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Nuryanti A, Sarasati A, Ulfahastika L, Wartadiani MD, Syahruddin MH, A'yun RNSQ. Euphorbia hirta nanoextract as a piezoelectric ultrasonic scaler coolant in gingivitis treatment in a Wistar rat model. J Taibah Univ Med Sci 2024; 19:1-9. [PMID: 37868098 PMCID: PMC10585296 DOI: 10.1016/j.jtumed.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/24/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives This research was aimed at investigating the effects of various concentrations of Euphorbia hirta nanoextract as a piezoelectric scaler coolant on gingivitis healing in a Wistar rat model. Methods A piezoelectric ultrasonic scaler coolant was made from E. hirta nanoextract through ionic gelation. Experiments were conducted in 45 adult male Wistar rats divided into three groups treated with E. hirta nanoextract coolant (25%, 30%, and 35% concentrations), and negative and positive control groups. A silk ligature was used to trap debris and induce gingivitis in the maxillary incisors of the rats. Scaling was conducted with a piezoelectric ultrasonic scaler after the respective treatment for each group. Data were collected on days 3, 5, 7, 14, and 21 after treatment. Observations were collected with an Optilab® camera at 400× magnification. Angiogenesis and neutrophil data were analyzed with two-way analysis of variance (ANOVA) and post hoc Duncan tests at a 95% significance level. Results Use of E. hirta nanoextract as a piezoelectric ultrasonic coolant accelerated gingivitis healing in Wistar rats, particularly at a 25% concentration. Two-way ANOVA indicated a significant difference in angiogenesis and neutrophil counts between the control group and each treatment group (p < 0.05). Duncan's post-hoc test showed significant differences in mean neutrophil numbers and angiogenesis among groups on days 3, 5, 7, 14, and 21. The group treated with 25% nanoextract concentration showed no significant differences with respect to the positive control group. Conclusions Use of E. hirta nanoextract as a piezoelectric ultrasonic coolant had good therapeutic results in promoting gingivitis healing. E. hirta nanoextract may potentially resolve inflammation in gingivitis by modulating neutrophils and angiogenesis.
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Affiliation(s)
- Archadian Nuryanti
- Dental Biomedical Sciences Department, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Andari Sarasati
- Doctoral Study Program, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Latifah Ulfahastika
- Dentistry Study Program, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Maria Ditya Wartadiani
- Dentistry Study Program, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Agrawal A, Keerthipati S, Sreerama S, Singla D, Acharya S, Mehta D, Kumar S, Paiwal K. Effect of herbal mouthrinsein dental ultrasonic scalers among Indians. Bioinformation 2023; 19:1104-1110. [PMID: 38046514 PMCID: PMC10692984 DOI: 10.6026/973206300191104] [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: 11/01/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/05/2023] Open
Abstract
The use of herbal mouthrinse is gaining momentum in recent years. Therefore, it is of interest to evaluate the effect of 2 herbal mouthrinse (curcumin, cinnamon) in comparison with2 conventional mouthrinse (povidone iodine, chlorhexidine) when used as coolant in dental ultrasonic scalers. Hence, 200 participants were included in this study. Analysis of gingival index, periodontal index at baseline and one month follow up was completed. The inhibitory effects of both conventional and herbal mouth rinse in gingival health are similar. However, cinnamon and curcumin owing to its minimal adverse effects and low cost is useful as an alternative to chlorhexidine for reducing bacterial load in dental aerosols produced due to ultrasonic scalers.
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Affiliation(s)
- Ankita Agrawal
- Department of Conservative and Endodontics, Buddha Institute of Dental Sciences and Hospital, Patna, Bihar, India
| | - Shilpa Keerthipati
- Department of Orthodontics, Gitam Dental College and Hospital, Visakhapatnam, India
| | | | - Deepika Singla
- Department of Conservative Dentistry & Endodontics, Desh Bhagat Dental College & Hospital, Mandi Gobindgarh, Punjab, India
| | - Sonu Acharya
- Department of Pediatric and Preventive Dentistry, Institute of Dental Sciences, Siksha Anusandhan (Deemed to be) University, Bhubaneswar, India
| | - DhavalNiranjan Mehta
- Department of Oral Medicine and Radiology, Narsinbhai Patel Dental College and Hospital, Sankalchand PatelUniversity, Visnagar, Gujarat, India
| | - Santosh Kumar
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, Gujarat, India
| | - Kapil Paiwal
- Department of Oral & Maxillofacial Pathology, Daswani Dental College & Research Center, Kota, India
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Cao R, Qiu P, Xu B, Lin J, Chu D, Fan Z. Effectiveness of interventions to reduce aerosol generation in dental environments: A systematic review. Prev Med Rep 2023; 35:102383. [PMID: 37680854 PMCID: PMC10480641 DOI: 10.1016/j.pmedr.2023.102383] [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: 07/18/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
Certain dental procedures produce high levels of aerosols containing pathogenic microorganisms, posing a risk for the transmission of infections in dental settings. This study aimed to assess the effectiveness of various aerosol mitigation interventions during clinical dental procedures in real-world environments. A systematic literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and Embase for English studies up to March 2023 according to the PRISMA guidelines. Only peer-reviewed controlled clinical trials (CCT) or randomized controlled trials (RCT) studies involving human subjects were included. The risk of bias of selected researches were evaluated by two independent authors using the Cochrane Collaboration tool. The literature search yielded 3491 articles, of which 42 studies met the inclusion criteria and were included in this study. Most studies evaluated bacterial contamination in bio-aerosols, while the viral and fungal contamination was assessed in only three studies. Overall, various approaches have been applied in reducing aerosol contamination in clinical scenarios, including high-volume evacuators (HVE), mouse rinses and rubber dams, air cleaning systems, and high-efficiency particulate air (HEPA) filters. The available evidence suggests that various aerosol mitigation strategies could be implemented to decrease the risk of cross-infection during clinical dental procedures in real-world environments. However, further clinical trials are necessary to establish statistical validity in measuring aerosol contamination and mitigation, as well as to evaluate the risk of infection transmission for viral and fungal contamination.
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Affiliation(s)
- Rongkai Cao
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
| | - Piaopiao Qiu
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
| | - Borui Xu
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
| | - Jingying Lin
- College of Environmental Science and Engineering, Tongji University, Shanghai 200092, PR China
| | - Danna Chu
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
| | - Zhen Fan
- School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, No. 399, Middle Yanchang Rd, Shanghai 200072, PR China
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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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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
| | - 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
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Mutluay M, Egil E. Effect of work environment and specialty degree of dentists on cross-infection control in COVID-19 pandemic. Braz J Infect Dis 2021; 25:101592. [PMID: 34153223 PMCID: PMC8165091 DOI: 10.1016/j.bjid.2021.101592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives The aim of this study was to evaluate the effect of the work environment and expertise/specialty degree of dentists on their behavior, awareness, and attitudes regarding cross-infection control during the COVID-19 pandemic. Design The study population consisted of Turkish dentists who work in private clinics, public clinics and university hospitals. The demographic information of the participants, their awareness of the COVID-19 acute respiratory disease, and clinical measures taken against cross-infection were evaluated with an online survey. Between the 10th and 20th of November 2020, 2,400 surveys were e-mailed to dentists. Results A total 454 professionals answered the survey. According to the results, 29.3% of the participants performed only urgent care during the pandemic period, whereas 59.9% of them performed both urgent and routine treatments. Among the responding dentists, 90.6% stated that they were worried about aerosol-generating dental procedures, but there was no differences between genders (p = 0.119). Most participants, especially specialists (p = 0.160) , applied strict cross-infection control methods during the COVID-19 pandemic (77.2%). These dentists used personal protective equipment (PPE) at rates that varied between 75.5% and 98.4%. Nonetheless, the rate of PPE use was different between genders and degrees of expertise: women used PPE more frequently than men (p = 0.025), and specialists used PPE more often than the other dentists (p = 0.04). Finally, there was a weak positive correlation between the level of PPE use and expertise (r = 0.121; p = 0.010). Conclusions Despite the overall knowledge of the participants regarding COVID-19 symptoms, transmission routes, and the guidelines needed to prevent the virus from spreading, the dental specialists followed infection control methods more strictly. Even though the participants were concerned about dental practices that create microbial aerosols during the pandemic period, they continued their clinical routines using high PPE levels and taking extra clinical precautions to avoid cross-infection.
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Affiliation(s)
- Merve Mutluay
- Kirikkale University, Vocational School of Health Services, Department of Dental Hygiene, Kirikkale, Turkey
| | - Edibe Egil
- Istanbul Gelisim University, School of Dentistry, Department of Pediatric Dentistry, Istanbul, Turkey.
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Sukumar S, Dracopoulos SA, Martin FE. Dental education in the time of SARS-CoV-2. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2021; 25:325-331. [PMID: 33015929 PMCID: PMC7675464 DOI: 10.1111/eje.12608] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 05/09/2023]
Abstract
INTRODUCTION The SARS-CoV-2 virus has forced profound change on all aspects of society, with significant impact on dental education. Dental students like all other dental clinical personnel are considered to be at the highest risk amongst healthcare workers due to the nature of treatment, namely, working in the oral cavity (known reservoir for the virus) and the routine use of aerosol-generating procedures. The nature of this pandemic has created several challenges to dental clinical education. The aim of this paper is to discuss these challenges and how educators have sought to overcome them. MATERIALS AND METHODS This paper reviews the evidence base around bio-aerosol and infection control measures specifically in the context of dental education. RESULTS Using current knowledge of bio-aerosol and increasing understanding of the virus, dental educators can implement evidence-based measures to ensure safe teaching within both simulation and clinical environments. DISCUSSION This paper contextualises the current pandemic in a dental education setting by providing a critical appraisal of the challenges posed by SARS-CoV-2 and how these challenges may be managed. CONCLUSION The SARS-CoV-2 pandemic has created unique challenges for dental schools worldwide. Dental educators have sought to identify these challenges and find solutions appropriate to the stage of the pandemic specific to their geographical location.
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Affiliation(s)
- Smitha Sukumar
- Faculty of Medicine and HealthSydney Dental SchoolUniversity of SydneySydneyNSWAustralia
| | - Susie Athanasia Dracopoulos
- 3M AustraliaScientific Affairs and Education ManagerAustralia/New Zealand Oral Care DivisionPymbleNSWAustralia
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Johnson IG, Jones RJ, Gallagher JE, Wade WG, Al-Yaseen W, Robertson M, McGregor S, K C S, Innes N, Harris R. Dental periodontal procedures: a systematic review of contamination (splatter, droplets and aerosol) in relation to COVID-19. BDJ Open 2021; 7:15. [PMID: 33762575 PMCID: PMC7988384 DOI: 10.1038/s41405-021-00070-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/20/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The emergence of the SARS-CoV-2 virus and subsequent COVID-19 pandemic has had a significant effect on the delivery of routine dentistry; and in particular, periodontal care across the world. This systematic review examines the literature relating to splatter, droplet settle and aerosol for periodontal procedures and forms part of a wider body of research to understand the risk of contamination in relation to periodontal care procedures relevant to COVID-19. METHODS A search of the literature was carried out using key terms and MeSH words relating to the review questions. Sources included Medline (OVID), Embase (OVID), Cochrane Central Register of Controlled Trials, Scopus, Web of Science and LILACS, ClinicalTrials.Gov . Studies meeting inclusion criteria were screened in duplicate and data extraction was carried out using a template. All studies were assessed for methodological quality and sensitivity. Narrative synthesis was undertaken. RESULTS Fifty studies were included in the review with procedures including ultrasonic scaling (n = 44), air polishing (n = 4), prophylaxis (n = 2) and hand scaling (n = 3). Outcomes included bacterial (colony-forming units e.g. on settle plates) or blood contamination (e.g. visible splatter) and non bacterial, non blood (e.g. chemiluminescence or coloured dyes) contamination. All studies found contamination at all sites although the contamination associated with hand scaling was very low. Contamination was identified in all of the studies even where suction was used at baseline. Higher power settings created greater contamination. Distribution of contamination varied in relation to operator position and was found on the operator, patient and assistant with higher levels around the head of the operator and the mouth and chest of the patient. Settle was identified 30 min after treatments had finished but returned to background levels when measured at or after an hour. The evidence was generally low to medium quality and likely to underestimate contamination. CONCLUSION Ultrasonic scaling, air polishing and prophylaxis procedures produce contamination (splatter, droplets and aerosol) in the presence of suction, with a small amount of evidence showing droplets taking between 30 min and 1 h to settle. Consideration should be given to infection control, areas of cleaning particularly around the patient and appropriate personal protective equipment, with particular attention to respiratory, facial and body protection for these procedures. In addition, the use of lower power settings should be considered to reduce the amount and spread of contamination.
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Affiliation(s)
- Ilona G Johnson
- Cardiff University School of Dentistry, Applied Clinical Research and Public Health, College of Biomedical and Life Sciences, Heath Park, Cardiff, UK.
| | - Rhiannon J Jones
- Cardiff University School of Dentistry, Dental Education, Scholarship & Innovation, College of Biomedical and Life Sciences, Heath Park, Cardiff, UK
| | - Jennifer E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Denmark Hill Campus, Bessemer Road, London, UK
| | | | - Waraf Al-Yaseen
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, UK
| | - Mark Robertson
- School of Dentistry, Child Dental and Oral Health, University of Dundee, Dundee, UK
| | - Scott McGregor
- Library and Learning Centre, University of Dundee, Dundee, UK
| | - Sukriti K C
- Faculty of Dentistry, Oral & Craniofacial Surgery, King's College London, Centre for Host Microbiome Interactions, Denmark Hill Campus, Bessemer Road, London, UK
| | - Nicola Innes
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, UK
| | - Rebecca Harris
- Department of Public Health, Policy & Systems, University of Liverpool, Room 124, 1st Floor, Block B, Waterhouse Building, Liverpool, UK
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Kumbargere Nagraj S, Eachempati P, Paisi M, Nasser M, Sivaramakrishnan G, Verbeek JH. Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases. Cochrane Database Syst Rev 2020; 10:CD013686. [PMID: 33047816 PMCID: PMC8164845 DOI: 10.1002/14651858.cd013686.pub2] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Many dental procedures produce aerosols (droplets, droplet nuclei and splatter) that harbour various pathogenic micro-organisms and may pose a risk for the spread of infections between dentist and patient. The COVID-19 pandemic has led to greater concern about this risk. OBJECTIVES To assess the effectiveness of methods used during dental treatment procedures to minimize aerosol production and reduce or neutralize contamination in aerosols. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases on 17 September 2020: Cochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (in the Cochrane Library, 2020, Issue 8), MEDLINE Ovid (from 1946); Embase Ovid (from 1980); the WHO COVID-19 Global literature on coronavirus disease; the US National Institutes of Health Trials Registry (ClinicalTrials.gov); and the Cochrane COVID-19 Study Register. We placed no restrictions on the language or date of publication. SELECTION CRITERIA We included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on aerosol-generating procedures (AGPs) performed by dental healthcare providers that evaluated methods to reduce contaminated aerosols in dental clinics (excluding preprocedural mouthrinses). The primary outcomes were incidence of infection in dental staff or patients, and reduction in volume and level of contaminated aerosols in the operative environment. The secondary outcomes were cost, accessibility and feasibility. DATA COLLECTION AND ANALYSIS Two review authors screened search results, extracted data from the included studies, assessed the risk of bias in the studies, and judged the certainty of the available evidence. We used mean differences (MDs) and 95% confidence intervals (CIs) as the effect estimate for continuous outcomes, and random-effects meta-analysis to combine data. We assessed heterogeneity. MAIN RESULTS We included 16 studies with 425 participants aged 5 to 69 years. Eight studies had high risk of bias; eight had unclear risk of bias. No studies measured infection. All studies measured bacterial contamination using the surrogate outcome of colony-forming units (CFU). Two studies measured contamination per volume of air sampled at different distances from the patient's mouth, and 14 studies sampled particles on agar plates at specific distances from the patient's mouth. The results presented below should be interpreted with caution as the evidence is very low certainty due to heterogeneity, risk of bias, small sample sizes and wide confidence intervals. Moreover, we do not know the 'minimal clinically important difference' in CFU. High-volume evacuator Use of a high-volume evacuator (HVE) may reduce bacterial contamination in aerosols less than one foot (~ 30 cm) from a patient's mouth (MD -47.41, 95% CI -92.76 to -2.06; 3 RCTs, 122 participants (two studies had split-mouth design); very high heterogeneity I² = 95%), but not at longer distances (MD -1.00, -2.56 to 0.56; 1 RCT, 80 participants). One split-mouth RCT (six participants) found that HVE may not be more effective than conventional dental suction (saliva ejector or low-volume evacuator) at 40 cm (MD CFU -2.30, 95% CI -5.32 to 0.72) or 150 cm (MD -2.20, 95% CI -14.01 to 9.61). Dental isolation combination system One RCT (50 participants) found that there may be no difference in CFU between a combination system (Isolite) and a saliva ejector (low-volume evacuator) during AGPs (MD -0.31, 95% CI -0.82 to 0.20) or after AGPs (MD -0.35, -0.99 to 0.29). However, an 'n of 1' design study showed that the combination system may reduce CFU compared with rubber dam plus HVE (MD -125.20, 95% CI -174.02 to -76.38) or HVE (MD -109.30, 95% CI -153.01 to -65.59). Rubber dam One split-mouth RCT (10 participants) receiving dental treatment, found that there may be a reduction in CFU with rubber dam at one-metre (MD -16.20, 95% CI -19.36 to -13.04) and two-metre distance (MD -11.70, 95% CI -15.82 to -7.58). One RCT of 47 dental students found use of rubber dam may make no difference in CFU at the forehead (MD 0.98, 95% CI -0.73 to 2.70) and occipital region of the operator (MD 0.77, 95% CI -0.46 to 2.00). One split-mouth RCT (21 participants) found that rubber dam plus HVE may reduce CFU more than cotton roll plus HVE on the patient's chest (MD -251.00, 95% CI -267.95 to -234.05) and dental unit light (MD -12.70, 95% CI -12.85 to -12.55). Air cleaning systems One split-mouth CCT (two participants) used a local stand-alone air cleaning system (ACS), which may reduce aerosol contamination during cavity preparation (MD -66.70 CFU, 95% CI -120.15 to -13.25 per cubic metre) or ultrasonic scaling (MD -32.40, 95% CI - 51.55 to -13.25). Another CCT (50 participants) found that laminar flow in the dental clinic combined with a HEPA filter may reduce contamination approximately 76 cm from the floor (MD -483.56 CFU, 95% CI -550.02 to -417.10 per cubic feet per minute per patient) and 20 cm to 30 cm from the patient's mouth (MD -319.14 CFU, 95% CI - 385.60 to -252.68). Disinfectants ‒ antimicrobial coolants Two RCTs evaluated use of antimicrobial coolants during ultrasonic scaling. Compared with distilled water, coolant containing chlorhexidine (CHX), cinnamon extract coolant or povidone iodine may reduce CFU: CHX (MD -124.00, 95% CI -135.78 to -112.22; 20 participants), povidone iodine (MD -656.45, 95% CI -672.74 to -640.16; 40 participants), cinnamon (MD -644.55, 95% CI -668.70 to -620.40; 40 participants). CHX coolant may reduce CFU more than povidone iodine (MD -59.30, 95% CI -64.16 to -54.44; 20 participants), but not more than cinnamon extract (MD -11.90, 95% CI -35.88 to 12.08; 40 participants). AUTHORS' CONCLUSIONS We found no studies that evaluated disease transmission via aerosols in a dental setting; and no evidence about viral contamination in aerosols. All of the included studies measured bacterial contamination using colony-forming units. There appeared to be some benefit from the interventions evaluated but the available evidence is very low certainty so we are unable to draw reliable conclusions. We did not find any studies on methods such as ventilation, ionization, ozonisation, UV light and fogging. Studies are needed that measure contamination in aerosols, size distribution of aerosols and infection transmission risk for respiratory diseases such as COVID-19 in dental patients and staff.
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Affiliation(s)
- Sumanth Kumbargere Nagraj
- Department of Oral Medicine and Oral Radiology, Faculty of Dentistry, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia
| | - Prashanti Eachempati
- Department of Prosthodontics, Faculty of Dentistry, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia
| | - Martha Paisi
- Peninsula Dental Social Enterprise, Peninsula Dental School, University of Plymouth, Plymouth, UK
| | - Mona Nasser
- Peninsula Dental School, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | - Jos H Verbeek
- Cochrane Work, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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10
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Ashtiani RE, Tehrani S, Revilla-León M, Zandinejad A. Reducing the Risk of COVID-19 Transmission in Dental Offices: A Review. J Prosthodont 2020; 29:739-745. [PMID: 32935425 DOI: 10.1111/jopr.13261] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 epidemic has become a major public health challenge around the world. According to the World Health Organization (WHO), as of August 2020 there are more than 833,556 dead and over 24,587,513 people infected around the world. This pandemic has adversely affected many professions around the globe, including dentistry. COVID-19, caused by the Corona virus family, is transmitted mainly by direct contact with an infected person or through the spread of aerosol and droplets. Dentistry by nature is considered to be one of the most vulnerable professions with regards to the high risk of transmission between the dentist, dental team, and patients; therefore, a protocol for infection control and the prevention and spreading of the COVID-19 virus in dental settings is urgently needed. This article reviews essential knowledge about this virus and its transmission and recommends preventive methods based on existing scientific research and recommendations to prevent the spread of this virus in dental offices and clinics.
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Affiliation(s)
- Reza Eftekhar Ashtiani
- Department of Dental Technology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shabnam Tehrani
- Department of Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marta Revilla-León
- AEGD Residency Program, Department of Comprehensive Dentistry, College of Dentistry, Texas A&M University, Dallas, TX
| | - Amirali Zandinejad
- AEGD Residency Program, Department of Comprehensive Dentistry, College of Dentistry, Texas A&M University, Dallas, TX
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11
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Kumbargere Nagraj S, Eachempati P, Paisi M, Nasser M, Sivaramakrishnan G, Verbeek JH. Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases. Hippokratia 2020. [DOI: 10.1002/14651858.cd013686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sumanth Kumbargere Nagraj
- Department of Oral Medicine and Oral Radiology; Faculty of Dentistry, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Manipal; Melaka Malaysia
| | - Prashanti Eachempati
- Department of Prosthodontics; Faculty of Dentistry, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE); Melaka Malaysia
| | - Martha Paisi
- Peninsula Dental Social Enterprise, Peninsula Dental School; University of Plymouth; Plymouth UK
| | - Mona Nasser
- Peninsula Dental School; Plymouth University Peninsula Schools of Medicine and Dentistry; Plymouth UK
| | | | - Jos H Verbeek
- Cochrane Work Review Group; Academic Medical Center, University of Amsterdam; Amsterdam Netherlands
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12
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Koletsi D, Belibasakis GN, Eliades T. Interventions to Reduce Aerosolized Microbes in Dental Practice: A Systematic Review with Network Meta-analysis of Randomized Controlled Trials. J Dent Res 2020; 99:1228-1238. [PMID: 32660314 DOI: 10.1177/0022034520943574] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The aim of this systematic review and network meta-analysis was to identify and rank the effectiveness of different interventions used in dental practice to reduce microbial load in aerosolized compounds. Seven electronic databases were searched to April 6, 2020, for randomized controlled trials (RCTs) or nonrandomized prospective studies in the field. Study selection, data extraction, and risk-of-bias assessment were performed for all included studies, while the outcome of interest pertained to differences in bacterial load quantification through the use of different interventions prior to aerosol-generating procedures in dental practices. Random effects frequentist network meta-analysis was performed, with mean difference (MD) and 95% CI as the effect measure. Confidence in the documented evidence was assessed through the newly fueled CINeMA framework (Confidence in Network Meta-analysis) based on the GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation). Twenty-nine clinical trials were deemed eligible, 21 RCTs and 8 nonrandomized studies, while 11 RCTs contributed to the network meta-analysis, comprising 10 competing interventions. Tempered chlorhexidine (CHX) 0.2% as compared with nonactive control mouth rinse, prior to routine ultrasonic scaling, was most effective toward reduced postprocedural bacterial load with an MD of -0.92 (95% CI, -1.54 to -0.29) in log10 bacterial CFUs (colony-forming units). For CHX 0.2%, an MD of -0.74 (95% CI, -1.07 to -0.40) was observed as compared with control. Tempered CHX 0.2% presented the highest probabilities of being ranked the most effective treatment (31.2%). Level of confidence varied from very low to moderate across all formulated comparisons. These findings summarize the current state of research evidence in the field of aerosolized bacteria in dentistry. Instigated by the era of SARS-CoV-2 pandemic, the stipulation of a broader evaluation of the aerosolized microbes, including viruses, potentially coupled with disinfectant-based prevention schemes should be prioritized.
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Affiliation(s)
- D Koletsi
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - G N Belibasakis
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - T Eliades
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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