Background Dental procedures often produce aerosol and splatter which have the potential to transmit pathogens such as SARS‐CoV‐2. The existing literature is limited. Objective(s) To develop a robust, reliable and valid methodology to evaluate distribution and persistence of dental aerosol and splatter, including the evaluation of clinical procedures. Methods Fluorescein was introduced into the irrigation reservoirs of a high‐speed air‐turbine, ultrasonic scaler and 3‐in‐1 spray, and procedures were performed on a mannequin in triplicate. Filter papers were placed in the immediate environment. The impact of dental suction and assistant presence were also evaluated. Samples were analysed using photographic image analysis, and spectrofluorometric analysis. Descriptive statistics were calculated and Pearson’s correlation for comparison of analytic methods. Results All procedures were aerosol and splatter generating. Contamination was highest closest to the source, remaining high to 1–1.5 m. Contamination was detectable at the maximum distance measured (4 m) for high‐speed air‐turbine with maximum relative fluorescence units (RFU) being: 46,091 at 0.5 m, 3,541 at 1.0 m, and 1,695 at 4 m. There was uneven spatial distribution with highest levels of contamination opposite the operator. Very low levels of contamination (≤0.1% of original) were detected at 30 and 60 minutes post procedure. Suction reduced contamination by 67–75% at 0.5–1.5 m. Mannequin and operator were heavily contaminated. The two analytic methods showed good correlation ( r =0.930, n =244, p <0.001). Conclusion Dental procedures have potential to deposit aerosol and splatter at some distance from the source, being effectively cleared by 30 minutes in our setting.

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AbstractBackgroundDental procedures often produce aerosol and splatter which are potentially high risk for spreading pathogens such as SARS-CoV-2. The existing literature is limited.Objective(s)To develop a robust, reliable and valid methodology to evaluate distribution and persistence of dental aerosol and splatter, including the evaluation of clinical procedures.MethodsFluorescein was introduced into the irrigation reservoirs of a high-speed air-turbine, ultrasonic scaler and 3-in-1 spray and procedures performed on a mannequin in triplicate. Filter papers were placed in the immediate environment. The impact of dental suction and assistant presence were also evaluated. Samples were analysed using photographic image analysis, and spectrofluorometric analysis. Descriptive statistics were calculated and Pearson’s correlation for comparison of analytic methods.ResultsAll procedures were aerosol and splatter generating. Contamination was highest closest to the source, remaining high to 1-1.5 m. Contamination was detectable at the maximum distance measured (4 m) for high-speed air-turbine with maximum relative fluorescence units (RFU) being: 46,091 at 0.5 m, 3,541 at 1.0 m, and 1,695 at 4 m. There was uneven spatial distribution with highest levels of contamination opposite the operator. Very low levels of contamination (≤0.1% of original) were detected at 30 and 60 minutes post procedure. Suction reduced contamination by 67-75% at 0.5-1.5 m. Mannequin and operator were heavily contaminated. The two analytic methods showed good correlation (r=0.930, n=244, p<0.001).ConclusionDental procedures have potential to deposit aerosol and splatter at some distance from the source, being effectively cleared by 30 minutes in our setting.

Aim: To identify splatter and aerosol distribution resulting from aerosol generating procedures (AGPs) in the open plan clinical environment. A secondary aim is to explore the detailed time course of aerosol settling after an AGP. Methodology: Dental procedures were undertaken on a dental mannequin. Fluorescein dye was placed into the irrigation system of the high-speed air turbine handpiece for the first experimental design, and in the second, fluorescein dye was entered into the mannequin's mouth via artificial salivary ducts. Filter papers were placed at set distances around the open plan clinical environment to collect aerosol and splatter under various mitigating conditions including ventilation and aspiration flow rate. An 8-metre diameter rig was set up to investigate the effect of fallow time. Filter papers were analysed using imaging software and spectrofluorometric analysis. Results: The distribution of fluorescein contamination varied widely across the open plan clinic depending on the experimental conditions. Unmitigated (i.e. no suction) procedures have the potential to deposit contamination at large distances. Medium volume dental suction (159 L/min air) reduced contamination in the AGP bay by 53%, and in adjacent and distant bays/walkways by 81-83%. Low volume suction (40 L/min air) gave similar reductions. Cross-ventilation reduced contamination in adjacent and distant bays/walkways by 80-89%. In the most realistic model (dye in mouth with medium volume suction) the samples in distant bays (≥5 m head-to-head chair distance) either gave zero readings or very low readings (&lt; 0.0016% of the fluorescein introduced to the system during the procedure). Almost all (99.99%) of the splatter detected was retained within the AGP bay/walkway. Time course experiments showed that after 10 minutes, very little additional contaminated aerosol settled. Conclusions: The cross-infection risk from conducting AGPs in an open plan clinic environment appears small, particularly when bays are ≥ 5 m apart. There is a major dilution effect from the instrument water spray and a substantial protective effect from using dental suction. The majority of aerosol settles in the first 10 minutes, indicating that environmental cleaning may be appropriate after this time

Introduction: Persistent idiopathic dentoalveolar pain (PIDP) is a persistent pain condition isolated to the dentoalveolar region and has previously been known as PDAP/Atypical odontalgia. Presentation: The challenge in diagnosing PIDP means it is often confused for acute dental pain resulting in patients often receiving a number of dental interventions before a diagnosis is made. This highlights the need for practitioners to be aware of the signs of PIDP as early detection can reduce this risk. Aetiology: The pathophysiology behind PIDP is a subject for much debate. Theories suggest that there may be a link to nerve injury. However, this is complicated by suggestions of links to psychological factors and not all patients reporting dental interventions at the outset. Furthermore it is difficult to determine if the pain has continued since before the intervention or resulted after it. Treatment: Current first line treatment for PIDP revolves around the prescription of systemic medications. Whilst these have been proven to have some efficacy they are not universally effective and side effects can reduce compliance. Local treatments have been trailed to improve this, but further research is required and a gold standard has not been set. Conclusion: Persistent idiopathic dentoalveolar pain an uncommon and poorly understood condition making its diagnosis and treatment challenging. Advances in research are required to the aetiology and treatment of the condition as well as an improvement in clinician's awareness of PIDP. This will hopefully reduce the associated burden on quality of life.

Desensitising agents are added to dentifrices to occlude exposed dentine tubules and reduce pain associated with dentine hypersensitivity. In occluding the tubules these agents may alter the surface layer of the dentine and consequently affect bacterial biofilm formation. This research sought to examine the effects of desensitising agents on dentinal biofilms using an in vitro model. A constant depth film fermenter (CDFF) was selected to mimic the oral environment and human dentine with exposed tubules was analysed. Calcium sodium phosphosilicate (CSPS) was selected as a model desensitising agent. Dentine discs were treated with pumice or CSPS-containing dentifrices with or without fluoride, or left untreated (control). Dual-species biofilms of Streptococcus mutans and Streptococcus sobrinus were grown in artificial saliva and analysed by viable counts, polymerase chain reaction (PCR) and scanning electron microscopy (SEM). SEM images confirmed the presence of occluded tubules after CSPS application and demonstrated the formation of biofilms containing extracellular matrix material. Analysis of PCR and viable count data using a one-way ANOVA showed no significant differences for bacterial composition for any of the four treatments. There were, however, trends towards increased numbers of bacteria for the pumice and CSPS treated samples which was reversed by the addition of fluoride to CSPS. In conclusion, CSPS was not found to have a significant effect on biofilms and an in vitro model for testing desensitising agents has been developed, however, further work is required to improve the reproducibility of the biofilms formed and to explore the trends seen.

Tooth wear (tooth surface loss) is an ever increasing problem which can be challenging to prevent, restore and maintain. These cases frequently have reduced inter-occlusal space and are often managed by re-organizing the occlusion or using techniques such as the Dahl approach. This approach is not without difficulties and can be particularly challenging in cases of Class II skeletal classifications. This report discusses tooth wear in a single case which initially planned the use of a Dahl approach but which was adapted following review due to distalization of the mandible, and so highlights a potential issue with this approach. CPD/Clinical Relevance: With the increasing incidence of tooth wear it is important that general dental practitioners can assess, manage and restore worn dentitions in a safe and controlled manner.

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