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COVID-19 and the problem with dental aerosols
Dentistry is classified in the very-high-risk category of occupations involved with aerosol production. What does this have to do with COVID-19? Quite a lot. Here is the latest research.
Dentists who treat patients using aerosolization are at an extremely dangerous risk of inoculation of themselves, their dental assistants, other office staff members, and reinoculation of the patients. Most risk occurs from splatter and droplet transmission to the midface of the dentist and assistant, as well as the nasal area of the patient.10 In addition, periodontal treatment has a much higher incidence of droplet transmission than prosthetic treatment.11 Ultrasonic and sonic transmission during nonsurgical procedures had the highest incidence of particle transmission, followed by air polishing, air/water syringe, and high-speed handpiece aerosolization.12 One study found that ultrasonic instrumentation can transmit 100,000 microbes per cubic foot with aerosolization of up to six feet, and, if improper air current is present, microbes can last anywhere from 35 minutes to 17 hours.13
Because of these inherent dangers to dentists, team members, and patients, the Occupational Safety and Health Act (OSHA) just released a new report called “Guidance on Preparing Workplaces for COVID-19.”14 This document categorizes occupational risk as very high, high, medium, and lower risk. The occupations that are involved with aerosol production fall into the category of very high risk, according to OSHA.
Since dentistry is in the very-high-risk category, the section “Implement Workplace Controls, Engineering Controls” recommends that dental practices install negative-pressure rooms or airborne infection isolation rooms for operatories in which procedures involving aerosol will be performed. In addition, recommendations for the dentist and staff working in areas of direct contact with aerosols include wearing the following personal protective equipment (PPE) masks: “Other types of acceptable respirators include: a R/P95, N/R/P99, or N/R/P100 filtering facepiece respirator; an air-purifying elastomeric (e.g., half-face or full-face) respirator with appropriate filters or cartridges; powered air-purifying respirator (PAPR) with high-efficiency particulate arrestance (HEPA) filter; or supplied air respirator (SAR).”14
Many changes in infection control procedures and the associated dental armamentaria can be expected to arise in the post-COVID-19 world of dentistry. The extent and severity of change will be dictated by evidence and research into the best and safest practices. Prior to mandating change that will involve an extreme financial and architectural change of the current dental office, research should be conducted that evaluates current available practices, methodology, and instrumentation that can mitigate/obviate the risk of transmission, while being financially and practically expeditious.