Aerosols generated by high-speed handpiece and ultrasonic unit during endodontic coronal access alluding to the COVID-19 pandemic

The Efficacy of an Extraoral Suction Apparatus on Reduction of Splatter Contamination during Impacted Lower Third Molar Surgical Procedure: An Observational Study

Background

The COVID-19 pandemic has affected the delivery of dental care globally. Air contamination during aerosol and splatter-generating procedures is of great concern to dental healthcare provider during these times. Extra oral suction (EOS) apparatus has been shown to be effective in preventing infection by control of aerosol. But very limited data is available regarding the efficacy of the apparatus in preventing splatter contamination.

Objectives of the Study

To assess the efficacy of EOS apparatus in reducing frequency and mean intensity of splatter contamination at clinician, assistant, patient sites during lower third molar surgical procedures.

Materials and Methods

Patients who required surgical removal of an impacted lower third molar were divided into two groups (EOS and non-EOS) with 20 patients each. Universal indicating paper (UIP) was placed in specific locations on the surgeon, patient, and assistant. Colour changes after the settling of splatter on the UIP were analyzed to calculate the percentage intensity of splatter contamination.

Results

The use of an EOS device has shown an overall reduction in the total number of contaminated sites, with a difference of 6.36%. Surgeon, patient, and assistant sites showed reductions of 6.25, 10%, and 1.66%, respectively. The apparatus has showed statistically significant reduction of splatter frequency and intensity at the patient's chest and left shoulder regions respectively, during surgical removal of the impacted 48.

Conclusion

The magnitude of splatter contamination during minor dentoalveolar surgical procedures is inevitable. Therefore, to achieve a better working environment, usage of an EOS apparatus is advocated.

Aerosol-generating procedures and associated control/mitigation measures: Position paper from the Canadian Dental Hygienists Association and the American Dental Hygienists' Association

Background

Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosolgenerating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the evidence of the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry.

Methods

The authors searched 6 databases-MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar-for relevant scientific evidence published between January 2012 and December 2022 to answer 6 research questions about the risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols.

Results

A total of 78 studies fulfilled the eligibility criteria. The literature on the risk of infection transmission including SARS-CoV-2 between dental hygienists and their patients is limited. Although several mouthrinses are effective in reducing bacterial contaminations in aerosols, their effectiveness against SARS-CoV-2 is also limited. The combined use of eyewear, masks, and face shields is effective in preventing contamination of the facial and nasal region while performing AGPs. High-volume evacuation with or without an intraoral suction, low-volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories is effective in limiting the spread of aerosols.

Discussion and Conclusion

Aerosols produced during clinical procedures can pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence will ensure greater patient and provider safety in oral health settings. More studies in oral health clinical environments would shape future practices and protocols, ultimately to ensure the delivery of safe clinical care.

Bioaerosol distribution characteristics and potential SARS-CoV-2 infection risk in a multi-compartment dental clinic

Dental clinics have a potential risk of infection, particularly during the COVID-19 pandemic. Multi-compartment dental clinics are widely used in general hospitals and independent clinics. This study utilised computational fluid dynamics to investigate the bioaerosol distribution characteristics in a multi-compartment dental clinic through spatiotemporal distribution, working area time-varying concentrations, and key surface deposition. The infection probability of SARS-CoV-2 for the dental staff and patients was calculated using the Wells-Riley model. In addition, the accuracy of the numerical model was verified by field measurements of aerosol concentrations performed during a clinical ultrasonic scaling procedure. The results showed that bioaerosols were mainly distributed in the compartments where the patients were treated. The average infection probability was 3.8% for dental staff. The average deposition number per unit area of the treatment chair and table are 28729 pcs/m² and 7945 pcs/m², respectively, which creates a possible contact transmission risk. Moreover, there was a certain cross-infection risk in adjacent compartments, and the average infection probability for patients was 0.84%. The bioaerosol concentrations of the working area in each compartment 30 min post-treatment were reduced to 0.07% of those during treatment, and the infection probability was <0.05%. The results will contribute to an in-depth understanding of the infection risk in multi-compartment dental clinics, forming feasible suggestions for management to efficiently support epidemic prevention and control in dental clinics.

Factors Related to the Intention to Use Dental Care by Industrial Workers Due to COVID-19: Application of Anderson Model and Planned Behavior Theory

The COVID-19 pandemic has affected medical and dental care in Korea. This study aimed to investigate the factors influencing the intention to use dental care in industrial workers, an economically active population. An online questionnaire survey was completed by 301 industrial workers. Stress and anxiety to viral epidemics-6 (SAVE-6), attitude, subjective norm, perceived behavior control, and intention to use dental care, based on the theory of planned behavior (TPB), were measured. Predisposing, enabling, and need factors based on the Andersen model were measured as control variables for influencing factors. In the final hierarchical multiple regression analysis, the most significant relevant factors affecting intention to use dental care were attitude (β = 0.598, p < 0.001), followed by experience of dental clinic visits (β = 0.237, p < 0.001), subjective norm (β = 0.125, p < 0.001), perceived behavior control (β = 0.114, p = 0.004), SAVE-6 (β = -0.073, p = 0.025), and gingival bleeding (β = 0.062, p = 0.029). Dental care use decreased to 58.5%, and socio-psychological factors based on TPB were closely associated with the intention to use dental care. Therefore, awareness must be raised regarding oral health practices to increase the use of dental care among industrial workers.