Airborne Transmitted Disease Prevention in Dental Settings
Dental procedures can generate a significant amount of airborne material. This is evident to the dentist, dental team and patient when it forms an aerosol cloud during tooth preparation with rotary instruments or air abrasion, during use of water-air syringe for treatment, ultrasonic scaler and more. These materials are often contaminated by bacteria from saliva as well as blood that has been shed into them so contact lenses should be removed before proceeding with any procedure in order to avoid infection risk.
Dental procedures are a high-risk factor for airborne diseases. Pathogenic bacterial species, such as Mycobacterium tuberculosis and Staphylococcus spp., have been found to be spread by dental aerosols reaching most surfaces in the operatory during these procedures. Dentists are always looking for new ways to sterilize their equipment, and recent studies have shown that the cooling spray from dental handpieces is a major source of spatter. In fact, some studies demonstrated aerosols can travel as far away as any surface in the operatory.
Presently, the worldwide impact of the Coronavirus disease 2019 (COVID-19) pandemic is also felt in dental care since its outbreak. Procedures for infection control and personal protective equipment (PPE) have been updated globally to face these emerging diseases, based on minimal knowledge about present day conditions.
Aerosols or Splatter
The terms “aerosol” and “splatter” were defined as particles less than 50 micrometers in diameter.
The smaller particles of an aerosol (0.5 to 10 μm in diameter) can penetrate and lodge in the small passages of your lungs, which means they carry a great potential for transmitting infections.
Prevention of Airborne Transmitted Diseases
The CDC Infection control standards were initially developed for dentistry in response to the HIV epidemic and included Standard and Transmission-based Precautions. Based upon emerging evidence regarding SARS-CoV-2, spread is thought to occur mostly from person-to-person via respiratory droplets among close contacts.
Close contact with patients could be dangerous, because the risk of contracting a virus increases as you spend more time in such close proximity. The CDC identifies two ways that this can happen: either by being within 6 feet (2 meters) of someone who has COVID-19 for at least 30 minutes or if they have direct physical contact with liquids from an infected person’s mouth and other body fluids like saliva, sputum/mucus, blood serum, sweat droplets – basically anything coming out through their pores.
- Postponement of elective and non-essential dental procedures until deemed safe by public health authorities.
- Dental Health Care Practitioner or DHCP and Patients experiencing COVID-19 symptoms should stay at home and seek medical care as recommended by their doctors.
- Teledentistry is an alternative way to manage patients’ dental needs without having them come in for an appointment. They can be assessed and triaged remotely before being seen by the dentist, which ensures that they will receive high-quality care from someone who’s qualified without wasting their time coming into the office just for a checkup or emergency work. Patients with confirmed COVID-19 should avoid any exposure to other people as it could spread more easily than most viruses do – so even if you don’t have tooth pain but are exhibiting signs of fatigue, fever, gastrointestinal issues or cough/sore throat then contact your local urgent medical clinic immediately
- If urgent and/or emergent dental treatment must be delivered for an asymptomatic patient, DHCP should then assess the likelihood of aerosol production during care.
- If the procedure is unlikely to produce aerosols, DHCP can use routine PPE and consider it a low-risk process.
- Aerosols can be dangerous and should not be taken lightly. If you suspect that aerosol production may happen, the following precautions are recommended:
- N95 (KN95) or higher-level respirator masks
- Full face shield or goggles
- Disposable gown
- Head coverings
- Practice how to put on, take off and use PPE in a way that prevents you and your dental staff from getting infected.
- Perform hand hygiene with alcohol-based hand rub before and after all patient contact, contact with potentially infectious material, and before putting on or removing PPE. Use soap and water if hands are visibly soiled.
- The clinical surfaces should be cleaned and disinfected with the help of EPA-approved emerging viral pathogens claims.
- It is important to screen all DHCP at the beginning of their shift for fever and respiratory symptoms. Also keep a record for evident symptoms such as shortness of breath, new or change in cough, and sore throat.
Ongoing education and training is key for ensuring that infection prevention policies are followed. It’s important to offer up-to-date information on basic principles in order to have the best chance of preventing infections from spreading in your dental office.
Dental offices should provide new and existing employees with education and training on the setting norms, procedures, or tasks they will be performing. The type of information provided in these training can vary from formal lectures to demonstrations during an activity such as a safety meeting.