Aerosols and splatter in dentistry: a brief review of the literature and infection control implications

Stephen K Harrel, John Molinari, Stephen K Harrel, John Molinari

Abstract

Background: Aerosols and droplets are produced during many dental procedures. With the advent of the droplet-spread disease severe acute respiratory syndrome, or SARS, a review of the infection control procedures for aerosols is warranted.

Types of studies reviewed: The authors reviewed representative medical and dental literature for studies and reports that documented the spread of disease through an airborne route. They also reviewed the dental literature for representative studies of contamination from various dental procedures and methods of reducing airborne contamination from those procedures.

Results: The airborne spread of measles, tuberculosis and SARS is well-documented in the medical literature. The dental literature shows that many dental procedures produce aerosols and droplets that are contaminated with bacteria and blood. These aerosols represent a potential route for disease transmission. The literature also documents that airborne contamination can be minimized easily and inexpensively by layering several infection control steps into the routine precautions used during all dental procedures.

Clinical implications: In addition to the routine use of standard barriers such as masks and gloves, the universal use of preprocedural rinses and high-volume evacuation is recommended.

Figures

Figure 1
Figure 1
The visible aerosol cloud produced by an ultrasonic scaler using a flow of 17 milliliters per minute of coolant water.
Figure 2
Figure 2
The visible aerosol cloud, made up of water and abrasive at the levels recommended by the manufacturer, produced by an air polisher.
Figure 3
Figure 3
The two sources of aerosols produced during dental treatment: coolant water and the patient.

References

    1. Garner JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1996;17(1):53–80.
    1. Gottfried RS. The black death: Natural and human disaster in medieval Europe. Free Press; New York: 1983. pp. 7–10.
    1. Kenyon TA, Valway SE, Ihle WW, Onorato IM, Castro KG. Transmission of multidrug-resistant Mycobacterium tuberculosis during a long airplane flight. N Engl J Med. 1996;334(15):933–938.
    1. Bloch AB, Orenstein WA, Ewing WM. Measles outbreak in a pediatric practice: airborne transmission in an office setting. Pediatrics. 1985;75:676–683.
    1. World Health Organization Communicable disease surveillance and response (CSR): severe acute respiratory syndrome (SARS) Accessed June 14, 2003.
    1. CDC Interim domestic infection control precautions for aerosol-generating procedures on patients with severe acute respiratory syndrome (SARS) Accessed June 14, 2003.
    1. American Dental Association Severe acute respiratory syndrome (SARS). Available at. Accessed June 14, 2003.
    1. Micik RE, Miller RL, Mazzarella MA, Ryge G. Studies on dental aerobiology, I: bacterial aerosols generated during dental procedures. J Dent Res. 1969;48(1):49–56.
    1. Miller RL, Micik RE, Abel C, Ryge G. Studies of dental aerobiology, II: microbial splatter discharged from the oral cavity of dental patients. J Dent Res. 1971;50:621–625.
    1. Micik RE, Miller RL, Leong AC. Studies on dental aerobiology, 3: efficacy of surgical masks in protecting dental personnel from airborne bacterial particles. J Dent Res. 1971;50:626–630.
    1. Abel LC, Miller RL, Micik RE, Ryge G. Studies on dental aerobiology, IV: bacterial contamination of water delivered by dental units. J Dent Res. 1971;50:1567–1569.
    1. Miller RL, Micik RE. Air pollution and its control in the dental office. Dent Clin North Am. 1978;22:453–476.
    1. Hinds WC. Aerosol technology: Properties, behavior, and measurement of airborne particles. Wiley; New York: 1982. pp. 6–8.
    1. Cottone JA, Terezhalmy GT, Molinari JA. Practical infection control in dentistry. Williams & Wilkins; Baltimore: 1996. pp. 139–140.
    1. Zinsser H, Joklik WK. Zinsser microbiology. 20th ed. Appleton & Lange; Norwalk, Conn.: 1992. pp. 497–525.
    1. Murdoch-Kinch CA, Andrews NL, Atwan S, Jude R, Gleason MJ, Molinari JA. Comparison of dental water quality management procedures. JADA. 1997;128:1235–1243.
    1. Smith WH, Davies D, Mason KD, Onions JP. Intraoral and pulmonary tuberculosis following dental treatment. Lancet. 1982;1:842–844.
    1. Belting CM, Haberfelde GC, Juhl LK. Spread of organisms from dental air rotor. JADA. 1964;68:648–651.
    1. Shearer BG. MDR-TB. Another challenge from the microbial world. JADA. 1994;125(1):42–49.
    1. Harrel SK, Barnes JB, Rivera-Hidalgo F. Aerosol and splatter contamination from the operative site during ultrasonic scaling. JADA. 1998;129:1241–1249.
    1. King TB, Muzzin KB, Berry CW, Anders LM. The effectiveness of an aerosol reduction device for ultrasonic scalers. J Periodontol. 1997;68(1):45–49.
    1. Logothetis DD, Gross KB, Eberhart A, Drisko C. Bacterial airborne contamination with an air-polishing device. Gen Den. 1988;36:496–499.
    1. Bentley CD, Burkhart NW, Crawford JJ. Evaluating spatter and aerosol contamination during dental procedures. JADA. 1994;125:579–584.
    1. Legnani P, Checchi L, Pelliccioni GA, D’Achille C. Atmospheric contamination during dental procedures. Quintessence Int 994;25:435–9.
    1. Gross KB, Overman PR, Cobb C, Brockmann S. Aerosol generation by two ultrasonic scalers and one sonic scaler: a comparative study. J Dent Hyg. 1992;66:314–318.
    1. Muzzin KB, King TB, Berry CW. Assessing the clinical effectiveness of an aerosol reduction device for the air polisher. JADA. 1999;130:1354–1359.
    1. Harrel SK. Clinical use of an aerosol-reduction device with ultrasonic scaler. Compend Cont Educ Dent. 1996;17:1185–1193.
    1. Barnes JB, Harrel SK, Rivera-Hidalgo F. Blood contamination of the aerosols produced by the in vivo use of ultrasonic scalers. J Periodontol. 1998;69:434–438.
    1. Infection control recommendations for the dental office and the dental laboratory. ADA Council on Scientific Affairs and ADA Council on Dental Practice. JADA. 1996;127:672–680.
    1. Pippen DJ, Verderame RA, Weber KK. Efficacy of face masks in preventing inhalation of airborne contaminants. J Oral Maxillofac Surg. 1987;45:319–323.
    1. Logothetis DD, Martinez-Welles JM. Reducing bacterial aerosol contamination with a chlorhexidine gluconate pre-rinse. JADA. 1995;126:1634–1639.
    1. Fine DH, Korik I, Furgang D. Assessing pre-procedural subgingival irrigation and rinsing with an antiseptic mouthrinse to reduce bacteremia. JADA. 1996;127(5):641–642. 645–6.
    1. Harrel SK, Barnes JB, Rivera-Hidalgo F. Reduction of aerosols produced by ultrasonic scalers. J Periodontol. 1996;67(1):28–32.
    1. Jacks ME. A laboratory comparison of evacuation devices on aerosol reduction. J Dent Hyg. 2002;76(3):202–206.
    1. Klyn SL, Cummings DE, Richardson BW, Davis RD. Reduction of bacteria-containing spray produced during ultrasonic scaling. Gen Dent. 2001;49(6):648–652.
    1. Harrel SK, Barnes JB, Rivera-Hidalgo F. Aerosol reduction during air polishing. Quintessence Int. 1999;30:623–628.
    1. Occupational exposure to bloodborne pathogens: OSHA—Final rule. Fed Regist. 1991;56(235):64004–64182.
    1. Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, Centers for Disease Control and Prevention (CDC) Guidelines for infection control in dental health-care settings: 2003. MMWR Recomm Rep. 2003;52(RR-17):16–17.

Source: PubMed

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