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This review examines the risk of infection transmission in dental settings through aerosols, particularly in light of the COVID-19 pandemic. Dental procedures, particularly those involving highspeed instruments, produce aerosols containing saliva, blood, and microbes. These aerosols pose a significant risk of transmission, especially in close contact situations. Measures such as highvolume evacuation, barrier protection (masks, gloves, eye protection), and preprocedural rinses with antiseptic mouthwash can help reduce aerosol contamination. However, the effectiveness of these measures varies, and more research is needed to fully understand and mitigate the risk. The review also discusses the legal and regulatory considerations surrounding aerosol contamination in dental practices. Ultimately, adherence to recommended protocols from organizations like the CDC and ADA is crucial for minimizing aerosol-related infection transmission in dental settings, particularly in the context of the ongoing COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Abstract 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.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. The combination of HVE and intraoral suction devices significantly decreases microbial aerosols during oral prophylaxis procedures. [ABSTRACT FROM AUTHOR]

Aerosols are a suspension of fine solid particles or liquid droplets in the air or any other gas. Aerosols can naturally be seen in the environment around us. But in the dental clinic, especially in the working room, the air is filled with artificially produced aerosols. These aerosols are composed of air, water, and a variety of microorganisms like streptococcus, micrococcus, staphylococcus. Such aerosols produced in the dental clinic are very dangerous, especially to dental professionals. This review focuses on the various methods available to prevent unwanted aerosol production. All the articles were collected from various search engines like PubMed, Google Scholar, MeSH, etc. all the articles were collected regarding the topic without any fixed time frame. There was also no approval taken due to its absence of necessity. There are various methods available that can be modestly applied to various dental practices to reduce aerosol production and help control infection spread. This is of high relevance now as it is one of the main concerns of dental professionals due to the ongoing coronavirus pandemic. [ABSTRACT FROM AUTHOR]

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. • Two dental instruments, Mectron PIEZOSURGERY® and KaVo EXPERTtorque™, are studied. • Considering droplet sizes and evaporation rate, FFP2/KN95/N95 masks are recommended. • The design of the dental equipment can be improved to produce larger droplets. • At the reported velocities (∼2 m s−1), droplets can reach the dentist instantly. • Adjusting the relative humidity to 50% was suggested to keep the droplets larger. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to investigate quantitatively and qualitatively the airborne microbial load in a multi-chair dental clinic, a normal dental practice and a non-dental public area over a time period of four days and at different time points to estimate the risk of infections during dental surgery. Methods: A multi-chair and a single chair treatment room each were examined in comparison to a non-medical public area over a period of four days. The colony forming units m−3 (CFUs) were determined and isolated bacteria were characterised by morphological and biochemical analysis, gas chromatography and by 16S rRNA-gene sequencing. In the analyses enterococci were selectively searched for. Results: The CFUs in the multi-chair treatment room were between 20 and 1050CFUm−3. During treatment the maxima reached were below 800CFUm−3. The values in the dental practice were between 200 and 600CFUm−3 and remain slightly but not significantly below the levels of the clinic (p >0.05). In the common area, the CFUs were between 200 and 800CFUm−3. The proportion of micrococci was 56.8% in the clinic, 56.07% in the practice and 69.67% in the public area Coagulase-negative staphylococci constituted 35% at the dental clinic, 25% at the bank and 38% at the dental practice. No significant differences amongst the units were detected in the microbial composition of their dental aerosols (p >0.05). Conclusion: Although, the bacterial counts in dental room were not significantly higher than the bacterial counts in a public area, the risk from dental clinic might be higher than a public area due to the type of micro-organisms, host susceptibility and the exposure time. [Copyright &y& Elsevier]

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.

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., (© 2021 The Author(s).)

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 (ACH vent ). Equivalent ventilation provided by the PAC (ACH pac ) 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 (K n ) and with ventilation and PAC (K n+pac ), and by times needed to reach 95 % and 100 % removal of accumulated aerosol particles., Results: ACH vent varied from 3 to 45. K n and K n+pac were correlated with ACH vent (r = 0.90) and combined ACH total (r = 0.81), respectively. Accumulated aerosol particles could not be removed by ventilation alone within 30-min in rooms with ACH vent <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 ACH vent ., 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., (Copyright © 2021 Elsevier Ltd. All rights reserved.)