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Gund MP, Naim J, Rupf S, Gärtner B, Hannig M. Bacterial contamination potential of personal protective equipment itself in dental aerosol-producing treatments. Odontology 2024; 112:309-316. [PMID: 37702832 PMCID: PMC10925564 DOI: 10.1007/s10266-023-00848-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023]
Abstract
Personal protective equipment (PPE) has long been a high priority in dental aerosol-producing treatments. Since COVID-19 pandemic, its importance has increased yet again. While importance of PPE in preventing transmission and thus possible infection of pathogens is well known, contamination potential of PPE after treatment itself is less investigated. This review aims to give an overview of the current literature and contamination potential (viral, blood, bacterial) of components of protective equipment itself. The literature search was performed using the Medline database; furthermore, a hand search was conducted. Last search took place on 23 November 2022. Two categories of hygiene-related keywords were formed (category A: mask, face shield, goggles, eyewear, personal protective equipment; category B: contamination, aerosol). Each keyword from one category was combined with all keywords from the other one. In addition, the keyword "dental" was always added. First, a title and abstract screening was performed. Afterward, a full-text analysis was followed for the included studies. A total of 648 search hits were found in the Medline database. 47 were included after title and abstract screening. 22 studies were excluded after full-text analysis, 25 studies were included. The hand search resulted in 4 studies that were included. Bacterial contamination of PPE after treatment has been adequately studied, contamination with blood less. Microorganisms mainly originate from the oral and cutaneous flora; however, a transmission of potential pathogens like Staphylococcus aureus or Escherichia coli was also described. Studies showing transmission pathways starting from PPE and its various components are lacking. No measures have yet been described that fully protect the protective equipment from contamination. There is growing awareness that PPE itself can be a source of pathogen transmission, and thus possible infection. Therefore, not only wearing of protective clothing, but also conscious handling of it is crucial for transmission and possible infection prevention. However, studies showing transmission pathways starting from PPE and its various components are lacking. Several studies have investigated what measures can be taken to protect the protective equipment itself. So far, none of the methods evaluated can prevent contamination of PPE.
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Affiliation(s)
- Madline Priska Gund
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Clinic of Operative Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany.
| | - Jusef Naim
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Clinic of Operative Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany
| | - Stefan Rupf
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Clinic of Operative Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany
- Chair of Synoptic Dentistry, Homburg, Germany
| | - Barbara Gärtner
- Institute of Medical Microbiology and Hygiene, Department of Hospital Hygiene, Saarland University, Homburg, Germany
| | - Matthias Hannig
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Clinic of Operative Dentistry, Saarland University Hospital, Saarland University, Kirrberger Str. 100, Building 73, 66421, Homburg, Saar, Germany
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Gund MP, Naim J, Bayhan HM, Hannig M, Gärtner B, Halfmann A, Boros G, Rupf S. Dental aerosol-producing treatments: Comparison of contamination patterns of face shields and surgical masks. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2024; 21:126-135. [PMID: 38393941 DOI: 10.1080/15459624.2023.2285363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
During the COVID-19 pandemic, dental face shields were recommended to protect the eyes. This study aimed to examine to what extent face shield and mask contamination differ when a pre-procedural mouth rinsing with Chlorhexidine (CHX) is conducted before treatment. In this prospective, randomized study, three groups of subjects were formed (rinsing with 0.1% CHX, water, or no rinsing (control) before aerosol-producing treatments). After each of the 301 treatments, the practitioner's face shield was swabbed with eSwab and the mask was brought into contact with agar plates. Sampling was done from the exterior surface only. Samples were cultured for 48 h at 35 °C under aerobic and anaerobic conditions. Bacteria were classified by phenotypic characteristics, biochemical test methods, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Colony-forming units were counted and mean values were compared (WSR, H-test, U-test, p < 0.05). Within each subject group, face shields showed significantly more contamination than surgical masks (control group: 350 CFU, 50 CFU; intervention water: 270 CFU, 40 CFU; intervention CHX: 250 CFU, 30 CFU). Comparison of face shields of the different subject groups did not reveal any statistically significant differences. However, CHX resulted in a statistically significant bacterial reduction on surgical masks compared to the water and control group (control: 50 CFU, intervention water: 40 CFU, intervention CHX: 30 CFU). Contamination of face shields and surgical masks was highest in the control group, followed by the water group, and lowest in the intervention group with CHX. Streptococcus spp. and Staphylococcus spp. dominated, representing the oral and cutaneous flora. Contamination of masks worn with or without face shields did not differ. Presumably, face shields intercept first splashes and droplets, while the masks were mainly exposed to bioaerosol mist. Consequently, face shields protect the facial region and surroundings from splashes and droplets, but not the mask itself. A pre-procedural mouth rinse with CHX had no statistically significant reducing effect on contamination of the face shield, but a statistically significant reducing effect was observed on contamination of the mask.
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Affiliation(s)
- Madline P Gund
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
- Oral Surgery Clinic, German Armed Forces Central Hospital, Koblenz, Germany
| | - Jusef Naim
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
| | - Halil Muhammed Bayhan
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
| | - Matthias Hannig
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
| | - Barbara Gärtner
- Institute of Medical Microbiology and Hygiene, Department of Hospital Hygiene, Saarland University, Homburg, Germany
| | - Alexander Halfmann
- Institute of Medical Microbiology and Hygiene, Department of Hospital Hygiene, Saarland University, Homburg, Germany
| | - Gabor Boros
- Oral Surgery Clinic, German Armed Forces Central Hospital, Koblenz, Germany
| | - Stefan Rupf
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
- Synoptic Dentistry, Saarland University, Homburg, Germany
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Ghoneim A, Proaño D, Kaur H, Singhal S. Aerosol-generating procedures and associated control/mitigation measures: Position paper from the Canadian Dental Hygienists Association and the American Dental Hygienists' Association. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2024; 58:48-63. [PMID: 38505316 PMCID: PMC10946320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/29/2023] [Accepted: 09/25/2023] [Indexed: 03/21/2024]
Abstract
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.
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Affiliation(s)
| | - Diego Proaño
- Faculty of Dentistry, University of Toronto, Toronto, ON Canada
| | - Harpinder Kaur
- Faculty of Dentistry, University of Toronto, Toronto, ON Canada
| | - Sonica Singhal
- Faculty of Dentistry, University of Toronto, Toronto, ON Canada
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Gund MP, Naim J, Lang J, Hannig M, Gärtner B, Halfmann A, Boros G, Rupf S. Detection of viable oral bacteria of the patient on the surgical mask of dentists. BDJ Open 2024; 10:4. [PMID: 38228600 DOI: 10.1038/s41405-023-00182-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 01/18/2024] Open
Abstract
INTRODUCTION AND AIM Bioaerosols contaminate the personal protective equipment (PPE), especially masks. The PPE harbors microorganisms from various sources. However, no previous studies have investigated the specific sources of bacteria found on used masks and their correlation with those from the treated patient. SETTING, DESIGN, MATERIAL AND METHODS Intraoral samples from the patient were collected prior to dental aerosol-producing treatments using a nylon flock fiber swab. After treatment, the practitioner's mask was imprinted onto agar plates. MAIN OUTCOME METHODS Following cultivation, colony forming units were counted and identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). After the samples were analyzed, the intraoral samples as well as the mask samples were assessed for the presence of identical species, which were subsequently quantified. RESULTS 126 treatments were included. One species match occurred most frequently (26.2%), followed by two (11.9%%) and three or more (3.97%). In the intraoral samples, Neisseria subflava occurred most often, within mask samples Staphylococcus epidermidis were detected most. Staphylococcus aureus could be cultivated three times more often in intraoral samples than on the mask. DISCUSSION AND CONCLUSION Oral microorganisms originating from the patient's oral cavity can be found on the outside of masks. When using PPE during treatments, it should therefore always be in mind that potentially pathogenic microorganisms may land on the mask becoming a source of for itself.
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Affiliation(s)
- Madline Priska Gund
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany.
- Oral Surgery Clinic, German Armed Forces Central Hospital, Koblenz, Germany.
| | - Jusef Naim
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
| | - Janina Lang
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
| | - Matthias Hannig
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
| | - Barbara Gärtner
- Institute of Medical Microbiology and Hygiene, Department of Hospital Hygiene, Saarland University, Homburg, Germany
| | - Alexander Halfmann
- Institute of Medical Microbiology and Hygiene, Department of Hospital Hygiene, Saarland University, Homburg, Germany
| | - Gabor Boros
- Oral Surgery Clinic, German Armed Forces Central Hospital, Koblenz, Germany
| | - Stefan Rupf
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
- Synoptic Dentistry, Saarland University, Homburg, Germany
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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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Tsuchiya H. The Oral Cavity Potentially Serving as a Reservoir for SARS-CoV-2 but Not Necessarily Facilitating the Spread of COVID-19 in Dental Practice. Eur J Dent 2022. [DOI: 10.1055/s-0042-1757909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractIntraoral tissues, secretions, and microenvironments may provide severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with the conditions necessary for viral cellular entry and inhabitation. The aim of the present study is to overview the oral cavity that potentially serves as a reservoir for SARS-CoV-2, and then discuss the possibility that such oral cavity facilitates the spread of coronavirus disease 2019 (COVID-19) in dental practice. Articles were retrieved from PubMed/Medline, LitCovid, ProQuest, Google Scholar, and preprint medRxiv databases. Results of the literature search indicated that SARS-CoV-2 host cell entry-relevant receptor and virus/cell membrane fusion mediators are expressed in major and minor salivary glands, tongue, taste bud, periodontal tissue, and dental pulp, which would be a target and reservoir for SARS-CoV-2. SARS-CoV-2 is present in saliva and gingival crevicular fluid of COVID-19 patients. These secretions would contaminate dental aerosol and droplet with SARS-CoV-2. SARS-CoV-2 inhabits periodontal pocket, gingival sulcus, and dental caries lesion, which could provide SARS-CoV-2 with a habitat. SARS-CoV-2 ribonucleic acid is preserved in dental calculus, which may inform of the previous infection with SARS-CoV-2. Despite involvement of the oral cavity in SARS-CoV-2 transmission and infection, to date, there have been no clusters of COVID-19 in dental practice. Dental settings are much less likely to facilitate the spread of COVID-19 compared with general medical settings, which may be explained by the situation of dentistry that the number of patients to visit dental offices/clinics was decreased during the COVID-19 pandemic, the characteristics of dentistry that dental professionals have maintained high awareness of viral infection prevention, adhered to a strict protocol for infection control, and been using personal protective equipment for a long time, the experimental results that dental devices generate only small amounts of aerosol responsible for the airborne viral transmission, irrigant from the dental unit contributes to the aerosol microbiota much rather than saliva, and the commonly used evacuation or suction system effectively reduces aerosol and droplet generation, and the possibility that human saliva exhibits the antiviral activity and the property to inhibit SARS-CoV-2 infection. It is considered that dental treatment and oral health care can be delivered safely in the COVID-19 era.
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Affiliation(s)
- Hironori Tsuchiya
- Department of Dental Basic Education, Asahi University School of Dentistry, Mizuho, Gifu, Japan
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8
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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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9
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Aghili SS, Pourzal A, Mosaddad SA, Amookhteh S. COVID-19 Risk Management in Dental Offices: A Review Article. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND: As all the dental staff, including nurses and practitioners, are exposed to various routes of contamination due to the novel COVID-19 virus, which is still unknown to the scientific world, developing strategies to reduce the risk of transmission and decontaminate surfaces in a dental office would be of high importance. Although there is still insufficient data on managing this virus in dental offices, several studies have suggested protocols for improving care.
AIM: This study aimed to review present investigations and reach a conclusion on what we know and need to know to combat this virus.
MATERIALS AND METHODS: In this review, Scopus, PubMed, and MEDLINE databases were searched using the keywords “COVID-19,” “SARS-CoV-2,” “Medical Disinfectants,” “Personal Protective Equipment’s,” and “Surface Decontamination.” Articles were reviewed, and finally, relevant articles published during 2000–2022 were included in the final paper.
RESULTS: The present research concluded that using a combination of the face shield and N95 masks protected the eyes, nose, and mouth. To have more efficient protection, water-resistant long-sleeved gowns and gloves were highly suggested. To overcome aerosols, high-performance air filters and ultraviolet were found quite effective. Allowing the patient to use antiseptic mouthwash before starting the treatment could reduce oral microorganisms and the following airborne contamination.
CONCLUSION: This review has gathered all available data regarding dentistry and COVID-19 in order to conclude what has been achieved yet in the prevention of this virus through dental offices; however, more investigations are needed to have a definitive protocol against the virus.
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10
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Böke ES, Keleş A, Keskin C, Tanrıverdi Çaycı Y, Turk T. Are aerosol control devices effective in preventing the spread of dental aerosol? PeerJ 2022; 10:e13714. [PMID: 35855907 PMCID: PMC9288161 DOI: 10.7717/peerj.13714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/21/2022] [Indexed: 01/17/2023] Open
Abstract
Background In dental clinics, aerosols produced from dental instruments have become a matter of concern following breakout of coronavirus disease 19 (COVID-19) evolving into a pandemic. This study compared aerosol reduction systems and in terms of their ability to reduce Enterococcus faecalis (E. faecalis) contaminated aerosol in a simulated dental office set-up. Methods Closed clinic model with manikin and mandibular molar typodont was simulated. For 10 min, the air and water dispersed by the rotating bur mounted on an aerator was contaminated by pouring the suspension containing 1-3 × 108 CFU/mL E. faecalis directly on the bur. During and after the procedures, the air within the cabin was also sampled. CFU count was recorded and scored. The mean CFU scores obtained from agar plate count and air sampling device was compared using Kruskal-Wallis H test among groups with 5% significance threshold. Results The use of WS Aerosol Defender device led to greater CFU scores on the agars levelled to patient's chest compared to other directions (p = 0.001). Combined use of VacStation and WS Aerosol Defender resulted in significantly decreased CFU score in the air samples compared to experimental and positive control groups (p = 0 < 0.05). Conclusions Although the devices prevented the spread of aerosol around the patient to some extent, they could not completely eliminate the contaminated aerosol load in the cabin environment.
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Affiliation(s)
- Elif Seher Böke
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Ali Keleş
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Cangül Keskin
- Department of Endodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
| | - Yeliz Tanrıverdi Çaycı
- Department of Medical Microbiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Tugba Turk
- Deapartment of Endodontics, Faculty of Dentistry, Ege University, İzmir, Türkiye
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11
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Teng WC, Chu YC, Tseng JY, Lai HY. A new protective barrier to reduce the aerosol dispersion in dental clinics during Omicron Covid-19 pandemic. J Chin Med Assoc 2022; 85:808-809. [PMID: 35648141 DOI: 10.1097/jcma.0000000000000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Wei-Chi Teng
- Department of Anesthesiology, Mennonite Christian Hospital, Hualien, Taiwan, ROC
| | - Ya-Chun Chu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan, ROC
| | - Jen-Yu Tseng
- National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hsien-Yung Lai
- Department of Anesthesiology, Mennonite Christian Hospital, Hualien, Taiwan, ROC
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12
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Silva HGE, Móra PMPK, Zajkowski LA, Celeste RK, Scarparo RK. Urgent dental care in the Brazilian public health system: learning lessons from the COVID-19 pandemic for future situations. CAD SAUDE PUBLICA 2022; 38:e00013122. [DOI: 10.1590/0102-311xen013122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 10/13/2022] [Indexed: 11/27/2022] Open
Abstract
This ecological study described the effect of the COVID-19 pandemic and socioeconomic development on the use and profile of urgent dental care (UDC). UDC rates per 100,000 inhabitants before (from March to June 2019) and during (from March to June 2020) the COVID-19 pandemic in 4,062 Brazilian municipalities were compared. Data were collected from official sources. COVID-19 mortality and hospitalization rates were indicative of levels of lockdown and Human Development Index (HDI) indicated socioeconomic development. Multiple logistic regression and relative excess risk due to interaction (RERI) were used for statistical analyses. The Student t-test was used to compare changes in the profile of UDC causes and procedures in the two periods. Lower UDC rates were found in 69.1% of municipalities and were associated with higher HDI (OR = 1.20; 95%CI: 1.01; 1.42). Mortality had OR = 0.88 (95%CI: 0.73; 1.06) for municipalities with HDI < 0.70 and OR = 1.45 (95%CI: 1.07; 1.97) for municipalities with HDI > 0.70. RERI between HDI and COVID-19 was 0.13 (p < 0.05). Municipalities with greater primary health care coverage had a smaller reduction in emergency rates. Endodontic treatment and dental pain were the most frequent factors both before and during the pandemic. The percentage of UDCs due to pain and soft tissue damage, as well as temporary sealing and surgical procedures, increased. Socioeconomic variables affected UDC rates during the most restrictive period of the COVID-19 pandemic and should be considered in the planning of health actions in future emergencies.
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13
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Zellmer S, Bachmann E, Muzalyova A, Ebigbo A, Kahn M, Traidl-Hoffmann C, Frankenberger R, Eckstein FM, Ziebart T, Meisgeier A, Messmann H, Römmele C, Schlittenbauer T. One Year of the COVID-19 Pandemic in Dental Medical Facilities in Germany: A Questionnaire-Based Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:175. [PMID: 35010434 PMCID: PMC8750787 DOI: 10.3390/ijerph19010175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
(1) Background: The COVID-19 pandemic forced healthcare workers to adapt to challenges in both patient care and self-protection. Dental practitioners were confronted with a potentially high possibility of infection transmission due to aerosol-generating procedures. This study aims to present data on healthcare worker (HCW) screening, infection status of HCWs, pre-interventional testing, the use of personal protective equipment (PPE) and the economic impact of the pandemic in dental facilities. (2) Methods: Dental facilities were surveyed nationwide using an online questionnaire. The acquisition of participants took place in cooperation with the German Society for Dentistry, Oral and Maxillofacial Medicine. (3) Results: A total of 1094 private practices participated. Of these, 39.1% treated fewer than 600 patients per quarter and 59.9% treated over 600 patients per quarter. Pre-interventional testing was rarely performed in either small (6.6%) or large practices (6.0%). Large practices had a significantly higher incidence of at least one SARS-CoV-2-positive HCW than small practices (26.2% vs.14.4%, p < 0.01). The main source of infection in small practices was the private environment, and this was even more significant in large practices (81.8% vs. 89.7%, p < 0.01). The procedure count either remained stable (34.0% of small practices vs. 46.2% of large practices) or decreased by up to 50% (52.6% of small practices vs. 44.4% of large practices). Revenue remained stable (24.8% of small practices vs. 34.2% of large practices) or decreased by up to 50% (64.5% of small practices vs. 55.3% of large practices, p = 0.03). Overall, employee numbers remained stable (75.5% of small practices vs. 76.8% of large practices). A vaccination readiness of 60-100% was shown in 60.5% (n = 405) of large practices and 59.9% (n = 251) of small practices. (4) Conclusion: Pre-interventional testing in dental practices should be increased further. Economic challenges affected small practices as well as large practices. Overall, a steady employee count could be maintained. Vaccination readiness is high in dental practices, although with some room for improvement.
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Affiliation(s)
- Stephan Zellmer
- Department of Internal Medicine III—Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany; (A.M.); (A.E.); (M.K.); (H.M.); (C.R.)
| | - Ella Bachmann
- Department of Oral and Maxillofacial Surgery, University Hospital Augsburg, Sauerbruchstraße 6, 86179 Augsburg, Germany;
| | - Anna Muzalyova
- Department of Internal Medicine III—Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany; (A.M.); (A.E.); (M.K.); (H.M.); (C.R.)
| | - Alanna Ebigbo
- Department of Internal Medicine III—Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany; (A.M.); (A.E.); (M.K.); (H.M.); (C.R.)
| | - Maria Kahn
- Department of Internal Medicine III—Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany; (A.M.); (A.E.); (M.K.); (H.M.); (C.R.)
| | - Claudia Traidl-Hoffmann
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Neusäßer Straße 47, 86156 Augsburg, Germany;
| | - Roland Frankenberger
- Department of Operative Dentistry, Endodontics and Pediatric Dentistry, Campus Marburg, University Medical Center Giessen and Marburg, Georg-Voigt-Str. 3, 35039 Marburg, Germany;
| | - Fabian M. Eckstein
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, 30625 Hannover, Germany;
| | - Thomas Ziebart
- Department of Oral and Maxillofacial Surgery, Campus Marburg, Philipps University Marburg and University Medical Center Giessen and Marburg, Baldingerstr, 35033 Marburg, Germany; (T.Z.); (A.M.)
| | - Axel Meisgeier
- Department of Oral and Maxillofacial Surgery, Campus Marburg, Philipps University Marburg and University Medical Center Giessen and Marburg, Baldingerstr, 35033 Marburg, Germany; (T.Z.); (A.M.)
| | - Helmut Messmann
- Department of Internal Medicine III—Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany; (A.M.); (A.E.); (M.K.); (H.M.); (C.R.)
| | - Christoph Römmele
- Department of Internal Medicine III—Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany; (A.M.); (A.E.); (M.K.); (H.M.); (C.R.)
| | - Tilo Schlittenbauer
- Department of Oral and Maxillofacial Surgery, University Hospital Augsburg, Sauerbruchstraße 6, 86179 Augsburg, Germany;
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14
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Tan KS, Chew RJJ, Allen PF, Yu VSH. Aerosol-generating dental procedures: a reappraisal of analysis methods and infection control measures. J Hosp Infect 2021; 117:81-88. [PMID: 34534601 DOI: 10.1016/j.jhin.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/01/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dental aerosol-generating procedures (AGPs) have been associated with risk for transmitting infectious agents. However, existing infection control monitoring studies potentially underestimate the extent of contamination, due to methodological inadequacies. These studies employed settle plate methodology which only captures droplets that land on agar plates, but not those suspended in air. Furthermore, bacterial culture was used to determine the extent of contamination, without accounting for non-bacterial sources of contamination. AIMS This study sought to bridge these gaps by establishing a monitoring protocol involving active aerosol sampling and analysis of two dental AGPs, root canal treatment (RCT) and scaling. METHODS RCT and scaling were performed with standard aerosol mitigation precautions. Aerosols generated throughout each procedure were sampled using the air sampler device, while contamination of operatory fomites and personal protective equipment was sampled using surface swabs, before and post-treatment. The amount of contamination was quantified using bacterial culture and adenosine triphosphate (ATP) assay. FINDINGS RCT generated insignificant aerosol and splatter, supporting the infection control procedures' effectiveness. Conversely, scaling significantly increased the amount of aerosol and splatter. When comparing bacterial culture and ATP assay, the magnitude of contamination obtained with ATP assay was greater, suggesting that ATP assay may have detected additional contamination of human origin and bacteria that was not recovered by the culture conditions employed. CONCLUSIONS This monitoring protocol is feasible in the dental setting and determines the extent of contamination generated during AGPs. This could be adopted in future studies to overcome the limitations of the existing literature.
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Affiliation(s)
- K S Tan
- Faculty of Dentistry, National University of Singapore, Singapore.
| | - R J J Chew
- Faculty of Dentistry, National University of Singapore, Singapore
| | - P F Allen
- Faculty of Dentistry, National University of Singapore, Singapore
| | - V S H Yu
- Faculty of Dentistry, National University of Singapore, Singapore.
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15
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Daniel D, Lin M, Luhung I, Lui T, Sadovoy A, Koh X, Sng A, Tran T, Schuster SC, Jun Loh X, Thet OS, Tan CK. Effective design of barrier enclosure to contain aerosol emissions from COVID-19 patients. INDOOR AIR 2021; 31:1639-1644. [PMID: 33876847 PMCID: PMC8250690 DOI: 10.1111/ina.12828] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 05/04/2023]
Abstract
Facing shortages of personal protective equipment, some clinicians have advocated the use of barrier enclosures (typically mounted over the head, with and without suction) to contain aerosol emissions from coronavirus disease 2019 (COVID-19) patients. There is, however, little evidence for its usefulness. To test the effectiveness of such a device, we built a manikin that can expire micron-sized aerosols at flow rates close to physiological conditions. We then placed the manikin inside the enclosure and used a laser sheet to visualize the aerosol leaking out. We show that with sufficient suction, it is possible to effectively contain aerosol from the manikin, reducing aerosol exposure outside the enclosure by 99%. In contrast, a passive barrier without suction only reduces aerosol exposure by 60%.
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Affiliation(s)
- Dan Daniel
- Institute of Materials Research and EngineeringA*STAR (Agency for Science, Technology and ResearchInnovisSingapore
| | - Marcus Lin
- School of Mechanical and Aerospace EngineeringNanyang Technological UniversitySingapore
| | - Irvan Luhung
- Singapore Centre For Environmental Life Sciences Engineering (SCELSENanyang Technological UniversitySingaporeSingapore
| | - Tony Lui
- Ng Teng Fong General HospitalSingaporeSingapore
| | - Anton Sadovoy
- Institute of Materials Research and EngineeringA*STAR (Agency for Science, Technology and ResearchInnovisSingapore
| | - Xueqi Koh
- Institute of Materials Research and EngineeringA*STAR (Agency for Science, Technology and ResearchInnovisSingapore
| | - Anqi Sng
- Institute of Materials Research and EngineeringA*STAR (Agency for Science, Technology and ResearchInnovisSingapore
| | - Tuan Tran
- School of Mechanical and Aerospace EngineeringNanyang Technological UniversitySingapore
| | - Stephan C. Schuster
- Singapore Centre For Environmental Life Sciences Engineering (SCELSENanyang Technological UniversitySingaporeSingapore
| | - Xian Jun Loh
- Institute of Materials Research and EngineeringA*STAR (Agency for Science, Technology and ResearchInnovisSingapore
| | - Oo Schwe Thet
- School of EngineeringNgee Ann PolytechnicSingaporeSingapore
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16
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Pierre-Bez AC, Agostini-Walesch GM, Bradford Smith P, Hong Q, Hancock DS, Davis M, Marcelli-Munk G, Mitchell JC. Ultrasonic scaling in COVID-era dentistry: A quantitative assessment of aerosol spread during simulated and clinical ultrasonic scaling procedures. Int J Dent Hyg 2021; 19:474-480. [PMID: 34418305 PMCID: PMC8652710 DOI: 10.1111/idh.12548] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/02/2021] [Accepted: 08/19/2021] [Indexed: 12/11/2022]
Abstract
Objective Healthcare agencies recommend limited use of aerosol‐generating procedures to mitigate disease (COVID‐19) transmission. However, total dispersion patterns of aerosols, particularly respirable droplets, via dental ultrasonic units is unclear. The purpose of this study was to characterize and map total spatter, droplet and aerosol dispersion during ultrasonic scaling in simulated and clinical contexts. Methods Ultrasonic scaling was performed on dental simulation units using methylene blue dye‐stained water. All resultant stain profiles were photoanalysed to calculate droplet size and travel distance/direction. Airborne particle concentrations were also documented 0–1.2 m (0–4ft.) and 1.2–2.4 m (4–8ft.) from patients during in vivo ultrasonic scaling with a saliva ejector. Results Stain profiles showed droplets between 25 and 50µm in diameter were most common, with smaller droplets closer to the mouth. In‐vivo particle concentrations were uniformly low. The smallest (<1 µm, PM1) and largest (>10 µm, PM10+) particles were most common, especially within 1.2 m (4ft.) of the patient. Respirable particles (PM2.5) were uncommon. Conclusions Tests showed the highest concentration of small droplets in zones nearest the patient. While uncommon, particles were detected up to 2.4 m (8ft.) away. Furthermore, observed particle sizes were consistent with those that can carry infectious agents. Efforts to mitigate the spread of inhalable aerosols should emphasize proximate regions nearest the procedure, including personal protective equipment and the use of evacuation devices.
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Affiliation(s)
| | | | - P Bradford Smith
- College of Dental Medicine-Arizona, Midwestern University, Glendale, AZ, USA
| | - Qing Hong
- College of Dental Medicine-Arizona, Midwestern University, Glendale, AZ, USA
| | - David S Hancock
- College of Dental Medicine-Arizona, Midwestern University, Glendale, AZ, USA
| | - Megan Davis
- College of Dental Medicine-Arizona, Midwestern University, Glendale, AZ, USA
| | | | - John C Mitchell
- College of Dental Medicine-Arizona, Midwestern University, Glendale, AZ, USA
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17
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Esteban Florez FL, Thibodeau T, Oni T, Floyd E, Khajotia SS, Cai C. Size-resolved spatial distribution analysis of aerosols with or without the utilization of a novel aerosol containment device in dental settings. PHYSICS OF FLUIDS (WOODBURY, N.Y. : 1994) 2021; 33:085102. [PMID: 34471340 PMCID: PMC8404378 DOI: 10.1063/5.0056229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/10/2021] [Indexed: 05/06/2023]
Abstract
The coronavirus disease 2019 pandemic has imposed unprecedented occupational challenges for healthcare professionals. In dentistry, handheld instruments such as air and electric handpieces, ultrasonic scalers, and air/water syringes are capable of generating aerosols, droplets, and splatter, thereby exposing dental professionals to airborne contaminants such as viruses, bacteria, and fungi. The objective of the present study was to determine the spatial distribution of aerosols by size (0.30 to 20.00 μm) and the efficacy of a novel aerosol containment device (ACD) in a large operatory room with 12 dental chairs. Real-time portable laser aerosol spectrometers were used to measure the size-resolved number concentration of aerosols generated by a collision nebulizer. Results reported demonstrate that aerosol number concentrations significantly decreased as a function of distance with or without the utilization of the ACD. The ACD was able to efficiently decrease (up to 8.56-fold) the number and size distribution of particles in a large dental clinic. The novel device demonstrated higher efficiency for particles shown to contain the highest levels of severe acute respiratory syndrome coronavirus 2 in Chinese hospitals, thereby showing great promise to potentially decrease the spreading of nosocomial pathogens in dental settings.
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Affiliation(s)
- Fernando Luis Esteban Florez
- Department of Restorative Sciences, Division of Dental Biomaterials, College of Dentistry, The University of Oklahoma Health Sciences Center, 1201 N. Stonewall Avenue, Oklahoma City, Oklahoma 73117, USA
- Authors to whom the correspondence should be addressed: and
| | - Tyler Thibodeau
- School of Industrial and Systems Engineering, The University of Oklahoma, 202 W. Boyd Street, Norman, Oklahoma 73019, USA
| | - Toluwanimi Oni
- Department of Occupational and Environmental Health, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, Oklahoma 73126, USA
| | - Evan Floyd
- Department of Occupational and Environmental Health, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, Oklahoma 73126, USA
| | - Sharukh S. Khajotia
- Department of Restorative Sciences, Division of Dental Biomaterials, College of Dentistry, The University of Oklahoma Health Sciences Center, 1201 N. Stonewall Avenue, Oklahoma City, Oklahoma 73117, USA
| | - Changjie Cai
- Department of Occupational and Environmental Health, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, Oklahoma 73126, USA
- Authors to whom the correspondence should be addressed: and
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18
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Lempel E, Szalma J. Effect of spray air settings of speed-increasing contra-angle handpieces on intrapulpal temperatures, drilling times, and coolant spray pattern. Clin Oral Investig 2021; 26:523-533. [PMID: 34145477 PMCID: PMC8212794 DOI: 10.1007/s00784-021-04030-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/07/2021] [Indexed: 11/07/2022]
Abstract
Objectives Decreasing aerosol leaks are of great interest, especially in the recent era of COVID-19. The aim was to investigate intrapulpal heat development, coolant spray patterns, and the preparation efficiency of speed-increasing contra-angle handpieces with the spray air on (mist) or off (water jet) settings during restorative cavity preparations. Methods Standard-sized cavities were prepared in 80 extracted intact human molar teeth using diamond cylindrical drills with a 1:5 speed-increasing contra-angle handpiece. A custom-made device maintained the standardized lateral drilling force (3 N) and predetermined depth. Temperatures were measured using intrapulpal thermocouple probes. The four experimental groups were as follows: mist cooling mode at 15 mL/min (AIR15), water jet cooling mode at 15 mL/min (JET15), mist cooling mode at 30 mL/min (AIR30), and water jet cooling mode at 30 mL/min (JET30). The coolant spray pattern was captured using macro-photo imaging. Results The JET15 group had the highest increase in temperature (ΔT = 6.02 °C), while JET30 (ΔT = 2.24 °C; p < 0.001), AIR15 (ΔT = 3.34 °C; p = 0.042), and AIR30 (ΔT = 2.95 °C; p = 0.003) had significantly lower increases in temperature. Fine mist aerosol was formed in the AIR15 and AIR30 preparations but not in the JET15 and JET30 preparations (p < 0.001). The irrigation mode had no influence on the preparation time (p = 0.672). Conclusions Water jet irrigation using coolant at 30 mL/min appeared to be the optimal mode. Considering the safe intrapulpal temperatures and the absence of fine mist aerosols, this mode can be recommended for restorative cavity preparations. Clinical significance To increase infection control in dental practices, the water jet irrigation mode of speed-increasing handpieces with coolant flow rates of 30 mL/min should be considered for restorative cavity preparations. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04030-3.
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Affiliation(s)
- Edina Lempel
- Department of Conservative Dentistry and Periodontology, Medical School, University of Pécs, 5. Dischka St, 7621, Pécs, Hungary
| | - József Szalma
- Department of Oral and Maxillofacial Surgery, Medical School, University of Pécs, 5. Dischka Gy St, Pécs, 7621, Hungary.
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19
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Zheng J, Ni X, Yuan W, Hou L. Nursing strategies for COVID-19 prevention and control in a selected dental clinic. Int Nurs Rev 2021; 68:189-195. [PMID: 34053076 PMCID: PMC8206999 DOI: 10.1111/inr.12652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022]
Abstract
Aim To comprehensively introduce the prevention and control measures that we can take in dental clinics during the pandemic period of coronavirus disease 2019 (COVID‐19) and provide some practical experience for the development of nursing and health policies applicable to COVID‐19. Background The outbreak of COVID‐19 has placed the global health system under threat, which seriously influences the normal operations of human society. Safe and effective nursing measures should be taken to ensure the normal operation of dental clinics. Sources of evidence We searched and referenced many references on the PubMed database. Through the combination of related literatures and our experience, we describe various strategies, including personnel management, personal protection, disinfection and isolation, adopted in the dental clinic of our Chinese hospital during the pandemic of COVID‐19. Discussion/Conclusions We introduced strategies for the nursing staff in dental clinics to assist them with the prevention and control of COVID‐19. The successful implementation of the protective measures could ensure the safety of medical staff and patients, and contributed to the normal operation of dental clinics during the pandemic period. Conclusions for nursing and health policy During the pandemic, frontline nurses are under physical and mental pressure facing the threat of infection while at work. In addition to pandemic prevention, we should also pay attention to the needs of nursing staff. More reasonable and effective nursing and health policies should be formulated to ensure their safety and protect their rights and interests. This is the only way that the prevention and control of COVID‐19 can be achieved, and we can prepare for future public health events.
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Affiliation(s)
- Jiali Zheng
- Department of Oral and Craniomaxillofacial Surgery, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Ni
- Department of Oral and Craniomaxillofacial Surgery, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weijun Yuan
- Department of Oral and Craniomaxillofacial Surgery, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Hou
- Department of Nursing, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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20
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Casillas Santana MA, Dipp Velázquez FA, Sámano Valencia C, Martínez Zumarán A, Zavala Alonso NV, Martínez Rider R, Salas Orozco MF. Saliva: What Dental Practitioners Should Know about the Role of This Biofluid in the Transmission and Diagnostic of SARS-CoV-2. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:349. [PMID: 33917276 PMCID: PMC8067428 DOI: 10.3390/medicina57040349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023]
Abstract
A novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has become a global ongoing pandemic. This pandemic represents a great work risk for all health professionals, it includes dental professionals who are in constant contact with saliva, which represents one of the main routes of transmission of the disease. This is due to the fact that a wide variety of oral tissues and cells are susceptible to infection by SARS-CoV-2 and that they express the ACE2 receptor, which is the main route of entry of the virus into cells, as well as the proteins TMPRSS and furin that contributes to the binding of the virus to the host cells. According to recent studies, some of the oral cells most susceptible to infection by SARS-CoV-2 are the epithelial cells of the salivary glands. This explains the presence of the virus in the saliva of infected patients and provides scientific evidence that supports the use of saliva as a biofluid that offers the opportunity to develop new detection and diagnostic techniques. This is because saliva is much easier to collect compared to nasopharyngeal swab. However, the presence of the virus in saliva, also represents a great source of transmission, since the main form of infection is through microscopic drops that are generated when infected people cough or sneeze. Likewise, health professionals, such as dentists are exposed to contagion through saliva. The objective of this review article is to provide a perspective on the main cells and tissues that can be affected by the virus, the risk of contagion that the presence of the virus in saliva represents for dentists; and the new techniques developed from saliva samples for the diagnosis and surveillance of SARS-CoV-2 infection. This review is expected to contribute to the knowledge of oral health professionals about the risk of saliva in the spread of SARS-CoV-2, but also its advantages as a diagnostic tool for pandemic control. In conclusion, the authors can mention that information that provides more scientific evidence of the mechanisms of infection of the coronavirus in oral cells and tissues is being published continually. This also explains the presence of the virus in the saliva of infected people and the risk of contagion that this means. It also provides scientific evidence of the use of saliva as a biofluid for the detection, diagnosis, monitoring, and control of the spread of the virus.
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Affiliation(s)
- Miguel Angel Casillas Santana
- Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue. 72410, Mexico; (F.A.D.V.); (C.S.V.)
| | - Farid Alonso Dipp Velázquez
- Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue. 72410, Mexico; (F.A.D.V.); (C.S.V.)
| | - Carolina Sámano Valencia
- Maestría en Estomatología con Opción Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Pue. 72410, Mexico; (F.A.D.V.); (C.S.V.)
| | - Alan Martínez Zumarán
- Especialidad en Ortodoncia, Facultad de Estomatología, Univesidad Autónoma de San Luis Potosí, San Luis Potosí, S.L.P. 78290, Mexico; (A.M.Z.); (N.V.Z.A.); (R.M.R.)
| | - Norma Verónica Zavala Alonso
- Especialidad en Ortodoncia, Facultad de Estomatología, Univesidad Autónoma de San Luis Potosí, San Luis Potosí, S.L.P. 78290, Mexico; (A.M.Z.); (N.V.Z.A.); (R.M.R.)
| | - Ricardo Martínez Rider
- Especialidad en Ortodoncia, Facultad de Estomatología, Univesidad Autónoma de San Luis Potosí, San Luis Potosí, S.L.P. 78290, Mexico; (A.M.Z.); (N.V.Z.A.); (R.M.R.)
| | - Marco Felipe Salas Orozco
- Especialidad en Ortodoncia, Facultad de Estomatología, Univesidad Autónoma de San Luis Potosí, San Luis Potosí, S.L.P. 78290, Mexico; (A.M.Z.); (N.V.Z.A.); (R.M.R.)
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21
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Montalli VAM, Garcez AS, de Oliveira LVC, Sperandio M, Napimoga MH, Motta RHL. A novel dental biosafety device to control the spread of potentially contaminated dispersion particles from dental ultrasonic tips. PLoS One 2021; 16:e0247029. [PMID: 33600421 PMCID: PMC7891706 DOI: 10.1371/journal.pone.0247029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/31/2021] [Indexed: 11/19/2022] Open
Abstract
Strategies to return to dental practice in pandemic times is a new challenge due to the generation and spread of potentially contaminated dispersion particles (PCDP) that may contain the SARS-CoV-2, the etiological factor of the COVID-19 disease. Due to the significant dispersion of PCDP in the dental environment, the use of equipment such as ultrasonic tips have been inadvisable during the pandemic. Several clinical procedures, however, benefit from the use of such equipment. Thus, using a microbial dispersion model of PCDP, the aim of this study was to compare the dispersion caused by the dental drill (DD) an ultrasonic tip (UT) alone and the UT coupled with a Spray control (SC) device. The DD, UT (with or without the SC) were activated for one minute having had the water from the reservoir replaced with a suspension of Lactobacillus casei Shirota (1.5 x 108 CFU/mL). Petri dishes containing MRS agar were positioned at 50cm, 100cm and 150cm from the headrest of the dental chair at different angles (0 degree and 90 degrees). At 50 cm, the mean CFU (standard deviation) of L. casei Shirota was 13554.60 (4071.03) for the DD, 286.67 (73.99) for the US (97.89% reduction), and 4.5 (0.58) CFU for the UT-SC (p < 0.0001), establishing a further 98.43% reduction between UT and UT with SC. The UT with SC model proved effective in reducing dispersion from the UT, endorsing its use as an additional strategy to reduce PCDP in the dental environment in times of pandemic.
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Affiliation(s)
- Victor Angelo Martins Montalli
- Division of Microbiology, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil
- Division of Oral Medicine, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil
- * E-mail: ,
| | | | | | - Marcelo Sperandio
- Division of Oral Medicine, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil
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22
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Comisi JC, Ravenel TD, Kelly A, Teich ST, Renne W. Aerosol and spatter mitigation in dentistry: Analysis of the effectiveness of 13 setups. J ESTHET RESTOR DENT 2021; 33:466-479. [PMID: 33522677 PMCID: PMC8014276 DOI: 10.1111/jerd.12717] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/19/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The current study aims to investigate the aerosol and spatter mitigation quality of 13 dry-field isolation methods in a simulated setup that replicates real-life work scenarios encountered in dental practices. METHODS A crown preparation on a manikin was performed on tooth number 30 and repeated five times for each setup to simulate a patient under care. Aerosol, environmental, and operator face shield spatter, and sound intensity was measured. Generalized linear mixed models were used, and posthoc pairwise comparisons were performed to compare least-squares means when appropriate using a Tukey adjustment. RESULTS All tested setups showed some environmental spatter formation; however, these were able to control most (and in some cases all) spatter on the operator face shield. All methods resulted in excellent aerosol mitigation when a second line of high-volume evacuation (HVE) was added to the device setup. However, in most setups, total sound levels exceeded 85 dB, posing a concern for prolonged noise exposure. CONCLUSIONS The Prototype device and four other tested setups with secondary HVE addition completely eliminated aerosol creation as tested. Spatter of the Face Shield was best eliminated using the Prototype device. CLINICAL SIGNIFICANCE Within the limitations of this study, it can be concluded that the dental community has at its disposal equipment that can effectively mitigate aerosol and spatter.
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Affiliation(s)
- John C Comisi
- Medical University of South Carolina, James B. Edwards College of Dental Medicine, Charleston, South Carolina, USA
| | - Theodore D Ravenel
- Medical University of South Carolina, James B. Edwards College of Dental Medicine, Charleston, South Carolina, USA
| | - Abigail Kelly
- Medical University of South Carolina, James B. Edwards College of Dental Medicine, Charleston, South Carolina, USA
| | - Sorin T Teich
- Medical University of South Carolina, James B. Edwards College of Dental Medicine, Charleston, South Carolina, USA
| | - Walter Renne
- Medical University of South Carolina, James B. Edwards College of Dental Medicine, Charleston, South Carolina, USA
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23
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Galicia JC, Mungia R, Taverna MV, Mendoza MJ, Estrela C, Gaudin A, Zhang C, Vaughn BA, Khan AA. Response by Endodontists to the SARS-CoV-2 (COVID−19) Pandemic: An International Survey. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2020.617440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
As SARS-CoV-2 continues to wreak havoc, health care workers are on the front lines to protect our communities. Dentists, particularly endodontists who manage dental emergencies, are engaged in high risk procedures that necessitate the modification of their treatment strategies in order to protect themselves, their staff and their patients from exposure to SARS-CoV-2. This study gathered international data from 448 endodontists to describe their awareness, their clinical care modifications, their strategies for re-opening and their reflection on the effects of the pandemic on their lives. Most endodontic practitioners (78%, n = 350) provided but limited their treatments to emergency care during the government-mandated shutdowns. They agreed with their local government's actions more than that of the national government, screened their patients for symptoms prior to treatment and changed their clinical care protocol to mitigate the spread of the virus. The pandemic has impacted their income, their ability to retain staff, and their financial and personal outlook in life.
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24
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Innes N, Johnson IG, Al-Yaseen W, Harris R, Jones R, Kc S, McGregor S, Robertson M, Wade WG, Gallagher JE. A systematic review of droplet and aerosol generation in dentistry. J Dent 2020; 105:103556. [PMID: 33359043 PMCID: PMC7834118 DOI: 10.1016/j.jdent.2020.103556] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/28/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This review aimed to identify which dental procedures generate droplets and aerosols with subsequent contamination, and for these, characterise their pattern, spread and settle. DATA RESOURCES Medline(OVID), Embase(OVID), Cochrane Central Register of Controlled Trials, Scopus, Web of Science and LILACS databases were searched for eligible studies from each database's inception to May 2020 (search updated 11/08/20). Studies investigating clinical dental activities that generate aerosol using duplicate independent screening. Data extraction by one reviewer and verified by another. Risk of bias assessed through contamination measurement tool sensitivity assessment. STUDY SELECTION A total eighty-three studies met the inclusion criteria and covered: ultrasonic scaling (USS, n = 44), highspeed air-rotor (HSAR, n = 31); oral surgery (n = 11), slow-speed handpiece (n = 4); air-water (triple) syringe (n = 4), air-polishing (n = 4), prophylaxis (n = 2) and hand-scaling (n = 2). Although no studies investigated respiratory viruses, those on bacteria, blood-splatter and aerosol showed activities using powered devices produced greatest contamination. Contamination was found for all activities, and at the furthest points studied. The operator's torso, operator's arm and patient's body were especially affected. Heterogeneity precluded inter-study comparisons but intra-study comparisons allowed construction of a proposed hierarchy of procedure contamination risk: higher (USS, HSAR, air-water syringe, air polishing, extractions using motorised handpieces); moderate (slow-speed handpieces, prophylaxis, extractions) and lower (air-water syringe [water only] and hand scaling). CONCLUSION Gaps in evidence, low sensitivity of measures and variable quality limit conclusions around contamination for procedures. A hierarchy of contamination from procedures is proposed for challenge/verification by future research which should consider standardised methodologies to facilitate research synthesis. CLINICAL SIGNIFICANCE This manuscript addresses uncertainty around aerosol generating procedures (AGPs) in dentistry. Findings indicate a continuum of procedure-related aerosol generation rather than the common binary AGP or non-AGP perspective. The findings inform discussion around AGPs and direct future research to support knowledge and decision making around COVID-19 and dental procedures.
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Affiliation(s)
- N Innes
- Applied Clinical Research and Public Health, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
| | - I G Johnson
- Applied Clinical Research and Public Health, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - W Al-Yaseen
- Applied Clinical Research and Public Health, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - R Harris
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - R Jones
- Education, Scholarship and Innovation, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, UK
| | - S Kc
- Faculty of Dentistry, Oral & Craniofacial Sciences King's College London, London, UK
| | - S McGregor
- Library & Learning Centre, University of Dundee, Dundee, UK
| | - M Robertson
- Child Dental and Oral Health, School of Dentistry, University of Dundee, Dundee, UK
| | - W G Wade
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - J E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences King's College London, London, UK
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25
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Gandolfi MG, Zamparini F, Spinelli A, Sambri V, Prati C. Risks of Aerosol Contamination in Dental Procedures during the Second Wave of COVID-19-Experience and Proposals of Innovative IPC in Dental Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8954. [PMID: 33271981 PMCID: PMC7729834 DOI: 10.3390/ijerph17238954] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023]
Abstract
Dental-care workers operate very close to the patient's mouth and are at high risk of contamination by SARS-CoV-2. Droplets may be contaminated by patient's saliva and exhaled breath particles. All asymptomatic patients should be considered as Coronavirus positive. All dental procedures must be revised after positive identification of SARS-Cov-2. Novel recommendations as the use of novel suction cannula designed for fast spray/saliva aspiration, use of Tyvek suits and innovative sprayhoods designed for dental-care worker protections are proposed to prevent virus transmission. New tailored operative and clinical procedures are being currently developed by university dental clinics and hospitals in attempt to reduce risk for dental workers and patients.
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Affiliation(s)
- Maria Giovanna Gandolfi
- Laboratory of Green Biomaterials and Oral Pathology, School of Dentistry, DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.G.G.); (F.Z.)
| | - Fausto Zamparini
- Laboratory of Green Biomaterials and Oral Pathology, School of Dentistry, DIBINEM, University of Bologna, 40126 Bologna, Italy; (M.G.G.); (F.Z.)
| | - Andrea Spinelli
- Endodontic Clinical Section, School of Dentistry, DIBINEM, University of Bologna, 40125 Bologna, Italy;
| | - Vittorio Sambri
- Unit of Microbiology, DIMES, University of Bologna, 40125 Bologna, Italy;
- Unit of Microbiology, The Greater Romagna Hub Laboratory, 47822 Pievesestina, Italy
| | - Carlo Prati
- Endodontic Clinical Section, School of Dentistry, DIBINEM, University of Bologna, 40125 Bologna, Italy;
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26
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Teichert-Filho R, Baldasso CN, Campos MM, Gomes MS. Protective device to reduce aerosol dispersion in dental clinics during the COVID-19 pandemic. Int Endod J 2020; 53:1588-1597. [PMID: 32735690 PMCID: PMC7436703 DOI: 10.1111/iej.13373] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 01/25/2023]
Abstract
AIM To describe the use of a new protective device to reduce aerosol dispersion in dental clinics during the COVID-19 pandemic. METHODOLOGY The device consists of a rigid translucent acrylic structure (methyl polymethacrylate), adjusted to the dental chair, involving the patient's head, neck and chest. There is also a piping system to generate negative pressure, for aspiration and filtering of the air inside the device chamber. The operator works through small holes in the acrylic structure, to reduce contact with the microparticles arising from aerosols during dental procedures. Simulated dental procedures using a fluorescent dye in the water of the dental equipment were carried out, with and without the use of the device. The presence of the dye was analysed at various locations, such as on personal protective equipment (PPE), the dental chair and on the clinic floor. RESULTS In the simulated dental procedure without the device, the dye was obvious on surgical gloves, aprons (waist, chest, legs, fists) and face shields, as well as on the dental chair (backrest, light reflector) and clinic floor. In the simulated dental procedure using the device, the dye was observed only on surgical gloves, apron (fists), inside the pipe system and internal walls of the acrylic chamber. There was a certain limitation of movement and visualization by the dentist whilst using the device. CONCLUSIONS The present device is a low-cost complementary resource for use in conjunction with standard PPE, to reduce the transmission of SARS-CoV-2 in the dental setting. Further clinical trials should be carried out to test the efficacy of this device to reduce aerosol dispersion and the consequent vector of contamination, as well as the ergonomic impacts related to its use.
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Affiliation(s)
- R Teichert-Filho
- Programa de Pós-Graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,Centro Médico-Odontológico da Brigada Militar do Rio Grande do Sul, Porto Alegre, Brazil
| | - C N Baldasso
- Programa de Pós-Graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - M M Campos
- Programa de Pós-Graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - M S Gomes
- Programa de Pós-Graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.,Centro Médico-Odontológico da Brigada Militar do Rio Grande do Sul, Porto Alegre, Brazil
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