the studies, with the most concerning domains being blinding of the participants and the personnel and blinding of the outcome assessors. Accumulated consensual evidence points towards the use of dental suction devices with wide bore aspirating tips as effective procedural mitigation strategies. Variations in the literature can be observed concerning aerosol transmission associated with water spray use during debonding. Emerging direct evidence consistently supports adjunctive use of pre-procedural povidone-iodine mouthrinse to mitigate direct transmission risk in the orthodontic practice. CONCLUSIONS A thorough risk assessment concerning AGPs and implementation of consistent and evidence-based procedural mitigation strategies may play an indispensable role in navigating optimal orthodontic practice through unforeseen similar pandemic threats. High-quality robust research focussing on more biologically relevant models of dental bioaerosols in orthodontic settings is warranted.
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Affiliation(s)
- Harpreet Singh
- ESIC Dental College and Hospital, Department of Orthodontics and Dentofacial Orthopaedics, Sector 15, Rohini, Delhi, India
| | | | - Poonam Sharma
- ESIC Dental College and Hospital, Department of Orthodontics and Dentofacial Orthopaedics, Sector 15, Rohini, Delhi, India
| | - Pranav Kapoor
- ESIC Dental College and Hospital, Department of Orthodontics and Dentofacial Orthopaedics, Sector 15, Rohini, Delhi, India
| | - Tanmay Mittal
- ESIC Dental College and Hospital, Department of Orthodontics and Dentofacial Orthopaedics, Sector 15, Rohini, Delhi, India
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16
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Lloro V, Giovannoni ML, Luaces VLD, Manzanares MC. Perioral Aerosol Sequestration Suction Device Effectively Reduces Biological Cross-Contamination in Dental Procedures. Eur J Dent 2021; 15:340-346. [PMID: 33711845 PMCID: PMC8184308 DOI: 10.1055/s-0041-1724152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective
The infection risk during dental procedures is a common concern for dental professionals which has increased due to coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic. The development of devices to specifically mitigate cross-contamination by droplet/splatter is crucial to stop infection transmission. The objective of this study is to assess the effectiveness of a perioral suction device (Oral BioFilter, OBF) to reduce biological contamination spread during dental procedures.
Materials and Methods
Forty patients were randomized 1:1 to a standard professional dental hygiene treatment with OBF and without. Adenosine triphosphate (ATP) bioluminescence assay was used to evaluate the spread of potential contaminants. The total number of relative light units (RLU) from key dental operatory locations: operator’s face-shield, back of the surgical operator’s-gloves, patient’s safety-goggles, and instrumental table were measured. Percentage contamination reductions between control and OBF were compared.
Statistical Analysis
Primary outcome, total RLU, was analyzed by comparing the means of logged data, using a two-sided two-sample
t
-test. Secondary outcomes as RLU of logged data for the different locations were analyzed in the same way. Proportion of patients from whom different locations reported events (clean, acceptable, and failure) were analyzed by using Fisher’s exact test.
Results
For the whole dental environment, RLUs reduction (<150 units) achieved with OBF was 98.4% (97.4–99%). By dental operatory location the reduction in RLUs was from 99.6%, on the operator face-shield, to 83% on instrumental table. The control group reported a very high percentage of failures, (>300) being 100% on the surfaces closer to the patient’s mouth and decreasing to 70% on instrumental table. In contrast, the higher failure percentage in the OBF group was found on the patient’s goggles (40%), while the operator face-shield showed an absence of contamination.
Conclusion
OBF device has shown efficient reduction of biological aerosol cross-contamination during dental procedures as proved by ATP-bioluminescence assay. Nevertheless, for maximum safety, its use must be combined with standard protective gear such as goggles, face shield, and surgical gloves.
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Affiliation(s)
- Víctor Lloro
- Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, Faculty of Medicine and Health Sciences, Health University of Barcelona campus, L'Hospitalet 08907, Barcelona, Spain
| | - Maria Laura Giovannoni
- Odontology Hospital UB, Odontostomatology Department, Faculty of Medicine and Health Sciences, Health University of Barcelona campus, L'Hospitalet 08907; Universitat de Barcelona, Barcelona, Spain
| | - Vicente Lozano-de Luaces
- Faculty of Medicine and Health Sciences, Faculty of Medicine and Health Sciences, Health University of Barcelona campus, L'Hospitalet 08907, Barcelona, Spain
| | - Maria Cristina Manzanares
- Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, Faculty of Medicine and Health Sciences, Health University of Barcelona campus, L'Hospitalet 08907, Barcelona, Spain
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Abstract
During the first two months of the Coronavirus Disease 2019 (Covid-19) pandemic, Romania was in lockdown, and all dental practices were closed, so orthodontic patients had to postpone their check-ups for at least eight weeks. This led not only to a delayed end of treatment but also to accidents and complications. The present study tried to evaluate the orthodontic situation both from the patient's and orthodontist's point of view, so the patients were given a few questions to answer, and the orthodontist analyzed each treatment before and after the two-month lockdown and decided if it was mildly or severely affected by the absence of check-ups. The study group consisted of 105 patients evaluated by three orthodontists in the same private practice. Patients that have gotten worse after the lockdown or who had problems were included in the study. Also, all the patients were given a 7-question form in order to find out their opinion. After two months without check-ups, our orthodontists found that 9.52% got worse because of the lack of intermaxillary elastics, broken brackets, broken removable orthodontic appliances, and others. Most of the patients believe that their treatment was delayed by the Covid-19 pandemic, but none of the patients felt unsafe when visiting the clinic. The Covid-19 pandemic had severe effects on orthodontic treatments. Orthodontists noticed a delay for about one-third of their patients. However, from the patient's point of view, half believe that their treatment was negatively affected by the Covid-19 pandemic in different degrees.
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18
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Appointment impact and orthodontic emergency occurrence during the coronavirus disease 2019 pandemic: A retrospective study. Am J Orthod Dentofacial Orthop 2021; 161:e12-e19. [PMID: 34376339 PMCID: PMC7867386 DOI: 10.1016/j.ajodo.2020.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/01/2020] [Accepted: 12/01/2020] [Indexed: 02/05/2023]
Abstract
Introduction This retrospective study aimed to quantify the impact of coronavirus disease 2019 (COVID-19) on the orthodontic appointment and make an analysis of orthodontic emergencies (OEs) that occurred during the pandemic. Methods A total of 628 patients were randomly sampled from 3489 subjects who were undergoing active orthodontic treatment with fixed appliances, and the medical records were reviewed. OE occurrence was analyzed from 617 patients who had explicit return-visit records after the COVID-19 outbreak. Wilcoxon signed rank tests, chi-square tests, and a binary logistic regression were performed. Results The return-visit of 98.6% of the patients was delayed significantly with an increase over 8.98 ± 4.76 weeks (P <0.001). In general, 32.3% of the patients suffered from various OEs while waiting for their first return-visit, and bracket or band debonding was the most frequently reported category. Most OEs did not receive timely treatments because of the lockdown. The incidence was nearly 2 times higher than that of the normal appointment times. No correlation was found between OE occurrence and different demographic and clinical characteristics of patients. The therapeutic progress of patients, especially those in stage 3, was postponed because of the occurrence of OEs. Conclusions Regardless of the limitations, our study suggested that it is highly possible that the COVID-19 pandemic has delayed appointments of fixed orthodontic patients. OEs did bother a minority of patients and could not be settled in time during the lockdown, which had a negative impact on the near-term treatment progress and should have been prevented. Further studies are required to investigate the long-dated influence of COVID-19 on orthodontic practices.
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Malekshoar M, Malekshoar M, Javanshir B. Challenges, limitations, and solutions for orthodontists during the coronavirus pandemic: A review. Am J Orthod Dentofacial Orthop 2021; 159:e59-e71. [PMID: 33223376 PMCID: PMC7571895 DOI: 10.1016/j.ajodo.2020.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Orthodontic patients worldwide missed appointments during the early months of the coronavirus disease 2019 (COVID-19) pandemic. A significant problem with this virus is its high transmission power. Asymptomatic patients can transmit the virus. The aim of this review is to examine orthodontic emergencies and the necessary strategies and measures for emergency and nonemergency treatment during the coronavirus pandemic. METHODS The following databases were comprehensively searched: PubMed, MEDLINE, Scopus, and Google Scholar. Up-to-date data released by major health organizations such as the World Health Organization and major orthodontic associations involved in the pandemic were also evaluated. RESULTS Few studies were conducted on managing orthodontic offices or clinics during the pandemic, and most are not of high quality. Appropriate communication is the most important issue in managing orthodontic patients, particularly virtual counseling. Many orthodontic emergencies can be managed in this way by patients themselves. Most studies recommend using the filtering facepiece 2 masks, equivalent to N95 masks for non-COVID-19 patients undergoing aerosol-generating procedures and all suspected or confirmed COVID-19 patients in orthodontic visits. CONCLUSIONS At this time, there are no definitive clinical protocols supported by robust evidence for orthodontic practice during the COVID-19 pandemic. Orthodontists should not rush to return to routine orthodontic work and should follow state guidelines. Nonemergency orthodontic visits should be suspended during the severe acute respiratory syndrome coronavirus 2 pandemic in high-risk areas. Resuming orthodontic procedures during the pandemic requires paying special attention to screening, performing maximum efforts to reduce aerosol generation, using appropriate personal protective equipment, having proper ventilation, and fully adhering to sterilization and disinfection principles.
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Affiliation(s)
| | - Mehrdad Malekshoar
- Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Hormozgan, Iran
| | - Bahareh Javanshir
- Department of Orthodontics, Faculty of Dentistry, Anzali International Campus, Guilan University of Medical Sciences, Rasht, Gilan, Iran.
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20
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Testori T, Wang HL, Basso M, Bordini G, Dian A, Vitelli C, Miletic I, Del Fabbro M. COVID-19 and Oral Surgery: A narrative review of preoperative mouth rinses. Acta Stomatol Croat 2020; 54:431-441. [PMID: 33642607 PMCID: PMC7871429 DOI: 10.15644/asc54/4/10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/24/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To provide a narrative review of the preprocedural mouth rinse protocols suggested for oral surgery in order to contrast the presence of SARS-CoV-2 in aerosol. SOURCES AND METHODS Electronic searches were performed in medical databases PubMed, Medline, CINAHN and Scopus to identify relevant studies published up until the third week of April 2020. This research was supplemented by exploration through a web-based search engine as well as a manual search for international and national guidelines. Studies and protocols which suggested preoperative mouth rinsing as a recommended measure during the COVID-19 outbreak were included. Given the small number of studies, a narrative literature review was conducted. In total, 15 references (11 articles and 4 guidelines) were considered relevant and were critically analysed. CONCLUSION The findings show a high heterogeneity in the protocols suggested. Further research is required to better understand the viral features and epidemiologic characteristics of this new virus and to test the efficacy of commonly used antiseptics against SARS-CoV-2 in future clinical trials. However, the use of chlorhexidine, hydrogen peroxide, PVP-I and cetylpyridinium chloride in contrasting the spread of Covid-19 is described as advisable and substantial in different publications.
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Affiliation(s)
- Tiziano Testori
- Department of Implantology and Oral Rehabilitation, IRCCS Istituto Ortopedico Galeazzi, Dental Clinic, Director Prof. L. Francetti, Milan, Italy
| | - Hom-Lay Wang
- Professor and Director of Graduate Periodontics, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Matteo Basso
- Minimally Invasive Aesthetic and Digital Oral Rehabilitation Centre (CROMED), IRCCS Istituto Ortopedico Galeazzi, Dental Clinic (Director Prof. L. Francetti), Milan, Italy
| | | | - Arturo Dian
- Minimally Invasive Aesthetic and Digital Oral Rehabilitation Centre (CROMED), IRCCS Istituto Ortopedico Galeazzi, Dental Clinic (Director Prof. L. Francetti), Milan, Italy
| | - Carlo Vitelli
- Minimally Invasive Aesthetic and Digital Oral Rehabilitation Centre (CROMED), IRCCS Istituto Ortopedico Galeazzi, Dental Clinic (Director Prof. L. Francetti), Milan, Italy
| | - Ivana Miletic
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, 10000, Zagreb, Croatia
| | - Massimo Del Fabbro
- IRCCS Istituto Ortopedico Galeazzi, Dental Clinic, Milan, Italy. Associate Professor, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Marshall S, Duryea M, Huang G, Kadioglu O, Mah J, Palomo JM, Rossouw E, Stappert D, Stewart K, Tufekci E. COVID-19: What do we know? Am J Orthod Dentofacial Orthop 2020; 158:e53-e62. [PMID: 33131568 PMCID: PMC7505627 DOI: 10.1016/j.ajodo.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/01/2020] [Accepted: 08/01/2020] [Indexed: 12/14/2022]
Abstract
•Evidence regarding the provision of orthodontic care during the COVID-19 pandemic is examined.
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Affiliation(s)
- Steve Marshall
- Department of Orthodontics, University of Iowa College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa.
| | | | - Greg Huang
- Department of Orthodontics, University of Washington School of Dentistry, University of Washington, Seattle, Wash
| | - Onur Kadioglu
- Division of Graduate Orthodontics, Oklahoma University College of Dentistry, Oklahoma University, Oklahoma City, Okla
| | - James Mah
- Department of Orthodontics, University of Nevada Las Vegas School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, Nev
| | - Juan Martin Palomo
- Department of Orthodontics, Case Western Reserve University School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Emile Rossouw
- Division of Orthodontics, Eastman Institute for Oral Health, University of Rochester School of Medicine and Dentistry, University of Rochester, Rochester, NY
| | - Dina Stappert
- Division of Orthodontics, University of Maryland School of Dentistry, University of Maryland, Baltimore, MD
| | - Kelton Stewart
- Department of Orthodontics and Oral Facial Genetics, Indiana University School of Dentistry, Indiana University, Indianapolis, Ind
| | - Eser Tufekci
- Department of Orthodontics, Virginia Commonwealth University School of Dentistry, Virginia Commonwealth University, Richmond, Va
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22
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Sharan J, Chanu NI, Jena AK, Arunachalam S, Choudhary PK. COVID-19-Orthodontic Care During and After the Pandemic: A Narrative Review. JOURNAL OF INDIAN ORTHODONTIC SOCIETY 2020; 54:352-365. [PMID: 34191889 PMCID: PMC7899945 DOI: 10.1177/0301574220964634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To provide comprehensive information regarding the implications of the coronavirus disease 2019 (COVID-19), mode of transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and its effects on orthodontic care during the pandemic and post-pandemic outbreak of the disease, based on currently available literature and information. MATERIALS AND METHODS A comprehensive research for studies that focused on the COVID-19 pandemic and orthodontic care up to August 18, 2020, with no language restriction. The databases included PubMed, MEDLINE, Scopus, Google Scholar, and COVID-19 Open Research Dataset (CORD-19) 2020. The research was focused on presenting symptoms, disease transmission, infection control, orthodontic care, and financial implications affecting the delivery of orthodontic treatment. The research also included reports from major health policy regulatory bodies such as World Health Organization, Centers for Disease Control and Prevention, European Centre for Disease Control and Prevention, and major international dental and orthodontic societies and associations. The peer-reviewed publications and guidelines from the health regulatory authorities were given priority. RESULTS The latest information on the SARS-CoV-2 virus effects and orthodontic implications were arranged sequentially. The SARS-CoV-2 virus mode of transmission and its prevention were emphasized to keep the orthodontic and dental operatory safe for continuing practice. CONCLUSION The COVID-19 outbreak has changed the way orthodontics is practiced. Strict infection control, near-zero aerosol production, and minimal touch dentistry are the keys to prevent contamination of orthodontic operatory. During the pandemic, only emergency orthodontic procedures could be extended to the orthodontic patient while adhering to all the regulatory guidelines. Fortunately, to date, there is no reported case of cross-transmission of the SARS-CoV-2 virus at the dental setup.
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Affiliation(s)
- Jitendra Sharan
- Department of Dentistry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Ashok Kumar Jena
- Department of Dentistry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sivakumar Arunachalam
- Head-Children and Community Oral Health Division, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Prabhat Kumar Choudhary
- Department of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, Delhi, India
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23
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Kaur H, Kochhar AS, Gupta H, Singh G, Kubavat A. Appropriate orthodontic appliances during the COVID-19 pandemic: A scoping review. J Oral Biol Craniofac Res 2020; 10:782-787. [PMID: 33106770 PMCID: PMC7577275 DOI: 10.1016/j.jobcr.2020.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The esoteric Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) infection or COVID-19 has been an unusual plummet in dental/orthodontic practice. Based on current recommendations for various amendments in an orthodontic practice, this scoping review aims to identify orthodontic appliances that are most appropriate to us during this on-going pandemic. METHODS Electronic databases (PubMed, Scopus, Web of Science, Science Direct, and Google Scholar) were searched up until August 11, 2020. Full-text articles in English with keywords "COVID-19 and Orthodontics" and related search terms were included. RESULTS Out of 17 retracted articles, only 4 articles were found to be brief the choice for orthodontic appliances in pandemic times speculating clear aligner therapy (CAT) to be a pragmatic solution. The remaining articles were also thoroughly studied and the new norms set by the pandemic were determined. Criteria for orthodontic appliance selection included careful patient screening and collection of records, minimal physical visits, efficient use of technology, virtual consultations but the use of PPE for physical appointments; and lesser AGPs with a lesser risk of airborne transmission. CONCLUSIONS Subject to regional demands, CAT can be considered as the relatively safer modality-predictable and effective apposite to fixed orthodontic appliances in these unprecedented times.
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Affiliation(s)
- Harneet Kaur
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | | | - Harshita Gupta
- Department of Orthodontics and Dentofacial Orthopaedics, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
| | - Gurkeerat Singh
- Department of Orthodontics and Dentofacial Orthopaedics, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
| | - Ajay Kubavat
- Department of Orthodontics and Dentofacial Orthopaedics, Narsinhbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat, India
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