Dental aerosol

Last updated
Dental aerosol from a dental hand piece Dental aerosol.jpg
Dental aerosol from a dental hand piece

A dental aerosol is an aerosol that is produced from dental instrument, dental handpieces, three-way syringes, and other high-speed instruments. These aerosols may remain suspended in the clinical environment. [1] Dental aerosols can pose risks to the clinician, staff, and other patients. The heavier particles (e.g., >50 μm) contained within the aerosols are likely to remain suspended in the air for relatively short period and settle quickly onto surfaces, however, the lighter particles may remain suspended for longer periods and may travel some distance from the source. [2] These smaller particles are capable of becoming deposited in the lungs when inhaled and provide a route of diseases transmission. [3] Different dental instruments produce varying quantities of aerosol, and therefore are likely to pose differing risks of dispersing microbes from the mouth. Air turbine dental handpieces generally produce more aerosol, with electric micromotor handpieces producing less, although this depends on the configuration of water coolant used by the handpiece. [4] [5]

Contents

Spatter and aerosols flushing out of dental hand piece Dental aerosols.jpg
Spatter and aerosols flushing out of dental hand piece

Composition

These dental aerosols are bioaerosols which may be contaminated with bacteria, fungi, and viruses from the oral cavity, skin, and the water used in dental units. [6] Dental aerosols also have micro-particles from dental burs, and silica particles which are one of the components of dental filling materials like dental composite. [7] Depending upon the procedure and site, the aerosol composition may change from patient to patient. Apart from microorganisms, these aerosols may consist of particles from saliva, gingival crevicular fluid, blood, dental plaque, calculus, tooth debris, oronasal secretions, oil from dental handpieces, and micro-particles from grinding of the teeth and dental materials. [8] They may also consist of abrasive particles that are expelled during air abrasion and polishing methods. [3]

Size

Dental aerosols contain a wide range of particles with the majority being less than 50 μm. The smaller particles with size between 0.5 and 10 μm are more likely to be inhaled and have the potential to transmit infection. [3] Smaller particles are likely to remain suspended for longer periods of time, and may travel further from the source. Settling time of particles is described by Stokes' law in part as a function of their aerodynamic diameter.

Potential hazards and mitigation

The water used in the dental units may be contaminated with Legionella , and the aerosols produced by dental handpieces may contribute to the spread of the Legionella in the environment; there is therefore a risk of inhalation by the dentist, staff and patients. [9] The dental unit water lines (DUWLs) may also be contaminated with other bacteria like Mycobacterium spp and Pseudomonas aeruginosa . [10] Infection from Legionella species causes infections like Legionellosis and several pneumonia like diseases. [11] However, still there is no strong evidence that suggests the dentists are at greater occupational risk from Legionella. [9] Transmission of tuberculosis also occurs from the cough producing procedures on the patients with tuberculosis that involve production of aerosols. [12] Mycobacterium tuberculosis is transmitted in the form of droplet nuclei which are smaller than 5 μm which stay suspended in the environment for longer duration. The development of active tuberculosis in Dental Health Care Workers (DHCWs) is less likely than the rest of the other Health Care Workers (HCWs). There are lacking evidences to prove the active tuberculosis development resulting from this transmission in Dental health care Workers (DHCWs). [13]

The virus that caused the COVID-19 pandemic is named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses (ICTV) on 11 February 2020. [14] SARS-CoV-2 remains stable in aerosols for several hours. [15] The virus is viable for hours in aerosols and for few days on surfaces, hence the transmission of SARS-CoV-2 is feasible through aerosols and also shows fomite transmission. [16]

Dentists have previously been described as one of the top of the working groups with high risk of exposure to SARS-CoV-2. Due to the close proximity of the dental health care workers to the patients, dental procedures involving aerosol production is not advisable in patients who tested positive for COVID-19 except for emergency dental treatment. [17] On 16 March 2020, the American Dental Association (ADA) has advised dentists to postpone all elective procedures. [18] ADA also developed guidance specific to address dental services during the COVID-19 pandemic. [19]

Elements like calcium, aluminium, silica and phosphorus can also be found in the dental aerosols produced during the procedures like debonding of orthodontic appliances. [20] These particles may range from 2 to 30 μm in diameter and there are chances of inhaling them. [21]

A number of methods have been proposed, and are widely used, to control dental aerosols and reduce risk of disease transmission. For example, dental aerosols can be controlled or reduced using dental suction, [22] rubber dam, [5] alternative handpieces, [2] and local exhaust ventilation (extra-oral suction). [23]

See also

Related Research Articles

<span class="mw-page-title-main">Dentistry</span> Branch of medicine

Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions of the mouth, most commonly focused on dentition as well as the oral mucosa. Dentistry may also encompass other aspects of the craniofacial complex including the temporomandibular joint. The practitioner is called a dentist.

<span class="mw-page-title-main">Dental dam</span> A thin, rectangular sheet used in dentistry to isolate the operative site

A dental dam or rubber dam is a thin, 6-inch (150 mm) square sheet, usually latex or nitrile, used in dentistry to isolate the operative site from the rest of the mouth. Sometimes termed "Kofferdam", it was designed in the United States in 1864 by Sanford Christie Barnum. It is used mainly in endodontic, fixed prosthodontic and general restorative treatments. Its purpose is both to prevent saliva interfering with the dental work, and to prevent instruments and materials from being inhaled, swallowed or damaging the mouth. In dentistry, use of a rubber dam is sometimes referred to as isolation or moisture control.

<span class="mw-page-title-main">Dentist</span> Health care occupations caring for the mouth and teeth

A dentist, also known as a dental surgeon, is a health care professional who specializes in dentistry, the branch of medicine focused on the teeth, gums, and mouth. The dentist's supporting team aids in providing oral health services. The dental team includes dental assistants, dental hygienists, dental technicians, and sometimes dental therapists.

Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities, gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened deposits (tartar) not removed by routine cleaning. Those with dentures and natural teeth may supplement their cleaning with a denture cleaner.

<span class="mw-page-title-main">Surgical mask</span> Mouth and nose cover against bacterial aerosols

A surgical mask, also known by other names such as a medical face mask or procedure mask, is a personal protective equipment used by healthcare professionals that serves as a mechanical barrier that interferes with direct airflow in and out of respiratory orifices. This helps reduce airborne transmission of pathogens and other aerosolized contaminants between the wearer and nearby people via respiratory droplets ejected when sneezing, coughing, forceful expiration or unintentionally spitting when talking, etc. Surgical masks may be labeled as surgical, isolation, dental or medical procedure masks.

Tooth whitening or tooth bleaching is the process of lightening the color of human teeth. Whitening is often desirable when teeth become yellowed over time for a number of reasons, and can be achieved by changing the intrinsic or extrinsic color of the tooth enamel. The chemical degradation of the chromogens within or on the tooth is termed as bleaching.

Legionella longbeachae is one species of the family Legionellaceae. It was first isolated from a patient in Long Beach, California. It is found predominantly in potting soil and compost. Human infection from L. longbeachae is particularly common in Australia, but cases have been documented in other countries including the United States, Japan, Greece and the UK.

<span class="mw-page-title-main">Dental drill</span> Dental instrument

A dental drill or dental handpiece is a hand-held, mechanical instrument used to perform a variety of common dental procedures, including removing decay, polishing fillings, performing cosmetic dentistry, and altering prostheses. The handpiece itself consists of internal mechanical components that initiate a rotational force and provide power to the cutting instrument, usually a dental burr. The type of apparatus used clinically will vary depending on the required function dictated by the dental procedure. It is common for a light source and cooling water-spray system to also be incorporated into certain handpieces; this improves visibility, accuracy, and the overall success of the procedure. The burrs are usually made of tungsten carbide or diamond.

<span class="mw-page-title-main">Dental assistant</span> Medical profession

Dental assistants are members of the dental team. They support a dental operator in providing more efficient dental treatment. Dental assistants are distinguished from other groups of dental auxiliaries by differing training, roles and patient scopes.

<span class="mw-page-title-main">Airborne transmission</span> Disease transmission by airborne particles

Airborne transmission or aerosol transmission is transmission of an infectious disease through small particles suspended in the air. Infectious diseases capable of airborne transmission include many of considerable importance both in human and veterinary medicine. The relevant infectious agent may be viruses, bacteria, or fungi, and they may be spread through breathing, talking, coughing, sneezing, raising of dust, spraying of liquids, flushing toilets, or any activities which generate aerosol particles or droplets.

<span class="mw-page-title-main">Wells curve</span> Science of medicine

The Wells curve is a diagram, developed by W. F. Wells in 1934, which describes what is expected to happen to small droplets once they have been exhaled into air. Coughing, sneezing, and other violent exhalations produce high numbers of respiratory droplets derived from saliva and/or respiratory mucus, with sizes ranging from about 1 μm to 2 mm. Wells' insight was that such droplets would have two distinct fates, depending on their sizes. The interplay of gravity and evaporation means that droplets larger than a humidity-determined threshold size would fall to the ground due to gravity, while droplets smaller than this size would quickly evaporate, leaving a dry residue that drifts in the air. Since droplets from an infected person may contain infectious bacteria or viruses, these processes influence transmission of respiratory diseases.

<span class="mw-page-title-main">Respiratory droplet</span> Type of particle formed by breathing

A respiratory droplet is a small aqueous droplet produced by exhalation, consisting of saliva or mucus and other matter derived from respiratory tract surfaces. Respiratory droplets are produced naturally as a result of breathing, speaking, sneezing, coughing, or vomiting, so they are always present in our breath, but speaking and coughing increase their number.

A toilet plume is the dispersal of microscopic particles as a result of flushing a toilet. Normal use of a toilet by healthy individuals is considered unlikely to be a major health risk. However this dynamic changes if an individual is fighting an illness and currently shedding out a virulent pathogen in their urine, feces or vomitus. There is indirect evidence that specific pathogens such as norovirus or SARS coronavirus could potentially be spread by toilet aerosols, but as of 2015, no direct experimental studies had clearly demonstrated or refuted actual disease transmission from toilet aerosols. It has been hypothesized that dispersal of pathogens may be reduced by closing the toilet lid before flushing, and by using toilets with lower flush energy.

Occupational hazards in dentistry are occupational hazards that are specifically associated with a dental care environment. Members of the dental team, including dentists, hygienists, dental nurses and radiographers, must ensure local protocols are followed to minimize risk.

<span class="mw-page-title-main">Workplace hazard controls for COVID-19</span> Prevention measures for COVID-19

Hazard controls for COVID-19 in workplaces are the application of occupational safety and health methodologies for hazard controls to the prevention of COVID-19. Vaccination is the most effective way to protect against severe illness or death from COVID-19. Multiple layers of controls are recommended, including measures such as remote work and flextime, increased ventilation, personal protective equipment (PPE) and face coverings, social distancing, and enhanced cleaning programs.

<span class="mw-page-title-main">Cloth face mask</span> Mask made of common textiles worn over the mouth and nose

A cloth face mask is a mask made of common textiles, usually cotton, worn over the mouth and nose. When more effective masks are not available, and when physical distancing is impossible, cloth face masks are recommended by public health agencies for disease "source control" in epidemic situations to protect others from virus laden droplets in infected mask wearers' breath, coughs, and sneezes. Because they are less effective than N95 masks, surgical masks, or physical distancing in protecting the wearer against viruses, they are not considered to be personal protective equipment by public health agencies. They are used by the general public in household and community settings as protection against both infectious diseases and particulate air pollution.

An aerosol-generating procedure (AGP) is a medical or health-care procedure that a public health agency such as the World Health Organization or the United States Centers for Disease Control and Prevention (CDC) has designated as creating an increased risk of transmission of an aerosol borne contagious disease, such as COVID-19. The presumption is that the risk of transmission of the contagious disease from a patient having an AGP performed on them is higher than for a patient who is not having an AGP performed upon them. This then informs decisions on infection control, such as what personal protective equipment (PPE) is required by a healthcare worker performing the medical procedure, or what PPE healthcare workers are allowed to use.

<span class="mw-page-title-main">Source control (respiratory disease)</span> Strategy for reducing disease transmission

Source control is a strategy for reducing disease transmission by blocking respiratory secretions produced through speaking, coughing, sneezing or singing. Surgical masks are commonly used for this purpose, with cloth face masks recommended for use by the public only in epidemic situations when there are shortages of surgical masks. In addition, respiratory etiquette such as covering the mouth and nose with a tissue when coughing can be considered source control. In diseases transmitted by droplets or aerosols, understanding air flow, particle and aerosol transport may lead to rational infrastructural source control measures that minimize exposure of susceptible persons.

<span class="mw-page-title-main">Transmission of COVID-19</span> Mechanisms that spread coronavirus disease 2019

The transmission of COVID-19 is the passing of coronavirus disease 2019 from person to person. COVID-19 is mainly transmitted when people breathe in air contaminated by droplets/aerosols and small airborne particles containing the virus. Infected people exhale those particles as they breathe, talk, cough, sneeze, or sing. Transmission is more likely the closer people are. However, infection can occur over longer distances, particularly indoors.

Lidia Morawska is a Polish–Australian physicist and distinguished professor at the School of Earth and Atmospheric Sciences, at the Queensland University of Technology and director of the International Laboratory for Air Quality and Health (ILAQH) at QUT. She is also co-director of the Australia-China Centre for Air Quality Science and Management, an adjunct professor at the Jinan University in China, and a Vice-Chancellor fellow at the Global Centre for Clean Air Research (GCARE), University of Surrey in the United Kingdom. Her work focuses on fundamental and applied research in the interdisciplinary field of air quality and its impact on human health, with a specific focus on atmospheric fine, ultrafine and nanoparticles. Since 2003, she expanded her interests to include also particles from human respiration activities and airborne infection transmission.

References

  1. ↑ Chuang CY, Cheng HC, Yang S, Fang W, Hung PC, Chuang SY (2014). "Investigation of the spreading characteristics of bacterial aerosol contamination during dental scaling treatment". Journal of Dental Sciences. 9 (3): 294–296. doi: 10.1016/j.jds.2014.06.002 .
  2. 1 2 Holliday R, Allison JR, Currie CC, Edwards DC, Bowes C, Pickering K, et al. (February 2021). "Evaluating contaminated dental aerosol and splatter in an open plan clinic environment: Implications for the COVID-19 pandemic". Journal of Dentistry. 105: 103565. doi:10.1016/j.jdent.2020.103565. PMC   7787509 . PMID   33359041.
  3. 1 2 3 Harrel SK, Molinari J (April 2004). "Aerosols and splatter in dentistry: a brief review of the literature and infection control implications". Journal of the American Dental Association. 135 (4): 429–37. doi:10.14219/jada.archive.2004.0207. PMC   7093851 . PMID   15127864.
  4. ↑ Allison JR, Edwards DC, Bowes C, Pickering K, Dowson C, Stone SJ, et al. (September 2021). "The effect of high-speed dental handpiece coolant delivery and design on aerosol and droplet production". Journal of Dentistry. 112: 103746. doi:10.1016/j.jdent.2021.103746. PMID   34265364. S2CID   235961737.
  5. 1 2 Vernon JJ, Black EV, Dennis T, Devine DA, Fletcher L, Wood DJ, Nattress BR (August 2021). "Dental Mitigation Strategies to Reduce Aerosolization of SARS-CoV-2". Journal of Dental Research. 100 (13): 1461–1467. doi:10.1177/00220345211032885. PMC   8649409 . PMID   34338580. S2CID   236775223.
  6. ↑ Zemouri C, de Soet H, Crielaard W, Laheij A (2017-05-22). Zhou D (ed.). "A scoping review on bio-aerosols in healthcare and the dental environment". PLOS ONE. 12 (5): e0178007. Bibcode:2017PLoSO..1278007Z. doi: 10.1371/journal.pone.0178007 . PMC   5439730 . PMID   28531183.
  7. ↑ Sivakumar I, Arunachalam KS, Solomon E (November 2012). "Occupational health hazards in a prosthodontic practice: review of risk factors and management strategies". The Journal of Advanced Prosthodontics. 4 (4): 259–65. doi:10.4047/jap.2012.4.4.259. PMC   3517967 . PMID   23236581.
  8. ↑ King TB, Muzzin KB, Berry CW, Anders LM (January 1997). "The effectiveness of an aerosol reduction device for ultrasonic scalers". Journal of Periodontology. 68 (1): 45–9. doi:10.1902/jop.1997.68.1.45. PMID   9029451.
  9. 1 2 Petti S, Vitali M (July 2017). "Occupational risk for Legionella infection among dental healthcare workers: meta-analysis in occupational epidemiology". BMJ Open. 7 (7): e015374. doi:10.1136/bmjopen-2016-015374. PMC   5734417 . PMID   28710211.
  10. ↑ "WHO | Water safety in buildings". WHO. Archived from the original on September 30, 2016. Retrieved 2020-03-13.
  11. ↑ Legionella and the prevention of legionellosis. World Health Organization. 2007.
  12. ↑ "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005". www.cdc.gov. Retrieved 2020-03-16.
  13. ↑ Petti S (June 2016). "Tuberculosis: Occupational risk among dental healthcare workers and risk for infection among dental patients. A meta-narrative review". Journal of Dentistry. 49: 1–8. doi:10.1016/j.jdent.2016.04.003. PMID   27106547.
  14. ↑ "Naming the coronavirus disease (COVID-19) and the virus that causes it". www.who.int. Retrieved 2020-03-19.
  15. ↑ "New coronavirus stable for hours on surfaces". National Institutes of Health (NIH). 2020-03-17. Retrieved 2020-03-19.
  16. ↑ van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. (April 2020). "Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1". The New England Journal of Medicine (letter). 382 (16): 1564–1567. doi: 10.1056/nejmc2004973 . PMC   7121658 . PMID   32182409.
  17. ↑ Gamio L (2020-03-15). "The Workers Who Face the Greatest Coronavirus Risk". The New York Times. ISSN   0362-4331 . Retrieved 2020-03-16.
  18. ↑ "ADA Calls Upon Dentists to Postpone Elective Procedures". American Dental Association. 16 March 2020. Archived from the original on 8 May 2021. Retrieved 23 March 2020.
  19. ↑ "COVID-19 Resources for Dentists". American Dental Association. Retrieved 23 March 2020.
  20. ↑ Day CJ, Price R, Sandy JR, Ireland AJ (January 2008). "Inhalation of aerosols produced during the removal of fixed orthodontic appliances: a comparison of 4 enamel cleanup methods". American Journal of Orthodontics and Dentofacial Orthopedics. 133 (1): 11–7. doi:10.1016/j.ajodo.2006.01.049. PMID   18174065.
  21. ↑ Ireland AJ, Moreno T, Price R (December 2003). "Airborne particles produced during enamel cleanup after removal of orthodontic appliances". American Journal of Orthodontics and Dentofacial Orthopedics. 124 (6): 683–6. doi:10.1016/s0889-5406(03)00623-1. PMID   14666082.
  22. ↑ Allison JR, Currie CC, Edwards DC, Bowes C, Coulter J, Pickering K, et al. (January 2021). "Evaluating aerosol and splatter following dental procedures: Addressing new challenges for oral health care and rehabilitation". Journal of Oral Rehabilitation. 48 (1): 61–72. doi:10.1111/joor.13098. PMC   7537197 . PMID   32966633.
  23. ↑ Allison JR, Dowson C, Pickering K, Červinskytė G, Durham J, Jakubovics NS, Holliday R (November 2021). "Local Exhaust Ventilation to Control Dental Aerosols and Droplets". Journal of Dental Research. 101 (4): 384–391. doi:10.1177/00220345211056287. PMC   8935467 . PMID   34757884. S2CID   243987221.

Further reading

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.