Evaluating contaminated dental aerosol and splatter in an open plan clinic environment: Implications for the COVID-19 pandemic

Holliday, Richard; Allison, James R.; Currie, Charlotte C; Edwards, D. G.; Bowes, Charlotte; Pickering, Kimberley; Reay, Sarah; Durham, Justin; Lumb, Joanna; Rostami, Nadia; Coulter, Jamie; Nile, Christopher J.; Jakubovics, Nicholas S.

doi:10.1016/j.jdent.2020.103565

Cited by 76 publications

(94 citation statements)

References 37 publications

(41 reference statements)

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“…In our case, with virus titration control in saline suspension and splatter collected directly at the USS, the concentration reduction was 0.87 log, which is near 10x dilution and goes perfectly with the ratio of virus suspension and irrigant flow. This observation confirms the importance of dilution, stated in previous studies (Epstein et al 2020; Holliday et al 2021)…”

Section: Discussionsupporting

confidence: 93%

“…Personal protective equipment can protect the dental care providers; however, the contamination of clinical environments by sprays still necessitates periods of “fallow time” between appointments to protect patients and staff (Sergis et al 2020). A special concern was raised for open plan clinic environments, reporting a safe distance of 5m (Holliday et al 2021) Although preprocedural mouth-rinse is included in most recommendations (Clarkson et al 2020), its effectiveness is questionable as no scientific clinical evidence exists for reducing the viral load (Carrouel et al 2020). So far, antiseptic mouth rinses containing cetylpyridinium chloride or povidone-iodine have shown the highest potential to reduce viral load in infected subjects (Herrera et al 2020).…”

Section: Introductionmentioning

confidence: 99%

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Virus transmission by ultrasonic scaler and its prevention by antiviral agent

Fidler

Steyer

Gašperšič

2021

Preprint

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During an ultrasonic scaler (USS) operation, droplets and aerosol are generated that may contribute to the transmission of viruses contained in saliva and gingival crevicular fluid. The purpose of this research was to develop an experimental model for testing the spread of viruses during USS instrumentation and to examining the prevention of spreading by replacing the coolant with an antiviral agent. In a virus transmission tunnel, USS operation with saline coolant and delivery of a viral suspension to the vicinity of USS tip generated droplets and aerosol containing Equine Arteritis Virus (EAV). Evaluation of droplet transmission was evaluated with adherent 48h cell culture monolayer RK13 cell lines in standard 48-well-plates positioned at a distance from 30 to 55 cm. The aerosol was collected by a cyclone aero-sampler flow of 100l/min. Antiviral activity of 0.25% sodium hypochlorite or electrolyzed water (EOW) was tested by suspension test. The two tested antiviral agents' transmission prevention ability was evaluated by repeating the same experiment as with saline coolant. All experiments were repeated twice. With saline coolant, the cytopathic effect on cells was found in cells up to the distance of 45 cm, with the number of infected wells decreasing with distance. Viral particles were detected in only one AS in a very low concentration (≤4.2 TCID50/ml). In suspension test of 0.25% NaOCl and EOW, the TCID50/ml was below detection limit after 5s. With both antiviral agents, no cytopathic effect was found. However, the cytotoxic effect of 0.25% NaOCl was evident up to the distance of 35 cm. By USS activity, EAV could be transmitted by droplets up to a distance of 45 cm. Both antiviral agents could prevent virus droplet transmission. The transmission of EAV by aerosol yielded inconclusive results.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Virus transmission by ultrasonic scaler and its prevention by antiviral agent

Fidler

Steyer

Gašperšič

2021

Preprint

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“…There is a serious deficiency in the literature regarding the risks posed by aerosols and splatter from aerosol-generating procedures (AGPs) in dental settings and the efficacy of various aerosol mitigation techniques. A number of studies have collected aerosols and splatters directly onto a collecting surface for subsequent analysis, which include fluorescent [13][14][15][16][17] or non-fluorescent [18][19][20] based chromatic indicators and microbiological methods using culture media [21][22][23][24] . These studies are limited by their inefficient collection of small size aerosols (<~50 µm) which do not provide a comprehensive characterization over the entire size spectrum.…”

Section: Introductionmentioning

confidence: 99%

Characterization and mitigation of aerosols and splatters from ultrasonic scalers

Placucci

Danielson

et al. 2021

Preprint

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Background: Dental procedures often produce aerosols and splatter which have the potential to transmit pathogens such as SARS-CoV-2. The existing literature is limited. Methods: Aerosols and splatter were generated from an ultrasonic scaling procedure on a dental mannequin and characterized by two optical imaging methods – digital inline holography (DIH) and laser sheet imaging (LSI). Capture efficiencies of various aerosol mitigation devices were evaluated and compared. Results: The ultrasonic scaling procedure generates a wide size range of aerosols up to a few hundred micrometers and occasional large splatter which emit at low velocity (mostly below 3 m/s). Use of a saliva ejector (SE) and high-volume evacuator (HVE) resulted in 63% and 88% of overall reduction respectively while an extraoral local extractor (ELE) resulted in a reduction of 96% at the nominal design flow setting. Conclusions: The study results showed that the use of ELE or HVE significantly reduced aerosol and splatter emission. The use of HVE generally requires an additional person to assist a hygienist, while an ELE can be operated hands-free when a dental hygienist is performing ultrasonic scaling and other operations. Practical Implications: An extraoral local extractor aids in the reduction of aerosols and splatters during ultrasonic scaling procedures, potentially reducing transmission of oral or respiratory pathogens, like SARS-CoV-2. Position and airflow of the device are important to effective aerosol mitigation.

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“…In this regard, governments around the world have dedicated renewed attention to APGs used in dental daily practice [ 33 ]. In fact, governments—including the Italian one—have promoted rules or recommendations to suspend routine dental treatments during the pandemic period [ 34 , 35 , 36 ]; subsequently, measures to reduce or avoid the production of droplets and aerosols have been strongly recommended, such as not to reduce the fallow time below 10 min in order to prevent larger droplets from settling on exposed surfaces [ 27 , 37 ]. On the same basis, natural ventilation may be recommended before and after each patient’s appointment within the fallow period, in order to provide air ventilation in the operating room.…”

Section: Discussionmentioning

confidence: 99%

Effects of Natural Ventilation and Saliva Standard Ejectors during the COVID-19 Pandemic: A Quantitative Analysis of Aerosol Produced during Dental Procedures

Rexhepi

Mangifesta

Santilli

et al. 2021

IJERPH

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The novel Coronavirus Disease 2019 (COVID-19) pandemic has renewed attention to aerosol-generating procedures (AGPs). Dental-care workers are at high risk of contamination by SARS-CoV-2. The aim of this study was to evaluate the efficacy of standard saliva ejectors and natural ventilation in reducing particulate matter (PM) concentration during different routine dental procedures in the pandemic period. The DustTrak monitor was used to measure PM1, PM2.5, PM10, and breathable (<4 microns) total dust during 14 procedures performed with and without the presence of natural ventilation in a dental unit. Moreover, measurements were performed near the practitioners or near the standard saliva ejectors during the different procedures. In the latter condition, reduced levels of PM10 were recorded (82.40 ± 9.65 μg/m3 vs. 50.52 ± 0.23 μg/m3). Moreover, higher levels of PM (53.95 ± 2.29 μg/m3 vs. 27.85 ± 0.14 μg/m3) were produced when the dental unit’s windows were open. At the same time, the total level of PM were higher during scaling than during other procedures (data suggest not to adopt natural ventilation—both window and door opened—during dental procedures). It was also demonstrated that the use of standard saliva ejectors can considerably reduce the total released amount of PM10.

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Evaluating contaminated dental aerosol and splatter in an open plan clinic environment: Implications for the COVID-19 pandemic

Cited by 76 publications

References 37 publications

Virus transmission by ultrasonic scaler and its prevention by antiviral agent

Virus transmission by ultrasonic scaler and its prevention by antiviral agent

Characterization and mitigation of aerosols and splatters from ultrasonic scalers

Effects of Natural Ventilation and Saliva Standard Ejectors during the COVID-19 Pandemic: A Quantitative Analysis of Aerosol Produced during Dental Procedures

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