Dental Mitigation Strategies to Reduce Aerosolization of SARS-CoV-2. In a study that looked at the measurement of bioaerosols and viral concentrations in the air during endodontic simulations, the authors found that regardless of risk mitigation strategy (rubber dam or high-volume aspiration and a no-mitigation control), use of the high-speed contra-angle dental handpiece (HSCAH) produced much less bioaerosols both in the air and settled than did the air turbine. Combined with rubber dam use or high-volume aspiration, the HSCAH can significantly reduce the risk of viral aerosolization in the operatory. The authors suggest that a prolonged fallow period following a procedure is not needed with this approach. Click here to read Dental Mitigation Strategies to Reduce Aerosolization of SARS-CoV-2. (January 12, 2022)
What is an Aerosol-Generating Procedure? Aerosol generating procedures have warranted much consideration during the COVID-19 pandemic to inform clinical practices to reduce the risk of transmission from patients with COVID-19 infections. However, over the course of the COVID-19 pandemic, clinicians have seen a range of contexts in which there is a heightened degree of risk associated with a patient interaction, even if the procedure is not aerosol-generating. The authors of “What is an Aerosol-Generating Procedure” outline four factors from literature on respiratory transmission that help explain this phenomenon: 1) forced air, 2) symptoms and disease severity, 3) distance, and 4) duration. Each of these elements may be present during a procedure and their combination contributes to the risk of transmission in the clinic setting. These factors, they argue, are equally important considerations as aerosol-generating procedures when planning for proper respiratory protection. Click here to read "What is an Aerosol-Generating Procedure?". (December 6, 2021)
Sources of SARS-CoV-2 and Other Microorganisms in Dental Aerosols. Prompted by the COVID-19 pandemic, this study aimed to clarify the origins of pathogen containing aerosols and other sources of microbial bioload in the dental operatory during restorative procedures, ultrasonic scaling, and implant osteotomy. The investigation found that irrigant fluid is the main contributor to microbiota in dental aerosols, while microbiota in saliva was found in limited amounts (medium of 0%). Further, there was no trace of SARS-CoV-2 in the aerosols produced by the saliva of infected asymptomatic patients. The authors conclude that based on the data in this study, dental treatment can be practiced safely when infection control processes are in place during dental procedures. Click here to read Sources of SARS-CoV-2 and Other Microorganisms in Dental Aerosols. (May 18, 2021)
Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19. The author of this JADA article makes the argument for establishing a greater understanding of the biophysical underpinnings of host-to-host respiratory disease transmission. She explains that disease mitigation strategies building upon the current evidence of droplet and aerosol trajectories will offer the most effective protection for the public and health care professionals working through the COVID-19 pandemic. To read the paper, click here. (December 28, 2020)
Interventions to Reduce Aerosolized Microbes in Dental Practice: A Systematic Review with Network Meta-analysis of Randomized Controlled Trials. This review focuses on a select number of procedure-based infection control strategies to reduce aerosolized microbes loads in the dental setting. The authors conclude that of the procedures included in the review, the tempered chlorhexidine (CHX) 0.2% pre-procedural mouth rinse is likely the most effective procedure-based approach to reduce the bacterial load in aerosols produced during procedures, particularly ultrasonic scaling. To read more about the analysis, click here. (July 13, 2020)
Transmission of SARS-CoV-2: A Review of Viral, Host, and Environmental Factors. This article is a summary of the current understanding of SARS-CoV-2 transmission. The review supports that SARS-CoV-2 is primarily transmitted through respiratory droplets, and sometimes aerosols. While explaining that proximity and ventilation are the key factors influencing risk of transmission, the authors point out that the SARS-CoV-2 virus is heterogeneous in the way it moves from host to host. Further study is essential to create effective policy. To access this article, click here. (November 25, 2020)
Mitigation of Aerosol Generating Procedures in Dentistry: A Rapid Review, Scottish Dental Clinical Effectiveness Programme. A rapid review from the Scottish Dental Clinical Effectiveness Program, this paper provides an updated account of emerging knowledge of mitigation strategies for reducing aerosolized virus transmission in the dental setting during the COVID-19 pandemic. Contents highlight recommendations on several areas critical to reducing aerosol transmission risk in the dental setting. Click here to view. (October 9, 2020)
Aerosols and Spatter in Dentistry: A Brief Review of the Literature and Infection Control Implications. A look into the evidence base of airborne transmission of disease and the related implications for dental practice, this farsighted paper is a great place to start your aerosol studies. Particularly applicable to the Covid-19 era, the authors advise the incorporation of several procedure-based infection control practices when aerosols are present:
- Universal barrier precautions
- Preprocedural rinse used before treatment
- Use of a rubber damn
- Use of HVE
Click here to read. (April 28, 2020)
SARS-CoV-2 and Potential Airborne Transmission, CDC. The Centers for Disease Control and Prevention present this scientific brief to provide clarity on aerosolization and airborne transmission related to SARS-CoV-2. Acknowledging that information on the topic is still emerging, answers to significant questions will continue to evolve:
- How effective are mitigation efforts to prevent SARS-CoV-2 spread, especially ventilation and masking?
- What proportion of SARS-CoV-2 infections are acquired through airborne transmission?
- What are the conditions that facilitate airborne transmission?
- What is the infectious dose for SARS-CoV-2 (how many virions are required for infection to occur)?
- Do inoculum size and route of inoculation affect risk of infection and disease severity?
Click here to visit the webpage. (October 5, 2020)
Transmission of SARS-CoV-2: Implications for Infection Prevention Precautions, WHO. This scientific brief from the World Health Organization is an overview of the early understanding of SARS-CoV-2 modes of transmission, what was then known about host-to-host transmission, and what the infection control implications were at the time. Click here to read. (July 9, 2020)
Standard and Transmission-Based Precautions: An Update for Dentistry. A useful resource for those brushing up on infection control practices during the Covid-19 pandemic, this paper reviews standard precautions, emphasizing the significance of transmission-based precautions use in dentistry. Click here to read. (April 28, 2020)
More Resources:
Evaluating Spatter And Aerosol Contamination During Dental Procedures. Click here to view. (April 28, 2020)
Bloodborne Pathogens and Aerosols in Dentistry, CDC. Click here to view. (April 28, 2020)
California Workplace Guide to Aerosol Transmissible Diseases. Click here to view. (April 28, 2020)
Aerosols, NIOSH. Click here to view. (April 28, 2020)
Indoor Environmental Quality, NIOSH. Click here to view. (March 17, 2013)