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Aerosol Reduction in the Dental Office: Best Practices & Product Review

Aerosol Reduction in the Dental Office: Best Practices & Product Review

Aerosol Reduction in The Dental Office

Aerosol Reduction in the Dental Office: Best Practices & Product Review

By: Shannon Pace Brinker, CDA

February 22nd, 2021

Airborne contamination during dental procedures may come from a variety of sources. Dental handpieces, ultrasonic scalers, and the air-water syringes used in common dental practices can produce aerosols, usually a mix of air and water derived from these devices and the patient's saliva.

Airborne particles are classified based on size: coarse particles are 2.5–10 microns, fine particles are less than 2.5 microns, and ultrafine particles are less than 0.1 microns. The nose typically filters air particles above 10 microns. If a particle is less than 10 microns, it can enter the respiratory system. If it is less than 2.5 microns, it can enter the alveoli. A particle less than 0.1 microns, or an ultrafine particle like the COVID-19 virus, can enter the bloodstream and target organs such as the heart and brain.

The current scientific consensus is that most transmission via respiratory secretions happens in large respiratory droplets rather than small aerosols. Droplets are often heavy enough that they do not travel very far; instead, they fall from the air after traveling up to six feet.

The problem occurs when viral particles are aerosolized by a cough, sneeze, or dental care. In these instances, particles can potentially travel across far greater distances, with estimates up to 20 feet, from an infected person and then incite secondary infections elsewhere in the environment. These aerosolized droplet nuclei can remain in an area, suspended in the air, even after the person who emitted them has left; thus, can infect health care workers and contaminate surfaces. The coronavirus is also viable up to 72 hours after application to plastic and stainless steel surfaces. It is feasible for up to 24 hours on cardboard surfaces, up to nine hours on copper surfaces, and suspended aerosols for up to three hours.

Dental Infection Protection Measures

Infection Sources Solution
Dental handpieces, ultrasonic scalers, air polishers, air water syringes and air abrasion units. Bacterial counts indicate that airborne contamination is nearly equal to that of ultra-sonic scalers; available suction devices will reduce airborne contamination by more than 95 percent.
Large volumes of aerosols produced. Look for a high-volume evacuator (HVE) that removes up to 100 cubic feet of air per minute. Roughly 96% to 97% of the aerosol that we're worried about can be controlled with HVE, not a saliva ejector.
Breathing and coughing from a patient. Utilize a rubber dam when possible can control this aerosol.

Dental isolation systems are the most efficient tool a dentist can use to sequester a section of the mouth from moisture, such as saliva and blood, and provide clear visibility and access to the area away from sensitive tissues, such as the gums, cheeks, and tongue.

Isolite 3 by Zyris
The Isolite 3 dental isolation system features an integrated LED that provides both white light and true amber light. The non-curing amber light illuminates visibility when placing light-sensitive materials, including resins, composites, and adhesives. There are three light intensity settings with an indicator display with duel levers for high-level or low-level suction control. There are six single-use disposable mouthpiece size options to keep the working area dry and visible by continuous, uninterrupted suctioning. Pediatric, Extra Small, Small, Medium, Medium DV Deep Vestibule, and Large. Utilize the Zyris size chart included with your system to make sure you identify what size the patient needs.

DryShield Isolation Device does not have a light but has a lot of great perks to offer. Available in four different sizes that are both autoclavable and single-use. The Autoclavable option has a bite block that is interchangeable and available in multiple sizes for patient comfort. The Single-Use is a disposable all-in-one device. DryShield helped to keep the working area dry and visible by continuous, uninterrupted suctioning. The mouthpiece design helped to keep the patient's tongue and cheek out of the way. Utilizing the DryShield also helped to protect the airway from potential particles and debris. The mouth pop gives patients who have a hard time staying open the ability to rest their teeth on a soft, flexible mouth prop.

Ivory Relief
Ivory ReLeaf by Kulzer USA is an innovative, hands-free HVE suction device that connects to existing dental vacuum systems. Available in several sizes, the latex-free custom blend polymer allows it to be soft and flexible. The clinician can work in all four quadrants. History reveals most hygienists utilized a saliva ejector during hygiene procedures, and for some, this was a more straightforward conversion.

Some dental practices utilize dry angles for moisture control, but tissue irritation would occur when removing it. Patients with TMJ or bite issues may not be able to utilize a bite block, so this would be a good alternative.

The Purevac by Dentsply Sirona provides a combination of oral high volume evacuation, illumination, and retraction during dental procedures. It consists of the HVE Mirror Tip, a high-volume evacuation tip built in the dental mirror, and the HVE Hose Adapter that connects to a 360-degree swivel for the HVE Mirror Tip. Each system comes with three attachable HVE mirror tips. The advantage of the Purevac HVE mirror tip is the wide end for suctioning. The oval shape of the mirror tip suction allows for better retraction with cutting the patient's mucosa than standard HVE tips. The number one takeaway for the Purevac HVE System is the Fog Free mirror design that eliminates the clinician's need to stop during the dental procedure and wipe.

When deciding which system will work for your practice, think about your workflow, training, and procedures. Integrating an isolation system in your dental way will allow you to quickly and easily implement a standard protocol for consistent procedure outcomes. Achieve better visibility and moisture control, improve efficiency and clinical results while ensuring patient safety and comfort.

For additional information, visit the: American Dental Association (ADA), Center for Disease Control (CDC), Occupational Safety and Health Administration (OSHA), Organization for Safety Asepsis and Prevention (OSAP).

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