Dental Aerosol as a Hazard Risk for Dental Workers

Abstract

Standard dental procedures, when using a water coolant and rotary instruments, generate aerosols with a significantly higher number of various dangerous pathogens (viruses, bacteria, and fungi). Reducing the amount of aerosols to a minimum is mandatory, especially during the new coronavirus disease, COVID-19. The study aimed to evaluate the amount of aerosol generated during standard dental procedures such as caries removal (using dental bur on a high and low-speed handpiece and Er:YAG laser), ultrasonic scaling, and tooth polishing (using silicon rubber on low-speed handpiece) combined with various suction systems. The airborne aerosols containing particles in a range of 0.3–10.0 μm were measured using the PC200 laser particle counter (Trotec GmbH, Schwerin, Germany) at three following sites, manikin, operator, and assistant mouth, respectively. The following suction systems were used to remove aerosols: saliva ejector, high volume evacuator, saliva ejector with extraoral vacuum, high volume evacuator with extraoral vacuum, Zirc® evacuator (Mr.Thirsty One-Step®), and two customized high volume evacuators (white and black). The study results showed that caries removal with a high-speed handpiece and saliva ejector generates the highest amount of spray particles at each measured site. The aerosol measurement at the manikin mouth showed the highest particle amount during caries removal with the low and high-speed handpiece. The results for the new high volume evacuator (black) and the Zirc® evacuator showed the lowest increase in aerosol level during caries removal with a high-speed handpiece. The Er:YAG laser used for caries removal produced the lowest aerosol amount at the manikin mouth level compared to conventional dental handpieces. Furthermore, ultrasonic scaling caused a minimal aerosol rise in terms of the caries removal with bur. The Er:YAG laser and the new wider high volume evacuators improved significantly suction efficiency during dental treatment. The use of new suction systems and the Er:YAG laser allows for the improvement of biological safety in the dental office, which is especially crucial during the COVID-19 pandemic.

Impact of COVID-19 Pandemic on Healthcare Professionals and Oral Care Operational Services: A Systemic Review

“… 42–44 It is important to highlight the benefits of utilizing laser-assisted therapy for adult patients as well, due to its advantages in producing less aerosols, eliminating tooth vibration, minimal to less local anesthetic administration and providing analgesic effects. 45 …”

“…[42][43][44] It is important to highlight the benefits of utilizing laser-assisted therapy for adult patients as well, due to its advantages in producing less aerosols, eliminating tooth vibration, minimal to less local anesthetic administration and providing analgesic effects. 45 It is significant to emphasize tooth brushing with fluoridated toothpaste for all patients, including children, to prevent tooth decay. 46 A report by Addy highlighted the importance of oral hygiene by stating that the majority of toothpastes, if not all of them, contain detergents/surfactants with significant antimicrobial properties, which are similar to those in the detergents of many hand-washing formulations recommended against coronavirus.…”

Characterization and mitigation of aerosols and splatters from ultrasonic scalers

“…This is especially important as smaller aerosols may carry SARS-CoV-2 virus (0.06 -0.14 µm 25 ). Some investigations have used aerosol sampling techniques 21,[26][27][28][29][30][31] , but suffer from limited sampling of large aerosols and splatters or incorrect use of the sampling devices.…”

Aerosol formation due to a dental procedure: insights leading to the transmission of diseases to the environment

“…In a recent report, the World Health Organization (WHO) acknowledged the need for dental work to continue and highlighted that this necessitates the use of aerosol-producing tools [8,9]. Also, some other recent studies suggested the use of new suction systems and an Er:YAG laser, as well as the correct application of a disinfectant in order to improve biological safety in the dental clinic/office especially during the COVID-19 pandemic [10,11].…”