The efficacy of an extraoral scavenging device on reduction of splatter contamination during dental aerosol generating procedures: an exploratory study.

Shakeel Shahdad,Noha Seoudi,Neil Cagney,Ahmed Din,Claire Morgan,Annika Hindocha,Jens-Dominik Mueller,Tulsi Patel

doi:10.1038/s41415-020-2112-7

Abstract

Introduction This study was conducted in light of the SARS-CoV-2 pandemic, which brought UK dentistry to a standstill. The market has seen a recent influx of unproven extraoral scavengers (EOSs), which claim to reduce the risk of particulate spread.Aims To investigate the efficacy of a commercially available EOS device on contamination reduction during dental aerosol generating procedures (AGPs). The secondary aim was to investigate differences between open and closed dental operatories.Method Dental procedures were simulated on a dental manikin using citric acid (10%) added to the water lines with universal indicating paper (UIP) placed in strategic locations in the operatory, on the clinician and assistant. Chromatic change related to settling of splatter containing citric acid on the UIP was analysed to calculate percentage intensity of splatter contamination.Results EOSs resulted in 20% reduction in frequency and 75% reduction in mean intensity of contamination of operatory sites. There was a 33% and 76% reduction in mean intensity contamination for clinician and assistant, respectively. Use of rubber dam and four-handed dentistry resulted in further reduction.Discussion This exploratory study demonstrates contamination by splatter in a simulated dental setting. The concern in dentistry regarding aerosol requires further quantitative investigation of smaller particles.Conclusions The routine use of four-handed dentistry and rubber dam should continue where possible to maximise risk mitigation during AGPs. However, on the basis of our findings, the use of an EOS device can further mitigate the magnitude and concentration of splatter.

Highlights

This study was conducted in light of the SARS-CoV-2 pandemic, which brought UK dentistry to a standstill
extraoral scavengers (EOSs) resulted in 20% reduction in frequency and 75% reduction in mean intensity of contamination of operatory sites
Rubber dam is not Methods and materials. This in vitro experimental study was conducted at The Royal London Dental Hospital, UK, to investigate the efficacy of an EOS device in reducing splatter generated during various dental procedures (Appendix 1, 2 and 3)

Summary

Introduction

This study was conducted in light of the SARS-CoV-2 pandemic, which brought UK dentistry to a standstill. In the midst of the SARS-CoV-2 pandemic, increasing emphasis has been placed on limiting the spread of the virus and protecting healthcare workers and the public. Clinical dentistry poses an exposure risk to dental professionals and patients, largely owing to the nature of dental procedures which often generate airborne particulates contaminated with bacteria, blood, viruses and fungi.[1,2] From 25 March 2020 to 8 June 2020, all dental practices in the UK were closed for routine care.[3,4] With the reopening of practices, concerned dental professionals have been seeking strategies to minimise the risk of spread and contamination from SARS-CoV-2. There is debate as to whether SARS-CoV-2 is transmissible via an airborne route, with related evidence being contentious and incomplete.[5,6,7] The most comprehensive scientific evidence available associates procedures capable of generating an aerosol with having an increased risk of SARS-CoV-2 transmission.[6,8]

Methods

Results

Discussion

Conclusion