High-volume Suction Research Articles

Comparison of physical and acceptability tests of extra oral suction in rsgm ugm prof. Soedomo

The spread of COVID-19 through aerosols and droplets occurs during dental treatment. Dentists use high-volume suction (HVS) and saliva ejectors to suction saliva, blood, and water from the oral cavity. Since the pandemic, prototyping, production, and use of extraoral suction (EOS) have increased. EOS comprises HEPA (High-Efficiency Particulate Air), plasma ions, and ultraviolet (UV) filters. This study was used to see the effectiveness of the use of EOS through a comparison of physical and acceptability tests on the use of EOS at UGM Prof. Sodeomo Dental Hospital using three EOS brands, Coxo™, Eighteeth™ Vacstation, and Eostra™. Physical Test is used to assess the ability of a tool when used—Acceptability Test to assess user acceptance of EOS based on usage experience. The study was conducted at the UGM Prof. Soedomo Hospital (Professional Education Clinic, Resident Education Clinic, General Service Unit, and Specialistic Service Unit) in 2021 with 90 respondents who were EOS users. The EOS with the most incredible suction power, noise figure, and electrical power was Eostra™, while based on user experience, the EOS that was more accepted and more comfortable for users to use was Coxo™. EOS reduces aerosol exposure during dental treatment, and based on this study, EOS that had good capacity was not necessarily comfortable to use by users; this was because each brand had advantages and disadvantages, so the selection of EOS was adjusted to the capacity of the operator and the practice site.

Adaptations in orthodontics for current and future coronavirus disease 2019 best practices

This study aimed to determine adaptations orthodontists made during the coronavirus disease 2019 pandemic to maintain safety and determine which adaptations will remain after the pandemic. An original 34-question survey was sent by mail to a randomized selection of practicing orthodontic specialists (n= 1000). Questions included the changes made during the pandemic in 4 categories (infection control, social distancing, appliance type, and teleorthodontics) and whether those changes will remain postpandemic. The use of personal protective equipment increased during the pandemic, with a significant decrease anticipated after the pandemic. The most common aerosol modification during the pandemic and predicted after the pandemic was using an assistant with high-volume suction (61% and 49%, respectively; P= 0.0013). Ninety-six percent of orthodontists changed their waiting room protocol during the pandemic, but only 23% plan to continue that practice (P<0.0001). Forty-two percent of orthodontists increased clear aligners during the pandemic in response to patient demand (91%). The use of teleorthodontics increased from 8% to 68% during the pandemic and is expected to decrease significantly postpandemic. Virtual appointments are anticipated to be used for screening and consultations of new patients and monitoring active patients in clear aligners but not fixed appliances. The specialty recommended patient safety modifications during the coronavirus disease 2019 pandemic. Postpandemic, enhanced personal protective equipment is expected to decrease, and high-volume suction will likely be continued for aerosol-producing procedures. Teleorthodontics will likely remain in limited use.

SG-APSIC1045: A quantitative assessment of ATP bioluminescence on dental instruments reprocessed by automated washer-disinfector and ultrasonic machine

Objectives: Dental instruments are contaminated by blood and saliva during dental procedures. To prevent cross infection, all contaminants should be removed from the surfaces of instruments. Inadequate cleaning can hinder disinfection and sterilization process. To compare the cleaning efficacy of an automated washer–disinfector versus an ultrasonic machine on dental instruments, adenosine triphosphate (ATP) measurements were compared. Methods: From National University Polyclinic Bukit Panjang Dental Services, we collected 2 loads of 40 dental instruments previously used in dental treatments: extraction forceps, high-volume suction tips, Coupland elevators, matrix band holders, and ultrasonic scaler tips. At the point of use, gross soil was wiped from instrument surfaces with water. Each instrument was swabbed after cleaning either using a washer–disinfector or an ultrasonic machine. The relative light units (RLU) on the luminometer indicated the amount of ATP contaminants and residue bioburden present on the instruments. Results: The mean RLU values across all instruments in the washer–disinfector group was 2.5 times lower than the mean value of the instruments in the ultrasonic group (35.4 vs 89.9 RLU). This difference was statistically significant for all instrument groups except for the high-volume suction tips. The Mann-Whitney U test indicated that the RLU in the ultrasonic group was higher than the RLU for the washer–disinfector group for extraction forceps (P &lt; .001), ultrasonic scaler tips (P &lt; .023), and matrix bands (P &lt; .006). A t test indicated the same relationship for Coupland elevators (P &lt; .005). Conclusions: The mean RLU values for both cleaning methods were lower than the manufacturer’s benchmark (RLU ≤ 150), suggesting that both methods can achieve effective cleaning. However, cleaning using an automated washer–disinfector is significantly more effective than an ultrasonic machine for nonlumen instruments. The effectiveness of cleaning using ultrasonic machine varied greatly among different types of instruments with different design complexities.

Clinical Efficacy of an Extraoral Dental Evacuation Device in Aerosol Elimination During Endodontic Access Preparation

IntroductionCoronavirus disease 2019 (COVID-19) has caused many concerns in the dental field regarding aerosol production and the transmission of the severe acute respiratory syndrome coronavirus 2 virus during dental procedures. Because of the abrupt arrival of COVID-19, there has been little to no published research on the efficacy of dental suction devices in the removal of aerosols related to COVID-19 or the impact extraoral suction devices have on patients’ experiences. Therefore, the aim of this study was to measure the amount of aerosol produced during endodontic access preparation for root canal therapy with and without the use of an extraoral dental suction device and to gather information through a survey regarding patients’ experiences. MethodsAerosol measurements were recorded in 8 closed-door resident operatories each morning before the procedures, 1 minute during the procedure, and 15 minutes after the access was complete. The CICADA DTO KN99 Extraoral Dental Suction Device (Foshan Cicada, Guangdong, China) was placed in 4 operatories, whereas no DTO extraoral suction device was used in 4 control operatories. Twenty cases with DTO and 20 cases without it were completed, and the data were analyzed. ResultsAerosols 1 minute after access were higher with and without DTO. There was a significant reduction after 15 minutes when the DTO device was used compared to high-volume suction alone. Composite and zirconia produced the most aerosols at 1 minute. ConclusionThe results show that the reduction of aerosols is enhanced when the extraoral suction device is used in combination with traditional high-volume evacuation. However, the increased noise level when using the device can have a negative impact on patients’ dental experience.

Aerosol reduction efficacy of different intra-oral suction devices during ultrasonic scaling and high-speed handpiece use

BackgroundThe COVID-19 pandemic led to significant changes in the provision of dental services, aimed at reducing the spread of respiratory pathogens through restrictions on aerosol generating procedures (AGPs). Evaluating the risk that AGPs pose in terms of SARS-CoV-2 transmission is complex, and measuring dental aerosols is challenging. To date, few studies focus on intra-oral suction. This study sought to assess the effectiveness of commonly used intra-oral suction devices on aerosol mitigation.MethodsUltrasonic scaling and high-speed handpiece procedures were undertaken to generate aerosol particles. Multiple particle sensors were positioned near the oral cavity. Sensor data were extracted using single board computers with custom in-house Bash code. Different high-volume and low-volume suction devices, both static and dynamic, were evaluated for their efficacy in preventing particle escape during procedures.ResultsIn all AGPs the use of any suction device tested resulted in a significant reduction in particle counts compared with no suction. Low-volume and static suction devices showed spikes in particle count demonstrating moments where particles were able to escape from the oral cavity. High-volume dynamic suction devices, however, consistently reduced the particle count to background levels, appearing to eliminate particle escape.ConclusionsDynamic high-volume suction devices that follow the path of the aerosol generating device effectively eliminate aerosol particles escaping from the oral cavity, in contrast to static devices which allow periodic escape of aerosol particles. Measuring the risk of SARS-CoV-2 transmission in a dental setting is multi-factorial; however, these data suggest that the appropriate choice of suction equipment may further reduce the risk from AGPs.

Simulated and clinical aerosol spread in common periodontal aerosol-generating procedures

ObjectivesThis study evaluated particle spread associated with various common periodontal aerosol-generating procedures (AGPs) in simulated and clinical settings.Materials and methodsA simulation study visualized the aerosols, droplets, and splatter spread with and without high-volume suction (HVS, 325 L/min) during common dental AGPs, namely ultrasonic scaling, air flow prophylaxis, and implant drilling after fluorescein dye was added to the water irrigant as a tracer. Each procedure was repeated 10 times. A complementary clinical study measured the spread of contaminated particles within the dental operatory and quantified airborne protein dispersion following 10 min of ultrasonic supragingival scaling of 19 participants during routine periodontal treatment.ResultsThe simulation study data showed that air flow produced the highest amount of splatters and the ultrasonic scaler generated the most aerosol and droplet particles at 1.2 m away from the source. The use of HVS effectively reduced 37.5–96% of splatter generation for all three dental AGPs, as well as 82–93% of aerosol and droplet particles at 1.2 m for the ultrasonic scaler and air polisher. In the clinical study, higher protein levels above background levels following ultrasonic supragingival scaling were detected in fewer than 20% of patients, indicating minimal particle spread.ConclusionsWhile three common periodontal AGPs produce aerosols and droplet particles up to at least 1.2 m from the source, the use of HVS is of significant benefit. Routine ultrasonic supragingival scaling produced few detectable traces of salivary protein at various sites throughout the 10-min dental operatory.Clinical relevanceThe likelihood of aerosol spread to distant sites during common periodontal AGPs is greatly reduced by high-volume suction. Clinically, limited evidence of protein contaminants was found following routine ultrasonic scaling, suggesting that the the majority of the contamination consisits of the irrigant rather than organic matter from the oral cavity.

Aerosol exposure of staff during dental treatments: a model study

BackgroundDue to exposure to potentially infectious aerosols during treatments, the dental personnel is considered being at high risk for aerosol transmitted diseases like COVID-19. The aim of this study was to evaluate aerosol exposure during different dental treatments as well as the efficacy of dental suction to reduce aerosol spreading.MethodsDental powder-jet (PJ; Air-Flow®), a water-cooled dental handpiece with a diamond bur (HP) and water-cooled ultrasonic scaling (US) were used in a simulation head, mounted on a dental unit in various treatment settings. The influence of the use of a small saliva ejector (SE) and high-volume suction (HVS) was evaluated. As a proxy of aerosols, air-born particles (PM10) were detected using a Laser Spectrometer in 30 cm distance from the mouth. As control, background particle counts (BC) were measured before and after experiments.ResultsWith only SE, integrated aerosol levels [median (Q25/Q75) µg/m3 s] for PJ [91,246 (58,213/118,386) µg/m3 s, p < 0.001, ANOVA] were significantly increased compared to BC [7243 (6501/8407) µg/m3 s], whilst HP [11,119 (7190/17,234) µg/m3 s, p > 0.05] and US [6558 (6002/7066) µg/m3 s; p > 0.05] did not increase aerosol levels significantly. The use of HVS significantly decreased aerosol exposure for PJ [37,170 (29,634/51,719) µg/m3 s; p < 0.01] and HP [5476 (5066/5638) µg/m3 s; p < 0.001] compared to SE only, even reaching lower particle counts than BC levels for HP usage (p < 0.001).ConclusionsTo reduce the exposure to potentially infectious aerosols, HVS should be used during aerosol-forming dental treatments.

Evaluation of Aerosol and Splatter Production using Dental Handpieces and Ultrasonic Scalers during Dental Procedures: A Pilot Study

There have been many articles written about aerosols and splatter during dental procedures with the potential for disease transmission. Due to the global COVID-19 pandemic, aerosol production during dental procedures has been considered a potential disease transmission pathway. Since there is no documented cases of dental professionals acquiring SARS-Cov1 or COVID-19, we decided to see how much aerosol is produced by a Dental High speed drill and ultrasonic scaler. Also if the use of high volume suction can eliminate any aerosol transmission. A pilot study using Glo Germ in the water to evaluate under blacklight the aerosol pattern and spread produced by a high speed dental handpiece and an ultrasonic scaler was performed. The results found that high volume suction using an 8mm diameter suction tip eliminated aerosol spray spread with a high speed dental handpiece. Minimal aerosol spread was found with the use of a cavitron scaler.

Lessons Learned from the COVID-19 Pandemic in Implant Dentistry Settings

In 2019, Wuhan city of China announced the epidemic of COVID-19 as a public health disaster which has been recognized as an uncommon type of single stranded RNA virus belonging to Coronaviridae family and then quickly spread all over the world. Clinically symptomatic patients are identified as the primary source of COVID-19 transmission. Most of dental procedures require the use of high-speed handpieces which leads to aerosol generation. Implant dentistry is the field of dentistry which deals with prosthetic rehabilitation with minimal aerosol generation ensuring an aseptic surgical environment. There are several decisive recommendations regarding COVID-19 precautions that should be appreciated in implant dentistry. Sharp drills in slow speed drilling machines are preferred during surgery. Regular irrigation with high volume suction is greatly encouraged. Osteotomes are encouraged over ultrasonic devices to minimize the generation of aerosols during surgical procedures. Immediate implants placement is more preferred as the number of visits to the dentists is reduced. Impression techniques should be shifted to the digital approach instead of conventional methods. Full mouth rehabilitation cases requiring complex procedures should be accomplished restrictedly.

Aerosol Contamination in the Dental Operatory During Oral Prophylaxis: An Occupational Hazard

Aim: To investigate the level of aerosol contamination following oral prophylaxis using ultrasonic scalers at different positions in the dental operatory at different time.&#x0D; Methodology: In a pre-fumigatedroom of 10m*15m scaling was performed using ultrasonic scalers along with high volume suction while maintaining all aseptic precautions. Blood agar plates were positioned at the level of patient’s chest (P1), doctor’schest (P2), assistant’s chest (P3), on the floor directly below the patients headrest (P4) and 4 feet away from the dental chair at a height 3 feet above the ground (P5) to assess aerosol contamination occurring during scaling procedure. Similarly, blood agar plates were position at P3,P4,P5 for a time interval of 15 minutes after 1 and 3 hours of the procedure respectively to assess the levels of aerosol post procedure.&#x0D; All the blood agar plates were incubated at 37°C for 24 hours, following which bacterial colony forming unit (CFU) was calculatedfor each plate and gram staining was performed to identify the organism present.&#x0D; Results: At the time of procedure the patient was most exposed to the aerosol. At the end of 3 hours the percentage of aerosol reduction was 81 %. Gram staining showed that the streptococci were predominant organisms with a few short rods as observed on the plates obtained during the procedure, while gram positive bacilli were seen abundantly in samples obtained at the end of 3 hours.&#x0D; Conclusion: The study examined the spreading characteristics of aerosol during and after scaling procedure. Even after 3 hours of completion of the procedure some amount of aerosol present in the room. Hence, the dentist must ensure proper precautionary measures to prevent air-borne nosocomial infections.

The Spread of Droplets and Aerosols of Surgical Motor Handpiece Irrigation Using Different Suction Systems

Objective: This study aimed to compare the effectiveness of various combinations of dental suction devices in reducing the amount and distance of spread of aerosols and droplets using an electrical surgical motor model with a self-irrigation system.Materials and Methods: In a standard single-chaired air-conditioned ventilated dental clinic, an electrical dental surgical motor with a high-speed handpiece (Implantmed) cooled with 0.2% fluorescein containing normal saline was used to drill a gypsum block mounted on a phantom head in a supine position. A single operator performed thrice each of the following suction settings: (a) no suction, (b) low-volume suction, (c) low-volume + high-volume suctions, and (d) low-volume + external oral suctions. Aerosols (0.1–5 μm) were measured with a particle counter at the mouth opening of the phantom head, and droplet sizes and distances were analyzed via a machine learning algorithm by identifying fluorescence droplets on pre-loaded pieces of paper on the floor for each group.Results: The different suction systems have different performances in terms of droplet distance (p = 0.007), whereas using (c) high volume suctions (41.1 ± 22.9 cm) and (d) external oral suction unit (39 ± 18.2 cm) had significantly reduced the spread of droplets when compared with (a) without suction (58.9 ± 17.1 cm). Using (d) external oral suction or (c) high volume suction could reduce the number for all droplet sizes. The use of (c) high volume suction was most effective in reducing aerosol count of 0.3–1 μm, while (d) external oral suction was most effective in reducing aerosol count of 3–5 μm.Conclusions: Both external oral suction and high-volume suction were effective in reducing aerosols and droplets generated by the irrigation of a surgical high-speed motor handpiece. External oral suction could be an effective alternative to high volume suction in dental surgical procedures to reduce the spread of aerosols and droplets.Clinical Relevance: External oral suction or high-volume suction should be used in conjunction with low-volume suction in surgical procedure to reduce the spread of aerosols and droplets in a dental clinic environment.

Fallow time determination in dentistry using aerosol measurement in mechanically and non-mechanically ventilated environments.

Aim To calculate fallow time (FT) required following dental aerosol generating procedures (AGPs) in both a dental hospital (mechanically ventilated) and primary care (non-mechanically ventilated). Secondary outcomes were to identify spread and persistence of aerosol in open clinics compared to closed surgeries (mechanically ventilated environment), and identify if extraoral scavenging (EOS) reduces FT and production of aerosol.Methods In vitro simulation of fast handpiece cavity preparations using a manikin was conducted in a mechanically and non-mechanically ventilated environment using Optical Particle Sizer and NanoScan at baseline, during the procedure and fallow period.Results AGPs carried out in the non-mechanically, non-ventilated environment failed to achieve baseline particle levels after one hour. In contrast, when windows were opened after AGPs, there was an immediate reduction in all particle sizes. In mechanically ventilated environments, the baseline levels of particles were very low and particle count returned to baseline within ten minutes following the AGP. There was no detectable difference between particles in mechanically ventilated open bays and closed surgeries. The effect of the EOS on reducing the particle count was greater in the non-mechanically ventilated environment; additionally, it also reduced the spikes in particle counts in mechanically ventilated environments.Conclusion High-efficiency particulate, air-filtered mechanical ventilation, along with mitigation (high-volume suction), resulted in reduction of fallow time (ten minutes). Non-ventilated rooms failed to reach baseline level even after one hour of fallow time. There was no difference in particle counts in open bays or closed surgeries in mechanically ventilated settings with an extraoral suction device reducing particulate spikes. This study confirms that AGPs are not recommended in dental surgeries where no ventilation is possible.

Different Techniques for Rubber Dam Isolation: A Cross-Sectional Study

Objective: To assess knowledge, regarding use of rubber dam during root canal treatment among dentists in Rawalpindi and Islamabad.Study Design: Descriptive cross-sectionPlace and Duration of Study: Operative Department Armed Forces Institute of Dentistry (AFID) Rawalpindi from 1st March 2020 to 31st May 2020. Materials and Methods: A web-based questionnaire, comprising of close-ended questions in the categories of demographics, clinical experience, usage of isolation techniques and knowledge regarding rubber dam (RD) use, procedures, and contraindications was sent through internet to 387 dentists of Rawalpindi and Islamabad. The response rate was 77.5%. Data was analyzed using SPSS version 20, and was displayed as numbers and percentages.Results: 79 out of 300 i.e. 26.33% respondents used rubber dam in restorative and endodontic procedures. 73.3% were using other methods of isolation such as cotton rolls, saliva ejectors and high volume suction. All the respondents were aware about the importance of rubber dam. The most challenging factor for dentists (57.3%) was high influx of patients per day.Conclusion: Rubber dam is not being used commonly by participating dentists of tertiary dental hospitals of Rawalpindi and Islamabad mainly because of high patient turnover per day, combination of cotton rolls and saliva high-volume ejector or gauze is the most common alternative to rubber dam isolation. Rubber dam isolation is highly recommended.&#x0D;

Knowledge, Perception, and Attitude on Conservative and Endodontic Practice on COVID Pandemic Situation: A Qualitative Research.

Aim:The purpose of our study was to analyze the knowledge and attitude of conservative as well as endodontic practice among dental professionals during coronavirus pandemic situation.Methodology:A cross-sectional study was conducted over a period of 3 months among 1256 dental surgeons, which included 400 MDS and 856 BDS dentists. Questionnaire assessed knowledge of the participants about COVID-19, risk assessment about the pandemic, preparedness of the participants, as well as specific precautions in cases which require conservative and endodontic treatment strategies against COVID-19.Results:It was observed that around 83% of the study participants felt that rubber dams are a useful tool to prevent cross-infections, even COVID-19. However, COVID-19 prevention techniques such as use of low-speed handpiece and chemicomechanical techniques were preferred by a smaller number of participants: 25% of participants by former, only 12% for the latter. To prevent aerosol splatter, use of high-volume suction was preferred by 49% of dental surgeons.Conclusion:In our study, we concluded that dental surgeons, who come under high risk category; had good basic knowledge about COVID-19 disease process as well as transmission. However, it is imperative that these clinicians need to be extra cautious in handling cases during this pandemic time and limit the disease spread as well.

In Reply to the Letter to the Editor Regarding “Novel Decompressive Hemicraniectomy Technique for Traumatic Brain Injury: Technical Note”

Present guidelines on reducing aerosol generation during neurosurgical procedures are futile. The aim of this article was to describe a novel device to contain aerosol within a small localized environment around the operative field—the negative pressure assisted microenvironment surgical hood (NEPA-MESH).This device can be assembled using easily available materials—steel wires, image intensifier cover, surgical drape, and three-dimensional–printed self-locking copolyester double hoops. Large-bore pipes in continuity with a high-volume suction apparatus create a constant negative pressure microenvironment around the operative field. The CEM DT-9880 particle counter was used to estimate particle concentration inside the NEPA-MESH during various stages of a neurosurgical procedure as well as outside. The NEPA-MESH was tested in different craniotomies and endoscopic procedures.Mean particle concentration inside the NEPA-MESH and outside during drilling in various procedures was calculated and compared using unpaired t test. Significant reduction in particle concentrations was recorded for particles sized 0.3 μm (t = 17.55, P < 0.0001), 0.5 μm (t = 11.39, P < 0.0001), 1 μm (t = 6.36, P = 0.0002), 2.5 μm (t = 2.04, P = 0.074), 5.0 μm (t = 7.026, P = 0.0008), and 10 μm (t = 4.39, P = 0.0023).As definitive evidence demonstrating the presence of coronavirus disease 2019 (COVID-19) in aerosol particles is awaited, we describe a cost-effective strategy to reduce aerosol contamination. Significant reduction in particle concentrations was seen outside the NEPA-MESH compared with inside it during various stages of neurosurgical procedures.

Letter to the Editor Regarding “Evolution of Minimally Invasive Lumbar Spine Surgery”

Present guidelines on reducing aerosol generation during neurosurgical procedures are futile. The aim of this article was to describe a novel device to contain aerosol within a small localized environment around the operative field—the negative pressure assisted microenvironment surgical hood (NEPA-MESH).This device can be assembled using easily available materials—steel wires, image intensifier cover, surgical drape, and three-dimensional–printed self-locking copolyester double hoops. Large-bore pipes in continuity with a high-volume suction apparatus create a constant negative pressure microenvironment around the operative field. The CEM DT-9880 particle counter was used to estimate particle concentration inside the NEPA-MESH during various stages of a neurosurgical procedure as well as outside. The NEPA-MESH was tested in different craniotomies and endoscopic procedures.Mean particle concentration inside the NEPA-MESH and outside during drilling in various procedures was calculated and compared using unpaired t test. Significant reduction in particle concentrations was recorded for particles sized 0.3 μm (t = 17.55, P < 0.0001), 0.5 μm (t = 11.39, P < 0.0001), 1 μm (t = 6.36, P = 0.0002), 2.5 μm (t = 2.04, P = 0.074), 5.0 μm (t = 7.026, P = 0.0008), and 10 μm (t = 4.39, P = 0.0023).As definitive evidence demonstrating the presence of coronavirus disease 2019 (COVID-19) in aerosol particles is awaited, we describe a cost-effective strategy to reduce aerosol contamination. Significant reduction in particle concentrations was seen outside the NEPA-MESH compared with inside it during various stages of neurosurgical procedures.

Investigation of the Presence of SARS-CoV-2 in Aerosol After Dental Treatment

AimsThe objective of the present study was to investigate the presence of SARS-CoV-2 in aerosol and COVID-19 contamination distance asssociated with ultrasonic scaling and tooth preparation.MethodsTwenty-four patients with COVID-19 were included in this study. Removal of supragingival plaque with ultrasonic instruments for 10 minutes and high-speed air-turbine using for the simulation of cutting the maxillary right canine tooth with a round diamond bur for 5 minutes were performed. Patients were randomly assigned to 2 groups: In group A, medium-volume suction was used during treatment. In group B, high-volume suction with an aerosol cannula was added to medium-volume suction. Prior to treatment, 5 glass petri dishes containing viral transport medium were placed in the operating room. After treatment, petri dishes were immediately delivered to a microbiology laboratory for real-time polymerase chain reaction (RT-PCR) analysis.ResultsRT-PCR test results were negative for all specimens in group B. However, 5 positive test results for COVID-19 were detected in group A specimens.ConclusionsSuction with an aerosol cannula is very important to prevent COVID-19 viral contamination via aerosol. In addition, a high-volume suction capacity (air volume) of 150 mm Hg or 325 L/min is sufficient for elimination of viral contamination. Thus, high-volume suction should be used during dental treatments in COVID-19 patients.

Awareness, Knowledge and Risk Perception of COVID -19 among Dental Health Care Professionals and its Impact on Clinical Dental Practice and Oral Healthcare Delivery in the Western Region of Saudi Arabia

Introduction: The outbreak of novel coronavirus disease (COVID-19) has influenced every aspect of life. Healthcare professionals, especially dentists, are exposed to a higher risk of getting infected due to close contact with infected patients primarily through aerosol generated procedures. This study aimed to assess the awareness and risks of getting infected among dentists in the western region of Saudi Arabia, while working during the current novel coronavirus disease (COVID-19) pandemic. In addition, dentists’ knowledge about various practice modifications to combat COVID-19 cross infection and spread were evaluated.&#x0D; Materials and Methods: A total of 329 participants including 123 males and 196 females responded to an online questionnaire consisting of 30 questions, which was circulated among all kinds of dental healthcare professionals through social media and e-mails after obtaining approval from the institutional ethical committee.&#x0D; Results: Chi square tests revealed significant differences when comparing the responses of the participants based on qualification with regard to key responses related to awareness and practice perceptions such as HEPA filters, pulse oximeter, wearing an N-95 mask, using a face shield, a High volume suction and rubber dam.(p&lt;0.05)&#x0D; Conclusion: Although, there were variations in responses among the various dental professionals, it can be concluded that it is important to ensure increased knowledge and awareness of covid -19 risks and transmission which is absolutely essential in dental practice to ensure optimal oral care during the ongoing pandemic.

Dissemination of Aerosol and Splatter in Clinical Environment during Cavity Preparation: An In Vitro Study.

Dental health care workers around the world are in a constant state of fear and anxiety because they work in a constrained space of the dental practice. During routine dental procedures, they are exposed to aerosol and splatter. These airborne particles pose a great risk of transmitting contagious infections to health care workers and patients, especially in an era of social distancing due to COVID-19. The current study was conducted to evaluate contamination amount, duration, the distance of aerosol, and splatter produced after cavity preparation using a two-hole and four-hole handpiece. The study was performed on a dental manikin in a dental simulation laboratory at the College of Dentistry, King Faisal University Al Ahsa. The dental manikin was set to a reclined position to simulate the clinical operatory position of the patient for dental restorative procedures. Aerosol and splatter were collected on Grade 1 qualitative cotton cellulose filter paper. These were placed on adhesive tape extending from the headrest of the dental manikin in six different directions (2, 4, 6, 8, 10, and 12 o’clock) for up to 60 inches and on certain positions of the operator and assistant such as the chest, head, forearms, upper leg, and inside facemask. Class V cavity preparation was done by the principal investigator at a specific time of 3 min on tooth #11 using a two-hole high-speed handpiece, then on the next day, Class V cavity preparation was performed on tooth #21 by a four-hole handpiece. High volume suction was used throughout the cavity preparation. Immediately after cavity preparation, the first filter paper disc was replaced with new ones in all positions. The second set of filter papers was removed after 30 min. Transparent grids were used to count the contamination area on the filter paper disc. No statistically significant difference was found in the mean amount of aerosol and splatter produced by both handpieces, however, a statistically significant difference was found in an amount of aerosol and splatter produced at a 12, 24, and 36 inches distance immediately after cavity preparation and 30 min after cavity preparation, regardless of the type of handpiece used. It is advisable to refrain from removing the personal protective barriers immediately after the procedure within the vicinity of the dental practice. The use of other adjuncts such as high volume suction to reduce the spread of aerosol and splatter is also recommended.

Aerosol management in dentistry: An update for safe COVID-19 clinical practice

Bioaerosols and splatters generated by air syringes, ultrasonic scalers and high-speed turbine handpieces during dental treatment pose a potential hazard of infection not only to the patients but, to the dentists, dental hygienists, dental assistants as well as other healthcare workers. Severe infectious diseases such as Severe Acute Respiratory Syndrome (SARS), influenza, measles, tuberculosis, hepatitis, HIV AIDS can be transmitted through aerosols. With the emergence of β-coronavirus (COVID-19), questions concerning the protection from such viral transmission in the dental hospital setting have arisen due to close contact and its transmission through the exposure of saliva, blood and other body fluids. A systematic electronic search with relevant key terms viz. Aerosol Management, Dental Aerosols, Dentistry and COVID-19, Dental Unit Waterlines, Preprocedural Mouth rinsing, High Volume Suction Evacuators (HVE) and CDC Guidelines was executed in PubMed and Medline databases for literature extraction and data has been interpreted by including articles based on predefined inclusion criteria.In this review article, we address the importance of understanding and implementation dental safety by following various systems for the management of dental aerosols