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:10.1016/j.jdent.2020.103556

Cited by 113 publications

(128 citation statements)

References 48 publications

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“…Previously published studies represent the behaviour of droplets (splatter) in the dental clinics after AGP, rather than considering aerosol (of <5μm) (Shahdad et al 2020). Moreover, a recent literature review concluded that the current evidence base cannot support a defined and appropriate FT for dental AGPs in the context of the COVID-19 pandemic with very weak evidence that peaks in bacterial dissemination during dental procedures which may take approximately 30 minutes to dissipate (SDCEP 2020; Innes et al 2021).…”

Section: Discussionmentioning

confidence: 99%

Fallow time determination in dentistry using aerosol measurement

Shahdad

Hindocha

Patel

et al. 2021

Preprint

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AimTo calculate fallow time (FT) required following dental aerosol generating procedures (AGPs) in both a dental hospital (mechanically ventilated) and primary care (non-mechanically ventilated). Secondary outcomes were to identify spread and persistence of aerosol in open clinics compared to closed surgeries (mechanically ventilated environment), and identify if extra-oral scavenging (EOS) reduces production of aerosol and FT.MethodsIn vitro simulation of fast handpiece (FHP) cavity preparations using a manikin was conducted in a mechanically and non-mechanically ventilated environment using Optical Particle Sizer™ and NanoScan™ at baseline, during the procedure and fallow period.ResultsAGPs carried out in the non-mechanically, non-ventilated environment failed to achieve baseline particle levels after one hour. In contrast, when windows were opened after AGP, there was an immediate reduction in all particle sizes.In mechanically ventilated environments the baseline levels of particles were very low and particle count returned to baseline within 10 minutes following AGP. There was no detectable difference between particles in mechanically ventilated open bays and closed surgeries.The effect of the EOS was greater in non-mechanically ventilated environment on reducing the particle count; additionally, it also reduced the spikes in particle counts in mechanically ventilated environments.ConclusionHigh-efficiency particulate air filtered mechanical ventilation along with mitigating factors (high-volume suction) resulted in reduction of FT (10 minutes). Non-ventilated rooms failed to reach baseline level even after one hour of FT. There was no difference in particle counts in open bay or closed surgeries in mechanically ventilated settings. The use of an EOS device can reduce the particulate spikes during procedures in both mechanical and non-mechanical environments.This study confirms that AGPs are not recommended in dental surgeries where no ventilation is possible. No difference was demonstrated in FT required in open bays and closed surgeries in mechanically ventilated settings.Clinical significanceAGPs should not be carried out in surgeries where ventilation is not possible. Mechanical ventilation for AGPs should be gold standard; where not available or practical then the use of natural ventilation with EOS helps reduce FT. AGPs can be carried out in open bay environment with a minimum of 6 air changes per hour of mechanical ventilation. Four-handed dentistry with high-volume suction and saliva ejector are essential mitigating factors during AGPs.

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Section: Discussionmentioning

confidence: 99%

Fallow time determination in dentistry using aerosol measurement

Shahdad

Hindocha

Patel

et al. 2021

Preprint

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“…Recent evidence demonstrated three main routes for the transmission of SARS-CoV-2 in dental settings: (1) direct transmission via inhalation of the virus via cough droplets; (2) transmission via oral, nasal, or eye membranes; and (3) direct contact transmission ( 27 ). All these three transmission routes are facilitated by dental procedures generated aerosols ( 28 ). It's important to highlight here that the majority of previous studies quantifying bio-aerosol generation during dental instrumentations have a range of differences in between them.…”

Section: Practice-based Clinical Challengesmentioning

confidence: 99%

Dental Education in the Time of COVID-19 Pandemic: Challenges and Recommendations

Hassan

Amer

2021

Front. Med.

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Moving within the second wave of the coronavirus (COVID-19) pandemic, dental education delivery has been profoundly affected by this crisis, so has the structure, evaluation, and future of dental education. Both pre-clinical and clinical dental education have experienced challenges ranging from fully online educational content to limited dental training for senior dental students. This crisis appears to be a tipping point that produced confusion in dental teaching especially clinical sciences. Although medical institutions immediately started to adapt to the unexpected COVID-19 crisis, dental and oral health educational services are profoundly impaired due to the dental team's propinquity to the patient and the aerosols generated during routine dental therapeutic procedures. Dental students unlike other medical students are considered to be at the highest risk due to the nature of their clinical training that includes working in the oral cavity of patients using aerosol-generating equipment. Some dental schools have taken the leadership and documented their modifications during this pandemic; however, there is a serious need for further investigation and wide range screening of the situation in the dental schools during the COVID-19 crisis. The aim of this mini-review is to present these challenges and how academic dental institutions have implemented strategies to overcome them.

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“…55 Mechanical treatment with these composites by dental instruments (dental handpieces, ultrasonic scalers, air polishers) produces a significant amount of aerosolized particles with variable size in the operation room. 20,56 Nanoparticles originating from these materials, 57 fractioned teeth, droplet formation from mouth fluids or saliva are the major components of the produced aerosols. 55,58 Contrarily, background concentrations (unoccupied clinic) were considerably lower than activity concentrations (occupied clinic) for all particle size classes.…”

Section: Color Keymentioning

confidence: 99%

Airborne particles and microorganisms in a dental clinic: Variability of indoor concentrations, impact of dental procedures, and personal exposure during everyday practice

et al. 2021

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Studying air quality in healthcare facilities comprises of identification of the contaminant sources, their dispersion, and impact on indoor air. 1,2 Considering as ultimate purpose pathogen mitigation, minimization of the acquired infections both for the patients and the personnel is a challenging issue, 3,4 not only because of the direct contact with the contaminant sources but also due to their great variability in their characteristics and properties.Airborne particulate contaminants consist mainly of aerosols and/or particles of biological matter, that is, bioaerosols. Airborne aerosol properties vary considerably depending on their size and chemical/biological composition. 5 In turn, their size and composition are governed by their origin (natural environment, anthropogenic

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A systematic review of droplet and aerosol generation in dentistry

Cited by 113 publications

References 48 publications

Fallow time determination in dentistry using aerosol measurement

Fallow time determination in dentistry using aerosol measurement

Dental Education in the Time of COVID-19 Pandemic: Challenges and Recommendations

Airborne particles and microorganisms in a dental clinic: Variability of indoor concentrations, impact of dental procedures, and personal exposure during everyday practice

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