The oral cavity is a substantially contaminated environment to work in. Standard dental procedures like ultrasonic scaling, tooth preparation, or operating an air-water syringe, all produce aerosols and splatters. Respiratory infections among dentists have become more frequent, with symptoms related to the extremely contaminated air that is present within the environment. Aerosols remain in the atmosphere for long periods after the patient has completed their procedure, increasing the risk of harmful pathogens for dentists and their assistants.
An aerosol is defined as a suspension of solid or liquid particles in a gas, containing bacteria or viruses. The particle size of an aerosol is less than 50m, and airborne particles larger than this are considered spatter. Bacteria, blood elements, viruses, and particles of tooth, saliva, debris, and tissue can all make up solid and liquid aerosols. The severity of aerosol contamination can be affected by the health of a patient’s saliva, blood, plaque, nose and throat mucus, and the presence of any infection. Aerosol contamination can also occur when the quality of dental unit waterlines are compromised by factors such as water stagnation, heating of the dental chair unit, and contamination of reservoir bottles.2
Dental aerosols can vary in constitution, depending on the health status of the patient and type of procedure being performed. Possible harmful pathogens are most often found in the oropharynx, with the oral biofilm posing as a store for pathogens.2 All patients should be treated as infectious, and the same protective measures taken across the board.
Studies have shown that ultrasonic scalers produce the most intense aerosol and splatter emissions in the dental operatory. The same study reported masks worn by dentists and assistants to have the highest level of contamination. The most common course of contamination was via the respiration of infectious particles that were inhaled after settling on surfaces. Microorganisms present from the contaminated surfaces included Staphylococcus and streptococcus genus and gram-negative bacteria. NonDiptherial, corynebacterium, Staphylococcus aureus, fungi, and Pseudomonas spp were among those microorganisms found in the dental clinic.3
Existing protective measures such as face masks also pose a risk for both dental professionals and their patients. A 2016 study was conducted to analyze the microbiology of dental professionals’ face masks.8 Swabs taken from the face masks of general dental practitioners presented primary contamination of gram-negative Pseudomonas and gram-positive Streptococci species. A high concentration of potentially pathogenic strains such as Staphylococci species was also found. Given that these masks are often in close proximity to the patient’s face, further measures should be taken to minimize cross-contamination and ensure the masks are worn only for one patient and then discarded.
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