THE SARS-COV-2 PANDEMIC POSES A GREAT CHALLENGE FOR DENTAL PRACTICES.
Dental aerosols can present a health risk, as the virus can be detected in the area of the mouth, nose and throat. We would like to share with you useful information on the subject of aerosols.
The main transmission path is through droplet infection 1 . Recent studies indicate that transmission of SARS-CoV-2 via aerosols in normal social settings cannot be excluded. However, a final consensus does not seem possible at this stage 2. Aerosols differ from droplets and spray mist. Due to their smaller particle size (<50μm), they can be carried several meters away and can be detected in the room air for up to 30 minutes 3.
HOW CAN THE CONTAMINATION OF DENTAL AEROSOLS BE REDUCED?
It is well documented that the use of a pre-procedural mouth rinse with a CHX A solution for 30 - 60 seconds reduces the bacterial load in the aerosols by up to 70% 4,5,6. However, CHX shows low effectiveness against corona viruses 7,8. Hydrogen peroxide (H2O2) at a concentration of 0.5% or more is proven to effectively kill viruses 9,10.
Mouthwashes containing povidone-iodine solution of about 1% have been shown to be effective, too 8 . We recommend that patients gargle and rinse with H2O2 (1.5 %) or with povidone-iodine solution (1%) for 60 seconds at the beginning of each treatment. This process should be repeated, if possible after 30 minutes.
The correct use of mouth-nose protection masks, goggles and face-shields as well as the efficient and safe sterilization of instruments is mandatory. AIRFLOW® and PIEZON® handpieces and all Instruments (PS) should be sterilized after each treatment. The surface disinfection and regular rinsing of the suction system are further obligatory measures. Good ventilation of the treatment rooms after each patient is strongly recommended 11.
HOW CAN THE FORMATION OF AEROSOLS BE REDUCED?
Nearly all dental instruments used in common treatments generate aerosols: low- and high-speed handpieces, turbines, sonic- and ultrasonic devices, air water syringes, and air polishing devices 12. The use of a high-vacuum suction system with a suction volume of at least 300 l/min, in combination with an optimal saliva ejector can effectively reduce aerosol formation 12,13. Four-handed dentistry allows optimal suction 14. When working two-handed for professional mechanical biofilm removal, a skilled suction technique in combination with Optragate® supports reduction of aerosols very well.