scholarly journals The Debate: What Are Aerosol-Generating Procedures in Dentistry? A Rapid Review

2021 ◽  
pp. 238008442198994
Author(s):  
M.K. Virdi ◽  
K. Durman ◽  
S. Deacon
Keyword(s):  
High Risk ◽  
High Speed ◽  
High Volume ◽  
Rapid Review ◽  
Slow Speed ◽  
Efficient Manner ◽  
Dental Patients ◽  
Rubber Dam ◽  
Dental Procedures ◽  
Current Guidelines

Introduction: This article aims to review the current national and international dental guidance produced during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic to identify the level of consensus on aerosol-generating dental procedures (AGDPs). The outcomes intend to encourage increased collaboration with respect to dental guidelines in relation to the SARS-CoV-2 pandemic, as well as to improve decision making and safety for dental patients and staff. Methods: This rapid review was conducted by 2 authors (MKV and KD), with the support of a third author (SD), to assess current guidelines related to dental AGDPs. This streamlined review approach allowed synthesis of data in an efficient manner in the rapidly evolving environment associated with the SARS-CoV-2 pandemic. Results: The findings identified 1) a lack of consistency in reporting which procedures were deemed an AGDP; 2) that high-speed handpieces, air-water syringes, and mechanical scalers were consistently considered high-risk AGDPs; 3) a lack of consensus on the risk of coronavirus disease 2019 (COVID-19) transmission with the use of slow-speed handpieces; 4) a general agreement, when described, that rubber dam and high-volume evacuation can significantly reduce aerosol production; and 5) a lack of consistency in reporting whether procedures constitute a low, moderate, or high risk of COVID-19 transmission. The findings are discussed in relation to the guidance and future recommendations. Conclusion: It is recommended that future published guidance should indicate the risk stratification (low/moderate/high) of each procedure/exposure in a standardized international approach. Knowledge Transfer Statement: The results of this rapid review can be used by clinicians to increase their awareness of international guidance on aerosol-generating procedures in dentistry. It will also encourage those publishing future guidance to provide an internationally standardized, risk-stratified approach to describing aerosol-generating procedures. Currently, it allows clinicians to consider aerosol-generating procedures as a risk spectrum.

scholarly journals Factors affecting aerosol size distribution during various dental procedures

2021 ◽  
Author(s):  
Shruti Choudhary ◽  
Michael J Durkin ◽  
Daniel C Stoeckel ◽  
Heidi M Steinkamp ◽  
Martin H Thornhill ◽  
...  
Keyword(s):  
Particulate Matter ◽  
High Speed ◽  
High Volume ◽  
Routine Care ◽  
Mitigation Strategies ◽  
Aerosol Size Distribution ◽  
Dental Clinic ◽  
Factors Affecting ◽  
Dental Procedures ◽  
The Impact

Objectives: To determine the impact of various aerosol mitigation interventions and establish duration of aerosol persistence in a variety of dental clinic configurations. Methods: We performed aerosol measurement studies in endodontic, orthodontic, periodontic, pediatric, and general dentistry clinics. We used an optical aerosol spectrometer and wearable particulate matter sensors to measure real-time aerosol concentration from the vantage point of the dentist during routine care in a variety of clinic configurations (e.g, open bay, single room, partitioned operatories). We compared the impact of aerosol mitigation strategies [ventilation and high-volume evacuation (HVE)] and prevalence of particulate matter in the dental clinic environment before, during and after high-speed drilling, slow speed drilling and ultrasonic scaling procedures. Results: Conical and ISOVAC HVE were superior to standard tip evacuation for aerosol-generating procedures. When aerosols were detected in the environment, they were rapidly dispersed within minutes of completing the aerosol-generating procedure. Few aerosols were detected in dental clinics, regardless of configuration, when conical and ISOVAC HVE were used. Conclusions: Dentists should consider using conical or ISOVAC HVE rather than standard tip evacuators to reduce aerosols generated during routine clinical practice. Furthermore, when such effective aerosol mitigation strategies are employed, dentists need not leave dental chairs fallow between patients as aerosols are rapidly dispersed. Clinical Significance: ISOVAC HVE is highly effective in reducing aerosol emissions. With adequate ventilation and HVE use, dental fallow time can be reduced to 5 minutes.

scholarly journals The Spatial-Temporal Distribution and Control Measures Evaluation of Droplets and Aerosol Cloud in Dental Procedures

2021 ◽  
Author(s):  
Chao Yuan ◽  
Hongtao Yang ◽  
Siyuan Zheng ◽  
Xiangyu Sun ◽  
Xiaochi Chen ◽  
...  
Keyword(s):  
High Speed ◽  
Control Measure ◽  
Operation Mode ◽  
Temporal Distribution ◽  
High Volume ◽  
Control Measures ◽  
Aerosol Cloud ◽  
Dental Procedures ◽  
Air Purifier ◽  
And Control

Abstract Background: Droplets and aerosol cloud generating procedures in dentistry can increase the risk of airborne transmission of diseases such as COVID-19. To gain insight into the diffusion of spatters and possible preventive measures, we measured the particle spatial-temporal distribution characteristic and evaluated the effectiveness of the control measures.Methods: We conducted an experiment to observe the emitted spatters obtained during the simulated dental preparation by using high-speed videography. We measured the particle size distributions by laser diffraction and preliminarily estimated its velocity. We qualitatively and quantitatively described the spatial-temporal distributions of spatters and their control measure effects. Results: Majority of the dental spatters were small droplets (diameter less than 50 μm). A large number of smallest droplets (diameter less than 10 μm) were generated by high-speed air turbine handpiece. At the oral outlet, the speed of large droplets could exceed 2.63 m/s, and the speed of aerosol clouds ranged from 0.31–2.37 m/s. The evolution of the spatters showed that the more fully developed the state, the greater the number of spatters and the wider the contamination range. When the operation mode was moved from the central incisor to the first molar, the spatter direction became increasingly concentrated, and the velocities were enhanced. Larger droplets randomly moved along trajectories and rapidly settled. The aerosol cloud tended to float as a mass that interacted with the surrounding air. The high-volume evacuation could effectively clear away most of the dental spatters. The suction air purifier could change the diffusion direction of the spatters, compress the contamination range, and control aerosol escape into surrounding air. Conclusions: Our view is that we should combine the ‘point’ control measure (high-volume evacuation) and ‘area’ control measure (suction air purifier) to reduce the scope of pollution and prevent the aerosol escape into the surroundings. The study contributes to devising more accurate infection control guidelines, establishing appropriate interventions for different oral treatments, and minimizing the spread of respiratory diseases so that we can reduce cost and achieve the best results when medical resources are limited.

scholarly journals The Efficacy of High-Volume Evacuators and Extraoral Vacuum Aspirators in Reducing Aerosol and Droplet in Ultrasonic Scaling Procedures during the COVID-19 Pandemic

2022 ◽  
Author(s):  
Trijani Suwandi ◽  
Vidya Nursolihati ◽  
Mikha Sundjojo ◽  
Armelia Sari Widyarman
Keyword(s):  
Statistical Analysis ◽  
High Speed ◽  
High Volume ◽  
Limited Data ◽  
Dental Procedures ◽  
Significant Difference ◽  
Kolmogorov Smirnov ◽  
Airborne Disease ◽  
Better Than ◽  
Smirnov Test

Abstract Objective SARS-CoV-2 can be carried by aerosols and droplets produced during dental procedures, particularly by the use of high-speed handpieces, air-water syringes, and ultrasonic scalers. High-volume evacuators (HVEs) and extraoral vacuum aspirators (EOVAs) reduce such particles. However, there is limited data on their efficacy. This study aimed to determine the efficacy of HVE and EOVA in reducing aerosols and droplets during ultrasonic scaling procedures. Materials and Methods Three ultrasonic scaling simulations were conducted on mannequins: 1. saliva ejector (SE) was used alone (control); 2. SE was used in combination with HVE; and 3. SE was used in combination with HVE and EOVA. Paper filters were placed on the operator's and assistant's face shields and bodies, and the contamination of aerosols and droplets was measured by counting blue spots on the paper filters. Statistical Analysis All data were analyzed for normality using the Kolmogorov–Smirnov test. The differences between each method were analyzed using a two-way ANOVA, followed by a posthoc test. The differences were considered statistically significant when p < 0.05 Result Using HVE and EOVA reduced aerosols and droplets better than using SE alone or SE and HVE: the posthoc test for contamination revealed a significant difference (p < 0.01). The assistant was subjected to greater contamination than the operator during all three ultrasonic scaling procedures. Conclusion The usage of HVE and EOVA significantly reduced aerosols and droplets compared with using SE solely. Using these techniques together could prevent the transmission of airborne disease during dental cleanings, especially COVID-19. Further studies of aerosol-reducing devices are still needed to ensure the safety of dental workers and patients.

scholarly journals Mitigating saliva aerosol contamination in a dental school clinic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maobin Yang ◽  
Asad Chaghtai ◽  
Marc Melendez ◽  
Hana Hasson ◽  
Eugene Whitaker ◽  
...  
Keyword(s):  
High Speed ◽  
Aerosol Particles ◽  
High Volume ◽  
Ambient Air ◽  
Dental School ◽  
Dental Chair ◽  
Dental Procedures ◽  
Dental Assistant ◽  
Dental School Clinic ◽  
Dental Providers

Abstract Background Transmission of COVID-19 via salivary aerosol particles generated when using handpieces or ultrasonic scalers is a major concern during the COVID-19 pandemic. The aim of this study was to assess the spread of dental aerosols on patients and dental providers during aerosol-generating dental procedures. Methods This pilot study was conducted with one volunteer. A dental unit used at the dental school for general dental care was the site of the experiment. Before the study, three measurement meters (DustTrak 8534, PTrak 8525 and AeroTrak 9306) were used to measure the ambient distribution of particles in the ambient air surrounding the dental chair. The volunteer wore a bouffant, goggles, and shoe covers and was seated in the dental chair in supine position, and covered with a surgical drape. The dentist and dental assistant donned bouffant, goggles, face shields, N95 masks, surgical gowns and shoe covers. The simulation was conducted by using a high-speed handpiece with a diamond bur operating in the oral cavity for 6 min without touching the teeth. A new set of measurement was obtained while using an ultrasonic scaler to clean all teeth of the volunteer. For both aerosol generating procedures, the aerosol particles were measured with the use of saliva ejector (SE) and high-speed suction (HSS) followed a separate set of measurement with the additional use of an extra oral high-volume suction (HVS) unit that was placed close to the mouth to capture the aerosol in addition to SE and HSS. The distribution of the air particles, including the size and concentration of aerosols, was measured around the patient, dentist, dental assistant, 3 feet above the patient, and the floor. Results Four locations were identified with elevated aerosol levels compared to the baseline, including the chest of the dentist, the chest of patient, the chest of assistant and 3 feet above the patient. The use of additional extra oral high volume suction reduced aerosol to or below the baseline level. Conclusions The increase of the level of aerosol with size less than 10 µm was minimal during dental procedures when using SE and HSS. Use of HVS further reduced aerosol levels below the ambient levels.

scholarly journals Challenges and Opportunities of Mass Vaccination Centers in COVID-19 Times: A Rapid Review of Literature

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 574
Author(s):  
Vincenza Gianfredi ◽  
Flavia Pennisi ◽  
Alessandra Lume ◽  
Giovanni Emanuele Ricciardi ◽  
Massimo Minerva ◽  
...  
Keyword(s):  
High Speed ◽  
High Volume ◽  
The United States ◽  
Mass Vaccination ◽  
Rapid Review ◽  
Current Review ◽  
Challenges And Opportunities ◽  
September 11 Attacks ◽  
And Performance ◽  
Set Up

A mass vaccination center is a location, normally used for nonhealthcare activities, set up for high-volume and high-speed vaccinations during infectious disease emergencies. The high contagiousness and mortality of COVID-19 and the complete lack of population immunity posed an extraordinary threat for global health. The aim of our research was to collect and review previous experiences on mass vaccination centers. On 4 April 2021, we developed a rapid review searching four electronic databases: PubMed/Medline, Scopus, EMBASE, Google Scholar and medRxiv. From a total of 2312 papers, 15 of them were included in the current review. Among them, only one article described a COVID-19 vaccination center; all of the others referred to other vaccinations, in particular influenza. The majority were conducted in the United States, and were simulations or single-day experiences to practice a mass vaccination after bioterrorist attacks. Indeed, all of them were published after September 11 attacks. Regarding staff, timing and performance, the data were highly heterogenous. Several studies used as a model the Center for Disease Control and Prevention guidelines. Results highlighted the differences around the definition, layout and management of a mass vaccination center, but some aspects can be considered as a core aspect. In light of this, we suggested a potential definition. The current review answers to the urgency of organizing a mass vaccination center during the COVID-19 pandemic, highlighting the most important organizational aspects that should be considered in the planning.

scholarly journals Infection Risk Prediction Model for COVID-19 Based on an Analysis of the Settlement of Particles Generated during Dental Procedures in Dental Clinics

2021 ◽  
Vol 2021 ◽  
pp. 1-16
Author(s):  
Paula Alejandra Baldion ◽  
Henry Oliveros Rodríguez ◽  
Camilo Alejandro Guerrero ◽  
Alberto Carlos Cruz ◽  
Diego Enrique Betancourt
Keyword(s):  
High Risk ◽  
Prediction Model ◽  
Risk Prediction ◽  
High Speed ◽  
Infection Risk ◽  
Risk Prediction Model ◽  
Dental Clinics ◽  
Dental Procedures ◽  
Risk Of Exposure ◽  
Phantom Head

Background. The health emergency declaration owing to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has drawn attention toward nosocomial transmission. The transmission of the disease varies depending on the environmental conditions. Saliva is a recognized SARS-CoV-2 reservoir in infected individuals. Therefore, exposure to fluids during dental procedures leads to a high risk of contagion. Objective. This study aimed to develop an infection risk prediction model for COVID-19 based on an analysis of the settlement of the aerosolized particles generated during dental procedures. Materials and Methods. The settlement of aerosolized particles during dental aerosol-generating procedures (AGPs) performed on phantoms was evaluated using colored saliva. The gravity-deposited particles were registered using a filter paper within the perimeter of the phantom head, and the settled particles were recorded in standardized photographs. Digital images were processed to analyze the stained area. A logistic regression model was built with the variables ventilation, distance from the mouth, instrument used, area of the mouth treated, and location within the perimeter area. Results. The largest percentage of the areas stained by settled particles ranged from 1 to 5 µm. The maximum settlement range from the mouth of the phantom head was 320 cm, with a high-risk cutoff distance of 78 cm. Ventilation, distance, instrument used, area of the mouth being treated, and location within the perimeter showed association with the amount of settled particles. These variables were used for constructing a scale to determine the risk of exposure to settled particles in dentistry within an infection risk prediction model. Conclusion. The greatest risk of particle settlement occurs at a distance up to 78 cm from the phantom mouth, with inadequate ventilation, and when working with a high-speed handpiece. The majority of the settled particles generated during the AGPs presented stained areas ranging from 1 to 5 µm. This model was useful for predicting the risk of exposure to COVID-19 in dental practice.

scholarly journals Making Evidence-based Crash Risk Estimation Routine by using the SESA Process

2020 ◽  
Vol 31 (1) ◽  
pp. 40-50
Keyword(s):  
High Risk ◽  
Road Safety ◽  
High Speed ◽  
Prediction Models ◽  
Risk Estimation ◽  
High Volume ◽  
Safety Analysis ◽  
Crash Risk ◽  
Evidence Based ◽  
Safety Research

Achieving safe system or vision zero outcomes at high-risk urban intersections, especially priority cross-roads and high volume traffic signals, is a major challenge for most cities. Even after decades of crash analysis and improvement works many of these intersections still perform poorly. While best practice for optimising the efficiency of intersections requires the use of modelling tools, like Sidra, this is rarely the case with optimising road safety outcomes. This is despite the large number of evidence-based safety analysis models and tools that are now available to understand intersection crash risk. This paper outlines the SESA (Site-specific Evidence-based Safety Analysis) Process that has been developed to enable transport professionals to estimate and predict crash risk at intersections and other sites. This process utilises existing crash risk estimation tools (based on crash prediction models and crash reduction factors), relevant road safety research, crash severity factors, professional judgement and crash data to predict the underlying crash risk at intersections (and other sites) and the effectiveness of improvement options. The output includes both the number and return period of ‘all injury’ and ‘fatal and serious injury (FSI)’ crashes for each option. The paper includes three applications of the process to high risk intersections in three New Zealand cities, consisting of two priority cross-roads and one high speed roundabout. The case studies demonstrate how the process can be used to assess intersection features and improvement options that are not covered within the available crash estimation tools.

scholarly journals A Systematic Review of Droplet and Aerosol Generation in Dentistry

2020 ◽  
Author(s):  
Nicola Innes ◽  
Ilona Johnson ◽  
Waraf Al-Yaseen ◽  
Rebecca Harris ◽  
Rhiannon Jones ◽  
...  
Keyword(s):  
Disease Transmission ◽  
High Speed ◽  
Oral Surgery ◽  
Data Extraction ◽  
Transmission Risk ◽  
Future Research ◽  
Slow Speed ◽  
Air Polishing ◽  
Aerosol Generation ◽  
Dental Procedures

Introduction: Against the COVID-19 pandemic backdrop and potential disease transmission risk by dental procedures that can generate aerosol and droplets. Objectives: This review aimed to identify which clinical dental procedures do generate droplets and aerosols with subsequent contamination, and for these, characterise their pattern, spread and settle. Materials and Method: Six databases were searched and citation chasing undertaken (to 11/08/20). Screening stages were undertaken in duplicate, independently, by two researchers. Data extraction was performed by one reviewer and verified by another. Results: Eighty-three studies met the inclusion criteria and covered: Ultrasonic scaling (USS, n=44), high speed air-rotor (HSAR, n=31); oral surgery (n=11), slow-speed handpiece (n=4); air-water (triple) syringe (n=4), air-polishing (n=4), prophylaxis (n=2) and hand-scaling (n=2). Although no studies investigated respiratory viruses, those on bacteria, blood splatter and aerosol showed activities using powered devices produced the greatest contamination. Contamination was found for all activities, and at the furthest points studied. The operator torso operator arm, and patient body were especially affected. Heterogeneity precluded significant inter-study comparisons but intra-study comparisons allowed construction of a proposed hierarchy of procedure contamination risk: higher risk (USS, HSAR, air-water syringe [air only or air/water together], air polishing, extractions using motorised hand-pieces); moderate (slow-speed handpieces, prophylaxis with pumice, extractions) and lower (air-water syringe [water only] and hand scaling. Conclusion: Significant gaps in the evidence, low sensitivity of measures and variable quality limit firm conclusions around contamination for different procedures. However, a hierarchy of contamination from procedures can be proposed for challenge/verification by future research which should consider standardised methodologies to facilitate research synthesis. Clinical significance (49 words): This manuscript addresses uncertainty around aerosol generating procedures (AGPs) in dentistry. Findings indicate a continuum of procedure-related aerosol generation rather than the current binary AGP or non-AGP perspective. This informs discussion around AGPs and direct future research to help support knowledge and decision making around COVID-19 and dental procedures.

scholarly journals Dental Mitigation Strategies to Reduce Aerosolization of SARS-CoV-2

2021 ◽  
pp. 002203452110328
Author(s):  
J.J. Vernon ◽  
E.V.I. Black ◽  
T. Dennis ◽  
D.A. Devine ◽  
L. Fletcher ◽  
...  
Keyword(s):  
Pseudomonas Syringae ◽  
High Speed ◽  
Artificial Saliva ◽  
High Volume ◽  
Mitigation Strategies ◽  
Particle Analysis ◽  
Worst Case ◽  
Dental Surgery ◽  
Rubber Dam ◽  
Air Turbine

Limiting infection transmission is central to the safety of all in dentistry, particularly during the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Aerosol-generating procedures (AGPs) are crucial to the practice of dentistry; it is imperative to understand the inherent risks of viral dispersion associated with AGPs and the efficacy of available mitigation strategies. In a dental surgery setting, crown preparation and root canal access procedures were performed with an air turbine or high-speed contra-angle handpiece (HSCAH), with mitigation via rubber dam or high-volume aspiration and a no-mitigation control. A phantom head was used with a 1.5-mL min−1 flow of artificial saliva infected with Φ6-bacteriophage (a surrogate virus for SARS-CoV-2) at ~108 plaque-forming units mL−1, reflecting the upper limits of reported salivary SARS-CoV-2 levels. Bioaerosol dispersal was measured using agar settle plates lawned with the Φ6-bacteriophage host, Pseudomonas syringae. Viral air concentrations were assessed using MicroBio MB2 air sampling and particle quantities using Kanomax 3889 GEOα counters. Compared to an air turbine, the HSCAH reduced settled bioaerosols by 99.72%, 100.00%, and 100.00% for no mitigation, aspiration, and rubber dam, respectively. Bacteriophage concentrations in the air were reduced by 99.98%, 100.00%, and 100.00% with the same mitigations. Use of the HSCAH with high-volume aspiration resulted in no detectable bacteriophage, both on nonsplatter settle plates and in air samples taken 6 to 10 min postprocedure. To our knowledge, this study is the first to report the aerosolization in a dental clinic of active virus as a marker for risk determination. While this model represents a worst-case scenario for possible SARS-CoV-2 dispersal, these data showed that the use of HSCAHs can vastly reduce the risk of viral aerosolization and therefore remove the need for clinic fallow time. Furthermore, our findings indicate that the use of particle analysis alone cannot provide sufficient insight to understand bioaerosol infection risk.

Prevention of infective endocarditis (IE)

2018 ◽  
pp. 127-130
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Infective Endocarditis ◽  
High Risk ◽  
Antibiotic Prophylaxis ◽  
High Risk Patients ◽  
Operative Site ◽  
Dental Patients ◽  
Risk Patients ◽  
Current Guidelines ◽  
Dental Work

Infective endocarditis is a serious condition due to bacteraemia resulting from interventions. Current guidelines suggested antibiotic prophylaxis should not be used for routine dental or non-dental patients even in high-risk patients. However, it should be considered for high-risk patients for interventional dental work and also in other circumstances if the operative site suspected to be infective and might result in bacteraemia in high-risk patients.

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