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Upper anterior quadrant isolation by the rubber dam. Upper anterior quadrant isolation by the rubber dam.
Source publication
Dental health care workers around the world are in a constant state of fear and anxiety because they work in a constrained space of the dental practice. During routine dental procedures, they are exposed to aerosol and splatter. These airborne particles pose a great risk of transmitting contagious infections to health care workers and patients, esp...
Context in source publication
Context 1
... manikin was set to a reclined position to simulate the clinical operatory position of the patient for dental restorative procedures. Rubber dam isolation was achieved for the upper anterior quadrant from tooth #13 to #23, as shown in Figure 1. Adhesive tape was placed in six different directions from the head of the manikin at 2, 4, 6, 8, 10, and 12 o'clock positions (Figure 2). ...
Citations
... However, instrumental methods can measure particle concentration but are limited to particles of a fixed size, making it challenging to discern viral particles [22,23]. Similarly, filter paper, optical, and spectroscopic methods are unable to measure particle concentration, providing only droplet counts [9,20,24,25]. Microbiological methods typically prioritize the detection of alpha-hemolytic streptococci or anaerobes, often neglecting viruses [6,10]. The latest research utilized state-of-the-art experimental fluid mechanics tools to detect the number and the transmission speed of aerosol droplets through the advanced high-speed imaging techniques and optical flow tracking velocimetry. ...
Background
During dental procedures, critical parameters, such as cooling condition, speed of the rotary dental turbine (handpiece), and distance and angle from pollution sources, were evaluated for transmission risk of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), simulated by spiking in a plasmid encoding a modified viral spike protein, HexaPro (S6P), in droplets and aerosols.
Methods
To simulate routine operation in dental clinics, dental procedures were conducted on a dental manikin within a digital dental unit, incorporating different dental handpiece speeds and cooling conditions. The tooth model was immersed in Coomassie brilliant blue dye and was pre-coated with 100 μL water spiked-in with S6P-encoding plasmid. Furthermore, the manikin was surrounded by filter papers and Petri dishes positioned at different distances and angles. Subsequently, the filter papers and Petri dishes were collected to evaluate the aerosol splash points and the viral load of S6P-encoding plasmid in aerosols and splatters generated during the dental procedure.
Results
Aerosol splashing generated a localized pollution area extended up to 60 cm, with heightened contamination risks concentrated within a 30 cm radius. Significant differences in aerosol splash points and viral load by different turbine handpiece speeds under any cooling condition (P < 0.05) were detected. The highest level of aerosol splash points and viral load were observed when the handpiece speed was set at 40,000 rpm. Conversely, the lowest level of aerosol splash point and viral load were found at a handpiece speed of 10,000 rpm. Moreover, the aerosol splash points with higher viral load were more prominent in the positions of the operator and assistant compared to other positions. Additionally, the position of the operator exhibited the highest viral load among all positions.
Conclusions
To minimize the spread of aerosol and virus in clinics, dentists are supposed to adopt the minimal viable speed of a dental handpiece with limited cooling water during dental procedures. In addition, comprehensive personal protective equipment is necessary for both dental providers and dental assistants.
... Comparison of contamination of outside and inside of masks was also subject of several in vitro studies showing that the inner side of the mask is regularly contaminated during treatments [45][46][47][48]. In one of these studies, contamination on the outer surface and even on the inner surface of single-layered surgical masks could be detected by both the operator and assistant on the dummy head where cavity preparation was performed using filter papers to assess the spread of the spray [45]. ...
Personal protective equipment (PPE) has long been a high priority in dental aerosol-producing treatments. Since COVID-19 pandemic, its importance has increased yet again. While importance of PPE in preventing transmission and thus possible infection of pathogens is well known, contamination potential of PPE after treatment itself is less investigated. This review aims to give an overview of the current literature and contamination potential (viral, blood, bacterial) of components of protective equipment itself. The literature search was performed using the Medline database; furthermore, a hand search was conducted. Last search took place on 23 November 2022. Two categories of hygiene-related keywords were formed (category A: mask, face shield, goggles, eyewear, personal protective equipment; category B: contamination, aerosol). Each keyword from one category was combined with all keywords from the other one. In addition, the keyword “dental” was always added. First, a title and abstract screening was performed. Afterward, a full-text analysis was followed for the included studies. A total of 648 search hits were found in the Medline database. 47 were included after title and abstract screening. 22 studies were excluded after full-text analysis, 25 studies were included. The hand search resulted in 4 studies that were included. Bacterial contamination of PPE after treatment has been adequately studied, contamination with blood less. Microorganisms mainly originate from the oral and cutaneous flora; however, a transmission of potential pathogens like Staphylococcus aureus or Escherichia coli was also described. Studies showing transmission pathways starting from PPE and its various components are lacking. No measures have yet been described that fully protect the protective equipment from contamination. There is growing awareness that PPE itself can be a source of pathogen transmission, and thus possible infection. Therefore, not only wearing of protective clothing, but also conscious handling of it is crucial for transmission and possible infection prevention. However, studies showing transmission pathways starting from PPE and its various components are lacking. Several studies have investigated what measures can be taken to protect the protective equipment itself. So far, none of the methods evaluated can prevent contamination of PPE.
... Previous studies investigating the spread of aerosol and splatter contamination to individuals and the environment during and after AGDPs [29][30][31][32][33][34][35] showed that the contamination rates were highest in the area around the dental unit. Such an area, likely penetrated by aerosols and splatter during AGDPs, was thus defined as the "red zone" and is recommended to be treated with careful cleaning and disinfection with antimicrobial agents after such procedures [57]. As expected, in the "red zone", the patient and oral healthcare workers were most susceptible to contamination during AGDPs, including ultrasonic scaling [28]. ...
The risk of microbial air contamination in a dental setting, especially during aerosol-generating dental procedures (AGDPs), has long been recognized, becoming even more relevant during the COVID-19 pandemic. However, individual pathogens were rarely studied, and microbial loads were measured heterogeneously, often using low-sensitivity methods. Therefore, the present study aimed to assess microbial air contamination in the dental environment, identify the microorganisms involved, and determine their count by active air sampling at the beginning (T0), during (T1), and at the end (T2) of ultrasonic scaling in systemically and periodontally healthy subjects. Air microbial contamination was detected at T0 in all samples, regardless of whether the sample was collected from patients treated first or later; predominantly Gram-positive bacteria, including Staphylococcus and Bacillus spp. and a minority of fungi, were identified. The number of bacterial colonies at T1 was higher, although the species found were similar to that found during the T0 sampling, whereby Gram-positive bacteria, mainly Streptococcus spp., were identified. Air samples collected at T2 showed a decrease in bacterial load compared to the previous sampling. Further research should investigate the levels and patterns of the microbial contamination of air, people, and the environment in dental settings via ultrasonic scaling and other AGDPs and identify the microorganisms involved to perform the procedure- and patient-related risk assessment and provide appropriate recommendations for aerosol infection control.
... Many studies have been conducted on aerosols, droplets, and splatter contamination during dental treatments [9][10][11][12][13][14][15][16][17][18][19]. In some studies, dental manikin, phantom teeth, or extracted teeth have been used [12,14,16,17]. ...
... Many studies have been conducted on aerosols, droplets, and splatter contamination during dental treatments [9][10][11][12][13][14][15][16][17][18][19]. In some studies, dental manikin, phantom teeth, or extracted teeth have been used [12,14,16,17]. However, more aerosols are generated during dental treatment with live patient, and these aerosols contain saliva, blood, dental plaque, and tooth debris [17]. ...
... Therefore, in the present study, all measurements have been made while performing routine dental preparation in a specific dental room with live patients. The majority of studies used open culture plates, which measured droplets and aerosols fallen onto the surface [9,[12][13][14][15][16]. However, small particles may remain suspended in the air for many hours. ...
Objectives:
Aerosols formed during dental treatments have a huge risk for the spread of bacteria and viruses. This study is aimed at determining which part of the working area and at what size aerosol is formed and ensuring more effective use of HEPA-filtered devices.
Materials and methods:
Anterior tooth preparation was performed by one dentist with one patient. Particle measurements were made using an airborne particle counter and were taken at four different locations: the chest of the patient, the chest of the dentist, the center of the room, and near the window. Three groups were determined for this study: group 1: measurement in a 24-h ventilated room (before the tooth preparation, empty room), group 2: measurement with the use of saliva ejector (SE), and group 3: measurement with the use of saliva ejector and HEPA-filtered extra-oral suction (HEOS) unit.
Results:
The particles generated during tooth preparation were separated according to their sizes; the concentration in different locations of the room and the efficiency of the HEOS unit were examined.
Conclusions:
The present study showed that as the particle size increases, the rate of spread away from the dentist's working area decreases. The HEPA-filtered extra-oral suction unit is more effective on particles smaller than 0.5 microns. Therefore, infection control methods should be arranged according to these results.
Clinical relevance:
The effective and accurate use of HEPA-filtered devices in clinics significantly reduces the spread of bacterial and viral infections and cross-infection.
... ACE2 is an enzyme receptor that binds to SARS-CoV, and a majority is found in salivary ducts [88] and epithelial cells of the tongue [89], making the oral cavity a highly susceptible area of transmission and infection for the virus [88,89]. Multitudes of studies have outlined methods to prevent contamination with the use of high-volume evacuation [90,91], intraoral and extraoral suctions [90,92], use of nonsurgical procedures [93,94], mouth rinses [95][96][97], rubber dams [98], and PPE [99]. Although these preventative methods are often practiced in dentistry, adding antimicrobial components may benefit both patients and health care professionals in viral transmissions, such as COVID- 19. ...
There has been profound growth in the use of 3D printed materials in dentistry in general, including orthodontics. The opportunity to impart antimicrobial properties to 3D printed parts from existing resins requires the capability of forming a stable colloid incorporating antimicrobial fillers. The objective of this research was to characterize a colloid consisting of a 3D printable resin mixed with Ag-ion releasing zeolites and fumed silica to create 3D printed parts with antiviral properties. The final composite was tested for antiviral properties against SARS-CoV-2 and HIV-1. Antiviral activity was measured in terms of the half-life of SARS-CoV-2 and HIV-1 on the composite surface. The inclusion of the zeolite did not interfere with the kinetics measured on the surface of the ATR crystal. While the depth of cure, measured following ISO4049 guidelines, was reduced from 3.8 mm to 1.4 mm in 5 s, this greatly exceeded the resolution required for 3D printing. The colloid was stable for at least 6 months and the rheological behavior was dependent upon the fumed silica loading. The inclusion of zeolites and fumed silica significantly increased the flexural strength of the composite as measured by a 3 point bend test. The composite released approximately 2500 μg/L of silver ion per gram of composite as determined by potentiometry. There was a significant reduction of the average half-life of SARS-CoV-2 (1.9 fold) and HIV-1 (2.7 fold) on the surface of the composite. The inclusion of Ag-ion releasing zeolites into 3D-printable resin can result in stable colloids that generate composites with improved mechanical properties and antiviral properties.
... Up until now, there have been more than 517 million COVID-19 confirmed cases and about 6.2 million deaths worldwide [3]. The most common transmission routes for COVID-19 include touching contaminated surfaces, touching the face or eyes, coughing and sneezing (from infected people), as well as through contamination from droplets and aerosol-cloud generating procedures [4,5]. ...
... Dentistry is one profession that commonly involves procedures that generate aerosols. Therefore, among many other healthcare teams, dental teams and patients are the most vulnerable groups to SARS-CoV-2 infection [4,5]. In this case, the risks are mainly due to the possibility of infection by inhalation of contaminated particles generated by aerosol, the handling of patient secretions, contact with contaminated surfaces, and face-to-face communication [4,5,6]. ...
... Therefore, among many other healthcare teams, dental teams and patients are the most vulnerable groups to SARS-CoV-2 infection [4,5]. In this case, the risks are mainly due to the possibility of infection by inhalation of contaminated particles generated by aerosol, the handling of patient secretions, contact with contaminated surfaces, and face-to-face communication [4,5,6]. ...
Objective: To assess oral healthcare-seeking behaviors during the COVID-19 lockdown period in eastern Saudi Arabia.
Methods: A cross-sectional questionnaire-based study was conducted from October 2020 to December 2020 at Dental Clinic Complex, College of Dentistry, King Faisal University Al Ahsa, Saudi Arabia. Three hundred and sixty patients who visited the Dental Clinic Complex after relaxation of lockdown and consented to participate
were included in this study. Participants were instructed to complete a questionnaire on oral health and dental care during the lockdown period, consisting of five sections.
Results: Out of 360 participants, 168 reported requiring dental help during the lockdown period; however, only 27 participants contacted a dentist to emergency advice on phone, and 102 participants visited a dentist. Most participants used toothpaste for sensitive teeth, followed by over-the-counter pain killers, and clove oil. In this regard, 72.8% of females used toothpaste for sensitive teeth. A considerable number of participants needed filling, followed by root canal treatment, denture repair, and dental extraction. Most participants were treated with pain killers, followed by antibiotics, and referral to a hospital. More than 80% of them expressed that regular visits to the dentist are beneficial.
Conclusion: A substantial proportion of participants sought oral health care during the lockdown period, mainly for restorative treatment. This was mostly achieved by visiting a dentist, or via telephone consultation to a lesser extent. Analgesics were the most common prescriptions, followed by antibiotics. Dental patients should be encouraged to regularly visit dentists to mitigate the drawbacks that lockdowns may cause in the provision of oral healthcare services.
... • fluorescein-stained aerosol/droplets generated during the dental procedure on a manikin. These stains were captured by placing filtered papers across different locations, that surround the dental procedure area [15,16,18,19,26,35,37] and • different sized particles using particle counters. Suspended particles that were generated while conducting a dental procedure on a manikin. ...
... All five out of six studies [15,16,18,19,26,37], looking at contamination using filter paper recording methods, found a reduction in contamination over distances beyond 60 cm. One study [26], found a drop in results to 0 relative fluorescein units [38] per surface area at 2 to 3 m but registered positive contamination beyond this distance. ...
... The COVID-19 pandemic has hampered such investigations, but some methodologies could be adapted to mimic clinical environments by using mannequins and in simulated clinics. However, one of the implications of this is the difference between measuring contamination from solution spread when the fluorescein dye being measured is in the fluid reservoir as opposed to saliva [15,16,18,19,26,35,37]. One group who published five of recent studies, used slightly different methodologies to investigate different aspects, as noted in one of their most recent papers [35], "The contamination readings obtained in the present study by using fluorescein in the mouth of the mannequin were significantly lower for the positive control condition (anterior crown preparation with suction) than we have previously reported using fluorescein in the irrigation reservoirs of dental instruments [35]. ...
Introduction
The COVID-19 pandemic has caused major disruptions in dental care globally, in part due to the potential for contaminated aerosol to be generated by dental activities. This systematic review assesses the literature for changes in aerosol-contamination levels when rotary instruments are used, (1) as distance increases from patient’s mouth; (2) as time passes after the procedure; and (3) when using different types of handpieces.
Methods
The review methods and reporting are in line with PRISMA statements. A structured search was conducted over five platforms (September 2021). Studies were assessed independently by two reviewers. To be eligible studies had to assess changes in levels of aerosol contamination over different distances, and time points, with rotary hand instruments. Studies’ methodologies and the sensitivity of the contamination-measurement approaches were evaluated. Results are presented descriptively.
Results
From 422 papers identified, 23 studies were eligible. All investigated restorative procedures using rotary instruments and one study additionally looked at orthodontic bracket adhesive material removal. The results suggest contamination is significantly reduced over time and distance. However, for almost all studies that investigated these two factors, the sizes of the contaminated particles were not considered, and there were inconclusive findings regarding whether electric-driven handpieces generate lower levels of contaminated particles.
Conclusion
Aerosol contamination levels reduce as distances, and post-procedure times increase. However, there was sparce and inconsistent evidence on the clearing time and no conclusions could be drawn. High-speed handpieces produce significantly higher levels of contamination than slow-speed ones, and to a lesser extent, micro-motor handpieces. However, when micro-motor handpieces were used with water, the contamination levels rose and were similar to high-speed handpiece contamination levels.
... to minimize the aerosols in dental operatory 13,,14 and operation theatres15as suggested using head caps, disposable surgical gowns, safety glasses, and face shields, and refrain from removing them immediately after the procedure within the dental operatory and an aerosol box while performing clinical procedures. 16 Reducing the number of aerosols in dental practice is imperative to avoid cross-infection with COVID-19. 2,5 The authors recommend using the aerosol box (Dentist's Shield) while performing ...
COVID-19 affected healthcare professionals globally, especially dentists, which is airborne and transmitted through contact. Most dental procedures are aerosol generated and these aerosols in dental practice tend to transmit acute respiratory infections like COVID-19. Recently, a few authors recommended using the aerosol box to reduce the aerosol count in a dental setting. However, the study aims to describe and recommend a reformed aerosol box desand to practice safe dentistry.
... Under these circumstances, the conventional protective measures were no longer effective in the case of SARS-CoV-2 virus presence [4,5]. When evaluating the contamination produced after cavity preparation using a two-hole and four-hole handpiece, Ahmed et Jouhar (2021) found that the mean amount of aerosol and splatter produced by both handpieces was not statistically significant; however, the amount of aerosol and splatter produced at a distance of 12, 24, and 36 inches immediately after cavity preparation and 30 min after cavity preparation was statistically significant, regardless of the type of handpiece used [6]. While current guidelines suggest minimizing the use of airborne spreading devices (in order to reduce the production of PM particles), some studies have shown that avoiding natural ventilation during the performance of dental activities and using low-volume suction might considerably reduce the total amount of PM particles [2,7]. ...
... While current guidelines suggest minimizing the use of airborne spreading devices (in order to reduce the production of PM particles), some studies have shown that avoiding natural ventilation during the performance of dental activities and using low-volume suction might considerably reduce the total amount of PM particles [2,7]. In addition, special precautions against aerosol transmission should be taken, and the use of aspirating systems with HEPA filters, which evacuate air and dissipate in the atmosphere, has been advocated [8]. ...
Background:
For the past two and half years, dentists all across the world, along with their patients, have faced numerous challenges. In this context, the aim of this integrative review was to assess if dentists' and patients' attitudes regarding teledentistry (TD) have changed since the COVID-19 outbreak, and if the use of TD will continue to rise, even in the post-pandemic period; (2) Methods: A literature search was performed between August 2021 and January 2022. The PubMed, Scopus, and Science Direct databases were searched for articles published between 2012 and 2022 using a combination of the following Mesh terms: "COVID-19", "pandemic", "oral telemedicine", "teledentistry"; (3) Results: Among the 52 included papers, nine papers were published between 2011 and 2019, and 43 articles were published after 2020 (12 were published in 2020, 29 papers were published in 2021, and two in 2022). Among the articles published before 2020, seven out of nine included papers were reviews, and two were original research. Among the 43 papers published after 2020, 18 were reviews and 25 original research. (4) Conclusions: Based on the results of this integrative review, there is clear evidence that the interest in teledentistry and teleassistance in the dental field has increased rapidly, especially in the context of the COVID-19 pandemic. Therefore, while dental practitioners should be encouraged to keep themselves updated about new technologies, patients should also be constantly informed about their options for receiving special oral health care.
... 29 A recent study by Ahmed and Jouhar stated splatter and aerosols are produced 12, 24, and 36 inches distance immediately after cavity preparation and 30 min after cavity preparation. 30 Therefore, it is advisable to refrain from removing the personal protective barriers immediately after the procedure within the vicinity of the dental practice. 30 Previous evidence had revealed that human coronaviruses, that is, severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS), persist on nonliving surfaces for up to 9 days. ...
... 30 Therefore, it is advisable to refrain from removing the personal protective barriers immediately after the procedure within the vicinity of the dental practice. 30 Previous evidence had revealed that human coronaviruses, that is, severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS), persist on nonliving surfaces for up to 9 days. 31 Nevertheless, their spread can be limited by using various alcohol and hydrogen peroxide (H 2 O 2 ) based disinfectants. ...
Introduction: Clinical activities at dental premises after the COVID-19 lockdown period or post-COVID-19 are likely to be a challenge for all practicing dentists. To assess the impact of the COVID-19 pandemic on dentists and change in dental practice following lockdown.
Material and Methods: A total of 1150 participants were approached through online survey forms registered on www.surveys.google. A link containing details of the questionnaire and a consent form was sent to dentists through emails and social media forums. The questionnaire included three domains comprising of seventeen questions. The first section focused on demographics. The second section inquired about the change in dental practice i.e. clinical hours, use of PPE, type of treatment, and patient flow. The third section investigated the impact of COVID-19 on dentistry. Means, standard deviation, and percentages were calculated using descriptive statistics. Chi-square was used to find an association between different variables.
Results: The response rate was 87%. Demographic factors revealed, participants aged from 20.45 to 40.55 years. The data showed around 89.6% (896) of dentists have altered their clinical working hours post lockdown and approximately, 59.7% (597) of dentists provided only emergency treatments.88.1% (881) of the dentists wore PPE during dental procedures. Overall, a huge negative impact of the COVID-19 pandemic was observed among practicing dentists in terms of the dental supply chain, cost, and availability of dental equipment, treatment cost, and bill payments.
Conclusion: COVID-19 pandemic compromised dental care. Though dentists were taking precautionary measures and have changed their practice according to the guidelines provided by the ADA and WHO they were still experiencing monetary loss due to decrease patient influx post lockdown.
