A Systematic Review of Droplet and Aerosol Generation in Dentistry

Innes, Nicola; Johnson, Ilona; Al-Yaseen, Waraf; Harris, Rebecca; Jones, Rhiannon; KC, Sukriti; McGregor, Scott; Robertson, Mark; Wade, William; Gallagher, Jennifer E.

doi:10.1101/2020.08.28.20183475

Cited by 14 publications

(28 citation statements)

References 35 publications

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“…A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart, 33 detailing the number of studies through each stage of the larger review process, is available as a pre-print online. 23 Papers across all procedures (n = 193) were obtained for full-text screening. Papers, eligible for inclusion, were categorised by the procedure.…”

Section: Methodsmentioning

confidence: 99%

“…Key data items were extracted using a standardised data extraction form developed a priori and refined based on repeat pilot testing with a minimum of five publications and three data extractors. The data extracted for the overall study are presented in a table available at medRixiv, 23 including study overview; dental procedures investigated; methodology; and relevant findings (related to the review outcomes). Detection methods for contamination were categorised as microbial, blood and other (non-microbial/non-blood).…”

Section: Methodsmentioning

confidence: 99%

“…However, in the current pandemic, the importance of understanding the risk of exposure through both droplets and aerosol (particles ≤ 5 µm) has been realised and the historical wealth of evidence for dentistry revisited. 23,24 For oral surgery, the risks of transmission via blood, following concerns over blood-borne viruses such as HIV and hepatitis B and C, have resulted in clinicians regularly wearing standard surgical PPE in recent decades, rather than merely relying on universal precautions.…”

Section: Introductionmentioning

confidence: 99%

“…The objectives of this review follow the wider review, 23,24 as follows, to: (a) Characterise the pattern of aerosol spread and settle relevant to oral surgery in dental surgery. (b) Identify whether there is evidence of an association with exposure, infection and transmission of pathogenic microorganisms.…”

Section: Introductionmentioning

confidence: 99%

“…The overarching paper compares procedures and has proposed a hierarchy of risk. 23 While the overarching data have been reported separately by our research team, 23 further reports detailing the context of different dental procedures helps enable research to inform future policy and practice.…”

Section: Introductionmentioning

confidence: 99%

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A systematic review of contamination (aerosol, splatter and droplet generation) associated with oral surgery and its relevance to COVID-19

et al. 2020

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Introduction The current COVID-19 pandemic caused by the SARS-CoV-2 virus has impacted the delivery of dental care globally and has led to re-evaluation of infection control standards. However, lack of clarity around what is known and unknown regarding droplet and aerosol generation in dentistry (including oral surgery and extractions), and their relative risk to patients and the dental team, necessitates a review of evidence relating to specific dental procedures. This review is part of a wider body of research exploring the evidence on bioaerosols in dentistry and involves detailed consideration of the risk of contamination in relation to oral surgery. Methods A comprehensive search of Medline (OVID), Embase (OVID), Cochrane Central Register of Controlled Trials, Scopus, Web of Science, LILACS and ClinicalTrials.Gov was conducted using key terms and MeSH (Medical Subject Headings) words relating to the review questions. Methodological quality including sensitivity was assessed using a schema developed to measure quality aspects of studies using a traffic light system to allow inter- and intra-study overview and comparison. A narrative synthesis was conducted for assessment of the included studies and for the synthesis of results. Results Eleven studies on oral surgery (including extractions) were included in the review. They explored microbiological (bacterial and fungal) and blood (visible and/or imperceptible) contamination at the person level (patients, operators and assistants) and/or at a wider environmental level, using settle plates, chemiluminescence reagents or air samplers; all within 1 m of the surgical site. Studies were of generally low to medium quality and highlighted an overall risk of contaminated aerosol, droplet and splatter generation during oral surgery procedures, most notably during removal of impacted teeth using rotatory handpieces. Risk of contamination and spread was increased by factors, including proximity to the operatory site, longer duration of treatment, higher procedural complexity, non-use of an extraoral evacuator and areas involving more frequent contact during treatment. Conclusion A risk of contamination (microbiological, visible and imperceptible blood) to patients, dental team members and the clinical environment is present during oral surgery procedures, including routine extractions. However, the extent of contamination has not been explored fully in relation to time and distance. Variability across studies with regards to the analysis methods used and outcome measures makes it difficult to draw robust conclusions. Further studies with improved methodologies, including higher test sensitivity and consideration of viruses, are required to validate these findings.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A systematic review of contamination (aerosol, splatter and droplet generation) associated with oral surgery and its relevance to COVID-19

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Long-Term Cardiovascular Outcomes in Children and Adolescents With Hypertension

Robinson,

Hussain,

Jeyakumar

et al. 2024

JAMA Pediatr

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ImportanceHypertension affects 6% of all children, and its prevalence is increasing. Childhood hypertension tracks into adulthood and is associated with subclinical cardiovascular disease; however, there is a lack of evidence linking childhood hypertension to cardiovascular outcomes, which may contribute to underdiagnosis and undertreatment.ObjectiveTo determine the long-term associated risk of major adverse cardiac events (MACE) among children diagnosed with hypertension.Design, Setting, and ParticipantsThis was a population-based, retrospective, matched cohort study conducted from 1996 to 2022. The study included all children (aged 3-18 years) alive in Ontario, Canada, from 1996 to 2021, who were identified using provincial administrative health databases. Children with prior kidney replacement therapy were excluded.ExposureIncident hypertension diagnosis, identified by validated case definitions using diagnostic and physician billing claims. Each case was matched with 5 controls without hypertension by age, sex, birth weight, maternal gestational hypertension, prior comorbidities (chronic kidney disease, diabetes, cardiovascular surgery), and a propensity score for hypertension.Main Outcomes and MeasuresThe primary outcome was MACE (a composite of cardiovascular death, stroke, hospitalization for myocardial infarction or unstable angina, or coronary intervention). Time to MACE was evaluated using the Kaplan-Meier method and Cox proportional hazards regression.ResultsA total of 25 605 children (median [IQR] age, 15 [11-17] years; 14 743 male [57.6%]) with hypertension were matched to 128 025 controls without hypertension. Baseline covariates were balanced after propensity score matching, and prior comorbidities were uncommon (hypertension vs control cohort: malignancy, 1451 [5.7%] vs 7908 [6.2%]; congenital heart disease, 1089 [4.3%] vs 5408 [4.2%]; diabetes, 482 [1.9%] vs 2410 [1.9%]). During a median (IQR) of 13.6 (7.8-19.5) years of follow-up, incidence of MACE was 4.6 per 1000 person-years in children with hypertension vs 2.2 per 1000 person-years in controls (hazard ratio, 2.1; 95% CI, 1.9-2.2). Children with hypertension were at higher associated risk of stroke, hospitalization for myocardial infarction or unstable angina, coronary intervention, and congestive heart failure, but not cardiovascular death, compared with nonhypertensive controls.Conclusions and RelevanceChildren diagnosed with hypertension had a higher associated long-term risk of MACE compared with controls without hypertension. Improved detection, follow-up, and control of pediatric hypertension may reduce the risk of adult cardiovascular disease.

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Novel use of riboflavin as a fluorescent tracer in the dissemination of aerosol and splatter in an open operatory dental clinic

Emery¹,

Reed²,

McCracken³

2023

Clinical & Exp Dental Res

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Objectives: The rapid spread of severe acute respiratory syndrome coronavirus 2 and the ensuing rise of the COVID-19 pandemic have impacted healthcare unprecedentedly. With the scarcity of available resources, including healthcare providers themselves, novel methods for tracking aerosol and splatter in real time are required to alleviate demand and increase safety. This study evaluates the utility of riboflavin (vitamin B 2 ) as a tracer for splatter/aerosol distribution from ultrasonic scaling in an open operatory clinic.Material and Methods: In two experimental designs, ultrasonic scaling was performed on 18 volunteers or simulated on a manikin. Riboflavin was introduced into the irrigation system, and aerosol and splatter dissemination were evaluated for both experimental designs.Results: Ultrasonic scaling utilizing riboflavin solution, in volunteers and manikins, leads to observable particle fluorescence under UV light. Contamination distribution varied across the different suction methods and between the volunteer and manikin trials. Nearly all observed incidences of contamination occurred within the operatory in use.Conclusions: Riboflavin can be used with minimal risk during dental procedures and allows for the detection of droplet spread in clinical settings in real time.

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A Systematic Review of Droplet and Aerosol Generation in Dentistry

Cited by 14 publications

References 35 publications

A systematic review of contamination (aerosol, splatter and droplet generation) associated with oral surgery and its relevance to COVID-19

A systematic review of contamination (aerosol, splatter and droplet generation) associated with oral surgery and its relevance to COVID-19

Long-Term Cardiovascular Outcomes in Children and Adolescents With Hypertension

Novel use of riboflavin as a fluorescent tracer in the dissemination of aerosol and splatter in an open operatory dental clinic

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