AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2643-6612/027
Rutgers School of Dental Medicine.
*Corresponding Author: Pamela L Alberto, Rutgers School of Dental Medicine.
Citation: Pamela L Alberto, M Conte,T Scorziello. (2022). Evaluation of Aerosol and Splatter Production using Dental Handpieces and Ultrasonic Scalers during Dental Procedures: A Pilot Study. Dentistry and Oral Maxillofacial Surgery. 5(1); DOI: 10.31579/2643-6612/027
Copyright: © 2022 Pamela L Alberto, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 11 November 2021 | Accepted: 27 December 2021 | Published: 06 January 2022
Keywords: aerosol; splatter; disease transmission
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.
COVID-19 was first reported to the World Health Organization Country Office in China on December 31, 2019. Within a few months, it spread rapidly to become a global pandemic [1]. The mechanism of spread is important to try to prevent exposure. SARS-CoV-2 is thought to be transmitted via 2 mechanisms: 1) inhalation of droplets produced by close contact with infectious people and 2) contact with contaminated surfaces [2]. It is also thought to be transmitted directly or indirectly through saliva. There has been much concern about dental aerosols and splatters potential to transmit disease to dental health care providers. These aerosols are thought to remain suspended in air for 4 hours [3]. So dental health care professionals and patients are exposed to aerosols that contain microorganisms during dental treatment [4]. Harrel and Molinari reviewed the literature about aerosols, splatter and infection control and found that it showed dental procedures produced aerosols and droplets that contained bacteria and blood. These aerosols represent potential route of disease transmission [5]. These articles were not an evidence-based analysis and none determined the exact infection risk from this bioaerosol. Also, There are no documented cases of dental health care worker effected by SARS-Cov1 in a dental setting [6]. Peng and Xu looked at transmission routes of COVID-19 and controls in dental practice and found that no dental professional had reported to acquire COVID-19 infection in China at the time of their paper in February 2020 [3]. The object of our pilot study was to see exactly how much aerosol or splatter is produced during dental procedures and the effectiveness of high volume suction limiting the spread. This would provide information on infection risk during dental procedures.
In this study, GloGerm an illumination marker was placed in the bottle resivar water supply of a dental unit. GloGerm contains proven safe ingredients formulated to be the same size as bacteria, basically 5 microns or less in size. An ultra-violet light was used to illuminate and visualize the spread of the aerosol and splatter. Using a high speed handpiece with a small round bur (figure.1), the handpiece was operated with full water on a flat surface to see the direction and amount of aerosol and splatter (Figure.2) and then the handpiece operated 1 inch above the flat surface (figure.3). Operatory lights were turned off and a UV light was used to view the aerosol and splatter pattern. Then a Typodont was placed in an operatory to simulate a patient. Construction paper was placed hanging from the light 2 ft (0.6 meters) down to the typodont. Also construction paper was placed on the chair in front of the typodont (figure.4). Then a preparation was performed on a posterior molar with full water spray and utilization of the existing dental high volume evacuation system with the bevel of the suction tip 90 degrees to the generated aerosol. Then a UV lamp was used to view the aerosol and splatter pattern. The construction paper was changed and then an anterior incisor tooth preparation was performed using a high speed handpiece with full water and the existing dental high volume evacuation system again with the bevel of the plastic suction tip placed at a 90 degree angle to the generated aerosol. Then a UV lamp was used to view the aerosol and splatter pattern. The construction paper was changed. Then an ultrasonic scaler with a high volume suction was used posteriorly for 1 minute (Figure .5). The UV lamp was used to view the aerosol and splatter pattern. The construction paper was changed. The ultrasonic scaler with high volume suction was then used anteriorly for 1 minute. The UV lamp was used to view the aerosol and splatter pattern. All the aerosol and splatter patterns were photographed for evaluation.
When a high speed handpiece is operated with full water it creates most of the splatter and aerosol posterior to the clockwise turning bur (Figure.1). Operating the handpiece with less water will create the most aerosol. Pam, is this correct? What about reducing the amount of water and “chip air” used to disperse the water spray????????? It would seem logical that we would recommend to reduce both. We then operated the handpiece on the flat surface with the bur just contacting the surface using full water spray and found that no spray could be visualized just a puddle of water in front of the handpiece(Figure.2). Repeating this but lifting the bur 1 inch above the flat surface, splatter and aerosol was visualized posteriorly with the puddle of water anteriorly (Figure .3).
During the typodont simulation, the handpiece was operated with full water spray without high volume suction preparing an anterior tooth. The UV lamp was used to view the aerosol and splatter pattern. There was visible spray or splatter on the construction paper in front of the typodont, on my personal protection gown and gloves but not on my facemask (Figure.6).
During the typodont simulation, the handpiece was operated with full water spray and high volume suction with a 8mm diameter suction tip preparing a posterior tooth. The UV lamp was used to view the aerosol and splatter pattern. There was no visible spray or splatter on the construction paper in front of the typodont, on my face mask or on my personal protection gown. Also no spray was noted on my gloves (Figure .7). Then the handpiece was operated with full water spray and high volume suction with a 8mm diameter suction tip preparing a maxillary central incisor. The UV lamp was used to view the aerosol and splatter pattern. There also was no visible spray or splatter on the construction paper in front of the typodont, on my face mask or on my personal protection gown. Also no spray was noted on my gloves.
Then an ultrasonic scaler without high volume suction was used posteriorly on the typodont for 1 minute. The UV lamp was used to view the aerosol and splatter pattern. There was visible spray on my gloves and gown in my lap. No spray was seen on my face mask. Then an ultrasonic scaler with high volume suction was used posteriorly on the typodont for 1 minute. The UV lamp was used to view the aerosol and splatter pattern. There was visible spray on my gloves. No spray was seen on my face mask. We then utilized the ultrasonic scaler on anterior teeth with no high volume suction. The UV lamp was used to view the aerosol and splatter pattern. There was visible spray on my gloves, gown and mask. When high volume suction was used with the ultrasonic scaler on anterior teeth, we found significant reduction in spray (Figure .8). There was no visible spray on the construction paper or my face mask. There was spray on my gloves, sleeves and lap of my gown.
It has been documented for many decades that dental procedures create aerosols. These aerosols are a natural result of the ether the dental high speed handpiece or ultrasonic instruments’ interaction with the unit supplied coolant, usually water and the working end of the dental instrument. (CHIPPER AIR) This aerosol can be contaminated via two vectors. The first is dental unit waterline biofilm. For years now, the development of a biological plaque buildup in the small diameter water lines has been understood. Many manufactures of dental units have incorporated auto flush valves as well as instructions for use related to shocking and maintaining their water lines. Most of the dental profession has now moved away from the municipal water supply, to a bottle water supply system to counter act the development of this biofilm. It is now a considered a standard of care to monitor the quality of our dental units water. The second vector of contamination of this aerosol originates from contamination via the patients saliva, blood, plaque, calculus [4]. Historically dentistry has been able to manage this contamination of the aerosol through the use of a rubber dam and the high volume evacuation, hence there is no documentation of transmission of airborne diseases from a dental office.
Transmission of SARS-COV2 is thought to be from inhalation of liquid droplets from close contact with infected people, and infected surfaces. Airborne transmission and spread depends on particle size. Coughing or sneezing disperses the pathogens into the air. There are small droplets which are about 1 to 5 microns in diameter that are called droplet nuclei and there are large droplets more than 5 microns in diameter called droplets. Both can carry infectious pathogens. Droplets travel shorter distances about 3 feet, before rapidly falling to the ground where droplet nuclei stay airborne longer. The dental handpiece produces aerosol and splatter which is defined as particles less than 50 microns in diameter for aerosols and splatter defined as particles more than 50 microns in diameter [5]. The SARS coronavirus is spread thru droplets and direct contact [6]. That is why close contact is required for direct transmission.
Our study has shown that aerosols from dental handpieces can almost be completely eliminated with the use of high volume suction. Aerosols from the use of ultrasonic scalers cannot be completely eliminated. This has also been documented in other studies [5]. With the use of high volume suction aerosols should be completely eliminated during dental procedures. Maintaining proper infection control methods with standard PPE and preprocedural rinsed will minimize the risk of exposure with all dental procedures [8]. Since no data exist regarding the infectivity of contaminated saliva through the droplet route more studies are needed.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
