Airborne particles and microorganisms in a dental clinic: Variability of indoor concentrations, impact of dental procedures, and personal exposure during everyday practice

Air disinfection performance of upper-room ultraviolet germicidal irradiation (UR-UVGI) system in a multi-compartment dental clinic

Multi-compartment dental clinics present significant airborne cross-infection risks. Upper-room ultraviolet germicidal irradiation (UR-UVGI) system have shown promise in preventing airborne pathogens, but its available application data are insufficient in multi-compartment dental clinics. Therefore, the UR-UVGI system's performance in a multi-compartment dental clinic was comprehensively evaluated in this study. The accuracy of the turbulence and drift flux models was verified by experimental data from ultrasonic scaling. The effects of the ventilation rate, irradiation zone volume, and irradiation flux on UR-UVGI performance were analyzed using computational fluid dynamics coupled with a UV inactivation model. Different patient numbers were considered. The results showed that UR-UVGI significantly reduced virus concentrations and outperformed increased ventilation rates alone. At a ventilation rate of six air changes per hour (ACH), UR-UVGI with an irradiation zone volume of 20% and irradiation flux of 5 μW/cm2 achieved a 70.44% average virus reduction in the whole room (WR), outperforming the impact of doubling the ventilation rate from 6 to 12 ACH without UR-UVGI. The highest disinfection efficiency of UR-UVGI decreased for WRs with more patients. The compartment treating patients exhibited significantly lower disinfection efficiency than others. Moreover, optimal UR-UVGI performance occurs at lower ventilation rates, achieving over 80% virus disinfection in WR. Additionally, exceeding an irradiation zone volume of 20% or an irradiation flux of 5 μW/cm2 notably reduces the improvement rates of UR-UVGI performance. These findings provide a scientific reference for strategically applying UR-UVGI in multi-compartment dental clinics.

Bacterial contamination potential of personal protective equipment itself in dental aerosol-producing treatments

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.

Detection of viable oral bacteria of the patient on the surgical mask of dentists

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.

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.

How the high-volume evacuation alters the flow-field and particle removal characteristics in the mock-up dental clinic

The exposure risk of droplets and aerosols emitted from the oral cavity to the dental professionals and patients has received more attention especially the ongoing outbreak of COVID-19. The aim of this study is to address the question about how the use of the high-volume evacuation (HVE) alters the risk profiles compared with the situation only personal protective equipment (PPE). The risk profiles of the different situations were analyzed in terms of droplet velocity, flow field characteristics, and particle removal efficiency. The ultrasonic scaling with suction was performed in the mock-up experimental dental clinic, and the instantaneous moment when the HVE acted on the droplets was visualized using a laser light scattering technique. From the results of the velocity profiles, the hypothesis about the moderate effect of the HVE on high-velocity small droplets near the mannequin's mouth had been firstly proven in this study. The suction can be characterized as low-threshold equipment to bring substantial benefits to reduce the area of the contaminated region. Once the cooperation of suction, the pair of vortexes that were in the face shield area of the dental professional would be eliminated, removing the high-level contaminated region near the breathing area of dental professionals. Compared with the low and medium volume evacuation, the particle removal efficiency of the HVE was more stable at 60%. The research will provide references to the HVE recommendation in the dentistry clinical practice guidelines.

Recommendations for Safe Dental Care: A Systematic Review of Clinical Practice Guidelines in the First Year of the COVID-19 Pandemic

In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical to guide dental staff towards the safe provision of dental care; detailed knowledge of the recommendations will help to achieve the intended results. We carried out a systematic review of the recommendations in clinical practice guidelines (CPGs) on the provision of dental care issued during the first year of the COVID-19 pandemic. A systematic database search was performed in MEDLINE, EMBASE, LILACS, Epistemonikos, and Trip databases to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. The selection process and data extraction were carried out by two researchers independently. The majority of CPGs recommended the use of rubber dam, high-volume evacuator, mouthwash prior to dental care, four-handed work, and mechanical barriers. The use of aerosol-generating equipment should be avoided whenever possible. In aerosol-generating procedures, the use of a N95 respirator (or similar) is recommended, in addition to a face protector, an impermeable disposable apron/gown, a cap, and gloves. The CPGs developed during the first year of the pandemic offer recommendations which guide dental staff in providing safe dental care, minimizing exposure to SARS-CoV-2 and reducing the risk of COVID-19 infection in the clinical environment. Such recommendations must, however, be updated as new evidence arises.