Due to the recent health threat and the possibility of contracting a potentially life-threatening virus we all know as COVID-19, many dental professionals are looking at ways they can reduce aerosols and splatter in dentistry and provide clean air quality in dental offices.
Creating clean air quality in dental offices is not possible solely with the use of high suction and a central air conditioning system. Using high suction devices and having a great air conditioning system with good HEPA filters will reduce the amounts of harmful pathogens in the dental office. But we like to take it further.
What are the top products for reducing aerosols and splatter in dentistry to aid in creating clean air quality in dental offices?
Today, a group of products and tactics can be used together to help minimize the number of aerosols in the dental office and reduce the clinicians’ exposure to aerosols. Although there isn’t just one measure by itself that will fully resolve the problem, all of these precautions used in combination with one another can substantially lower risk levels.
So, what are these tactics that dental clinicians can implement to help improve the management of aerosols in their offices and create clean air quality in dental offices?
10 products and tactics that are used to capture aerosols and splatter and to create clean air quality in dental offices:
1. Servicing and updating the existing building’s heating, ventilation, and air conditioning (HVAC) system.
2. Negative Pressure Room, Installing commercial-grade exhaust fans.
3. ERV system (energy recovery ventilator).
4. Freestanding, commercial-grade air purification systems.
5. Extra-oral fume evacuator.
6. HVE system.
7. Use of a rubber dam.
8. Hydrogen peroxide or iodine rinse before any treatment or exam thereby decreasing loads of pathogens coming from patients’ mouths.
9. Use of high Filtration: N95 or similar masks.
10. Use of physical barriers: gloves, fresh gown, face shield.
#1. Servicing and Updating the Existing Building’s Heating, Ventilation, and Air Conditioning (HVAC) System
At Tooth & Co we regularly service our HVAC system to ensure it works properly and to its fullest capacity. It is furnished with HEPPA filters in both clinical and non-clinical areas.
#2. Creating Negative Pressure Rooms by Installing Commercial Grade Exhaust Fans to Help Create Clean Air Quality in Dental Offices
Negative pressure is maintained and generated by a ventilation system that takes more air out of a room than is allowed to enter. For example, if 400 cubic meters of air enters the room, but 900 cubic meters of air leaves the room, more air is leaving the room than coming in. Therefore, by definition, this would be considered a negative pressure room. We installed Commercial Grade Exhaust Fans in each of our operatory rooms when we first built the practice and have always provided care with this above standard level of ventilation.
#3. ERV System (Energy Recovery Ventilator)
What is an ERV system? An ERV (Energy Recovery Ventilator) allows fresh air into a building while retaining pre-conditioned cooling or heating. If the outside temperature is 0ºF, and the indoor air temperature is 70ºF, your HVAC unit must heat the mixture of outside air and the building’s return air to maintain an indoor building temperature of 70ºF. This is similar to your lungs as they can bring cold air in and make it warm. ERVs bring in new air and make it less humid, less hot, or less cold. An ERV brings in more outside air and makes it more accustomed to our liking by changing the temperature or humidity. This option is a way to bring more air into the dental office if desired to do so, and at Tooth & Co we have this option available to us.
#4. Freestanding, commercial-grade air purification systems
Our Honeywell True HEPA Air Purifier offers 3 powerful cleaning levels and reduces the amount of airborne particles, including bacteria and viruses. Its long-life True HEPA filter captures up to 99.97% of particles as small as 0.3 microns from the air that passes through the filter. The model at Tooth & Co has a 360° air intake for maximum efficiency and features a carbon pre-filter that prolongs the filter life by removing large particles before they can enter the HEPA filter.
#5. Extra-oral Aerosol Evacuator
Such evacuators are designed specifically to remove and filter viruses, bacteria, potentially toxic vapors and microbiological contaminants away from the immediate area of the dentist, assistant and patient.
Our evacuators clean the operatory air when performing prophylaxis, laser dentistry, high speed drilling and certain other procedures where an oral aerosol vacuum system is recommended or required. We designed our evacuators with kids in mind, thus making them look clean, modern, with a flexible, hands-free duct that captures and filters toxic odors, vapors and particulates away from the breathing area for a safer breathing environment.
#6. HVE and the Use of HVE Systems for Hygiene Procedures
High velocity evacuation, or HVE, used during all procedures, has made researchers aware of the potential effectiveness. HVE is effective in the control of aerosols when appropriately used. Some tests show a 95% reduction in aerosols with the use of HVE alone. Likewise, it is as effective when adjusted at optimal velocity and when positioned close to the operating site.
Can you capture 100 % of aerosols and splatter using HVE? Can the use of HVE prevent aerosols when multiple providers work at the office at the same time?
We looked at a few studies to find the answers:
Study #1: Aerosols and splatter in dentistry: A brief review of the literature and infection control implications: https://pubmed.ncbi.nlm.nih.gov/15127864/
Conclusion of this study: HVEs do not work well if used separately from an HVE suction tip.
Study #2: Efficacy of High-volume Evacuator in Aerosol Reduction: Truth or Myth? A Clinical and Microbiological Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206761/
Conclusion of this study: The conclusion of the study is that to work properly, the placement of HVE devices should be approximately 6-15 mm away from the active handpiece.
According to those studies, HVE works only when used properly. Consequently, it is easier to do so for dentists while working with a dental assistant.
#7. Use of a Rubber Dam
A rubber dam isolates the teeth that need to be treated from the saliva, soft tissues, and tongue of the oral cavity. Isolation with a rubber dam will reduce the number of microorganisms in the aerosols generated during treatment. This is in addition to the value of rubber dams in providing patient comfort and safety, a dry area, and increased access for visibility when performing restorative work.
Dr. Sakhi has always used rubber dam isolation to ensure patient safety and comfort, and to provide restorations that are of best predictability and highest quality.
#8 Hydrogen Peroxide Prior to Any Treatment or Exam Decreasing the Loads of Pathogens in Patients’ Mouths
The best mouthwash to kill coronavirus?
The answer is not clear yet. But an antimicrobial mouth rinse is thought to reduce the number of oral microbes. Listerine, commonly used as a mouth rinse, may not be effective in killing coronavirus. Additionally, since coronavirus is vulnerable to oxidation, any mouth rinse containing oxidative agents such as 1% hydrogen peroxide or 0.2% povidone is recommended to reduce the salivary load of oral microbes, including potential coronavirus.
Learn more at:
Efficacy of Povidone-Iodine Gargle/Mouthwash Against Respiratory and Oral Tract Pathogens
We realize kids may not be able to comply with this step, depending on their age, skills, and sensitivity to tastes. As with all else, we’ll assess the needs and benefits and proceed accordingly.
#9. Use of N95 Masks
How Big Are Coronavirus Particles and Can N95 masks protect?
Scientists have used electron microscopes to measure how big the coronavirus is. Coronavirus particles (fancy scientific name “virions”) are spheres with diameters of approximately 0.125 microns (125 nm). The smallest particles are 0.06 microns, and the largest is 0.14 microns.
Learn more about masks capturing coronavirus particles here.
Do N95 masks provide a 95% protection level against airborne viruses, and are they more efficient than traditional surgical masks?
The results indicate that the penetration of particles, like virions, through the NIOSH-certified N95 masks (National Institute for Occupational Safety and Health), is significantly less than with surgical masks.
An N95 FFR is a type of mask which removes particles from the air breathed through it. These masks or respirators filter out at least 95% of very small (0.3 micron) particles. N95 FFRs are capable of filtering out all types of particles, including bacteria and viruses.
What is the main difference between N95 and surgical masks?
The fit of the mask is a major difference. Masks, especially N95 masks, should fit tightly while surgical masks do not provide a tight enough fit thereby allowing aerosols to sneak underneath.
N95 masks reduce the wearer’s exposure to airborne particles, from small particle aerosols to large droplets. N95 respirators are tight-fitting respirators that filter out at least 95% of particles in the air, including large and small particles. When properly fitted and worn, minimal leakage occurs around edges of the respirator when the user inhales. This means almost all of the air is directed through the filter media.
You can learn more about masks and their differences:
Centers for Disease Control and Prevention. N95 Respirators and Surgical Masks. https://blogs.cdc.gov/niosh-science-blog/2009/10/14/n95/ .
#10. Use of physical barriers: gloves, fresh gown, face shield
All PPE prevent contact with the infectious agent, or body fluid that may contain infectious agent, by creating a barrier between the worker and the infectious material. Gloves, protect the hands, gowns protect the skin and clothing, masks and respirators protect mouth and nose, goggles and glasses protect eyes, face shields protect the entire face.
The key factors to consider when selecting PPE are:
Type of exposure anticipated
Splash/spray vs touch
Category of isolation precautions
Durability and appropriateness for the task
Fit
At Tooth & Co we practice Standard Precautions, which is intended to prevent the transmission of common infectious agents to healthcare personnel, patients and visitors. During care of any patient, we assume that an infectious agent could be present in the patient’s blood or body fluids, including all secretions and excretions. Thus, appropriate precautions, including use of appropriate PPE, is taken.
To learn more about the degree of details in our PPE Training, visit: www.cdc.gov