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Lordly K, Karataş AE, Lin S, Umapathy K, Mohindra R. Effectiveness of a suction device for containment of pathogenic aerosols and droplets. PLoS One 2024; 19:e0305842. [PMID: 39046940 PMCID: PMC11268607 DOI: 10.1371/journal.pone.0305842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/05/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND As the global community begins recovering from the COVID-19 pandemic, the challenges due to its aftermath remain. This health crisis has highlighted challenges associated with airborne pathogens and their capacity for rapid transmission. While many solutions have emerged to tackle this challenge, very few devices exist that are inexpensive, easy to manufacture, and versatile enough for various settings. METHODS This paper presents a novel suction device designed to counteract the spread of aerosols and droplets and be cost-effective and adaptable to diverse environments. We also conducted an experimental study to evaluate the device's effectiveness using an artificial cough generator, a particle counter, and a mannequin in an isolated system. We measured droplet removal rates with simulated single and repeated cough incidents. Also, measurements were taken at four distinct areas to compare its effectiveness on direct plume versus indirect particle removal. RESULTS The device reduced airborne disease transmission risk, as evidenced by its capacity to decrease the half-life of aerosol volume from 23.6 minutes to 15.6 minutes, effectively capturing aerosol-sized droplets known for their extended airborne persistence. The suction device lessened the peak total droplet volume from peak counts. At 22 minutes post peak droplet count, the count had dropped 24% without the suction device and 43% with the suction device. CONCLUSIONS The experiment's findings confirm the suction device's capability to effectively remove droplets from the environment, making it a vital tool in enhancing indoor air quality. Given the sustained performance of the suction device irrespective of single or multiple cough events, this demonstrates its potential utility in reducing the risk of airborne disease transmission. 3D printing for fabrication opens the possibility of a rapid iterative design process, flexibility for different configurations, and rapid global deployment for future pandemics.
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Affiliation(s)
- Kai Lordly
- Department of Aerospace Engineering, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Ahmet E. Karataş
- Department of Aerospace Engineering, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Steve Lin
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Emergency Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karthi Umapathy
- Department of Electrical, Computer and Biomedical Engineering, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Rohit Mohindra
- Division of Emergency Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Biomedical Engineering, Faculty of Engineering and Architectural Sciences, Toronto Metropolitan University, Toronto, Ontario, Canada
- Schwartz Reisman Emergency Medicine Institute, Toronto, Ontario, Canada
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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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Kumar MS, He R, Feng L, Olin P, Chew HP, Jardine P, Anderson GC, Hong J. Particle generation and dispersion from high-speed dental drilling. Clin Oral Investig 2023; 27:5439-5448. [PMID: 37479870 DOI: 10.1007/s00784-023-05163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To investigate the characteristics of particle generation and dispersion during dental procedure using digital inline holography (DIH) METHODS: Particles at two locations, near-field and far-field, which represent the field closer to the procedure location and within 0.5 m from the procedure location respectively, are studied using two different DIH systems. The effect of three parameters namely rotational speed, coolant flow rate, and bur angle on particle generation and dispersion are evaluated by using 10 different operating conditions. The particle characteristics at different operating conditions are estimated from the holograms using machine learning-based analysis. RESULTS The particle concentration decreased by at least two orders of magnitude between the near-field and far-field locations across the 10 different operating conditions, indicating significant dispersion of the particles. High rotational speed is found to produce a larger number of smaller particles, while lower rotational speeds generate larger particles. Coolant flow rate is found to have a greater impact on particle transport to the far-field location. Irregular shape dental particles account for 29% of total particles at far-field location, with the majority of these irregular shape particles having diameters ranging from 12 to 18 μm. CONCLUSIONS All three parameters have significant effects on particle generation and dispersion, with rotational speed having a more significant influence on particle generation at near-field and coolant flow rate playing a more important role on particle transport to the far-field. CLINICAL RELEVANCE This study provides valuable insights on particle characteristics during high-speed drilling. It can help dental professionals minimize exposure risks for themselves and patients by optimizing clinical operating conditions.
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Affiliation(s)
- M Shyam Kumar
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Ruichen He
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN, USA
- Saint Anthony Falls Laboratory, University of Minnesota, Minneapolis, MN, USA
| | - Lei Feng
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN, USA
- Saint Anthony Falls Laboratory, University of Minnesota, Minneapolis, MN, USA
| | - Paul Olin
- University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - Hooi Pin Chew
- University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - Paul Jardine
- University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - Gary C Anderson
- University of Minnesota School of Dentistry, Minneapolis, MN, USA
| | - Jiarong Hong
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN, USA.
- Saint Anthony Falls Laboratory, University of Minnesota, Minneapolis, MN, USA.
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Matys J, Gedrange T, Dominiak M, Grzech-Leśniak K. Quantitative Evaluation of Aerosols Produced in the Dental Office during Caries Treatment: A Randomized Clinical Trial. J Clin Med 2023; 12:4597. [PMID: 37510712 PMCID: PMC10380424 DOI: 10.3390/jcm12144597] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Effective removal of aerosols generated during dental treatment is crucial for maintaining biosafety in dental practice. This study aimed to measure the aerosol amount and the number of aerobic bacteria in the air during caries treatment. METHODS The study involved 50 molar teeth (n = 50) in the mandible in 50 patients divided into two groups based on the type of a high-volume evacuator (HVE); G1 (n = 25) conventional HVE (EM19 EVO, Monoart® Euronda, Vicenza, Italy) and G2 (n = 25) a new, wider, customized HVE. The PC200 laser particle counter (Trotec GmbH, Schwerin, Germany) was used to measure aerosol particles in a range of 0.3-10.0 μm near the operator's mouth. The study used 60 microbiological plates with a microbiological medium (Columbia Agar with 5% Sheep Blood) to check the number of aerobic bacteria in the air. RESULTS The mean value of aerosol particles in the G1 group (conventional HVE) was 54,145 ± 7915, while in the G2 group (test, wider evacuator) was lower and amounted to 32,632 ± 1803. (p < 0.001). The median total bacteria count in the air per cubic meter in control, G1 (HVE), and G2 (NEW-HVE) groups were 50 [36-60]; 772 [643-881]; 120 [92-139], respectively. (p < 0.05). Gram-positive cocci were the predominant bacteria in the plates: Micrococcus sp. (50%), Bacillus species (36.4%), Staphylococcus epidermidis (3.8%), Staphylococcus saprophyticus (3.8%). CONCLUSIONS the application of the wider high-volume evacuator increases the air purity during caries treatment as well as the biological safety of a dental office.
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Affiliation(s)
- Jacek Matys
- Oral Surgery Department, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
- Department of Orthodontics, Technische Universitat Dresden, 01307 Dresden, Germany
| | - Tomasz Gedrange
- Oral Surgery Department, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
- Department of Orthodontics, Technische Universitat Dresden, 01307 Dresden, Germany
| | - Marzena Dominiak
- Oral Surgery Department, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
| | - Kinga Grzech-Leśniak
- Oral Surgery Department, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23284, USA
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Dey S, Tunio M, Boryc LC, Hodgson BD, Garcia GJM. Quantifying strategies to minimize aerosol dispersion in dental clinics. EXPERIMENTAL AND COMPUTATIONAL MULTIPHASE FLOW 2023; 5:290-303. [PMID: 37305074 PMCID: PMC10042415 DOI: 10.1007/s42757-022-0157-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/12/2022] [Accepted: 12/25/2022] [Indexed: 03/29/2023]
Abstract
Many dental procedures are aerosol-generating and pose a risk for the spread of airborne diseases, including COVID-19. Several aerosol mitigation strategies are available to reduce aerosol dispersion in dental clinics, such as increasing room ventilation and using extra-oral suction devices and high-efficiency particulate air (HEPA) filtration units. However, many questions remain unanswered, including what the optimal device flow rate is and how long after a patient exits the room it is safe to start treatment of the next patient. This study used computational fluid dynamics (CFD) to quantify the effectiveness of room ventilation, an HEPA filtration unit, and two extra-oral suction devices to reduce aerosols in a dental clinic. Aerosol concentration was quantified as the particulate matter under 10 µm (PM10) using the particle size distribution generated during dental drilling. The simulations considered a 15 min procedure followed by a 30 min resting period. The efficiency of aerosol mitigation strategies was quantified by the scrubbing time, defined as the amount of time required to remove 95% of the aerosol released during the dental procedure. When no aerosol mitigation strategy was applied, PM10 reached 30 µg/m3 after 15 min of dental drilling, and then declined gradually to 0.2 µg/m3 at the end of the resting period. The scrubbing time decreased from 20 to 5 min when the room ventilation increased from 6.3 to 18 air changes per hour (ACH), and decreased from 10 to 1 min when the flow rate of the HEPA filtration unit increased from 8 to 20 ACH. The CFD simulations also predicted that the extra-oral suction devices would capture 100% of the particles emanating from the patient's mouth for device flow rates above 400 L/min. In summary, this study demonstrates that aerosol mitigation strategies can effectively reduce aerosol concentrations in dental clinics, which is expected to reduce the risk of spreading COVID-19 and other airborne diseases.
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Affiliation(s)
- Shamudra Dey
- Joint Department of Biomedical Engineering, Marquette University, Medical College of Wisconsin, Milwaukee, 53226 USA
| | - Maryam Tunio
- School of Dentistry, Marquette University, Milwaukee, 53233 USA
| | - Louis C. Boryc
- School of Dentistry, Marquette University, Milwaukee, 53233 USA
| | | | - Guilherme J. M. Garcia
- Joint Department of Biomedical Engineering, Marquette University, Medical College of Wisconsin, Milwaukee, 53226 USA
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Jones K. Beyond the curriculum: the student experience at Newcastle Dental School. Br Dent J 2023; 234:51-53. [PMID: 36639485 PMCID: PMC9838383 DOI: 10.1038/s41415-022-5398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/08/2022] [Indexed: 01/14/2023]
Abstract
The student experience at Newcastle Dental School is not only influenced by the curriculum, but also extracurricular activity, which can be shaped by changes in our students, culture and society each year. Yet it is also guided by tradition that underpins the 'Newcastle experience'. This article looks beyond the curriculum and the experience of our students as told by one of our students. From the sense of community within the School to reaching out to our local community and across the globe, the student experience beyond the curriculum is special and it is important to support the activities that underpin this to allow our students to make the most of their time at university.
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Affiliation(s)
- Kiran Jones
- grid.1006.70000 0001 0462 7212Undergraduate Student, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK
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Piela K, Watson P, Donnelly R, Goulding M, Henriquez FL, MacKay W, Culshaw S. Aerosol reduction efficacy of different intra-oral suction devices during ultrasonic scaling and high-speed handpiece use. BMC Oral Health 2022; 22:388. [PMID: 36068515 PMCID: PMC9447970 DOI: 10.1186/s12903-022-02386-w] [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: 04/14/2022] [Accepted: 07/28/2022] [Indexed: 12/01/2022] Open
Abstract
Background The COVID-19 pandemic led to significant changes in the provision of dental services, aimed at reducing the spread of respiratory pathogens through restrictions on aerosol generating procedures (AGPs). Evaluating the risk that AGPs pose in terms of SARS-CoV-2 transmission is complex, and measuring dental aerosols is challenging. To date, few studies focus on intra-oral suction. This study sought to assess the effectiveness of commonly used intra-oral suction devices on aerosol mitigation. Methods Ultrasonic scaling and high-speed handpiece procedures were undertaken to generate aerosol particles. Multiple particle sensors were positioned near the oral cavity. Sensor data were extracted using single board computers with custom in-house Bash code. Different high-volume and low-volume suction devices, both static and dynamic, were evaluated for their efficacy in preventing particle escape during procedures. Results In all AGPs the use of any suction device tested resulted in a significant reduction in particle counts compared with no suction. Low-volume and static suction devices showed spikes in particle count demonstrating moments where particles were able to escape from the oral cavity. High-volume dynamic suction devices, however, consistently reduced the particle count to background levels, appearing to eliminate particle escape. Conclusions Dynamic high-volume suction devices that follow the path of the aerosol generating device effectively eliminate aerosol particles escaping from the oral cavity, in contrast to static devices which allow periodic escape of aerosol particles. Measuring the risk of SARS-CoV-2 transmission in a dental setting is multi-factorial; however, these data suggest that the appropriate choice of suction equipment may further reduce the risk from AGPs. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02386-w.
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Affiliation(s)
- Krystyna Piela
- Oral Sciences, Glasgow Dental Hospital and School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G2 3JZ, UK
| | - Paddy Watson
- Oral Sciences, Glasgow Dental Hospital and School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G2 3JZ, UK
| | - Reuben Donnelly
- Oral Sciences, Glasgow Dental Hospital and School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G2 3JZ, UK
| | | | - Fiona L Henriquez
- School of Health and Life Sciences, University of the West of Scotland, Lanarkshire Campus, Blantyre, G72 0HL, UK
| | - William MacKay
- School of Health and Life Sciences, University of the West of Scotland, Lanarkshire Campus, Blantyre, G72 0HL, UK
| | - Shauna Culshaw
- Oral Sciences, Glasgow Dental Hospital and School, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G2 3JZ, UK.
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Al-yaseen W, Jones R, McGregor S, Wade W, Gallagher J, Harris R, Johnson I, KC S, Robertson M, Innes N. Aerosol and splatter generation with rotary handpieces used in restorative and orthodontic dentistry: a systematic review. BDJ Open 2022; 8:26. [PMID: 36068221 PMCID: PMC9447949 DOI: 10.1038/s41405-022-00118-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/04/2022] [Accepted: 07/09/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction The COVID-19 pandemic has caused major disruptions in dental care globally, in part due to the potential for contaminated aerosol to be generated by dental activities. This systematic review assesses the literature for changes in aerosol-contamination levels when rotary instruments are used, (1) as distance increases from patient’s mouth; (2) as time passes after the procedure; and (3) when using different types of handpieces. Methods The review methods and reporting are in line with PRISMA statements. A structured search was conducted over five platforms (September 2021). Studies were assessed independently by two reviewers. To be eligible studies had to assess changes in levels of aerosol contamination over different distances, and time points, with rotary hand instruments. Studies’ methodologies and the sensitivity of the contamination-measurement approaches were evaluated. Results are presented descriptively. Results From 422 papers identified, 23 studies were eligible. All investigated restorative procedures using rotary instruments and one study additionally looked at orthodontic bracket adhesive material removal. The results suggest contamination is significantly reduced over time and distance. However, for almost all studies that investigated these two factors, the sizes of the contaminated particles were not considered, and there were inconclusive findings regarding whether electric-driven handpieces generate lower levels of contaminated particles. Conclusion Aerosol contamination levels reduce as distances, and post-procedure times increase. However, there was sparce and inconsistent evidence on the clearing time and no conclusions could be drawn. High-speed handpieces produce significantly higher levels of contamination than slow-speed ones, and to a lesser extent, micro-motor handpieces. However, when micro-motor handpieces were used with water, the contamination levels rose and were similar to high-speed handpiece contamination levels.
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Graetz C, Hülsbeck V, Düffert P, Schorr S, Straßburger M, Geiken A, Dörfer CE, Cyris M. Influence of flow rate and different size of suction cannulas on splatter contamination in dentistry: results of an exploratory study with a high-volume evacuation system. Clin Oral Investig 2022; 26:5687-5696. [PMID: 35536440 PMCID: PMC9088725 DOI: 10.1007/s00784-022-04525-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/01/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES SOPs recommend high-volume evacuation (HVE) for aerosol-generating procedures (AGPs) in dentistry. Therefore, in the exploratory study, the area of splatter contamination (SCON in %) generated by high-speed tooth preparation (HSP) and air-polishing (APD) was measured when different suction cannulas of 6 mm diameter (saliva ejector (SAE)), 11 mm (HC11), or 16 mm (HC16) were utilized versus no-suction (NS). MATERIALS AND METHODS Eighty tests were performed in a closed darkened room to measure SCON (1m circular around the manikin head (3.14 m2) via plan metrically assessment through fluorescence technique. HSP (handpiece, turbine (Kavo, Germany)) or APD (LM-ProPowerTM (Finland), Airflow®-Prophylaxis-Master (Switzerland)) for 6 min plus 5 s post-treatment were performed either without suction or with low-flow (150 l/min for SAE) or high-flow rate (250 l/min/350 l/min for HC11/HC16) suction. All tests were two-tailed (p≤0.05, Bonferroni corrected for multi-testing). RESULTS Irrespective the AGP, SCON was higher for NS (median [25th; 75th percentiles]: 3.4% [2.6; 5.4]) versus high-flow suction (1.9% [1.5; 2.5]) (p=0.002). Low-flow suction (3.5% [2.6; 4.3]) versus NS resulted in slightly lower but not statistically significantly lower SCON (p=1.000) and was less effective than high-flow suction (p=0.003). Lowest contamination values were found with HC16 (1.9% [1.5; 2.5]; p≤0.002), whereat no significant differences were found for HC11 (2.4% [1.7; 3.1]) compared to SAE (p=0.385) or NS (p=0.316). CONCLUSIONS Within study's limitations, the lowest splatter contamination values resulted when HC16 were utilized by a high-flow rate of ≥250 l/min. CLINICAL RELEVANCE It is strongly recommended to utilize an HVE with suction cannulas of 16mm diameter for a high-flow rate during all AGPs and afterwards also to disinfect all surface of patients or operators contacted.
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Affiliation(s)
- Christian Graetz
- Clinic of Conservative Dentistry and Periodontology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (Haus B), 24105, Kiel, Germany.
| | - Viktor Hülsbeck
- Clinic of Conservative Dentistry and Periodontology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (Haus B), 24105, Kiel, Germany
| | - Paulina Düffert
- Clinic of Conservative Dentistry and Periodontology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (Haus B), 24105, Kiel, Germany
| | - Susanne Schorr
- Clinic of Conservative Dentistry and Periodontology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (Haus B), 24105, Kiel, Germany
| | - Martin Straßburger
- Clinic of Conservative Dentistry and Periodontology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (Haus B), 24105, Kiel, Germany
| | - Antje Geiken
- Clinic of Conservative Dentistry and Periodontology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (Haus B), 24105, Kiel, Germany
| | - Christof E Dörfer
- Clinic of Conservative Dentistry and Periodontology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (Haus B), 24105, Kiel, Germany
| | - Miriam Cyris
- Clinic of Conservative Dentistry and Periodontology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 (Haus B), 24105, Kiel, Germany
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Air Quality in a Dental Skills Lab during the SARS-CoV-2 Pandemic: Results of an Experimental Study. Int J Dent 2022; 2022:9973623. [PMID: 35769944 PMCID: PMC9234770 DOI: 10.1155/2022/9973623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/28/2022] [Accepted: 06/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives The study aimed to analyze different ways to control air quality during/after aerosol-generating procedures (AGPs) in a small skills lab with restricted natural air ventilation in preclinical dental training (worst-case scenario for aerogen infection control). Different phases were investigated (AGP1: intraoral high-volume evacuation (HVE); AGP2: HVE plus an extraoral mobile scavenger (EOS)) and afterward (non-AGP1: air conditioning system (AC), non-AGP2: AC plus opened door). Methods Continuous data collection was performed for PM1, PM2.5, and PM10 (µg/m3), CO2 concentration (ppm), temperature (K), and humidity (h−1) during two summer days (AGP: n = 30; non-AGP: n = 30). While simulating our teaching routine, no base level for air parameters was defined. Therefore, the change in each parameter (Δ = [post]-[pre] per hour) was calculated. Results We found significant differences in ΔPM2.5 and ΔPM1 values (median (25/75th percentiles)) comparing AGP2 versus AGP1 (ΔPM2.5: 1.6(0/4.9)/−3.5(−10.0/−1.1), p=0.003; ΔPM1: 1.6(0.6/2.2)/−2.2(−9.3/−0.5), p=0.001). Between both non-AGPs, there were no significant differences in all the parameters that were measured. ΔCO2 increased in all AGP phases (AGP1/AGP2: 979.0(625.7/1126.9)/549.9(4.0/788.8)), while during non-AGP phases, values decreased (non-AGP1/non-AGP2: −447.3(−1122.3/641.2)/−896.6(−1307.3/−510.8)). ∆Temperature findings were similar (AGP1/AGP2: 12.5(7.8/17.0)/9.3(1.8/15.3) versus non-AGP1/non-AGP2: −13.1(−18.7/0)/−14.7(−16.8/−6.8); p ≤ 0.003)), while for ∆humidity, no significant difference (p > 0.05) was found. Conclusions Within the limitations of the study, the combination of HVE and EOS was similarly effective in controlling aerosol emissions of particles between one and ten micrometers in skill labs during AGPs versus that during non-AGPs. After AGPs, air exchange with the AC should be complemented by open doors for better air quality if natural ventilation through open windows is restricted.
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Shrimpton AJ, Brown JM, Cook TM, Penfold CM, Reid JP, Pickering AE. Quantitative evaluation of aerosol generation from upper airway suctioning assessed during tracheal intubation and extubation sequences in anaesthetized patients. J Hosp Infect 2022; 124:13-21. [PMID: 35276282 PMCID: PMC9172909 DOI: 10.1016/j.jhin.2022.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Open respiratory suctioning is defined as an aerosol generating procedure (AGP). Laryngopharyngeal suctioning, used to clear secretions during anaesthesia, is widely managed as an AGP. However, it is uncertain whether upper airway suctioning should be designated as an AGP due to the lack of both aerosol and epidemiological evidence. AIM To assess the relative risk of aerosol generation by upper airway suctioning during tracheal intubation and extubation in anaesthetized patients. METHODS This prospective environmental monitoring study was undertaken in an ultraclean operating theatre setting to assay aerosol concentrations during intubation and extubation sequences, including upper airway suctioning, for patients undergoing surgery (N=19). An optical particle sizer (particle size 0.3-10 μm) sampled aerosol 20 cm above the patient's mouth. Baseline recordings (background, tidal breathing and volitional coughs) were followed by intravenous induction of anaesthesia with neuromuscular blockade. Four periods of laryngopharyngeal suctioning were performed with a Yankauer sucker: pre-laryngoscopy, post-intubation, pre-extubation and post-extubation. FINDINGS Aerosol was reliably detected {median 65 [interquartile range (IQR) 39-259] particles/L} above background [median 4.8 (IQR 1-7) particles/L, P<0.0001] when sampling in close proximity to the patient's mouth during tidal breathing. Upper airway suctioning was associated with a much lower average aerosol concentration than breathing [median 6.0 (IQR 0-12) particles/L, P=0.0007], and was indistinguishable from background (P>0.99). Peak aerosol concentrations recorded during suctioning [median 45 (IQR 30-75) particles/L] were much lower than during volitional coughs [median 1520 (IQR 600-4363) particles/L, P<0.0001] and tidal breathing [median 540 (IQR 300-1826) particles/L, P<0.0001]. CONCLUSION Upper airway suctioning during airway management was not associated with a higher aerosol concentration compared with background, and was associated with a much lower aerosol concentration compared with breathing and coughing. Upper airway suctioning should not be designated as a high-risk AGP.
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Affiliation(s)
- A J Shrimpton
- Anaesthesia, Pain and Critical Care, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
| | - J M Brown
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital NHS Trust, Bath, UK
| | - C M Penfold
- Bristol Biomedical Research Centre, University of Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - J P Reid
- School of Chemistry, University of Bristol, Bristol, UK
| | - A E Pickering
- Anaesthesia, Pain and Critical Care, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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12
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Allison J, Dowson C, Jakubovics N, Nile C, Durham J, Holliday R. Waterline Disinfectants Reduce Dental Bioaerosols: A Multitracer Validation. J Dent Res 2022; 101:1198-1204. [PMID: 35492016 PMCID: PMC9397394 DOI: 10.1177/00220345221093522] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Oral microbes are dispersed during dental treatment and reduction methods have been proposed, but dental unit waterline (DUWL) disinfectants have received little attention; specifically, the effect on viruses has not been studied. This study aims to 1) investigate the effect of DUWL disinfectants on viral dispersion in dental bioaerosols and 2) establish a dual-tracer system using live bacteriophage and fluorescein supported by optical particle measurement. Bacteriophage MS2 was used as a viral tracer and fluorescein as a fluorescent tracer. Validation experiments were conducted to exclude interference of one tracer with the other or of DUWL disinfectants on detection methods. Simulated “saliva” containing the tracers was infused into the mouth of a dental mannequin during 10-min dental procedures with an air turbine handpiece (n = 3 replicates). Aerosols and droplets were sampled in an enclosed dental operatory using air samplers and settlement onto sterile filter papers. Bacteriophage was quantified using plaque assays and reverse transcription quantitative polymerase chain reaction (RT-qPCR). Fluorescein was quantified fluorometrically. The effect of DUWL disinfectants on total aerosol concentration was assessed in separate experiments using an optical particle counter. DUWL disinfectants reduced bacteriophage viability, and interference between tracers was not observed. In simulated clinical procedures, the disinfectant ICX reduced bacteriophage detection substantially (P < 0.001; 2-way analysis of variance). MS2 RNA was detected in all experimental samples but not negative controls. Samples positive on RT-qPCR but not plaque assays may indicate that virions at distant sites are nonviable. Fluorescein tracer showed good agreement with the bacteriophage tracer. DUWL disinfectants designed for continuous presence in irrigants reduce the dispersion of viable virus in dental bioaerosols during simulated procedures. Their use may therefore be important for routine infection control and as a mitigation factor during infectious disease outbreaks. Future studies should explore this using a range of viruses and other microbes.
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Affiliation(s)
- J.R. Allison
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - C. Dowson
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - N.S. Jakubovics
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - C. Nile
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - J. Durham
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - R. Holliday
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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13
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Rafiee A, Carvalho R, Lunardon D, Flores-Mir C, Major P, Quemerais B, Altabtbaei K. Particle Size, Mass Concentration, and Microbiota in Dental Aerosols. J Dent Res 2022; 101:785-792. [PMID: 35384778 PMCID: PMC9210116 DOI: 10.1177/00220345221087880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Many dental procedures are considered aerosol-generating procedures that may put the dental operator and patients at risk for cross-infection due to contamination from nasal secretions and saliva. This aerosol, depending on the size of the particles, may stay suspended in the air for hours. The primary objective of the study was to characterize the size and concentrations of particles emitted from 7 different dental procedures, as well as estimate the contribution of the nasal and salivary fluids of the patient to the microbiota in the emitted bioaerosol. This cross-sectional study was conducted in an open-concept dental clinic with multiple operators at the same time. Particle size characterization and mass and particle concentrations were done by using 2 direct reading instruments: Dust-Trak DRX (Model 8534) and optical particle sizer (Model 3330). Active bioaerosol sampling was done before and during procedures. Bayesian modeling (SourceTracker2) of long-reads of the 16S ribosomal DNA was used to estimate the contribution of the patients’ nasal and salivary fluids to the bioaerosol. Aerosols in most dental procedures were sub-PM1 dominant. Orthodontic debonding and denture adjustment consistently demonstrated more particles in the PM1, PM2.5, PM4, and PM10 ranges. The microbiota in bioaerosol samples were significantly different from saliva and nasal samples in both membership and abundance (P < 0.05) but not different from preoperative ambient air samples. A median of 80.15% of operator exposure was attributable to sources other than the patients’ salivary or nasal fluids. Median operator’s exposure from patients’ fluids ranged from 1.45% to 2.75%. Corridor microbiota showed more patients’ nasal bioaerosols than oral bioaerosols. High-volume saliva ejector and saliva ejector were effective in reducing bioaerosol escape. Patient nasal and salivary fluids are minor contributors to the operator’s bioaerosol exposure, which has important implications for COVID-19. Control of bioaerosolization of nasal fluids warrants further investigation.
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Affiliation(s)
- A Rafiee
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - R Carvalho
- Department of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - D Lunardon
- Department of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - C Flores-Mir
- Department of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - P Major
- Department of Dentistry, University of Alberta, Edmonton, AB, Canada
| | - B Quemerais
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Altabtbaei
- Department of Dentistry, University of Alberta, Edmonton, AB, Canada
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14
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He Z, Gao Q, Henley A, Khatchadourian ZD, Somerville W, Wiseman M, Mongeau L, Tamimi F. Efficacy of Aerosol Reduction Measures for Dental Aerosol Generating Procedures. AEROSOL SCIENCE AND TECHNOLOGY : THE JOURNAL OF THE AMERICAN ASSOCIATION FOR AEROSOL RESEARCH 2022; 56:413-424. [PMID: 36311996 PMCID: PMC9616072 DOI: 10.1080/02786826.2022.2040729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/06/2022] [Accepted: 01/28/2022] [Indexed: 06/16/2023]
Abstract
Aerosol particles generated by dental procedures could facilitate the transmission of infectious diseases and contain carcinogen particles. Such particles can penetrate common surgical masks and reach the lungs, leading to increased risk for dental care professionals. However, the risk of inhaling contaminated aerosol and the effectiveness of aerosol reduction measures in dental offices remain unclear. The present study aimed to quantify aerosols produced by drilling and scaling procedures and to evaluate present recommendations for aerosol reduction. The concentration of aerosol particles released from the mock scaling and drilling procedures on dental mannequin were measured using a TSI Optical Particle Sizer (OPS 3330) during 15-min sessions carried out in a single-patient examination room. Using a drilling procedure as the aerosol source, the aerosol reduction performance of two types of high-volume evacuators (HVEs) and a commercial off-the-shelf air purifier was evaluated in a simulated clinical setting. Using either HVEs or the air purifier individually reduced the aerosol accumulated over the course of a 15-minutes drilling procedure at a reduction rate of 94.8 to 97.6%. Using both measures simultaneously raised the reduction rate to 99.6%. The results show that existing HVEs can effectively reduce aerosol concentration generated by a drilling procedure and can be further improved by using an air purifier. Following current regulatory guidelines can ensure a low risk of inhaling contaminated aerosol for dentists, assistants, and patients.
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Affiliation(s)
- Zixin He
- Department of Mechanical Engineering, McGill University, Montreal, Canada
| | - Qiman Gao
- Department of Mechanical Engineering, McGill University, Montreal, Canada
- Faculty of Dentistry, McGill University, Montreal, Canada
| | - Anna Henley
- Department of Mechanical Engineering, McGill University, Montreal, Canada
| | | | | | | | - Luc Mongeau
- Department of Mechanical Engineering, McGill University, Montreal, Canada
| | - Faleh Tamimi
- College of Dentistry, QU Health, Qatar University, Doha, Qatar
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