Dental aerosols are a top concern in the era of COVID-19. Even with reduced capacity, a busy dental practice is a community hub ‒ meaning that if someone gets infected, whether you, a colleague, or a patient, there's an increased chance of super-spreading.
You know that your trade's essential tools – ultrasonic scalers and air polishers – generate dental aerosols. Recently, we provided a general review on the risk of aerosols in dentistry. Here, you’ll find a refresher on a few ways to effectively control these aerosols in the age of COVID-19.
Dental aerosols are tiny microdroplets (under 50μm in diameter) caused when ultrasonic power scalers, air polishers, and other dental equipment are used on patients. Generally, ultrasonic scalers are the worst offenders.
The two main sources of dental aerosols are dental unit waterlines (DUWL) and patients.
Whenever high-speed equipment makes contact with a patient’s saliva, blood, or plaque, it is bound to create microdroplets. That’s a given.
However, the water used to cool the scaler’s ultrasonic tip could also contain bacteria which can then become aerosolized. This risk tends to be exacerbated when you connect the scaler to an older style water source that's poorly maintained.
While not all dental aerosols are harmful, they may contain harmful bacteria and viruses. These pathogens, including viruses like COVID-19, can linger in the atmosphere or settle on surfaces for long after the patient has left.
Many studies speak to COVID-19's ability to cover vast distances and stay airborne over several hours. Although there is no peer-reviewed research to date about COVID-19 and dental aerosols, most experts indicate that aerosols can play host to the virus.
It's yet to be 100% determined that aerosols generated during dental procedures carry a large enough viral load to spread infection. All the same, proceeding with caution wins the day, and industry professionals are doing everything possible to control droplets.
All the best intentions in the world mean nothing if you aren't following the consensus best practices to mitigate aerosol generation risks.
Right away, we'll point out that solely relying on a saliva ejector won't adequately control aerosols and splatter. You need a more robust control system to optimize everybody's safety.
Below are proven techniques to offset aerosol and splatter production. Better yet, these techniques will work even if you don't have an assistant to help out.
1. Use High Volume Evacuation (HVE) Devices
High-volume evacuation devices control aerosols much more successfully than saliva ejectors, according to multiple studies.
More specifically, the Journal of Dental Hygiene published a study citing how HVE devices reduced 89.7% to 90.8% of aerosols. Yes, operating these devices while using a scaler or polisher without an assistant presents challenges. But there are ways you can do it.
The following suggestions can help make your HVE device more useful without relying on an assistant.
2. Rinse Before Every Procedure
An antiseptic rinse before the procedure lessens the bacterial bioburden and viral presence in your patients' mouths. A 1992 study in the Journal of Periodontology found a 94.1% reduction in aerosols after a 30-second preprocedural antiseptic rinse (Listerine).
Although the study referenced measured applied 30-seconds of rinsing, use a 60-second rinse-time for your patients after they're seated. Repeat this process once you've taken your patient history and performed every other pretreatment task.
Moreover, the patient should rinse multiple times throughout the entire treatment. This is due to how quickly the bacteria and viruses re-develop in one's mouth.
Ensuring the rinsing process is repeated reduces potentially infectious bacteria at the source. Thus, your HVE will be more effective since there will be less harmful pathogens to manage.
3. Leverage Isolation and Suction Devices
Nowadays, there's a diverse array of isolation and suction devices on the market. The HVE ports connect to a hose where these devices can connect.
Isolation is provided with these isolation and suction devices. Furthermore, they keep your patient's mouth open while providing high-volume suction.
4. Use a Microbial and Enzymatic Evacuation System Cleaner
Years of sludge and debris can build up and clog your suction lines. This prevents your vacuum suction from performing at full pump capacity, limiting your ability to control dental aerosols via evacuation.
Flushing the system with an all natural, enzymatic cleaner like Bio-Pure can improve suction performance. Bio-Pure contains naturally occurring, non-pathogenic microorganisms that digest organic waste (ex. blood, saliva and mucus) that would normally build up inside the system. What cannot be digested is loosened and flushed through!
Bio-Pure maintenance comes in 3 different formulas: an end of day powder, end of day liquid, and between patient flush. You can easily adopt it as part of your existing maintenance routine to help your vacuum suction perform at peak capacity and enhance your ability to control dental aerosols.
In the new normal, infection prevention has never been more of a priority. On top of that, the dental industry – given the equipment being used – is associated with many viral risks. Your community relies on you to follow the safest possible practices. By adhering to the above suggestions, you'll be doing your part!