A clinical investigation of dental evacuation systems in reducing aerosols

Abstract

Background The route of transmission of severe acute respiratory syndrome coronavirus 2 has challenged dentistry to improve the safety for patients and the dental team during various treatment procedures. The purpose of this study was to evaluate and compare the effectiveness of dental evacuation systems in reducing aerosols during oral prophylactic procedures in a large clinical setting. Methods This was a single-center, controlled clinical trial using a split-mouth design. A total of 93 student participants were recruited according to the inclusion and exclusion criteria. Aerosol samples were collected on blood agar plates that were placed around the clinic at 4 treatment periods: baseline, high-volume evacuation (HVE), combination (HVE and intraoral suction device), and posttreatment. Student operators were randomized to perform oral prophylaxis using ultrasonic scalers on 1 side of the mouth, using only HVE suction for the HVE treatment period and then with the addition of an intraoral suction device for the combination treatment period. Agar plates were collected after each period and incubated at 37 °C for 48 hours. Colony-forming unit (CFU) counts were determined using an automatic colony counter. Results The use of a combination of devices resulted in significant reductions in CFUs compared with the use of the intraoral suction device alone ( P < .001). The highest amounts of CFUs were found in the operating zone and on patients during both HVE and combination treatment periods. Conclusions Within limitations of this study, the authors found significant reductions in the amount of microbial aerosols when both HVE and an intraoral suction device were used. Practical Implications The combination of HVE and intraoral suction devices significantly decreases microbial aerosols during oral prophylaxis procedures.

Indoor Air Quality Evaluation Using Mechanical Ventilation and Portable Air Purifiers in an Academic Dentistry Clinic during the COVID-19 Pandemic in Greece

“…Avoiding the recycling of unfiltered air is very important mainly in healthcare-related installations as the airborne transmission of the virus is possible, as mentioned above [14,15,23,24]. In a recent study, it was shown that the combination of the intraoral and extraoral mechanical suction of the produced aerosol had better results in reducing the microbial load in the air than the use of intraoral alone [25]. The same conclusions arose in a very recent article stating that even portable high-efficiency particulate filters may be installed especially in an old-fashioned ward in healthcare institutions with suboptimal ventilation [13].…”

Aerosol reduction efficacy of different intra-oral suction devices during ultrasonic scaling and high-speed handpiece use

“…In the absence of a ‘gold standard’ for measurements, and the absence of an ‘acceptable threshold’ of aerosol, measuring aerosol mitigation remains challenging. Many studies have evaluated aerosol mitigation using extra-oral high-volume suction devices, [ 7 , 10 , 15 , 16 , 19 ]. In some settings, these devices show effective aerosol removal but these devices are not widely used.…”

Hospital's Dental Clinic Service Readiness in Facing Covid-19

“…Two types of HVE available are HVE that is attached directly to the dental unit and portable HVE that is not installed in the dental unit. The HVE that is installed directly on the dental unit utilizes the suction system of the dental unit integrated with the drain line (12,27). This HVE uses a cannula that looks like a small funnel attached to the suction and can be positioned directly close to the tooth being treated.…”

“…This HVE uses a cannula that looks like a small funnel attached to the suction and can be positioned directly close to the tooth being treated. The use of HVE makes the aerosol generated in the process of action can be directly sucked in large volumes (27,28).…”

“…The Hospital's Dental Clinic must also follow up on other potential solutions to meet the recommended service standards. Formulating SOPs for dental services during the Covid-19 pandemic is important by applying the principle of minimizing direct face to face interaction between dentists and patients, and avoiding the possibility of the spread of Covid-19 among health workers and patients (27,(29)(30)(31)(32). SOP is a guideline to regulate the stages of processes or work procedures to ensure that operational activities run smoothly (30).…”