Comparative evaluation of chlorhexidine and cinnamon extract used in dental unit waterlines to reduce bacterial load in aerosols during ultrasonic scaling
“…The unit water quality must comply with the safe drinking water standard (<500 CFU/mL). [30] Extra-precaution regarding dental unit and sterilization of hand instruments were reported by 32.4% and 29.8% of the participants, respectively. However, routine cleaning and maintenance of autoclaves, air compressors, suction systems and aspirators, radiography equipment, amalgam mixers and other dental equipment should be meticulously done according to the manufacturer's instructions to avoid cross infection.…”
Introduction
Performing dental procedures during the COVID-19 pandemic carries certain risks in terms of cross contamination.
Objectives
To evaluate the effect of specialty education and work environment on of dentists’ behavior, awareness and attitude regarding cross-infection control in COVID-19 pandemic.
Design
The study population consisted of Turkish dentists who work in private clinics, public clinics and university hospitals. Demographics of the participants, awareness of COVID-19 and clinical measures taken against cross-infection were evaluated with an online survey. Between 10th-20th of November 2020, 1,000 surveys were e-mailed to the dentists.
Results
A total 454 dentists answered the survey; 29.3% of the participants deliver only urgent care, 59.9% both urgent and routine treatments and personal protective equipment (PPE) were used at rates varying between 75.5% and 98.4%. 90.6% of the dentists stated that they were worried about aerosol generating dental procedures and there was no difference between sexes in this regard (p=0.119). The majority of participants, mainly specialists (p=0.16), applied strict cross-infection control methods during the COVID-19 pandemic (77.2%). The rate of PPE use was statistically higher by women compared to men (p=0.025) and by specialists compared to others (p=0.04). There was a weak positive correlation between level of PPE use and expertise (r=0.121, p=0.01).
Conclusions
Although participants' knowledge about the symptoms of COVID-19, transmission routes and following the guidelines were at a sufficient level, dental specialists apply protection equipment procedures more strictly. Although participants were concerned about dental practices that create microbial aerosols during the pandemic period, still they continue their dental routines using high levels of PPE and taking extra clinical precautions to avoid cross-infection.
“…The unit water quality must comply with the safe drinking water standard (<500 CFU/mL). [30] Extra-precaution regarding dental unit and sterilization of hand instruments were reported by 32.4% and 29.8% of the participants, respectively. However, routine cleaning and maintenance of autoclaves, air compressors, suction systems and aspirators, radiography equipment, amalgam mixers and other dental equipment should be meticulously done according to the manufacturer's instructions to avoid cross infection.…”
Introduction
Performing dental procedures during the COVID-19 pandemic carries certain risks in terms of cross contamination.
Objectives
To evaluate the effect of specialty education and work environment on of dentists’ behavior, awareness and attitude regarding cross-infection control in COVID-19 pandemic.
Design
The study population consisted of Turkish dentists who work in private clinics, public clinics and university hospitals. Demographics of the participants, awareness of COVID-19 and clinical measures taken against cross-infection were evaluated with an online survey. Between 10th-20th of November 2020, 1,000 surveys were e-mailed to the dentists.
Results
A total 454 dentists answered the survey; 29.3% of the participants deliver only urgent care, 59.9% both urgent and routine treatments and personal protective equipment (PPE) were used at rates varying between 75.5% and 98.4%. 90.6% of the dentists stated that they were worried about aerosol generating dental procedures and there was no difference between sexes in this regard (p=0.119). The majority of participants, mainly specialists (p=0.16), applied strict cross-infection control methods during the COVID-19 pandemic (77.2%). The rate of PPE use was statistically higher by women compared to men (p=0.025) and by specialists compared to others (p=0.04). There was a weak positive correlation between level of PPE use and expertise (r=0.121, p=0.01).
Conclusions
Although participants' knowledge about the symptoms of COVID-19, transmission routes and following the guidelines were at a sufficient level, dental specialists apply protection equipment procedures more strictly. Although participants were concerned about dental practices that create microbial aerosols during the pandemic period, still they continue their dental routines using high levels of PPE and taking extra clinical precautions to avoid cross-infection.
“…In 2 studies (Shetty et al 2013; Swaminathan et al 2014), no data or distributional parameters of the samples were readily available or could be inferred from the published article within text, figures, or tables, while communication with authors was attempted but still remained unsuccessful. Of the 21 randomized controlled trials, 8 were noneligible, and the reasons were related to noncomparable procedural settings—that is, interventions for air polishing (Logothetis and Martinez-Welles 1995), ultrasonic liquid coolers (Jawade et al 2016; Sethi et al 2019), added solutions in DUWL (Mamajiwala et al 2018), correlated study design (Fine et al 1992; King et al 1997), or noncomparable assessment of the outcome and use of effect measure. Nonrandomized studies were a priori excluded from the network meta-analysis, following the design of the protocol.…”
Section: Resultsmentioning
confidence: 99%
“…An array of interventions has been proposed over a considerable amount of time to reduce environmental or patient- and professional-related aerosol-induced contamination, mainly directed toward the use of antiseptic agents as preprocedural mouthwash rinse solutions (Logothetis and Martinez-Welles 1995; Sethi et al 2019). Use of alternative schemes has also been reported, such as high-volume evacuators (Holloman et al 2015), in-service instrumentation coolant agents (Jawade et al 2016), and antiseptic agents directly applied to the DUWLs (Mamajiwala et al 2018).…”
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.
“…35,36 The most prevalent recorded approaches were preprocedural mouth rinse using a wide variety of potentially antimicrobial agents, such as, chlorhexidine (CHX) 0.12%, CHX 0.2% or tempered CHX 0.2%, cetylpiridinium chloride 0.05%, povidone iodine (PI) 1%, chlorine dioxide, herbal-based agents, or others pertaining to ozone irrigation, use of high volume evacuators and/or dental isolation systems, or agents added to DUWLs to reduce the load. 27,28,37,38 Evidence from a study on bacterial load during orthodontic procedures comparing bracket debonding followed by enamel clean-up with high-speed handpiece and water cooling versus standard orthodontic care involving archwire and/or ligature change, and replacing procedures, highlighted the increased pathogenic state of aerosols produced by the former, with a mean difference of 49.2 (95% CI, 19.4-79.0) in total CFUs. 31 This highlights the exposure hazards of orthodontists related to certain orthodontic procedures in practice and draws attention to additional prophylactic measures to be selectively taken within the dental operating office.…”
Section: Microbiologic Considerations and Bio-aerosolsmentioning
confidence: 99%
“… 35 , 36 The most prevalent recorded approaches were preprocedural mouth rinse using a wide variety of potentially antimicrobial agents, such as, chlorhexidine (CHX) 0.12%, CHX 0.2% or tempered CHX 0.2%, cetylpiridinium chloride 0.05%, povidone iodine (PI) 1%, chlorine dioxide, herbal-based agents, or others pertaining to ozone irrigation, use of high volume evacuators and/or dental isolation systems, or agents added to DUWLs to reduce the load. 27 , 28 , 37 , 38 Fig 2 Network map geometry for competing interventions with regard to bacterial load reduction in produced aerosol within dental settings. Size of the node is analogous to the contribution of the sample size for each intervention overall and width of edge to the number of direct comparisons.…”
Section: Microbiologic Considerations and Bio-aerosolsmentioning
The purpose of this critical review is to list the sources of aerosol production during orthodontic standard procedure, analyze the constituent components of aerosol and their dependency on modes of grinding, the presence of water and type of bur, and suggest a method to minimize the quantity and detrimental characteristics of the particles comprising the solid matter of aerosol. Minimization of water-spray syringe utilization for rinsing is suggested on bonding related procedures, while temporal conditions as represented by seasonal epidemics should be considered for the decision of intervention scheme provided as a preprocedural mouth rinse, in an attempt to reduce the load of aerosolized pathogens. In normal conditions, chlorhexidine 0.2%, preferably under elevated temperature state should be prioritized for reducing bacterial counts. In the presence of oxidation vulnerable viruses within the community, substitute strategies might be represented by the use of povidone iodine 0.2%-1%, or hydrogen peroxide 1%. After debonding, extensive material grinding, as well as aligner related attachment clean-up, should involve the use of carbide tungsten burs under water cooling conditions for cutting efficiency enhancement, duration restriction of the procedure, as well as reduction of aerosolized nanoparticles. In this respect, selection strategies of malocclusions eligible for aligner treatment should be reconsidered and future perspectives may entail careful and more restricted utilization of attachment grips. For more limited clean-up procedures, such as grinding of minimal amounts of adhesive remnants, or individualized bracket debonding in the course of treatment, handinstruments for remnant removal might well represent an effective strategy. Efforts to minimize the use of rotary instrumentation in orthodontic settings might also lead the way for future solutions. Measures of self-protection for the treatment team should never be neglected. Dressing gowns and facemasks with filter protection layers, appropriate ventilation and fresh air flow within the operating room comprise significant links to the overall picture of practice management. Risk management considerations should be constant, but also updated as new material applications come into play, while being grounded on the best available evidence.
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