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COVID-19: AEROSOLS IN DENTISTRY

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EMS INFORMS:

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.

FURTHER INFORMATION AND RECOMMENDATIONS

We refer to the scientific publication «COVID-19 Transmission in Dental Practice: Brief Review of Preventive Measures in Italy» by Prof. Filippo Graziani, University of Pisa. Prof. Graziani is the former President of the European Federation of Periodontology (EFP) and the Italian Society of Periodontology and Implantology. (A)

The Bavarian State Chamber of Dentists and the Association of Statutory Health Insurance Dentists of Bavaria have addressed patients with reassuring words from their letter «Dental treatment: No increased risk in dental practices despite Covid-19». (B)

The new Corona virus strain, SARS-CoV-2, will be with us for a long time - and so will biofilm. We hope that you will soon be able to offer your patients a good feeling with the EMS Guided Biofilm Therapy.

Health is our highest good.
Stay healthy!

April 29, 2020


A Chlorhexidine-di-Gluconate
B Cetylpyridinium Chloride 
                                                              

 mensi signature        lussi signature          wildgen signature BASTENDORF SIGNATURE                                             

 Prof. M. Mensi                        Prof. em. Dr. med. dent                Dr. med. dent.                  Dr. med. dent.
            DDS,                                  Dipl. Chem. Ing. ETH                   S. Wildgen                    K. D. Bastendorf 
          Brescia                                      Adrian Lussi                               Munich                            Eislingen
                                                                  Bern     

REFERENCES AND INTERESTING LINKS:

 

A. «COVID-19 Transmission in Dental Practice: Brief Review of Preventive Measures in Italy» by Prof. Filippo Graziani, University of Pisa.

B. «Dental treatment: No increased risk in dental practices despite Covid-19».

 

1. Yang HY, Duan GC (2020) Analysis on the epidemic factors for the Corona Virus Disease. Zhonghua Yu Fang Yi Xue Za Zhi 3;54(0):E021 doi: 10.3760/cma.j.cn112150-20200227-00196

2. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Steckbrief.html

3. Drisko CL, Cochran DL, Blieden T, Bouwsma OJ, Cohen RE, Damoulis P, Fine JB, Greenstein G, Hinrichs J, Somerman MJ, Iacono V, Genco RJ (2000) Position paper: sonic and ultrasonic scalers in periodontics. Research, Science and Therapy Committee of the American Academy of Periodontology. J Periodontol 71(11):1792-801.

4. Gupta G, Mitra D, Ashok KP, Gupta A, Soni S, Ahmed S, Arya A (2004) Efficacy of preprocedural mouth rinsing in reducing aerosol contamination produced by ultrasonic scaler: a pilot study. J Periodontol 85(4):562-8. doi: 10.1902/jop.2013.120616

5. Harrel SK (2004) Airborne spread of disease­the implications for dentistry. J Calif Dent Assoc 32(11):901-6.

6. Narayana TV, Mohanty L, Sreenath G, Vidhyadhari P (2016) Role of preprocedural rinse and high volume evacuator in reducing bacterial contamination in bioaerosols. J Oral Maxillofac Pathol 20(1):59-65. doi: 10.4103/0973-029X.180931.

7. Baqui AA, Kelley JI, Jabra-Rizk MA, Depaola LG, Falkler WA, Meiller TF (2001) In vitro effect of oral antiseptics on human immunodeficiency virus-1 and herpes simplex virus type. J Clin Periodontol 28(7):610-6.

8. Kampf G, Todt D, Pfaender S, Steinmann E. (2020) Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect 104(3):246-251. doi: 10.1016/j.jhin.2020.01.022.

9. Caruso AA, Del Prete A, Lazzarino AI, Capaldi R, Grumetto L (2020) May hydrogen peroxide reduce the hospitalization rate and complications of SARS-CoV-2 infection? Infect Control Hosp Epidemiol 22:1-5. doi: 10.1017/ ice.2020.170

10. Mentel’ R, Shirrmakher R, Kevich A, Dreĭzin RS, Shmidt I (1977) Virus inactivation by hydrogen peroxide. Vopr Virusol (6):731-3.

11. Izzetti R, Nisi M, Gabriele M, Graziani F (2020) COVID-19 Transmission in Dental Practice: Brief Review of Preventive Measures in Italy. J Dent Res 17:22034520920580. doi: 10.1177/0022034520920580

12. Graetz C, Bielfeldt J, Tillner A, Plaumann A, Dörfer CE (2014) Splatter contamination in dental practices – how can it be prevented? Rev Med Chir Soc Med Nat, Iaşi 118(4):1122-34.

13. Reitemeier B, Jatzwauk L, Jesinghaus S, Reitemeier C, Neumann K (2010) Effektive Reduktion des Spraynebel- Rückpralls - Möglichkeiten und Grenzen ZMK 662-673.

14. Meng L, Hua F, Bian Z. (2020) Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine J Dent Res 99(5):481-487. doi: 10.1177/0022034520914246

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PREVENT & PROTECT - VIRTUAL DENTAL SUMMIT

Stay up to date with the first edition of the prevent & protect webinar series! Watch the recorded webinars and learn about new strategies, insights and tactics about COVID-19 as it relates to you and your dental practice now and during the recovery phase. 

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FREE COVID-19 WEBINAR

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COVID-19:
AEROSOLS IN DENTISTRY