Possible aerosol transmission of COVID-19 and special precautions in dentistry

Zi-Yu Ge, Lu-Ming Yang, Jia-Jia Xia, Xiao-Hui Fu, Yan-Zhen Zhang, Zi-Yu Ge, Lu-Ming Yang, Jia-Jia Xia, Xiao-Hui Fu, Yan-Zhen Zhang

Abstract

Since its emergence in December 2019, corona virus disease 2019 (COVID-19) has impacted several countries, affecting more than 90 thousand patients and making it a global public threat. The routes of transmission are direct contact, and droplet and possible aerosol transmissions. Due to the unique nature of dentistry, most dental procedures generate significant amounts of droplets and aerosols, posing potential risks of infection transmission. Understanding the significance of aerosol transmission and its implications in dentistry can facilitate the identification and correction of negligence in daily dental practice. In addition to the standard precautions, some special precautions that should be implemented during an outbreak have been raised in this review.

Keywords: Corona virus disease 2019 (COVID-19); Aerosol; Infection control.

Conflict of interest statement

Compliance with ethics guidelines: Zi-yu GE, Lu-ming YANG, Jia-jia XIA, Xiao-hui FU, and Yan-zhen ZHANG declare that they have no conflict of interests.

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Different routes of transmission in dental setting: aerosol, droplet, and fomite
Fig. 2
Fig. 2
Aerosols generated by dental high-speed handpiece (a), ultrasonic scaler (b), and air-water syringe (c)

References

    1. Atkinson J, Chartier Y, Pessoa-Silva CL, et al. Natural Ventilation for Infection Control in Health-Care Settings. World Health Organization, Geneva, Switzerland; 2009.
    1. Bentley CD, Burkhart NW, Crawford JJ. Evaluating spatter and aerosol contamination during dental procedures. J Am Dent Assoc. 1994;125(5):579–584.
    1. Centers for, Disease Control, and Prevention. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, USA; 2016. pp. 8–16.
    1. Chen JL. Pathogenicity and transmissibility of 2019-nCoV–a quick overview and comparison with other emerging viruses. Microbes Infect, in press. 2020 doi: 10.1016/j.micinf.2020.01.004.
    1. Chinese Stomatological Association. Clinical Treatment Guidance for Oral Medicine, 2016 Ed. People’s Medical Publishing House, Beijing, China; 2016. (in Chinese)
    1. Chinese Stomatological Association. Guidelines of the Clinical Technique for Oral Medicine, 2017 Ed. People’s Medical Publishing House, Beijing, China; 2017. (in Chinese)
    1. Chowell G, Abdirizak F, Lee S, et al. Transmission characteristics of MERS and SARS in the healthcare setting: a comparative study. BMC Med, 13:210. 2015 doi: 10.1186/s12916-015-0450-0.
    1. Chuaybamroong P, Chotigawin R, Supothina S, et al. Efficacy of photocatalytic HEPA filter on microorganism removal. Indoor Air. 2010;20(3):246–254. doi: 10.1111/j.1600-0668.2010.00651.x.
    1. Cochran MA, Miller CH, Sheldrake MA. The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment. J Am Dent Assoc. 1989;119(1):141–144.
    1. Day DB, Xiang J, Mo J, et al. Combined use of an electrostatic precipitator and a high-efficiency particulate air filter in building ventilation systems: effects on cardiorespiratory health indicators in healthy adults. Indoor Air. 2018;28(3):360–372. doi: 10.1111/ina.12447.
    1. Farah RI. Effect of cooling water temperature on the temperature changes in pulp chamber and at handpiece head during high-speed tooth preparation. Restor Dent Endod. 2019;44(1):e3. doi: 10.5395/rde.2019.44.e3.
    1. Feres M, Figueiredo LC, Faveri M, et al. The effectiveness of a preprocedural mouthrinse containing cetylpyridinium chloride in reducing bacteria in the dental office. J Am Dent Assoc. 2010;141(4):415–422.
    1. Fung ICH, Cairncross S. Effectiveness of handwashing in preventing SARS: a review. Trop Med Int Health. 2006;11(11):1749–1758. doi: 10.1111/j.1365-3156.2006.01734.x.
    1. Grenier D. Quantitative analysis of bacterial aerosols in two different dental clinic environments. Appl Environ Microbiol. 1995;61(8):3165–3168. doi: 10.1128/AEM.61.8.3165-3168.1995.
    1. Harrel SK, Molinari J. Aerosols and splatter in dentistry: a brief review of the literature and infection control implications. J Am Dent Assoc. 2004;135(4):429–437.
    1. Jin YH, Cai L, Cheng ZS, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version) Military Med Res, 7:4. 2020 doi: 10.1186/s40779-020-0233-6.
    1. Jones RM, Brosseau LM. Aerosol transmission of infectious disease. J Occup Environ Med. 2015;57(5):501–508. doi: 10.1097/JOM.0000000000000448.
    1. Kampf G, Todt D, Pfaender S, et al. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect, online ahead of print. 2020 doi: 10.1016/j.jhin.2020.01.022.
    1. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis, 6:130. 2006 doi: 10.1186/1471-2334-6-130.
    1. Krishna R, de Stefano JA. Ultrasonic vs. hand instrumentation in periodontal therapy: clinical outcomes. Periodontology. 2016;71(1):113–127. doi: 10.1111/prd.12119.
    1. Kutter JS, Spronken MI, Fraaij PL, et al. Transmission routes of respiratory viruses among humans. Curr Opin Virol. 2018;28:142–151. doi: 10.1016/j.coviro.2018.01.001.
    1. Li Q, Guan XH, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med, online. 2020 doi: 10.1056/NEJMoa2001316.
    1. Li RWK, Leung KWC, Sun FCS, et al. Severe acute respiratory syndrome (SARS) and the GDP. Part II: implications for GDPs. Br Dent J. 2004;197(3):130–134. doi: 10.1038/sj.bdj.4811522.
    1. Lu CW, Liu XF, Jia ZF. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet. 2020;395(10224):PE39. doi: 10.1016/S0140-6736(20)30313-5.
    1. Marui VC, Souto MLS, Rovai ES, et al. Efficacy of preprocedural mouthrinses in the reduction of microorganisms in aerosol: a systematic review. J Am Dent Assoc. 2019;150(12):1015–1026e1. doi: 10.1016/j.adaj.2019.06.024.
    1. Narayana TV, Mohanty L, Sreenath G, et al. Role of preprocedural rinse and high volume evacuator in reducing bacterial contamination in bioaerosols. J Oral Maxillofac Pathol. 2016;20(1):59–65. doi: 10.4103/0973-029X.180931.
    1. National Health, Commission of the, People’s Republic of China, et al. 6th Edition of COVID-19 Treatment Regimen (Trial Implementation) (in Chinese). http://www. [Accessed on Mar. 7, 2020].2020.
    1. Nejatidanesh F, Khosravi Z, Goroohi H, et al. Risk of contamination of different areas of dentist’s face during dental practices. Int J Prev Med. 2013;4(5):611–615.
    1. Ng MY, Lee EY, Yang J, et al. Imaging profile of the COVID-19 infection: radiologic findings and literature review. Radiol Cardiothorac Imaging. 2020;2(1):e200034. doi: 10.1148/ryct.2020200034.
    1. The Novel Coronavirus Pneumonia, Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Chin J Epidemiol. 2020;41(2):145. doi: 10.3760/cma.j.issn.0254-6450.2020.02.003. (in Chinese)
    1. Otter JA, Yezli S, Salkeld JAG, et al. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings. Am J Infect Control. 2013;41(5):S6–S11. doi: 10.1016/j.ajic.2012.12.004.
    1. Rabenau HF, Kampf G, Cinatl J, et al. Efficacy of various disinfectants against SARS coronavirus. J Hosp Infect. 2005;61(2):107–111. doi: 10.1016/j.jhin.2004.12.023.
    1. Ricci ML, Fontana S, Pinci F, et al. Pneumonia associated with a dental unit waterline. Lancet. 2012;379(9816):684. doi: 10.1016/S0140-6736(12)60074-9.
    1. Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. 2020;382:970–971. doi: 10.1056/NEJMc2001468.
    1. Samaranayake LP, Peiris M. Severe acute respiratory syndrome and dentistry: a retrospective view. J Am Dental Assoc. 2004;135(9):1292–1302.
    1. Smith WHR, Mason KD, Davies D, et al. Intraoral and pulmonary tuberculosis following dental treatment. Lancet. 1982;319(8276):842–844. doi: 10.1016/s0140-6736(82)91886-4.
    1. Wang WK, Chen SY, Liu IJ, et al. Detection of SARS-associated coronavirus in throat wash and saliva in early diagnosis. Emerg Infect Dis. 2004;10(7):1213–1219. doi: 10.3201/eid1007.031113.
    1. WHO Guidelines on Hand Hygiene, in Health Care: First Global Patient Safety, Challenge–Clean Care is Safer Care, et al. World Health Organization, Geneva, Switzerland; 2009.
    1. Infection Prevention and Control of, Epidemic- and Pandemic-Prone Acute Respiratory, Infections in Health Care, et al. World Health Organization, Geneva, Switzerland; 2014.
    1. Decontamination and Reprocessing, of Medical Devices, for Health-Care Facilities, et al. World Health Organization, Geneva, Switzerland; 2016.
    1. Clinical Management of Severe Acute, Respiratory Infection when Novel Coronavirus (2019-nCoV), Infection is Suspected: Interim Guidance, et al. World Health Organization, Geneva, Switzerland; 2020.
    1. Coronavirus Disease 2019 (COVID-19): Situation Report, 46. World Health Organization, Geneva, Switzerland; 2020.
    1. Infection Prevention and Control During Health Care when Novel Coronavirus (‎‎‎nCoV)‎‎‎ Infection, is Suspected: Interim Guidance. World Health Organization, Geneva, Switzerland. [Accessed on Jan. 25, 2020].2020.
    1. Wood A, Payne D. The action of three antiseptics/disinfectants against enveloped and non-enveloped viruses. J Hosp Infect. 1998;38(1):283–295. doi: 10.1016/s0195-6701(98)90077-9.
    1. Xu H, Zhong L, Deng JX, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;12(1):1–5. doi: 10.1038/s41368-020-0074-x.
    1. Zemouri C, de Soet H, Crielaard W, et al. A scoping review on bio-aerosols in healthcare and the dental environment. PLoS ONE. 2017;12(5):e0178007. doi: 10.1371/journal.pone.0178007.

Source: PubMed

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