At the time of this writing, infection and cross-contamination are an ongoing and vital discussion in health care circles. The bulk of the discussion is focused on the ongoing battle against the COVID-19 Coronavirus. However, there are other ongoing concerns for oral health care providers across America. With many dental offices closed for regular care due to pandemic shutdown/stay at home orders, we’d like to take this opportunity to renew the discussion around dental aerosols and the dangers they pose in a dental practice.
Dental Aerosols, What are they?
In a scientific context, aerosols are defined as minute particles of a solid or liquid suspended in a gas. In the context of a dental practice, aerosols are most often created by dental instruments that rely on compressed air or water to function. However, many instruments can create aerosols or splatter. Including, but not limited to, any instrument which uses low- or high-speed handpieces, lasers, electrosurgery units, ultrasonic scalers, air polishers, prophy angles, hand instruments, or air/water syringes.
The oral cavity is home to over 700 microbial species of all sorts. This has the potential to spread infection or contamination broadly. Contamination by aerosols is up to four times higher in areas where such equipment is in use. Further compounding the issue, aerosol contamination can persist for hours or days. This is depending on the nature of the contaminant and the physical conditions of the setting. Considering this, dental professionals of all strips must be vigilant in maintaining appropriate sanitation and sterilization procedures and practices.
Reducing the Danger
With that in mind, what are the best practices for reducing the danger of aerosol contamination and the resulting hazards for both dental staff and patients? Research has shown the advanced use of an antiseptic mouthwash reduces danger. It can reduce the number of viable microorganisms in spray and splatter created by many dental procedures. Mouthwash use can reduce the spread of bacteria by up to 60% in some instances. Combined with standard sanitation and sterilization procedures, this can go a long way toward helping oral health care providers mitigate the dangers posed by aerosol contamination.
However, mouthwash alone is not enough. Among the many potentially infectious illnesses that can be carried by aerosols are a number of respiratory infections. Including acute bronchitis, the common cold, the flu, pneumonia, SARS, and tuberculosis. Managing these risks involves a twofold approach focusing on both personal protective equipment (PPE) and ventilation management. Gloves should, of course, be worn as well as surgical masks in combination with solid side shields or face shields. This application of PPE can effectively reduce the risk of person-to-person transmission via aerosols or other means of infection. Likewise adequately ventilated spaces with air filtered by either HEPA or electrostatic filters can reduce the concentration of airborne particles.
Dental aerosols pose a risk, perhaps especially now, and addressing their origin, spread, and containment should be a critical part of daily practice for any oral health care provider. While patient care is always the priority, one should bear in mind practitioners and staff are exposed far more often than patients are. Care should be taken to keep them safe as they provide services for their patients.