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BACKGROUND: In dentistry, nosocomial infection poses a great challenge to clinicians. The microbial contamination of water in dental unit waterlines (DUWLs) is ubiquitous. Such infected DUWLs can transmit oral microbes in the form of aerosols. Previous studies have suggested treating DUWLs with various disinfectants to reduce cross-contamination. The literature lacks a comparative evaluation of the effect of the use of 0.2% chlorhexidine (CHX) and 0.1% sodium hypochlorite (NaOCl) in DUWLs on aerosolized bacteria generated during dental procedures. OBJECTIVE: To compare the effect of NaOCl and CHX in DUWLs on aerosolized bacteria generated during restorative and endodontic procedures. MATERIALS AND METHODS: A total of 132 patients were equally divided into three groups (n = 44 in each group) according to the content of DUWL as follows. Group I-0.1% NaOCl Group II-0.2% CHX Group III-distilled water (Positive control) One-way ANOVA was performed and the Kruskal-Wallis test was used for intergroup comparison. RESULTS: For the restorative procedure, inter-group comparison of mean colony-forming units (CFU) scores showed a statistically significant difference between the groups (p - .001) with the score of group 3 higher than group 2 followed by group 1. For the endodontics, an inter-group comparison of CFU scores showed a statistically significant difference between the groups (p - .003) with the mean score in group 1 being the lowest and group 3 being the highest. CONCLUSION: The addition of NaOCl or CHX in DUWLs shows an effective reduction in aerosolized bacteria compared to distilled water.
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Clorexidina , Hipoclorito de Sódio , Humanos , Bactérias , Clorexidina/farmacologia , Clorexidina/uso terapêutico , Contagem de Colônia Microbiana , Assistência Odontológica , Equipamentos Odontológicos/microbiologia , Hipoclorito de Sódio/farmacologia , Água/farmacologiaRESUMO
Since the outbreak of COVID-19 pandemic, maintaining safety in dental operations has challenged health care providers and policy makers. Studies on dental aerosols often focus on bacterial viability or particle size measurements inside dental offices during and after dental procedures, which limits their conclusions to specific cases. Fundamental understanding on atomization mechanism and dynamics of dental aerosols are needed while assessing the risks. Most dental instruments feature a build-in atomizer. Dental aerosols that are produced by ultrasonic or rotary atomization are considered to pose the highest risks. In this work, we aimed to characterize dental aerosols produced by both methods, namely by Mectron PIEZOSURGERY® and KaVo EXPERTtorque™. Droplet size distributions and velocities were measured with a high-speed camera and a rail system. By fitting the data to probability density distributions and using empirical equations to predict droplet sizes, we were able to postulate the main factors that determine droplet sizes. Both dental instruments had wide size distributions including small droplets. Droplet size distribution changed based on operational parameters such as liquid flow rate or air pressure. With a larger fraction of small droplets, rotary atomization poses a higher risk. With the measured velocities reaching up to 5 m s-1, droplets can easily reach the dentist in a few seconds. Small droplets can evaporate completely before reaching the ground and can be suspended in the air for a long time. We suggest that relative humidity in dental offices are adjusted to 50% to prevent fast evaporation while maintaining comfort in the office. This can reduce the risk of disease transmission among patients. We recommend that dentists wear a face shield and N95/FFP2/KN95 masks instead of surgical masks. We believe that this work gives health-care professionals, policy makers and engineers who design dental instruments insights into a safer dental practice.
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BACKGROUND: The coronavirus 2019 (COVID-19) pandemic posed a new challenge not only to public health but also to the health care systems and dentists are one of the highly vulnerable health care professionals for COVID-19 infection. OBJECTIVE: To assess the COVID-19 prevalence, associated factors, and infection control practices among dentists in Andhra Pradesh State, India. METHODS: A cross-sectional web-based questionnaire survey was conducted among dentists in Andhra Pradesh State, India. 21-item pretested questionnaire was used for data collection between January 30, 2021 and February 21, 2021. 3700 dentists from the Andhra Pradesh state were selected from the Dentists Register of India through systematic random sampling method. RESULTS: Out of 3700 dentists invited to participate in this study, responses from 1876 dentists were received with response rate of 51%. Prevalence of 8 among the study population was 9%. Patients were the primary source of infection for 60.5% of the COVID-19 positive study participants. 65.8% of total respondents using full face shield and two-third of them using N95 or equivalent mask while providing dental care. CONCLUSION: This study found a high prevalence rate of COVID-19 among the dentists. Among the associated factors, being into active practice during the pandemic was found to be statistically significant. This study recommend for additional infection control protocols specific to the COVID-19 pandemic.
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COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Prevalência , Pandemias/prevenção & controle , Estudos Transversais , Odontólogos , Inquéritos e Questionários , Índia/epidemiologia , Atenção à Saúde , Controle de InfecçõesRESUMO
The use of herbal mouthrinse is gaining momentum in recent years. Therefore, it is of interest to evaluate the effect of 2 herbal mouthrinse (curcumin, cinnamon) in comparison with2 conventional mouthrinse (povidone iodine, chlorhexidine) when used as coolant in dental ultrasonic scalers. Hence, 200 participants were included in this study. Analysis of gingival index, periodontal index at baseline and one month follow up was completed. The inhibitory effects of both conventional and herbal mouth rinse in gingival health are similar. However, cinnamon and curcumin owing to its minimal adverse effects and low cost is useful as an alternative to chlorhexidine for reducing bacterial load in dental aerosols produced due to ultrasonic scalers.
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Many dental procedures are aerosol-generating and pose a risk for the spread of airborne diseases, including COVID-19. Several aerosol mitigation strategies are available to reduce aerosol dispersion in dental clinics, such as increasing room ventilation and using extra-oral suction devices and high-efficiency particulate air (HEPA) filtration units. However, many questions remain unanswered, including what the optimal device flow rate is and how long after a patient exits the room it is safe to start treatment of the next patient. This study used computational fluid dynamics (CFD) to quantify the effectiveness of room ventilation, an HEPA filtration unit, and two extra-oral suction devices to reduce aerosols in a dental clinic. Aerosol concentration was quantified as the particulate matter under 10 µm (PM10) using the particle size distribution generated during dental drilling. The simulations considered a 15 min procedure followed by a 30 min resting period. The efficiency of aerosol mitigation strategies was quantified by the scrubbing time, defined as the amount of time required to remove 95% of the aerosol released during the dental procedure. When no aerosol mitigation strategy was applied, PM10 reached 30 µg/m3 after 15 min of dental drilling, and then declined gradually to 0.2 µg/m3 at the end of the resting period. The scrubbing time decreased from 20 to 5 min when the room ventilation increased from 6.3 to 18 air changes per hour (ACH), and decreased from 10 to 1 min when the flow rate of the HEPA filtration unit increased from 8 to 20 ACH. The CFD simulations also predicted that the extra-oral suction devices would capture 100% of the particles emanating from the patient's mouth for device flow rates above 400 L/min. In summary, this study demonstrates that aerosol mitigation strategies can effectively reduce aerosol concentrations in dental clinics, which is expected to reduce the risk of spreading COVID-19 and other airborne diseases.
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Background: Barrier enclosure systems were suggested as the protective equipment for aerosol-generating procedures. Objective: The aim of this study was to investigate the efficiency of dental barriers in aerosols and splatters reduction during an ultrasonic scaling. Materials and Methods: Two types of dental barriers: (1) metal frame with plastic wrap (MFPW) and (2) plastic shield chamber (PSC) were investigated. Ultrasonic scaling was performed on dental phantom head with and without the use of dental barriers. To detect the splatter contamination, the water system of the scaler was circulated with 0.1% fluorescein dye and filter papers were set at several parts of dental chair, body of an operator, and assistance. For bioaerosol production, water containing 107 colony-forming unit (CFU)/mL of Lactobacillus acidophilus was used as a water coolant system of the scaler. Results: The total surface contamination found on the body of the operator was significantly decreased when using both MFPW and PSC barriers (P < 0.05). A significant reduction on the assistant's body and the dental chair was only observed when PSC was used (P < 0.05). For bacterial aerosols, both barriers significantly reduced the number of bacterial colonies when compared with no barrier used (P < 0.05). The percentages of total colonies reduction for MFPW and PSC were 78.13 (±1.69) and 69.24 (±2.49), respectively. However, no difference in the total number of bacterial colonies was observed between the two types of barriers. Conclusion: A dental barrier system was effective in aerosols and splatters reduction during an ultrasonic scaling.
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Background: The COVID-19 pandemic has heightened the awareness of a common hazard encountered in the dental clinic: aerosol transmission of pathogens. Treatment of sources of infection before or during dental procedures is one means of decreasing pathogen load and aerosol transmission. Methods: An ultrasonic scaler supplied with aqueous ozone was used to examine the effect of its viability on planktonic cultures and biofilms formed by 2 model bacteria: Rothia mucilaginosa and Escherichia coli. Results: Both organisms showed susceptibility to aqueous ozone alone (97% and 99.5% lethality, respectively). When combined with manual scaling using an ultrasonic scaler, a greater than 99% reduction in colony-forming units (CFUs)/mL could be reached with an aqueous ozone concentration of approximately 2 mg/L (R. mucilaginosa) or 0.75 mg/L (E. coli) after 5 through 6 seconds of scaling. Conclusions: Aqueous ozone coupled with ultrasonic scaling exhibited a higher efficiency of microbial kill than either method used alone. Both gram-positive and gram-negative species were affected by this treatment. Studies on other oral microbiota constituents, including fungi and viruses, will provide information on the efficacy of this method on a greater biological scale. Studies to verify concomitant reduction of microbial load in dispersed aerosols in clinical settings should be completed to support practical applications of this treatment.
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Dentists and dental staff have an increased risk of airborne infection with pathogens such as SARS-CoV-2 since they are exposed to high levels of droplets and aerosols produced during specific dental procedures. Hence, new guidelines such as patient screening and temperature control, air purification, space, surface and hand sanitizing and the use of protective equipment and physical barriers have been successfully implemented. In addition, the use of teledentistry has expanded considerably in pediatric dentistry, orthodontics, oral medicine and periodontics in order to address oral and dental health issues during the COVID-19 pandemic while minimizing virus transmission. Thus, teleconsultation, telediagnosis, teletriage, teletreatment and telemonitoring have emerged as valuable tools not only in the delivery of care, but also in the academic and research training of dental health professionals. This narrative review summarizes the current literature on the impact of the pandemic on dental care, dental staff and dental education, with an emphasis on how newly emerging protocols and technologies can be successfully utilized as integral parts of various branches of the dental practice and their future implications without compromising patient care.
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COVID-19 , Pandemias , COVID-19/epidemiologia , Criança , Assistência Odontológica , Educação em Odontologia , Humanos , SARS-CoV-2RESUMO
BACKGROUND: The route of transmission of severe acute respiratory syndrome coronavirus 2 has challenged dentistry to improve the safety for patients and the dental team during various treatment procedures. The purpose of this study was to evaluate and compare the effectiveness of dental evacuation systems in reducing aerosols during oral prophylactic procedures in a large clinical setting. METHODS: This was a single-center, controlled clinical trial using a split-mouth design. A total of 93 student participants were recruited according to the inclusion and exclusion criteria. Aerosol samples were collected on blood agar plates that were placed around the clinic at 4 treatment periods: baseline, high-volume evacuation (HVE), combination (HVE and intraoral suction device), and posttreatment. Student operators were randomized to perform oral prophylaxis using ultrasonic scalers on 1 side of the mouth, using only HVE suction for the HVE treatment period and then with the addition of an intraoral suction device for the combination treatment period. Agar plates were collected after each period and incubated at 37 °C for 48 hours. Colony-forming unit (CFU) counts were determined using an automatic colony counter. RESULTS: The use of a combination of devices resulted in significant reductions in CFUs compared with the use of the intraoral suction device alone (P < .001). The highest amounts of CFUs were found in the operating zone and on patients during both HVE and combination treatment periods. CONCLUSIONS: Within limitations of this study, the authors found significant reductions in the amount of microbial aerosols when both HVE and an intraoral suction device were used. PRACTICAL IMPLICATIONS: The combination of HVE and intraoral suction devices significantly decreases microbial aerosols during oral prophylaxis procedures.
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Microbiologia do Ar , COVID-19 , Controle de Infecções Dentárias , Aerossóis , Humanos , SARS-CoV-2RESUMO
OBJECTIVES: To evaluate the mechanical ventilation rates of dental treatment rooms and assess the effectiveness of aerosol removal by mechanical ventilation and a portable air cleaner (PAC) with a high-efficiency particulate air (HEPA) filter. METHODS: Volumetric airflow were measured to assess air change rate per hour by ventilation (ACHvent). Equivalent ventilation provided by the PAC (ACHpac) was calculated based on its clean air delivery rate. Concentrations of 0.3, 0.5 and 1.0 µm aerosol particles were measured in 10 dental treatment rooms with various ventilation rates at baseline, after 5-min of incense burn, and after 30-min of observation with and without the PAC or ventilation system in operation. Velocities of aerosol removal were assessed by concentration decay constants for the 0.3 µm particles with ventilation alone (Kn) and with ventilation and PAC (Kn+pac), and by times needed to reach 95 % and 100 % removal of accumulated aerosol particles. RESULTS: ACHvent varied from 3 to 45. Kn and Kn+pac were correlated with ACHvent (r = 0.90) and combined ACHtotal (r = 0.81), respectively. Accumulated aerosol particles could not be removed by ventilation alone within 30-min in rooms with ACHvent<15. PAC reduced aerosol accumulation and accelerated aerosol removal, and accumulated aerosols could be completely removed in 4 to 12-min by ventilation combined with PAC. Effectiveness of the PAC was especially prominent in rooms with poor ventilation. Added benefit of PAC in aerosol removal was inversely correlated with ACHvent. CONCLUSIONS: Aerosol accumulation may occur in dental treatment rooms with poor ventilation. Addition of PAC with a HEPA filter significantly reduced aerosol accumulation and accelerated aerosol removal. CLINICAL SIGNIFICANCE: Addition of PAC with a HEPA filter improves aerosol removal in rooms with low ventilation rates.
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Respiração Artificial , Ventilação , Aerossóis , PoeiraRESUMO
BACKGROUND: Dental procedures often produce aerosols and spatter, which have the potential to transmit pathogens such as severe acute respiratory syndrome coronavirus 2. The existing literature is limited. METHODS: Aerosols and spatter were generated from an ultrasonic scaling procedure on a dental manikin and characterized via 2 optical imaging methods: digital inline holography and laser sheet imaging. Capture efficiencies of various aerosol mitigation devices were evaluated and compared. RESULTS: The ultrasonic scaling procedure generated a wide size range of aerosols (up to a few hundred µm) and occasional large spatter, which emit at low velocity (mostly < 3 m/s). Use of a saliva ejector and high-volume evacuator (HVE) resulted in overall reductions of 63% and 88%, respectively, whereas 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 spatter emission. The use of HVE generally requires an additional person to assist a dental hygienist, whereas an ELE can be operated hands free when a dental hygienist is performing ultrasonic scaling and other operations. PRACTICAL IMPLICATIONS: An ELE aids in the reduction of aerosols and spatters during ultrasonic scaling procedures, potentially reducing transmission of oral or respiratory pathogens like severe acute respiratory syndrome coronavirus 2. Position and airflow of the device are important to effective aerosol mitigation.
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COVID-19 , Ultrassom , Aerossóis , Raspagem Dentária , Humanos , SARS-CoV-2RESUMO
Dental services are significantly impacted by the COVID-19 pandemic. Almost all dental procedures carry a high infection risk for providers and patients due to the spread of aerosols. As a consequence, public health agencies and professional associations have issued guidelines for enhanced infection control and personal protection equipment and have also limited care to urgent or emergency services. However, there is no dental service concept for pandemic disaster preparedness or response that might be applied. Moreover, pathways to dental care provision in a post-pandemic future with persisting risks are needed. We propose Safer Aerosol-Free Emergent Dentistry (SAFER Dentistry) as one approach to dental services during and emerging from the pandemic. The concept's starting point is the identification of the most common patient needs. The next step is to replace common treatments addressing the most frequent needs with alternative interventions involving a lower infection risk because they do not generate aerosols. SAFER Dentistry is innovative, avoids risk, and responds to the requirements of a pandemic and post-pandemic emergency where the risk of airborne disease transmission remains high. SAFER Dentistry thereby ensures continuity of dental services while protecting providers and patients from infectious pathogens. Moreover, SAFER Dentistry allows dental service providers to remain operational and generate income even under pandemic conditions. Potential implementation and policy options for SAFER Dentistry include universal availability without co-payments by patients and a uniform bundled payment scheme for providers to simplify budgeting, reimbursement, and administration during a pandemic. Adaptations and adjustments of the concept are possible and encouraged as long as the principle of avoiding aerosol-generating procedures is maintained.