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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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2
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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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3
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Malmgren R, Välimaa H, Oksanen L, Sanmark E, Nikuri P, Heikkilä P, Hakala J, Ahola A, Yli-Urpo S, Palomäki V, Asmi E, Sofieva S, Rostedt A, Laitinen S, Romantschuk M, Sironen T, Atanasova N, Paju S, Lahdentausta-Suomalainen L. High-volume evacuation mitigates viral aerosol spread in dental procedures. Sci Rep 2023; 13:18984. [PMID: 37923796 PMCID: PMC10624893 DOI: 10.1038/s41598-023-46430-3] [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: 04/11/2023] [Accepted: 10/31/2023] [Indexed: 11/06/2023] Open
Abstract
Dental healthcare personnel (DHCP) are subjected to microbe-containing aerosols and splatters in their everyday work. Safer work conditions must be developed to ensure the functioning of the healthcare system. By simulating dental procedures, we aimed to compare the virus-containing aerosol generation of four common dental instruments, and high-volume evacuation (HVE) in their mitigation. Moreover, we combined the detection of infectious viruses with RT-qPCR to form a fuller view of virus-containing aerosol spread in dental procedures. The air-water syringe produced the highest number of aerosols. HVE greatly reduced aerosol concentrations during procedures. The air-water syringe spread infectious virus-containing aerosols throughout the room, while other instruments only did so to close proximity. Additionally, infectious viruses were detected on the face shields of DHCP. Virus genomes were detected throughout the room with all instruments, indicating that more resilient viruses might remain infectious and pose a health hazard. HVE reduced the spread of both infectious viruses and viral genomes, however, it did not fully prevent them. We recommend meticulous use of HVE, a well-fitting mask and face shields in dental procedures. We advise particular caution when operating with the air-water syringe. Due to limited repetitions, this study should be considered a proof-of-concept report.
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Affiliation(s)
- Rasmus Malmgren
- Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Viikinkaari 9, 00790, Helsinki, Finland.
| | - Hanna Välimaa
- Department of Virology, University of Helsinki, Haartmanninkatu 3, 00014, Helsinki, Finland
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Haartmanninkatu 1, 00014, Helsinki, Finland
- Meilahti Vaccine Research Center MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Annankatu 32, 00029, Helsinki, Finland
| | - Lotta Oksanen
- Faculty of Medicine, University of Helsinki, Haartmaninkatu 4, 00014, Helsinki, Finland
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, 00029, Helsinki, Finland
| | - Enni Sanmark
- Faculty of Medicine, University of Helsinki, Haartmaninkatu 4, 00014, Helsinki, Finland
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, 00029, Helsinki, Finland
| | - Petra Nikuri
- Helsinki University Hospital, 00029, Helsinki, Finland
| | - Paavo Heikkilä
- Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Korkeakoulunkatu 3, 33720, Tampere, Finland
| | - Jani Hakala
- VTT Technical Research Centre of Finland, Visiokatu 4, 33101, Tampere, Finland
| | - Aleksi Ahola
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Haartmanninkatu 1, 00014, Helsinki, Finland
| | - Simeoni Yli-Urpo
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Haartmanninkatu 1, 00014, Helsinki, Finland
| | - Ville Palomäki
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Haartmanninkatu 1, 00014, Helsinki, Finland
| | - Eija Asmi
- Atmospheric Composition Research, Finnish Meteorological Institute, Erik Palménin Aukio 1, 00560, Helsinki, Finland
| | - Svetlana Sofieva
- Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Viikinkaari 9, 00790, Helsinki, Finland
- Atmospheric Composition Research, Finnish Meteorological Institute, Erik Palménin Aukio 1, 00560, Helsinki, Finland
| | - Antti Rostedt
- Aerosol Physics Laboratory, Physics Unit, Faculty of Engineering and Natural Sciences, Tampere University, Korkeakoulunkatu 3, 33720, Tampere, Finland
| | - Sirpa Laitinen
- Occupational Safety, Finnish Institute of Occupational Health, Neulaniementie 4, 70210, Kupio, Finland
| | - Martin Romantschuk
- Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Viikinkaari 9, 00790, Helsinki, Finland
| | - Tarja Sironen
- Department of Virology, University of Helsinki, Haartmanninkatu 3, 00014, Helsinki, Finland
- Veterinary Biosciences, University of Helsinki, Agnes Sjöberginkatu 2, 00014, Helsinki, Finland
| | - Nina Atanasova
- Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Viikinkaari 9, 00790, Helsinki, Finland
- Atmospheric Composition Research, Finnish Meteorological Institute, Erik Palménin Aukio 1, 00560, Helsinki, Finland
| | - Susanna Paju
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Haartmanninkatu 1, 00014, Helsinki, Finland
| | - Laura Lahdentausta-Suomalainen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Haartmanninkatu 1, 00014, Helsinki, Finland
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Guzmán-Flores EC, Fuentes-Ayala AR, Martínez-Martínez AC, Aguayo-Félix DE, Arellano-Osorio MV, Campuzano-Donoso M, Román-Galeano NM, Llerena-Velásquez M, Vásquez-Tenorio Y. Reduction of aerosol dissemination in a dental area generated by high-speed and scaler ultrasonic devices employing the "Prime Protector". PLoS One 2023; 18:e0278791. [PMID: 37535637 PMCID: PMC10399923 DOI: 10.1371/journal.pone.0278791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/19/2023] [Indexed: 08/05/2023] Open
Abstract
The use of an external dome aerosol containment device (Prime Protector) is proposed to reduce the spread of particles within the dental office. Hence, the aim of our study was to compare the spread of bioaerosols generated by a High-speed Handpiece (HH) and an Ultrasonic Prophylaxis Device (UPD), with and without the Prime Protector dome (PP) by counting Colony Forming Units (CFU) of Lactobacillus casei Shirota, at different distances on the x and y axis. The PP was located considering the parallelism between the base of the dome and the frontal plane of the simulator, aligning the center of the mouth with the center of the dome. The PP dome measurements are 560.0mm x 255.0mm x 5mm. Petri dishes were placed at 0.5 m, 1 m and 1.5 m respectively. Aerosol generation in the laboratory environment was done three times with the following experimental groups 1) HH, 2) HH-PP, 3) UPD, 4) UPD-PP. Each dental device activation (HH and UPD) had a time frame of 2 minutes on the upper anterior teeth of the dental phantom with a liquid suspension containing Lactobacillus casei Shirota (YAKULT 0836A 0123; 1027F 0407). Air pressure and ventilation were parameterized. No separate high-volume evacuation used, nor was there any air removal attached to the dome. Results showed no significant difference between distance and axis in the CFU count. When means for devices and distances were compared between each of them all showed significant differences except for UPD and UPD-PP (p <0,004). In conclusion, external devices like Prime Protector could help decrease aerosol diffusion during high-speed handpiece activation. However, this dome does not replace the use of PPE inside dental clinics.
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Affiliation(s)
| | | | | | | | | | - Martín Campuzano-Donoso
- School of Dentistry, Faculty of Medical Sciences, International University of Ecuador, Quito, Ecuador
| | | | - Melanie Llerena-Velásquez
- School of Dentistry, Faculty of Medical Sciences, International University of Ecuador, Quito, Ecuador
| | - Yajaira Vásquez-Tenorio
- School of Dentistry, Faculty of Medical Sciences, International University of Ecuador, Quito, Ecuador
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5
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Johnstone M, Evans M. Clinical and medico-legal considerations in endodontics. Aust Dent J 2023; 68 Suppl 1:S153-S164. [PMID: 37805420 DOI: 10.1111/adj.12984] [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] [Accepted: 09/18/2023] [Indexed: 10/09/2023]
Abstract
Endodontic treatment can be challenging for a number of reasons, including the microscopic nature of the clinical environment, reliance on tactile sensation and lack of direct visualization of the work being performed. Commonly, endodontic patients present with pain and distress, which can exacerbate an already difficult clinical situation. Complications may might arise prior to, or during treatment, despite practising with the utmost care and skill. Preventing and managing these complications can take considerable time and energy, and oftentimes assistance from or referral to more experienced colleagues is required. The aim of this review is to discuss medico-legal considerations in endodontics, with clinical correlations and a focus on the Australian legal landscape. [Correction added on 18 October 2023, after first online publication: The abstract was amended from a structured to an unstructured abstract.].
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Affiliation(s)
- M Johnstone
- Private Practice, Maribyrnong, Victoria, Australia
| | - M Evans
- The University of Melbourne, Melbourne, Victoria, Australia
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6
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Van der Weijden F. Aerosol in the oral health-care setting: a misty topic. Clin Oral Investig 2023:10.1007/s00784-023-05034-x. [PMID: 37162570 PMCID: PMC10170433 DOI: 10.1007/s00784-023-05034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/18/2023] [Indexed: 05/11/2023]
Abstract
Studies have shown that mouth and respiratory tract microorganisms can be transported in aerosol and spatter. Due to aerosol-generating procedures, there are potentially various infection risks for patients and those working in health care, especially in oral health care. Dental aerosol can contaminate not only the mucous membranes of the oral health-care professional's mouth, respiratory passages, and eyes but also exposed surfaces and materials in the environment. As such, preventing disease transmission within oral health-care offices is important issue. Since the start of the COVID-19 pandemic, an innumerable amount of (mis)information and advice on how to stay safe and prevent the spread of coronavirus has been published. What preventive measures can and have been taken to counteract this, and what have we learned during the pandemic? This review summarizes relevant literature that has addressed the presence and dispersal of aerosol and spatter as a concern in health care. It includes the sources of dental aerosol, their potential health threats, and strategies for controlling and mitigating their impact. It shows that further research is needed to better understand the potential health risks of dental aerosol and to develop effective strategies for mitigating them. CLINICAL RELEVANCE: Using personal protective equipment, high-volume evacuation systems and pre-procedural antimicrobial agents can help to reduce the potential for infection in oral health-care settings and protect the well-being of oral health-care workers and their patients.
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Affiliation(s)
- Fridus Van der Weijden
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands.
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7
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Brahim Belhaouari D, Baudoin JP, Lagier JC, Monnet-Corti V, La Scola B, Antezack A. Microscopic observations of SARS-CoV-2 like particles in different oral samples. Eur J Oral Sci 2022; 130:e12903. [PMID: 36404273 PMCID: PMC10099536 DOI: 10.1111/eos.12903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/21/2022] [Indexed: 11/22/2022]
Abstract
The emerging coronavirus pneumonia epidemic caused by the SARS-CoV-2 infection has spread rapidly around the world. The main routes of transmission of SARS-CoV-2 are currently recognised as aerosol/droplet inhalation. However, the involvement of the oral cavity in coronavirus disease 2019 (COVID-19) is poorly known. The current data indicates the presence of viral RNA in oral samples, suggesting the implication of saliva in SARS-CoV-2 transmission, however, no direct observation of SARS-CoV-2 particles in different oral samples has been reported. In this study, we investigated whether particles of SARS-CoV-2 were present in oral samples collected from three symptomatic COVID-19 patients. Using scanning electron microscopy (SEM), the correlative strategy of light microscopy and electron microscopy and immunofluorescence staining, we showed the presence of SARS-like particles in RT-qPCR SARS-CoV-2-positive saliva, dental plaque and gingival crevicular fluid (GCF) samples. In the saliva samples, we demonstrated the presence of epithelial oral cells with morphogenetic features of SARS-CoV-2 infected cells. Inside those cells, vacuoles filled with nascent particles were observed, suggesting the potential infection and replication of SARS-CoV-2 in oral tissues. Our results corroborate previous studies and confirm that the oral cavity may be a potential niche for SARS-CoV-2 infection and a potential source of transmission.
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Affiliation(s)
- Djamal Brahim Belhaouari
- IRD, AP-HM, IHU Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France.,Department of Veterinary Pathobiology, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Jean-Pierre Baudoin
- IRD, AP-HM, IHU Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France.,Assistance Publique-Hopitaux de Marseille, Hopital Timone, Marseille, France
| | - Jean-Christophe Lagier
- IRD, AP-HM, IHU Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France.,Assistance Publique-Hopitaux de Marseille, Hopital Timone, Marseille, France
| | - Virginie Monnet-Corti
- IRD, AP-HM, IHU Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France.,Assistance Publique-Hopitaux de Marseille, Hopital Timone, Marseille, France.,Faculté des Sciences Médicales et Paramédicales, Ecole de Médecine Dentaire, Aix Marseille Univ, Marseille, France
| | - Bernard La Scola
- IRD, AP-HM, IHU Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France.,Assistance Publique-Hopitaux de Marseille, Hopital Timone, Marseille, France
| | - Angéline Antezack
- IRD, AP-HM, IHU Méditerranée Infection, MEPHI, Aix Marseille Univ, Marseille, France.,Assistance Publique-Hopitaux de Marseille, Hopital Timone, Marseille, France.,Faculté des Sciences Médicales et Paramédicales, Ecole de Médecine Dentaire, Aix Marseille Univ, Marseille, France
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8
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Kayahan E, Wu M, Van Gerven T, Braeken L, Stijven L, Politis C, Leblebici ME. Droplet size distribution, atomization mechanism and dynamics of dental aerosols. JOURNAL OF AEROSOL SCIENCE 2022; 166:106049. [PMID: 35891888 PMCID: PMC9304037 DOI: 10.1016/j.jaerosci.2022.106049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
Since the outbreak of COVID-19 pandemic, maintaining safety in dental operations has challenged health care providers and policy makers. Studies on dental aerosols often focus on bacterial viability or particle size measurements inside dental offices during and after dental procedures, which limits their conclusions to specific cases. Fundamental understanding on atomization mechanism and dynamics of dental aerosols are needed while assessing the risks. Most dental instruments feature a build-in atomizer. Dental aerosols that are produced by ultrasonic or rotary atomization are considered to pose the highest risks. In this work, we aimed to characterize dental aerosols produced by both methods, namely by Mectron PIEZOSURGERY® and KaVo EXPERTtorque™. Droplet size distributions and velocities were measured with a high-speed camera and a rail system. By fitting the data to probability density distributions and using empirical equations to predict droplet sizes, we were able to postulate the main factors that determine droplet sizes. Both dental instruments had wide size distributions including small droplets. Droplet size distribution changed based on operational parameters such as liquid flow rate or air pressure. With a larger fraction of small droplets, rotary atomization poses a higher risk. With the measured velocities reaching up to 5 m s-1, droplets can easily reach the dentist in a few seconds. Small droplets can evaporate completely before reaching the ground and can be suspended in the air for a long time. We suggest that relative humidity in dental offices are adjusted to 50% to prevent fast evaporation while maintaining comfort in the office. This can reduce the risk of disease transmission among patients. We recommend that dentists wear a face shield and N95/FFP2/KN95 masks instead of surgical masks. We believe that this work gives health-care professionals, policy makers and engineers who design dental instruments insights into a safer dental practice.
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Affiliation(s)
- Emine Kayahan
- Center for Industrial Process Technology, Department of Chemical Engineering, KU Leuven, Agoralaan Building B, 3590, Diepenbeek, Belgium
| | - Min Wu
- Center for Industrial Process Technology, Department of Chemical Engineering, KU Leuven, Agoralaan Building B, 3590, Diepenbeek, Belgium
| | - Tom Van Gerven
- Process Engineering for Sustainable Systems, Department of Chemical Engineering, KU Leuven, Celestijnenlaan 200F, B-3001 Heverlee, Belgium
| | - Leen Braeken
- Center for Industrial Process Technology, Department of Chemical Engineering, KU Leuven, Agoralaan Building B, 3590, Diepenbeek, Belgium
| | - Lambert Stijven
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - M Enis Leblebici
- Center for Industrial Process Technology, Department of Chemical Engineering, KU Leuven, Agoralaan Building B, 3590, Diepenbeek, Belgium
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9
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Amnuaiphanit P, Thumbuntu T, Gaewkhiew P, Ampornaramveth RS. Paradigm shift in infection control practices in dental clinics in response to COVID-19 among dental professionals in Thailand. FRONTIERS IN ORAL HEALTH 2022; 3:979600. [PMID: 36211253 PMCID: PMC9532690 DOI: 10.3389/froh.2022.979600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Infection control (IC) practice routines depend mainly on knowledge, perception, and awareness of a disease among dental professionals. However, there has been no report on the perception, awareness, and adaptability to the new practice guidelines of Thai dental professionals (dentists, dental nurses, dental assistants, and dental technicians) to the COVID-19 pandemic. This study aims to investigate how dental professionals in Thailand perceive and are aware of COVID-19, and how they have changed their IC practices in response to the pandemic. Online cross-sectional surveys using convenience sampling during September 2021 were sent to Thai dental professionals. The data were analyzed using descriptive statistics and the Chi-square test. Statistical analysis was performed using the Statistical Package for Social Sciences, version 22.0. The tests were two-tailed, with a significance level of p < 0.05 and 95% confidence intervals (CIs). The 1,177 dental professionals who completed the questionnaire were from the public and private sectors. Most respondents obtained their knowledge about COVID-19 from social media (91.8%). 86.7% had adapted to the new IC practice guidelines. The respondents reported that they had modified their work practices in several aspects; changes in administrative control, 1,039 (88.3%); enhancing local source control of dental aerosols, 1,031 (87.6%); heightening sterilization and disinfection procedures, 1,032 (87.7%); and improving the ventilation system, 994 (84.5%). As of October 2021, 1,162 (98.7%) respondents were vaccinated, and 47 (3.99%) had tested positive for COVID-19 compared with 2.30% in the general population. Among infected individuals, 10 (21.3%) were suspected of being infected while working in the dental setting. In conclusion, with an average worry score well over 4.10 out of 5, more than 96% of Thai dental professionals reported seeking updated knowledge and agreed that escalation of IC measures was needed. However, only 86.7% improved their COVID-19 infection prevention practices in 4 aspects and appropriate PPE use. The infection rate in dental professionals was 3.99%, with the highest infection rate in dental assistants. Despite statistical insignificance of infection rate between changed and unchanged group, it cannot be concluded that stricter IC measures are negligible as ones might contract disease from setting other than work.
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Affiliation(s)
| | | | - Piyada Gaewkhiew
- Department of Community Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
- Correspondence: Piyada Gaewkhiew Ruchanee Salingcarnboriboon Ampornaramveth
| | - Ruchanee Salingcarnboriboon Ampornaramveth
- Center of Excellence on Oral Microbiology and Immunology, Department of Microbiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Correspondence: Piyada Gaewkhiew Ruchanee Salingcarnboriboon Ampornaramveth
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10
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Gualtieri L, Yong R, Ah-Kion J, Jamil ALA, Bazaei A, Kotecha J, Long S, Silcock G, Miller CM. Droplet Distribution in a University Dental Clinic Setting: The Importance of High-Volume Evacuation. Healthcare (Basel) 2022; 10:healthcare10091799. [PMID: 36141411 PMCID: PMC9499005 DOI: 10.3390/healthcare10091799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study is to compare droplet distribution during a piezoelectric ultrasonic debridement procedure using either high-volume or slow-volume evacuation. Droplet distribution during a crown preparation with slow-volume evacuation is also examined. Fluorescein dye is added to the water reservoir and the procedures are performed by a single operator for 15 min on a dental manikin with artificial upper and lower teeth. Placement of filter paper squares (10 cm × 10 cm) in radiating lines away from the oral cavity of the dental manikin allows for visualization of droplet dispersion. Results show minimal difference in the spread of the droplets between the two evacuators during the debridement procedure; however, the slow-volume evacuator produces a higher concentration of droplets than the high-volume evacuator. An even higher concentration of droplets in the vicinity of the dental chair is observed during the crown preparation procedure. This study recommends the use of a high-volume evacuator where possible during professional debridement and crown preparation to reduce contamination around the dental chair from potentially pathogenic microorganisms.
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Affiliation(s)
- Linda Gualtieri
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4870, Australia
| | - Ronald Yong
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4870, Australia
| | - Jessley Ah-Kion
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4870, Australia
| | - Amanda L. A. Jamil
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4870, Australia
| | - Asmae Bazaei
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4870, Australia
| | - Jhanvi Kotecha
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4870, Australia
| | - Sharron Long
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4870, Australia
| | - Gloria Silcock
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4870, Australia
| | - Catherine M. Miller
- College of Medicine and Dentistry, James Cook University, Smithfield, QLD 4870, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Smithfield, QLD 4870, Australia
- Correspondence:
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11
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Silva PG, Branco PTBS, Soares RRG, Mesquita JR, Sousa SIV. SARS-CoV-2 air sampling: A systematic review on the methodologies for detection and infectivity. INDOOR AIR 2022; 32:e13083. [PMID: 36040285 PMCID: PMC9538005 DOI: 10.1111/ina.13083] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
This systematic review aims to present an overview of the current aerosol sampling methods (and equipment) being used to investigate the presence of SARS-CoV-2 in the air, along with the main parameters reported in the studies that are essential to analyze the advantages and disadvantages of each method and perspectives for future research regarding this mode of transmission. A systematic literature review was performed on PubMed/MEDLINE, Web of Science, and Scopus to assess the current air sampling methodologies being applied to SARS-CoV-2. Most of the studies took place in indoor environments and healthcare settings and included air and environmental sampling. The collection mechanisms used were impinger, cyclone, impactor, filters, water-based condensation, and passive sampling. Most of the reviewed studies used RT-PCR to test the presence of SARS-CoV-2 RNA in the collected samples. SARS-CoV-2 RNA was detected with all collection mechanisms. From the studies detecting the presence of SARS-CoV-2 RNA, fourteen assessed infectivity. Five studies detected viable viruses using impactor, water-based condensation, and cyclone collection mechanisms. There is a need for a standardized protocol for sampling SARS-CoV-2 in air, which should also account for other influencing parameters, including air exchange ratio in the room sampled, relative humidity, temperature, and lighting conditions.
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Affiliation(s)
- Priscilla G Silva
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- School of Medicine and Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Porto, Portugal
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
- Epidemiology Research Unit (EPI Unit), Institute of Public Health, University of Porto, Porto, Portugal
| | - Pedro T B S Branco
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Porto, Portugal
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
| | - Ruben R G Soares
- Department of Biochemistry and Biophysics, Science for Life Laboratory, Stockholm University, Solna, Sweden
- Division of Nanobiotechnology, Department of Protein Science, Science for Life Laboratory, KTH Royal Institute of Technology, Solna, Sweden
| | - João R Mesquita
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Epidemiology Research Unit (EPI Unit), Institute of Public Health, University of Porto, Porto, Portugal
| | - Sofia I V Sousa
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Porto, Portugal
- ALiCE - Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
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12
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A Review on Risk Management of Coronavirus Disease 19 (COVID-19) Infection in Dental Practice: Focus on Prosthodontics and All-Ceramic Materials. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4030028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: A novel β-coronavirus infection (COVID-19) was first detected in Wuhan city, spreading rapidly to other countries and leading to a pandemic. Dental professionals and patients are exposed to a high risk of COVID-19 infection, particularly in the prosthodontic practice, because of the bio-aerosol produced during teeth preparation with dental handpieces and the strict contact with oral fluids during impression making. This paper aimed to provide an overview to limit the risk of transmission of COVID-19 infections during prosthetic procedures in dental offices. Methods: An electronic search was conducted on the electronic databases of PubMed/Medline, Google Scholar, Embase, Scopus, Dynamed, and Open Grey with the following queries: (COVID-19) AND/OR (SARS-CoV-2) AND/OR (Coronavirus) AND/OR (contaminated surface) AND/OR (cross-infection) AND/OR (Prosthodontics) AND/OR (dental ceramic) AND/OR (glass-ceramic). A manual search was performed as well. Results: From the 1023 collected records, 32 papers were included. Conclusions: Dental offices are at high risk of spreading SARS-CoV-2 infection due to the close contact with patients and continuous exposure to saliva during dental procedures. Therefore, pre-check triages via telephone, decontamination, the disinfection of impressions, the sterilization of scanner tips, and the use of specific personal protective equipment, dental high-speed handpieces with dedicated anti-retraction valves, and effective mouthwashes are strongly recommended.
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13
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Aerosol reduction of two dental extraoral scavenger devices in vitro. Int Dent J 2022; 72:691-697. [PMID: 35810011 PMCID: PMC9159968 DOI: 10.1016/j.identj.2022.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Since the outbreak of SARS-CoV-2, aerosol control in the operatory has become a key safety issue in dentistry. The utilisation of extraoral scavenger devices (EOSs) is one of the various approaches to in-treatment aerosol reduction in dentistry. The use and efficacy of EOSs in dental settings, however, are still a matter of debate in the literature and there are still open questions about their proper use. Thus, research into this area is essential to inform dental practice. The objective of this study was to examine the aerosol reduction efficacy of two different EOS in vitro. Methods Two commercially available EOSs were tested during modeled dental treatment in a setup that previously proved to generate high aerosol load. Measurements were done in two particle size ranges: 5.6–560 nm (the full range of the spectrometer) and 60.4–392.4 nm (a range that is especially relevant to the spread of SARS-CoV-2 with aerosol). Results Both devices managed to reduce the aerosol load to a statistically significant extent as compared to the scenario when only a high-volume evacuator and a saliva ejector (and no EOS) were used. Conclusions Within the limitations of the study, the results support the assumption that EOSs for aerosol reduction increase in-treatment safety in the dental operatory.
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14
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Ohya T, Nakagawa K, Arai Y, Kato H. Visualization of droplets produced by dental air turbines that require infection control measured during coronavirus 2019 outbreaks. J Hosp Infect 2022; 119:196-198. [PMID: 34637853 PMCID: PMC8501514 DOI: 10.1016/j.jhin.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- T. Ohya
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan,Corresponding author. Address: Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan. Tel.: +81-45-787-2659
| | - K. Nakagawa
- Department of Bioengineering, Department of Precision Engineering, The University of Tokyo, Tokyo, Japan
| | - Y. Arai
- Department of Otolaryngology, Head and Neck Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - H. Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan
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15
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The New Normalcy in Dentistry after the COVID-19 Pandemic: An Italian Cross-Sectional Survey. Dent J (Basel) 2021; 9:dj9080086. [PMID: 34435998 PMCID: PMC8391335 DOI: 10.3390/dj9080086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/25/2021] [Accepted: 07/28/2021] [Indexed: 12/16/2022] Open
Abstract
Background: After the first lockdown, Italian dentists resumed their practice while handling several challenges. Reducing contagion risk by complying with the stringent measures recommended by the Italian Ministry of Health for dental activity while also balancing patient needs was a difficult task. This work aims to understand the procedures that were adopted in the second phase of the COVID-19 pandemic (5 May–30 September 2020) and the dentists’ expectations and concerns about returning to normalcy. Methods: A national survey with 38 questions was conducted from November 2020 to January 2021 and comparisons were performed among the five main Italian geographic areas. Results: Located mainly in northwest Italy, 1028 dentists were included in the survey. About 83% of the Italian dentists fully restarted their activities after the lockdown. The resumption was significantly marked in North Italy and the Center than in the South (p < 0.01). Over 80% adopted the recommended precautional guidelines, modifying them according to the specific dental treatment executed. Fifty percent of dentists were confident in returning to normalcy after the COVID-19 crisis. Many precautions adopted during the pandemic will be continued, especially in South Italy and the Islands (p < 0.01). Conclusions: Italian dentists reported excellent autonomous organizational skills and the maintaining of high-quality precautions during the reopening phase.
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16
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Allison JR, Edwards DC, Bowes C, Pickering K, Dowson C, Stone SJ, Lumb J, Durham J, Jakubovics N, Holliday R. The effect of high-speed dental handpiece coolant delivery and design on aerosol and droplet production. J Dent 2021; 112:103746. [PMID: 34265364 DOI: 10.1016/j.jdent.2021.103746] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES High-speed dental instruments produce aerosol and droplets. The objective of this study was to evaluate aerosol and droplet production from a novel electric micromotor handpiece (without compressed air coolant) in real world clinical settings. METHODS 10-minute upper incisor crown preparations were performed in triplicate in an open-plan clinic with mechanical ventilation providing 3.45 air changes per hour. A 1:5 ratio electric micromotor handpiece which allows water coolant without compressed air (Ti-Max Z95L, NSK) was used at three speeds: 60,000 (60 K), 120,000 (120 K), and 200,000 (200 K) revolutions per minute. Coolant solutions contained fluorescein sodium as a tracer (2.65 mmol L - 1). High-speed air-turbine positive control, and negative control conditions were conducted. Aerosol production was evaluated at 3 locations (0.5 m, 1.5 m, and 1.7 m) using: (1) an optical particle counter (OPC; 3016-IAQ, Lighthouse) to detect all aerosol; and (2) a liquid cyclone air sampler (BioSampler, SKC Ltd.) to detect aerosolised fluorescein, which was quantified by spectrofluorometric analysis. Settled droplets were detected by spectrofluorometric analysis of filter papers placed onto a rig across the open-plan clinic. RESULTS Local (within treatment bay) settled droplet contamination was elevated above negative control for all conditions, with no difference between conditions. Settled droplet contamination was not detected above negative controls outside the treatment bay for any condition. Aerosol detection at 1.5 m and 1.7 m, was only increased for the air-turbine positive control condition. At 0.5 m, aerosol levels were highly elevated for the air-turbine, minimally elevated for 200 K and 120 K, and not elevated for 60 K. CONCLUSIONS Electric micromotor handpieces which use water-jet coolant alone without compressed air produce localised (within treatment bay) droplet contamination, but are unlikely to produce aerosol contamination beyond the immediate treatment area (1.5 m), allowing them to be used safely in most open-plan clinic settings.
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Affiliation(s)
- James R Allison
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, United Kingdom; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - David C Edwards
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, United Kingdom; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Charlotte Bowes
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, United Kingdom; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Kimberley Pickering
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Christopher Dowson
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, United Kingdom
| | - Simon J Stone
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, United Kingdom; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Joanna Lumb
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Justin Durham
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, United Kingdom; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Nicholas Jakubovics
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, United Kingdom
| | - Richard Holliday
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, United Kingdom; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom.
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