Mitigating aerosol contamination: strategies for contamination-free scaling

Exposure to aerosol spray generated by high-speed handpieces (HSHs) and ultrasonic scalers poses a significant health risk to oral health practitioners from airborne pathogens. Aerosol generation varies with different HSH designs, but to date, no study has measured this. We measured and compared aerosol generation by (1) dental HSHs with 3 different coolant port designs and (2) ultrasonic scalers with no suction, low-volume evacuation (LVE) or high-volume evacuation (HVE). Measurements used a particle counter placed near the operator's face in a single-chair, mechanically ventilated dental surgery. Volume concentrations of aerosol, totaled across a 0.3-25-µm size range, were compared for each test condition. HSH drilling and scaling produced significantly high aerosol levels (P < .001) with total volume concentrations 4.73×108µm3/m3 and 4.18×107µm3/m3, respectively. For scaling, mean volume of aerosol was highest with no suction followed by LVE and HVE (P < .001). We detected a negative correlation with both LVE and HVE, indicating that scaling with suction improved operator safety. For drilling, simulated cavity preparation with a 1-port HSH generated the most aerosol (P < .01), followed by a 4-port HSH. Independent of the number of cooling ports, lack of suction caused higher aerosol volume (1.98×107 µm3/m3) whereas HVE significantly reduced volume to -4.47×105 µm3/m3. High concentrations of dental aerosol found during HSH cavity preparation or ultrasonic scaling present a risk of infection, confirming the advice to use respiratory PPE. HVE and LVE both effectively reduced aerosol generation during scaling, whereas the new aerosol-reducing 'no air' function was highly effective and can be recommended for HSH drilling.

The aim of this study was to determine the microbial atmospheric contamination during initial periodontal treatment using a piezoelectric ultrasonic scaler in combination with either high-volume evacuation (HVE) or conventional dental suction (CDS). The study included 17 treatment sessions, consisting of a 40-min episode of continuous plaque and calculus removal using an ultrasonic unit (EMS). The treatment sessions were carried out in six patients with generalized adult periodontitis and ranged from two to four sessions per patient according to their needs. The use of HVE and CDS was randomly assigned over the sessions within each patient. Before each treatment, the operating room was not used for 15 h. To measure baseline microbial air pollution two Petri dishes containing blood agar were exposed for 10 min to the air. At the start of each treatment session, two Petri dishes were exposed for 5 min at a distance of 40 cm from the mouth of the patients. After 20 min, this procedure was repeated. At a distance of 150 cm, two Petri dishes were exposed for 20 min followed by exposure of two new Petri dishes for the rest of the session. The plates were cultured aerobically and anaerobically for 3 and 7 days, respectively. The mean colony forming units (CFU) before treatment never exceeded 0.6 colonies per plate. At 40 cm, the mean CFU, when considering a period of 40 min, was 8.0 for HVE and 17.0 for CDS. The mean CFU at 150 cm during this period was 8.1 with HVE and 10.3 with the CDS. With reference to the Air Microbial Index the operatory atmosphere was considered to be in a good condition during 40 min of continuous use of the ultrasonic scaler in combination with both HVE and CDS. Within the restrictions of this study, only limited atmospheric microbial contamination is produced when using a piezoelectric ultrasonic scaler.

Dental personnel are ranked among the highest risk occupations for exposure to SARS-CoV-2 due to their close proximity to the patient’s mouth and many aerosol generating procedures encountered in dental practice. One method to reduce aerosols in dental settings is the use of intraoral evacuation systems. Intraoral evacuation systems are placed directly into a patient’s mouth and maintain a dry field during procedures by capturing liquid and aerosols. Although multiple intraoral dental evacuation systems are commercially available, the efficacy of these systems is not well understood. The objectives of this study were to evaluate the efficacy of four dental evacuation systems at mitigating aerosol exposures during simulated ultrasonic scaling and crown preparation procedures. We conducted real-time respirable (PM4) and thoracic (PM10) aerosol sampling during ultrasonic scaling and crown preparation procedures while using four commercially available evacuation systems: a high-volume evacuator (HVE) and three alternative intraoral systems (A, B, C). Four trials were conducted for each system. Respirable and thoracic mass concentrations were measured during procedures at three locations including (1) near the breathing zone (BZ) of the dentist, (2) edge of the dental operatory room approximately 0.9 m away from the mannequin mouth, and (3) hallway supply cabinet located approximately 1.5 m away from the mannequin mouth. Respirable and thoracic mass concentrations measured during each procedure were compared with background concentrations measured in each respective location. Use of System A or HVE reduced thoracic (System A) and respirable (HVE) mass concentrations near the dentist’s BZ to median background concentrations most often during the ultrasonic scaling procedure. During the crown preparation, use of System B or HVE reduced thoracic (System B) and respirable (HVE or System B) near the dentist’s BZ to median background concentrations most often. Although some differences in efficacy were noted during each procedure and aerosol size fraction, the difference in median mass concentrations among evacuation systems was minimal, ranging from 0.01 to 1.48 µg/m3 across both procedures and aerosol size fractions.

Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases.

Context:Microbial contamination, which occurs during dental procedures, has been a potential threat to dental professionals and individuals. There has been a growing concern over the role of bioaerosols in spread of various airborne infections and also to reduce the risk of bioaerosol contamination.Aims:This study was to analyze the number of colony forming units (CFUs) in bioaerosols generated during ultrasonic scaling procedure as well as to evaluate the efficacy of chlorhexidine 0.12% (CHX) preprocedural mouth rinse and high volume evacuator (HVE) in minimizing the bioaerosol contamination.Methods:About 45 individuals were divided into three Groups A, B and C. These groups underwent ultrasonic scaling before and after the use of CHX (0.12%), HVE and combination of CHX (0.12%) and HVE. Bioaerosols were collected on blood agar plates which were incubated at 37°C for 48 h, and the CFUs were counted with manual colony counting device. A comparison was also done between A versus B, B versus C and A versus C groups.Statistical Analysis Used:Student's t-test.Results:We found a significant reduction in the CFUs when CHX (0.12%) preprocedural rinse (P < 0), or HVE (P < 0.001) or combination of both CHX (0.12%) and HVE were employed (P < 0.001). Maximum reduction in CFUs was observed when CHX (0.12%) and HVE were used in combination as compared to their individual use. A moderate significance was seen between A versus C groups but not with B versus C groups and A versus B groups.Conclusion:From our study, we conclude that individual methods such as CHX (0.12%) and HVE were useful to reduce the dental bioaerosols; however, combination of both CHX (0.12%) and HVE is more efficient to reduce dental bioaerosols than individual method.

Objective SARS-CoV-2 can be carried by aerosols and droplets produced during dental procedures, particularly by the use of high-speed handpieces, air-water syringes, and ultrasonic scalers. High-volume evacuators (HVEs) and extraoral vacuum aspirators (EOVAs) reduce such particles. However, there is limited data on their efficacy. This study aimed to determine the efficacy of HVE and EOVA in reducing aerosols and droplets during ultrasonic scaling procedures.Materials and Methods Three ultrasonic scaling simulations were conducted on mannequins: 1. saliva ejector (SE) was used alone (control); 2. SE was used in combination with HVE; and 3. SE was used in combination with HVE and EOVA. Paper filters were placed on the operator's and assistant's face shields and bodies, and the contamination of aerosols and droplets was measured by counting blue spots on the paper filters.Statistical Analysis All data were analyzed for normality using the Kolmogorov–Smirnov test. The differences between each method were analyzed using a two-way ANOVA, followed by a posthoc test. The differences were considered statistically significant whenp < 0.05.Result Using HVE and EOVA reduced aerosols and droplets better than using SE alone or SE and HVE: the posthoc test for contamination revealed a significant difference (p < 0.01). The assistant was subjected to greater contamination than the operator during all three ultrasonic scaling procedures.Conclusion The usage of HVE and EOVA significantly reduced aerosols and droplets compared with using SE solely. Using these techniques together could prevent the transmission of airborne disease during dental cleanings, especially COVID-19. Further studies of aerosol-reducing devices are still needed to ensure the safety of dental workers and patients.

Ultrasonic scaling is extensively applied as part of the initial therapy for periodontal diseases, which has been restricted since the outbreak of the COVID-19 pandemic due to droplets and aerosols generated by ultrasonic devices. An extraoral scavenging device (EOS) was designed for diminishing droplets and aerosols in dental clinics. The objective of this study is to evaluate the effect of EOS on eliminating droplets and aerosols during ultrasonic supragingival scaling. This single-blinded, randomised controlled clinical trial enrolled 45 patients with generalised periodontitis (stage I or II, grade A or B) or plaque-induced gingivitis. The patients were randomly allocated and received ultrasonic supragingival scaling under three different intervention measures: only saliva ejector (SE), SE plus EOS and SE plus high-volume evacuation (HVE). The natural sedimentation method was applied to sample droplets and aerosols before or during supragingival scaling. After aerobic culturing, colony-forming units (CFUs) were counted and analysed. Compared with the level before treatment, more CFUs of samples throughout treatment could be obtained at the operator's chest and the patient's chest and the table surface when using SE alone (p < 0.05). Compared with the SE group, the SE + EOS group and the SE + HVE group obtained decreasing CFUs at the operator's chest and the patient's chest (p < 0.05), while no significant difference was determined between these two groups. The EOS effectively eliminated splatter contamination from ultrasonic supragingival scaling, which was an alternative precaution for nosocomial contamination in dental clinics.

Standard dental procedures, when using a water coolant and rotary instruments, generate aerosols with a significantly higher number of various dangerous pathogens (viruses, bacteria, and fungi). Reducing the amount of aerosols to a minimum is mandatory, especially during the new coronavirus disease, COVID-19. The study aimed to evaluate the amount of aerosol generated during standard dental procedures such as caries removal (using dental bur on a high and low-speed handpiece and Er:YAG laser), ultrasonic scaling, and tooth polishing (using silicon rubber on low-speed handpiece) combined with various suction systems. The airborne aerosols containing particles in a range of 0.3–10.0 μm were measured using the PC200 laser particle counter (Trotec GmbH, Schwerin, Germany) at three following sites, manikin, operator, and assistant mouth, respectively. The following suction systems were used to remove aerosols: saliva ejector, high volume evacuator, saliva ejector with extraoral vacuum, high volume evacuator with extraoral vacuum, Zirc® evacuator (Mr.Thirsty One-Step®), and two customized high volume evacuators (white and black). The study results showed that caries removal with a high-speed handpiece and saliva ejector generates the highest amount of spray particles at each measured site. The aerosol measurement at the manikin mouth showed the highest particle amount during caries removal with the low and high-speed handpiece. The results for the new high volume evacuator (black) and the Zirc® evacuator showed the lowest increase in aerosol level during caries removal with a high-speed handpiece. The Er:YAG laser used for caries removal produced the lowest aerosol amount at the manikin mouth level compared to conventional dental handpieces. Furthermore, ultrasonic scaling caused a minimal aerosol rise in terms of the caries removal with bur. The Er:YAG laser and the new wider high volume evacuators improved significantly suction efficiency during dental treatment. The use of new suction systems and the Er:YAG laser allows for the improvement of biological safety in the dental office, which is especially crucial during the COVID-19 pandemic.

Ultrasonic and sonic scalers appear to attain similar results as hand instruments for removing plaque, calculus, and endotoxin. Ultrasonic scalers used at medium power seem to produce less root surface damage than hand or sonic scalers. Due to instrument width, furcations may be more accessible using ultrasonic or sonic scalers than manual scalers. It is not clear whether root surface roughness is more or less pronounced following power-driven scalers or manual scalers. It is also unclear if root surface roughness affects long-term wound healing. Periodontal scaling and root planing includes thorough calculus removal, but complete cementum removal should not be a goal of periodontal therapy. Studies have established that endotoxin is weakly adsorbed to the root surface, and can be easily removed with light, overlapping strokes with an ultrasonic scaler. A significant disadvantage of power-driven scalers is the production of contaminated aerosols. Because ultrasonics and sonics produce aerosols, additional care is required to achieve and maintain good infection control when incorporating these instrumentation techniques into dental practice. Preliminary evidence suggests that the addition of certain antimicrobials to the lavage during ultrasonic instrumentation may be of minimal clinical benefit. However, more randomized controlled clinical trials need to be conducted over longer periods of time to better understand the long-term benefits of ultrasonic and sonic debridement.

Cross-infection risk induced by dental-related droplets and aerosol particles has challenged service providers and patients alike. The dental clinic has been widely treated as one of the most vulnerable healthcare organizations with a high exposure risk to infection. The present study aims to investigate the effect of high-volume evacuation (HVE) on the emitted droplets and aerosol particles during dental atomization procedures. Ultrasonic scaling, one type of atomization procedure, is performed in the dental clinic. The laser light scattering method is employed to visualize the immediate moment with and without the cooperation of HVE on ultrasonic scaling. The Proper Orthogonal Decomposition analysis is employed to investigate the turbulent flow characteristics. The previous hypothesis about the moderate performance of HVE on tiny high-velocity droplets has been proven in the present study. The HVE can be characterized as significantly low-threshold measures to reduce the contaminated region. Besides, a pair of vortexes presented near the facial region of dental professionals will be eliminated when cooperating with HVE. The HVE can significantly reduce the emitted droplets (about 60%) and the airborne lifetime of suspended particles. HVE acting as additional mitigation measures could augment traditional/primary decontamination strategies such as ventilation and personal protective equipment.

Background and aims. Basic periodontal treatment aims at eliminating supra- and sub-gingival plaque and establishing conditions which will allow effective self-performed plaque control. This aim is primarily achieved with sonic and ultrasonic scalers. However, generation of bacterial aerosols during these procedures is of great concern to patients, the dentist and the dental assistant. The aim of this study was to compare the reduction in aerosol with and without high-volume evacuator through a microbiological study.Materials and methods. For this clinical study a fumigated closed operatory was selected. Maxillary incisors and canines were selected as an area for scaling. Piezoelectric ultrasonic scaling was performed in the absence and in the presence of a high-volume evacuator at 12 and 20 inches from the patient's oral cavity. In both groups scaling was carried out for 10 minutes. Nutrient agar plates were exposed for a total of 20 minutes. After this procedure, nutrient agar plates were incubated in an incubator at 37°C for 24 hours. The next day the nutrient agar plates were examined for colony forming units by a single microbiologist.Results. The results showed no statistically significant differences in colony forming units (CFU) with and without the use of a high-volume evacuator either at 12 or 20 inches from the patient's oral cavity.Conclusion. It was concluded that high-volume evacuator, when used as a separate unit without any modification, is not effective in reducing aerosol counts and environmental contamination.

This study aimed to explore microbial aerosol distribution characteristics in the dental clinic during ultrasonic scaling and evaluate the effects of three different interventions on aerosol distribution and protective effects. For twenty minutes, ultrasonic scaling was carried out in a standardized operatory room. A blank control group and three intervention groups were created: high-volume evacuator (HVE), plasma purification (PP), and fenestrated ventilation (VT). The mass concentration of PM1.0, PM2.5, and PM10.0 aerosol particles was tracked in real time, and colony counts were calculated using air deposition. After ultrasonic scaling, there was a significant increase in aerosol dispersion of various particle sizes and distribution within a 1.5-m radius of the core area (P < 0.05). The number of colonies in each group varied over time at 0.5 and 1.0 m from the patient’s head, but there was no significant difference at 1.5 m (P > 0.05). The PP group demonstrated the greatest decrease in aerosol mass concentration difference. The VT group initially had the lowest aerosol mass concentration difference, but with a slight decrease. The aerosol mass concentration difference between the HVE groups grew with distance. Traditional ultrasonic scaling poses a risk of aerosol contamination during and after treatment. The operatory room’s air can be efficiently purified by plasma purification, which maintains lower levels of aerosol particle size than other groups. Microbial aerosols created by ultrasonic scaling can be quickly reduced by ventilation. At close range, the high-volume evacuator can lower the risk of infection while the benefit diminishes as the distance increases.Trial registration: This study was registered on the website of China Clinical Trial Registration Center (ChiCTR2400090751) (12/10/2024).

A clinical investigation of dental evacuation systems in reducing aerosols

Background. Ultrasonic scaling generates aerosols and splatters contaminated with microorganisms, increasing the risk of disease transmission in the dental office. The present study aimed to evaluate the effectiveness of extraoral suction (EOS) units in aerosol and splatter reduction during ultrasonic scaling. Methods. Ultrasonic scaling was conducted on a dental manikin headset to simulate a scaling procedure. Water containing Lactobacillus acidophilus at a concentration of 107 colony-forming units per milliliter and 1% fluorescein solution was used as the water supply of the scaler. The scaling procedure was conducted with a high-volume evacuator (HVE) or the combination of HVE and an EOS unit. de Man–Rogosa–Sharpe agar plates were placed at different distances surrounding the dental chair. Filter papers were placed at various positions surrounding the oral cavity and on areas of the body. Results. Bioaerosols were detected at every sampling site and could travel as far as 150 cm from the oral cavity. The combination of HVE and EOS significantly reduced the total number of bacterial colonies in the air (P < 0.001). Dissemination of the stain was in the range of 20 cm from the oral cavity. The maximum contaminated surface area was at the 4 o’clock position from the oral cavity. The combination of EOS and HVE significantly reduced the contaminated area (P < 0.05). The stain was also found on the wrists, chest, abdomen, and lap of the operator and assistant. The lap was the most contaminated area of the body. Conclusion. EOS was effective in reducing the bioaerosols and splatters generated during ultrasonic scaling.

Removal of plaque and calculus by means of sonic and ultrasonic scalers causes considerable damage to implants. With a view to avoiding the aggressive effects of these instruments, an experimental study was carried out for which conventional sonic and ultrasonic scalers were coated with Teflon. The effects of these instruments on implant surfaces was then compared with that of plastic and metal implant curettes. Stereo-microscopy, scanning electron microscopy and surface profilometry were used to detect and record damage to implant surfaces and changes in surface roughness. Generation and propagation of heat in subgingival simulation of use of sonic and ultrasonic scalers were also recorded by means of temperature measurements at the implant surface. The results revealed that no discernible damage was caused by Teflon-coated sonic and ultrasonic scalers or implant curettes made of plastic on smooth titanium surfaces. Instrument material residues were found on rough implant surfaces. It was not the intention of this study to provide an analysis of the prerequisites for the cleaning of rough implant surfaces, but rather to determine what type of damage is to be expected when contact is made with smooth and rough surfaces unintentionally. Temperature measurements during the subgingival use of sonic and ultrasonic scalers indicated satisfactory functioning of the cooling system. Coating of sonic and ultrasonic scaler tips with Teflon thus facilitates the use of high-frequency instruments to achieve professional cleaning of implants.