Infection Control in Dental Clinics: Prosthodontics Perspectives.

AIM: The aim of this article is to discuss the infection control measures with focus on those related to prosthodontic work. BACKGROUND: The risk of transmission of several infectious microorganisms during dental procedures and the increased awareness and knowledge of infectious diseases have led to an increased attention to the importance of infection control. Prosthodontists and dental personnel are exposed directly or indirectly to a significant risk of acquiring healthcare-associated infections. REVIEW RESULTS: High standards of occupational safety and dental infection control must be applied by dental personnel for the safety of patients and dental healthcare workers. All reusable items (critical and semicritical instruments) that come in contact with the patient's saliva, blood, or mucous membranes must be heat-sterilized. Proper disinfectants should be used to disinfect nonsterilizable instruments (e.g., wax knifes, dental shade plastic mixing spatula, guides, fox bite plane, articulators, and facebows). CONCLUSION: In prosthodontics, items potentially contaminated with patient's blood and saliva are transported between dental clinics and dental laboratories. Such fluids may contain microorganisms with high potential for transmission of several diseases. Therefore, sterilization and disinfection of all items used during prosthodontic work should be part of infection control protocol in dental care setting. CLINICAL SIGNIFICANCE: In prosthodontic practice, a strict infection prevention plan should be implemented to minimalize the risk of infectious diseases transmission among prosthodontists, dental office, dental laboratory personnel, and patients.

Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases.

BACKGROUND: Many dental procedures produce aerosols (droplets, droplet nuclei and splatter) that harbour various pathogenic micro-organisms and may pose a risk for the spread of infections between dentist and patient. The COVID-19 pandemic has led to greater concern about this risk. OBJECTIVES: To assess the effectiveness of methods used during dental treatment procedures to minimize aerosol production and reduce or neutralize contamination in aerosols. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases on 17 September 2020: Cochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (in the Cochrane Library, 2020, Issue 8), MEDLINE Ovid (from 1946); Embase Ovid (from 1980); the WHO COVID-19 Global literature on coronavirus disease; the US National Institutes of Health Trials Registry (ClinicalTrials.gov); and the Cochrane COVID-19 Study Register. We placed no restrictions on the language or date of publication. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on aerosol-generating procedures (AGPs) performed by dental healthcare providers that evaluated methods to reduce contaminated aerosols in dental clinics (excluding preprocedural mouthrinses). The primary outcomes were incidence of infection in dental staff or patients, and reduction in volume and level of contaminated aerosols in the operative environment. The secondary outcomes were cost, accessibility and feasibility. DATA COLLECTION AND ANALYSIS: Two review authors screened search results, extracted data from the included studies, assessed the risk of bias in the studies, and judged the certainty of the available evidence. We used mean differences (MDs) and 95% confidence intervals (CIs) as the effect estimate for continuous outcomes, and random-effects meta-analysis to combine data. We assessed heterogeneity. MAIN RESULTS: We included 16 studies with 425 participants aged 5 to 69 years. Eight studies had high risk of bias; eight had unclear risk of bias. No studies measured infection. All studies measured bacterial contamination using the surrogate outcome of colony-forming units (CFU). Two studies measured contamination per volume of air sampled at different distances from the patient's mouth, and 14 studies sampled particles on agar plates at specific distances from the patient's mouth. The results presented below should be interpreted with caution as the evidence is very low certainty due to heterogeneity, risk of bias, small sample sizes and wide confidence intervals. Moreover, we do not know the 'minimal clinically important difference' in CFU. High-volume evacuator Use of a high-volume evacuator (HVE) may reduce bacterial contamination in aerosols less than one foot (~ 30 cm) from a patient's mouth (MD -47.41, 95% CI -92.76 to -2.06; 3 RCTs, 122 participants (two studies had split-mouth design); very high heterogeneity I² = 95%), but not at longer distances (MD -1.00, -2.56 to 0.56; 1 RCT, 80 participants). One split-mouth RCT (six participants) found that HVE may not be more effective than conventional dental suction (saliva ejector or low-volume evacuator) at 40 cm (MD CFU -2.30, 95% CI -5.32 to 0.72) or 150 cm (MD -2.20, 95% CI -14.01 to 9.61). Dental isolation combination system One RCT (50 participants) found that there may be no difference in CFU between a combination system (Isolite) and a saliva ejector (low-volume evacuator) during AGPs (MD -0.31, 95% CI -0.82 to 0.20) or after AGPs (MD -0.35, -0.99 to 0.29). However, an 'n of 1' design study showed that the combination system may reduce CFU compared with rubber dam plus HVE (MD -125.20, 95% CI -174.02 to -76.38) or HVE (MD -109.30, 95% CI -153.01 to -65.59). Rubber dam One split-mouth RCT (10 participants) receiving dental treatment, found that there may be a reduction in CFU with rubber dam at one-metre (MD -16.20, 95% CI -19.36 to -13.04) and two-metre distance (MD -11.70, 95% CI -15.82 to -7.58). One RCT of 47 dental students found use of rubber dam may make no difference in CFU at the forehead (MD 0.98, 95% CI -0.73 to 2.70) and occipital region of the operator (MD 0.77, 95% CI -0.46 to 2.00). One split-mouth RCT (21 participants) found that rubber dam plus HVE may reduce CFU more than cotton roll plus HVE on the patient's chest (MD -251.00, 95% CI -267.95 to -234.05) and dental unit light (MD -12.70, 95% CI -12.85 to -12.55). Air cleaning systems One split-mouth CCT (two participants) used a local stand-alone air cleaning system (ACS), which may reduce aerosol contamination during cavity preparation (MD -66.70 CFU, 95% CI -120.15 to -13.25 per cubic metre) or ultrasonic scaling (MD -32.40, 95% CI - 51.55 to -13.25). Another CCT (50 participants) found that laminar flow in the dental clinic combined with a HEPA filter may reduce contamination approximately 76 cm from the floor (MD -483.56 CFU, 95% CI -550.02 to -417.10 per cubic feet per minute per patient) and 20 cm to 30 cm from the patient's mouth (MD -319.14 CFU, 95% CI - 385.60 to -252.68). Disinfectants ‒ antimicrobial coolants Two RCTs evaluated use of antimicrobial coolants during ultrasonic scaling. Compared with distilled water, coolant containing chlorhexidine (CHX), cinnamon extract coolant or povidone iodine may reduce CFU: CHX (MD -124.00, 95% CI -135.78 to -112.22; 20 participants), povidone iodine (MD -656.45, 95% CI -672.74 to -640.16; 40 participants), cinnamon (MD -644.55, 95% CI -668.70 to -620.40; 40 participants). CHX coolant may reduce CFU more than povidone iodine (MD -59.30, 95% CI -64.16 to -54.44; 20 participants), but not more than cinnamon extract (MD -11.90, 95% CI -35.88 to 12.08; 40 participants). AUTHORS' CONCLUSIONS: We found no studies that evaluated disease transmission via aerosols in a dental setting; and no evidence about viral contamination in aerosols. All of the included studies measured bacterial contamination using colony-forming units. There appeared to be some benefit from the interventions evaluated but the available evidence is very low certainty so we are unable to draw reliable conclusions. We did not find any studies on methods such as ventilation, ionization, ozonisation, UV light and fogging. Studies are needed that measure contamination in aerosols, size distribution of aerosols and infection transmission risk for respiratory diseases such as COVID-19 in dental patients and staff.

Clinical validation of a nanodiamond-embedded thermoplastic biomaterial.

Detonation nanodiamonds (NDs) are promising drug delivery and imaging agents due to their uniquely faceted surfaces with diverse chemical groups, electrostatic properties, and biocompatibility. Based on the potential to harness ND properties to clinically address a broad range of disease indications, this work reports the in-human administration of NDs through the development of ND-embedded gutta percha (NDGP), a thermoplastic biomaterial that addresses reinfection and bone loss following root canal therapy (RCT). RCT served as the first clinical indication for NDs since the procedure sites involved nearby circulation, localized administration, and image-guided treatment progress monitoring, which are analogous to many clinical indications. This randomized, single-blind interventional treatment study evaluated NDGP equivalence with unmodified GP. This progress report assessed one control-arm and three treatment-arm patients. At 3-mo and 6-mo follow-up appointments, no adverse events were observed, and lesion healing was confirmed in the NDGP-treated patients. Therefore, this study is a foundation for the continued clinical translation of NDs and other nanomaterials for a broad spectrum of applications.

Importance of disinfection time and procedure with different alginate impression products to reduce dimensional instability.

AIMS: The aim of this study was to determine the best approach to reduce the unfavorable change in the three different dimensions of impressions using disinfection durations of 15 and 30 min; three different disinfection procedures; and alginate impression products as research factors. MATERIALS AND METHODS: CA37, impressional, and cream alginate impressions were used; distortion in the AB, AC, and BC dimensions of impressions using disinfection durations of 15 and 30 min was studied; and no disinfection (ND), conventional disinfection (CD), and sonicator-activated disinfection (SAD) procedures were measured. RESULTS: Regarding AB dimension, the impressional has best performance when CD was applied for both 15 and 30 min. When SAD was applied for 15 min, impressional and cream alginates provide best performance. When CD was applied for 15 min, CA37 and impressional alginates provide best performance. Although ND-applied CA37 alginate after 30 min provides best performance, because of many outlier values, its implication may not be considered as meaningful. Regarding AC dimension, cream alginate has best performance when CD was applied for 15 min. The AC distances in all the alginates are considerably different from the base model after 30 min. Regarding BC dimension, only the CA37 alginate has the best performance when ND was applied for 15 min. All the alginates are considerably different from that of the base model after 30 min. CONCLUSION: Preference of 15-min disinfection can provide favorable results to obtain all impressions with minimally distorted dimensions. CD is an adequate procedure. The studied SAD needs to be developed further. All alginates are comparably successful to obtain impressions with desired distortion degrees.

Knowledge, attitude and compliance of infection control guidelines among dental faculty members and students in KSU.

BACKGROUND: Infection is one of the most crucial problems in health care services worldwide. It is considered one of the most important causes of morbidity and mortality associated with clinical, diagnostic and therapeutic procedures. Therefore, the purpose of this study was to investigate knowledge, attitude, and compliance with recommended infection control guidelines among dental faculty members and students at King Saud University, Riyadh, Kingdom of Saudi Arabia. METHODS: A cross-sectional study was conducted to obtain information regarding knowledge, attitude, and compliance with recommended infection control guidelines. The sample (n = 317) comprised of dental faculty members and students (3rd, 4th and 5th year) in both male and female campuses of College of Dentistry (KSU). This questionnaire contained three parts (knowledge, attitude, and compliance) and was distributed to the participants. After validation of the survey, data were collected, entered and analyzed by SPSS software. RESULTS: A total of 317 dental faculty members and students participated in this study. Out of the total study subjects, 141 (44.5%) were female and 176 (55.5%) were male. A comparison between dental faculty members and students was made based on their knowledge, attitude, and compliance, which resulted in almost equal percentages of knowledge (49.6, 49.0% respectively). In addition, it revealed that faculty members' attitude toward infection control in the dental clinic was more positive compared to their compliance with the infection control guidelines (70.6, 65.2% respectively) while with the students it was vice versa (67.2, 69.6% respectively). There is no statistically significant difference in the knowledge and attitude of dental faculty members and students regarding infection control guidelines (P > 0.05). CONCLUSION: Our study showed that dental undergraduate student and faculty members at KSU demonstrated a good adherence to infection control guidelines. On the other hand, there was a lack in the knowledge of the basics of infection control standards.

Cleaning of used rotary nickel-titanium files in an ultrasonic bath by locally intensified acoustic cavitation.

AIM: To compare the pre-sterilization cleaning of rotary Ni-Ti files of different sizes previously used a. ex vivo and b. clinically by a washer-disinfector, a regular ultrasonic bath, and the same ultrasonic bath in combination with a recently developed cavitation intensifying method. METHODOLOGY: Two sets of two hundred rotary Ni-Ti files, one previously used ex vivo and another one used clinically, were collected from the undergraduate and postgraduate clinics of the Academic Centre for Dentistry Amsterdam (ACTA). The instruments were immersed in an enzymatic solution and subsequently cleaned either by a washer-disinfector, a regular ultrasonic bath combined with a glass beaker, the same bath combined with a beaker lined with two cavitation intensifying sheets or with two standard plastic sheets. The positive control consisted of used files that did not undergo any cleaning and the negative control included new unused files. The instruments were then stained to reveal remaining protein material and scored under a stereoscopic microscope. The results were analysed by nonparametric statistical tests (α = 0.05). RESULTS: No significant difference was found between the combination of the ultrasonic bath and the regular glass beaker and the same ultrasonic bath with the beaker lined with the cavitation intensifying sheets. The washer-disinfector left significantly more debris compared to the latter group when clinically used files were evaluated (P ≤ 0.001). The effect of instrument size on cleaning was not consistent. CONCLUSION: None of the tested methods was able to remove all residual protein material from the files; however, it could be noted that this study did not follow the reprocessing protocol provided by the manufacturer.

Awareness, knowledge, and attitude of dental students toward infection control in prosthodontic clinic of a dental school in India.

BACKGROUND: Infection control practices are crucial and important elements in clinical dentistry as there is an increase in the prevalence of infectious diseases among dental patients. This necessitates the application of recommended procedures for infection control in dental schools and clinics. OBJECTIVES: The aim is to evaluate the awareness, knowledge, and attitude of the undergraduate dental students toward infection control measures in the prosthodontic clinic and to assess their satisfaction toward applying these measures during prosthodontic treatment. MATERIALS AND METHODS: A questionnaire-based study was conducted among 180 third, fourth and fifth year dental students (119 females and 61 males) in November 2015 in a private dental school of Rani Durgawati University, Jabalpur (Madhya Pradesh), India. It included 25 close-ended questions related to vaccination status and previous sharp injuries, awareness, knowledge, and attitude toward infection control in the prosthodontic clinic, previous education about infection control, and subjects' satisfaction with their knowledge and attitude. The questionnaire was distributed among 3rd, 4th, and 5th year students and informed consent were obtained before commencing the questionnaire. RESULTS: A total of 180 participants responded to the questionnaire. Their perception toward infection control practices in the prosthodontic clinic varied from 14.4% to 100%, where former were regularly disinfecting dental cast before sending it to the laboratory and later ones were regularly using gloves while attending the patient. Most of the subjects responded "good" or "fair" to the questions related to the evaluation of their knowledge and policy implementation of infection control in prosthodontic clinic (P < 0.0001). Around 47.8% were almost satisfied, and 28.9% were fairly satisfied with their knowledge and performance. CONCLUSIONS: The study findings showed inadequate attitude and awareness of subjects toward infection control in prosthodontic practice. Their self-assessment and satisfaction reflect their performance toward infection control policy.

Antibacterial Effect of Surface Pretreatment Techniques against Streptococcus Mutans.

OBJECTIVE: The aim of this study was to evaluate the antibacterial surface pretreatment methods against Streptococcus mutans within the infected dentin surface using a tooth cavity model. MATERIAL AND METHODS: Seventy-two cavities were prepared on caries-free third molars (n = 8). After sterilization, teeth were inoculated with S. mutans for 48 h. One cavity of each tooth was used to evaluate the infection. Following inoculation, infected cavity surfaces were treated either with (1) Er:YAG Laser (1W; 5x5s, Smart 2940D Plus, Deka Laser), (2) Ozone (80s; HealOzone, Kavo), (3) ErYAG-Ozone combination, (4) Er:YAG-Ozone-CHX combination, (5) Chlorhexidine (CHX), (6) Clearfil Protect Bond (PB), (7) potassium-titanyl-phosphate (KTP) Laser (1W; 60 s, SMARTLITE D, Deka Laser), (8) KTP-Ozone combination, and (9) KTP-Ozone-CHX. Standardized amounts of dentin chips were obtained from the cavity walls, and the number of bacteria recovered was counted. Kruskal-Wallis test was used for statistical analyzes. RESULTS: Both sole antibacterial materials, CHX or Protect Bond application, exhibited the most effective antibacterial activity with 125 and 156 CFU is an acronym of "colony forming unit" usullay mentioned by acronym. (CFU/ml), respectively, among the groups evaluated (P < 0.05). Er:YAG laser irradiation and its combinations with other antibacterial surface pretreatment applications also inhibited the bacterial growth with, respectively, 1444, 406, and 294 CFU/ml bacterial recovery being more efficient than KTP laser irradiation and ozone combinations. CONCLUSIONS: As an alternative device with photodynamic effects, Er:YAG and KTP laser irradiations and their further combinations during the cavity pretreatment procedure with chlorhexidine and ozone treatments exerted antibacterial effect against S. mutans, whereas chlorhexidine and antibacterial dentin bonding application solely have the highest antibacterial effects.

[Implementation of effective infection control: furnishing a -dental practice]. / Infectiepreventie in de praktijk ­ het inrichten van de tandartspraktijk.

The increasing resistance to antibiotics and the aging of the population of patients who visit the dental practice can lead to more frequent infections with (resistant) microorganisms. The prevention of cross contamination by the implementation of effective measures in the area of hygiene and procedures of infection control is therefore important. The furnishing of a dental practice can play an important part in prevention. What are the important issues in furnishing a practice? A distinction is made between 'critical' and 'non-critical' rooms. Patients are only treated and instruments are only prepared for reuse in critical rooms. In these rooms, a strict separation is maintained between clean and contaminated, in both place and time. Only furniture that is strictly necessary for the treatment of patients is present in the critical rooms. Materials and equipment that are kept within the splatter area must be stored as much as possible in drawers and closed cabinets. Water taps can be controlled in a touch-free manner and are located within the present walking routes of the practice.

California Infection Control Regulations for Dental Professionals.

Infection control regulations that affect dental professionals come from several regulatory agencies and are increasingly complex. Staying up to date on changes and the overlapping requirements can challenge a busy dental practice. This article reviews the current regulations in California and suggests methods for ensuring every dental office is in compliance.

Sterilization for Large Volunteer Temporary Clinics.

Large portable clinics staffed by volunteers present many unique challenges, including establishing appropriate instrument processing services. This article explores many of the specific steps an organization can take to ensure a safe care environment for patients and a safe working environment for volunteers.

Dental unit water treatment with hydrogen peroxide and monovalent silver ions artificially contaminated with freshly isolated pathogens.

BACKGROUND: Dental unit water (DUW) could be contaminated by human pathogens coming from biological fluids penetrated during patient treatment and by opportunistic pathogens detached from aquatic biofilm. These microorganisms could be spread to following patients. We tested the disinfectant activity of hydrogen peroxide and monovalent silver ions (H(2)O(2)-Ag(+)) into DUW artificially contaminated with freshly isolated pathogens. METHODS: The tested microorganisms were Staphylococcus aureus, Enterococcus faecalis, Candida albicans, Pseudomonas aeruginosa, Legionella pneumophila, Mycobacterium chelonae, non-pathogenic Bacillus clausii spores. Bacterial suspensions were inoculated into the waterlines of pre-sterilized dental turbines. The test-turbines were connected to DUW and contaminated water was treated for 10 minutes with H(2)O(2)-Ag(+)-based disinfectant (H(2)O(2) 3% v/v, Ag(+) 0.001% w/v). The control-turbines were left untreated. Turbines were washed with sterile hard water used to assess the residual bacterial loads (expressed in colony forming units -cfu). Each strain was tested five times and the mean log loads were assessed. Following the European Standardization Committee, the disinfectant activity was evaluated as mean log load reduction, that is, the difference between the mean log load detected on the control-turbines and the mean log load detected on the test-turbines. RESULTS: Mean bacterial loads detected on the control-turbines ranged between 105-107 cfu. The mean log load reductions resulted 7.5 log cfu for S. aureus, E. faecalis, P. aeruginosa, 6.3 for C. albicans, 5.4 for L. pneumophila, 5.3 for M. chelonae, 2.9 for B. clausii spores. CONCLUSIONS: DUW disinfection with H(2)O(2)-Ag(+) could help minimize the risk that planktonic pathogens are spread to patients during dental treatment.

[Monitoring steam sterilisation processes in the dental office]. / Het monitoren van stoomsterilisatieprocessen in de mondzorgpraktijk.

In dental offices, steam sterilisation is used to sterilise instruments and in that way to prevent the cross-contamination of patients and the dental team. In order to ensure that the sterilisation process has been executed successfully, every sterilisation process has to be monitored. The monitoring of every load in the steam steriliser is necessary and often even required, either directly (by legislation) or indirectly (by harmonised standards). The complete monitoring protocol consists of controls of the installation, the exposure, the loading, the packaging and, finally, the 'track and trace' of the instruments. For examining the installation, a steam penetration test, such as the Bowie and Dick test, can be carried out.

Shall I go digital?

UNLABELLED: Dental radiographic imaging is slowly transferring to digital format. The decision to invest in this new technology should be based on a good understanding of the different types of digital imaging available within the dental field. This article outlines its use in general dental practice, highlighting the pros and cons of the various systems both for intra-oral and extra-oral radiography. CLINICAL RELEVANCE: An understanding of the mechanisms of digital imaging and their associated potential problems are required by any clinician moving to film-less imaging.

Tips for maintaining sterilization in your orthodontic work station.

Sterilization and disinfection have been a matter of concern amongst dental health care workers since long. Delicate materials, electrical parts, orthodontic pliers, orthodontic wire cutters, are to be treated according to the manufacturer's instructions to safe guard the life of the instrument as well as to claim warranty for any damage incurred. Sterilization procedures used in Orthodontics should be simple but effective and of relatively short duration so that there is a readily available supply of sterile instruments and materials. The procedure should not cause any appreciable damage to dental instruments and other materials. An attempt has been made through this article, to provide information concerning methods and means of disinfection and sterilization of orthodontic clinics, instruments, materials and also waste disposal which can be adopted in private clinics as well as in hospital set ups.

Monitoring compliance with the rules of antiseptics and decontamination by dental students at work.

INTRODUCTION: Dental personnel are potentially exposed to pathogenic microorganisms, as well as to possible sources of infection. The same is true for dental students, for whom it is crucial to acquire knowledge on infection control and appropriate dental techniques during their training.

Dental unit waterline infection control practice and knowledge gaps.

BACKGROUND: Dental unit waterline (DWL) infection control is critical to infection prevention. Identifying challenges and barriers to its implementation is a first step toward understanding how to improve engagement. METHODS: A survey was distributed to dentists, dental hygienists, and dental assistants via the Qualtrics XM platform (Qualtrics). Responses were analyzed to quantify engagement in practices contrary to Centers for Disease Control and Prevention guidance and identify avenues to improve engagement. RESULTS: Although oral health care providers recognized DWL infection control was important, there was a lack of clarity about appropriate routine engagement (eg, what lines should be tested), what should be noted in practice infection control records, and steps to be taken in response to a failed test result (ie, ≥ 500 colony-forming units/mL), such as taking a chair out of service. CONCLUSIONS: Survey results showed there were considerable gaps in knowledge and practice that could lead to patient harm. Oral health care provider training may not prepare personnel adequately to engage in, let alone supervise, DWL infection control. DWL infection control, like other aspects of infection control, requires action informed via an understanding of what needs to be done. Although good intentions are appreciated, better approaches to DWL infection control information dissemination and strategies to engage dental assistants, dental hygienists, and dentists in best practices are needed. PRACTICAL IMPLICATIONS: Evolving standards of care, including infection control, should be reflected in the provision of dental treatment. Improvements in communicating and ensuring engagement in best practices are needed when it comes to DWL infection control.

Effect of Different Isolation Methods on Bioaerosol Distribution: An In Vitro Study.

Purpose: The purposes of this in vitro study were to evaluate the effect of three isolation methods to mitigate bioaerosols during stainless steel crown (SSC) preparations and assess the distribution of Streptococcus mutans by aerosolization in closed-room operatories. Methods: Melamine teeth coated in laboratory-grown S. mutans biofilm were prepared for SSCs using three different isolation methods. Agar plates were placed in five locations throughout the operatory and opened during each preparation as well as for 10 minutes immediately following to collect aerosolized S. mutans. Bacterial colonies were counted after incubating plates for 48 hours. Data were analyzed for differences between the isolation method and plate locations. Results: Bacterial colony counts for teeth prepared using high-volume evacuation suction (HVE) with dental dam (DD) isolation were statistically significantly higher than for those prepared using HVE with a DryShield®(DS) and HVE with no isolation at the assistant (A) (P<0.001), operator face shield (FS) (P<0.001), and patient (Pt) (P=0.002) locations. No significant differences were found among isolation methods for parent (Pa) or rear delivery (RD) locations. The location that produced the most bacterial colony counts using HVE with DD isolation was FS (P<0.001), followed by A (P=0.04), Pt (P<0.001), and RD and Pa (P<0.001). Counts produced from teeth prepared with DS isolation were significantly higher at the Pt location than the A (P<0.001), FS (P=0.002), RD (P<0.001), and Pa (P=0.008) locations. Conclusion: The use of dental dam with high-volume evacuation suction during stainless steel crown preparations increased bioaerosols near the procedure, while dental evacuation systems (DryShield®) may effectively limit their spread.

Aerosol Generating Procedures and Associated Control/Mitigation Measures: A position paper from the Canadian Dental Hygienists Association and the American Dental Hygienists' Association.

Background Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosol generating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the existing evidence about the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry.Methods The authors searched six databases, MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar, for relevant scientific evidence published in the last ten years (January 2012 to December 2022) to answer six research questions about the the aspects of risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols.Results A total of 78 studies fulfilled the eligibility criteria. There was limited literature to indicate the risk of infection transmission of SARS-CoV-2 between dental hygienists and their patients. A number of mouthrinses are effective in reducing bacterial contaminations in aerosols; however, their effectiveness against SARS-CoV-2 was limited. The combined use of eyewear, masks, and face shields are effective for the prevention of contamination of the facial and nasal region, while performing AGPs. High volume evacuation with or without an intraoral suction, low volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories are effective in limiting the spread of aerosols.Conclusion Aerosols produced during clinical procedures can potentially pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence are best practices to ensure patient and provider safety in oral health settings. More studies in dental clinical environment would shape future practices and protocols, ultimately to ensure safe clinical care delivery.

The Effect of Coronavirus Disease 2019 and Other Emerging Infections on Dentistry.

The appearance of coronavirus disease 2019 (COVID-19) and other emerging infections has significantly impacted the field of dentistry, leading to widespread changes in practices and protocols. This has included the implementation of strict infection control measures, such as meticulous use of personal protective equipment, minimizing aerosol-generating procedures, and the adoption of teledentistry to reduce in-person contact. To date, the complete impact of delays in dental care caused by lockdowns has yet to be determined. The challenges faced during the COVID-19 pandemic have propelled innovation, shaping a new era of dentistry focused on safety against novel and re-emerging infections.