Introduction and Aims
Aerosol generation during dental procedures poses significant risks due to the potential for transmitting aerosol-bound microorganisms, including those in dental unit waterlines. This study aimed to quantify aerosol dispersion at various distances from dental procedures using a high-speed electric handpiece, with a focus on the effectiveness of various aerosol mitigation strategies.
Methods
Employing a mannequin head with an artificial tooth (typodont), we simulated clinical settings without the use of saliva to solely assess the contribution of dental unit waterlines and mechanical factors to aerosol production. Measurements were taken using a spectrometer at distances of 0, 0.9, and 1.8 meters from the handpiece.
Results
The results showed no significant difference in aerosol dispersion between 0.9 and 1.8 meters without evacuation. In contrast, the use of high-volume evacuators, particularly the Isolite system, significantly decreased aerosol dispersion across all distances.
Conclusion
We found that any type of high-volume evacuator can decrease aerosol dispersion, but the use of Isolate was the most effective.
Clinical Relevance
The results from this study can influence choice of safety measures to minimize aerosol spread during dental procedures.
Introduction
Dental procedures are a significant source of aerosols, which are fine particles suspended in the air that can carry saliva, blood, microorganisms, and other contaminants.1,2 These aerosols are generated during various dental procedures (aerosol-generating procedures) such as those that use high-speed handpieces, ultrasonic scalers, and air-water syringes. The nature of these aerosols, compounded by the complexity of their sources, including not only biological fluids but also substances from dental unit waterlines (DUWLs), necessitates a comprehensive understanding of their composition, sources of generation, associated risks, and the effect of mitigation strategies to ensure safety within dental settings.
The term ‘dental aerosol’ refers to the suspension of particles generated during dental interventions. These aerosols consist primarily of saliva droplets and irrigant that can contain pathogens such as bacteria or viruses present within the oral cavity as well as blood particles from gingival bleeding.3 The high-speed handpieces used in dentistry create a significant amount of turbulent airflow, which propels these saliva droplets into smaller sizes that remain airborne for extended periods,3 increasing the risk of inhalation and subsequent infection.
Furthermore, ultrasonic scalers produce intense vibrations that atomize water coolant into aerosols laden with biofilm debris, tooth debris, and dental materials,4 adding another layer of risk for contamination.
Exposure to dental aerosols poses multiple hazards for patients and healthcare professionals as inhalation or direct contact with contaminated droplets can lead to respiratory tract infections caused by pathogenic microorganisms present within the aerosols.5,6 The advent of severe acute respiratory syndrome coronavirus 2, responsible for the coronavirus disease of 2019, has dramatically highlighted the critical importance of understanding and mitigating the risks associated with dental aerosols.7, 8, 9, 10 Recent research has demonstrated that severe acute respiratory syndrome coronavirus 2 can be transmitted through aerosols generated during certain dental procedures.5 Furthermore, DUWLs are another potential source of pathogens, such as Legionella pneumophila,11,12 which could be carried by aerosols. This underscores the need for infection control measures to prevent disease transmission.
To effectively minimize the risks posed by dental aerosols, a variety of strategies can be employed in clinical settings. The use high-volume evacuators or suction devices during procedures to capture and remove aerosols at their source, significantly reducing the risk of aerosol dispersion.13 Preprocedural mouth rinses containing antimicrobial agents have been shown to significantly reduce the bacterial load in saliva, mitigating potential contamination.14 Moreover, the implementation of air purification systems equipped with HEPA filters can effectively remove airborne contaminants from the dental environment.13 The design of handpieces (air turbine vs electric handpiece) and DUWL disinfectants are also important bioaerosol control measures.15,16 Strategic use of dental rubber dams during procedures further helps in minimizing the generation and spread of aerosols, effectively isolating the treatment area from the oral environment.
The objectives of this study are to determine the concentration of aerosol particles at various distances from a dental procedure when using a high-speed electric handpiece without tooth preparation or the use of an evacuation system and to evaluate the efficacy of different evacuation systems in reducing these concentrations during simulated tooth preparation with high-speed electric handpieces.
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