Aerosol exposure of staff during dental treatments: a model study

Fear of COVID-19 associated with burnout syndrome in dentists of the Health Directorate of the National Police of Peru: a cross-sectional study at national level under multivariable regression model

BACKGROUND

During the pandemic, many police dentists had the crucial responsibility of ensuring law and order while providing dental care by taking government-approved health measures to stop the spread of the coronavirus. The aim of this study was to assess the association between the fear of COVID-19 and Burnout syndrome in Peruvian dentists belonging to the Health Department of the National Police of Peru (PNP), taking into account possible confounding variables.

METHODS

This cross-sectional and analytical study included 182 PNP dentists. The Fear COVID-19 Scale assessed fear of COVID-19 and the Maslach Burnout Inventory Test assessed burnout syndrome. The association between the fear of COVID-19 and Burnout syndrome (self-fulfilment) was analyzed using Spearman's Rho. A multivariable Poisson regression model with a robust variance estimation method was employed to evaluate the impact of fear of COVID-19 on the various dimensions of Burnout syndrome, considering possible confounding variables. The statistical significance level was set at p < 0.05.

RESULTS

Under bivariate analysis, fear of COVID-19 was significantly linked with low direct intensity toward emotional exhaustion (Rho = 0.325, p < 0.001), very low direct intensity toward depersonalization (Rho = 0.180, p = 0.015), and very low inverse intensity toward self-fulfilment (Rho =-0.186, p = 0.012). Under multivariable analysis, it was observed that dentists who exhibited fear of COVID-19 were 3.4 and 3.7 times more likely to experience emotional exhaustion and depersonalization, respectively (APR = 3.40, 95% CI: 1.74-6.63 and APR = 3.68, 95% CI: 1.31-10.37), as compared to those who did not display fear of COVID-19. Moreover, none of the potential confounding factors were found to have a significant impact on emotional exhaustion (p > 0.05), depersonalization (p > 0.05), and self-fulfilment (p > 0.05).

CONCLUSION

Fear of COVID-19 was significantly associated with emotional exhaustion and depersonalization, and inversely associated with self-fulfilment. PNP dentists who exhibited fear of COVID-19 were at greater risk for emotional exhaustion and depersonalization. In developing Burnout syndrome, no significant impact was observed from factors such as age, gender, marital status, children, hierarchy, years of service, work area, private practice, work over 40 h per week, type of service, work performed, sport practice and daily exercise time.

The effect of preprocedural mouthrinses against COVID-19 before acid etching on the microleakage of a resin-based sealant in permanent molars: An in vitro experimental study

Aim

To determine whether rinsing with preprocedural mouthrinses against coronavirus disease before acid etching affects resin-based sealant microleakage.

Materials and Methods

A presented in vitro experimental study was performed on 15 extracted permanent third molars. Samples were randomly allocated into five groups: Group 1-distilled water (control); Group 2-1% hydrogen peroxide; Group 3-1.5% hydrogen peroxide; Group 4-0.5% povidone-iodine; and Group 5-1% povidone-iodine. After the teeth were immersed in the assigned mouth rinses for 60 s, they were sealed with Concise™ white sealant. Subsequently, the teeth were thermocycled for 500 cycles, immersed in 2% methylene blue solution for 24 h, and sectioned with two parallel cuts in the buccolingual direction. Sixty surfaces (12 surfaces in each group) were examined for microleakage under a 40× light microscope and scored as described by Zyskind et al. Welch's one-way analysis of variance test and the Games-Howell test were used to analyze the results at a significance level of P < 0.05 for all tests.

Results

The intergroup comparisons indicated that the 0.5% povidone-iodine group and the 1% povidone-iodine group had significantly higher microleakage compared with the control group. The 1% and 1.5% hydrogen peroxide groups demonstrated no significant difference in mean microleakage scores compared with the control group. There was no significant difference between the povidone groups and the hydrogen peroxide groups.

Conclusions

Preprocedural rinsing with 0.5% and 1% povidone-iodine before acid etching caused higher microleakage of resin-based sealant, while hydrogen peroxide rinsing gave comparable microleakage compared with the control group.

Precise control of digital dental unit to reduce aerosol and splatter production: new challenges for future epidemics

BACKGROUND

During dental procedures, critical parameters, such as cooling condition, speed of the rotary dental turbine (handpiece), and distance and angle from pollution sources, were evaluated for transmission risk of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), simulated by spiking in a plasmid encoding a modified viral spike protein, HexaPro (S6P), in droplets and aerosols.

METHODS

To simulate routine operation in dental clinics, dental procedures were conducted on a dental manikin within a digital dental unit, incorporating different dental handpiece speeds and cooling conditions. The tooth model was immersed in Coomassie brilliant blue dye and was pre-coated with 100 μL water spiked-in with S6P-encoding plasmid. Furthermore, the manikin was surrounded by filter papers and Petri dishes positioned at different distances and angles. Subsequently, the filter papers and Petri dishes were collected to evaluate the aerosol splash points and the viral load of S6P-encoding plasmid in aerosols and splatters generated during the dental procedure.

RESULTS

Aerosol splashing generated a localized pollution area extended up to 60 cm, with heightened contamination risks concentrated within a 30 cm radius. Significant differences in aerosol splash points and viral load by different turbine handpiece speeds under any cooling condition (P < 0.05) were detected. The highest level of aerosol splash points and viral load were observed when the handpiece speed was set at 40,000 rpm. Conversely, the lowest level of aerosol splash point and viral load were found at a handpiece speed of 10,000 rpm. Moreover, the aerosol splash points with higher viral load were more prominent in the positions of the operator and assistant compared to other positions. Additionally, the position of the operator exhibited the highest viral load among all positions.

CONCLUSIONS

To minimize the spread of aerosol and virus in clinics, dentists are supposed to adopt the minimal viable speed of a dental handpiece with limited cooling water during dental procedures. In addition, comprehensive personal protective equipment is necessary for both dental providers and dental assistants.

Visualization of droplets and aerosols in simulated dental treatments to clarify the effectiveness of oral suction devices

PURPOSE

The hazards of aerosols generated during dental treatments are poorly understood. This study aimed to establish visualization methods, discover conditions for droplets/aerosols generated in simulating dental treatments and identify the conditions for effective suction methods.

METHODS

The spreading area was evaluated via image analysis of the droplets/aerosols generated by a dental air turbine on a mannequin using a light emitting diode (LED) light source and high-speed camera. The effects of different bur types and treatment sites, reduction effect of intra-oral suction (IOS) and extra-oral suction (EOS) devices, and effect of EOS installation conditions were evaluated.

RESULTS

Regarding the bur types, a bud-shaped bur on the air turbine generated the most droplets/aerosols compared with round-shaped, round end-tapered, or needle-tapered burs. Regarding the treatment site, the area of droplets/aerosols produced by an air turbine from the palatal plane of the anterior maxillary teeth was significantly higher. The generated droplet/aerosol area was reduced by 92.1% by using IOS alone and 97.8% by combining IOS and EOS. EOS most effectively aspirated droplets/aerosols when placed close (10 cm) to the mouth in the vertical direction (0°).

CONCLUSIONS

The droplets/aerosols generated by an air turbine could be visualized using an LED light and a high-speed camera in simulating dental treatments. The bur shape and position of the dental air turbine considerably influenced droplet/aerosol diffusion. The combined use of IOS and EOS at a proper position (close and perpendicular to the mouth) facilitated effective diffusion prevention to protect the dental-care environment.

The "new normal" of hygiene measures at the end of the COVID-19 epidemic: a survey among French dentists

OBJECTIVES

The COVID-19 epidemic upset the standards in terms of hygiene and protection in the dental office, bringing additional precautions for dentists. The objective of our study was to draw the "new normal" of hygiene measures at the end of the COVID-19 epidemic.

MATERIALS AND METHODS

A self-administered questionnaire about transitional recommendations for oral care in the context of the COVID-19 epidemic was published online in private groups dedicated to French dentists.

RESULTS

The 246 respondents understood the reasons behind those recommendations, since 10 out of 11 measures reached a mean score greater than 2.5 on a 0 (not at all) to 4 (absolutely) scale when it came to determining whether the measure made the practitioner feel safe and ensured patient safety. Besides, more of the respondents intended to maintain the measures than they were to apply them before the epidemic.

CONCLUSIONS

The COVID-19 epidemic reshaped the relationship to hygiene and protection measures in the context of dental practices. The "new normal" of hygiene measures at the end of the COVID-19 epidemic will probably involve more protective measures than before.

CLINICAL RELEVANCE

These results constitute interesting avenues for public health deliberation, which would make it possible to best adapt future health recommendations in order to define the "new normal" of hygiene measures in dental practices at the end of the COVID-19 epidemic. Therefore, it could have an impact on all practitioners in their clinical activities.

Evaluating the microbial aerosol generated by dental instruments: addressing new challenges for oral healthcare in the hospital infection

BACKGROUND

Using a rotary instrument or ultrasonic instrument for tooth preparation is a basic operation in the dental clinic that can produce a significant number of droplets and aerosols. The dental droplet and aerosol can lead to the transfer of harmful germs. The goal of this study was to analyze the properties of microbiological aerosol created by droplets and aerosol generated by three common tooth-preparation instruments.

METHODS

Streptococcus mutans UA159 was used as the biological tracer to visualize the droplets and aerosols. The passive sampling method was used to map the three-dimensional spatial distribution and the six-stage Andersen microbial sampler (AMS) was used as the active sampling method to catch aerosol particles at a specific time.

RESULTS

The aerosol concentration is related to instruments, three-dimensional spatial distribution, and dissipation time. Most aerosols were generated by air turbines. More microorganisms are concentrated at the 1.5 m plane. The majority of the post dental procedure contamination was detected within the 0-10-min period and it decreased rapidly within 30 min.

CONCLUSION

This study is conducive to the proposal and improvement of relevant infection control measures in dental procedures and provides a basis for the assessment of measures, reducing the risk of nosocomial infection.

Comparative Dissemination of Aerosol and Splatter Using Suction Device during Ultrasonic Scaling: A Pilot Study

Objective: This study compared the aerosol and splatter diameter and count numbers produced by a dental mouth prop with a suction holder device and a saliva ejector during ultrasonic scaling in a clinical setting. Methodology: Fluorescein dye was placed in the dental equipment irrigation reservoirs with a mannequin, and an ultrasonic scaler was employed. The procedures were performed three times per device. The upper and bottom board papers were placed on the laboratory platform. All processes used an ultrasonic scaler to generate aerosol and splatter. A dental mouth prop with a suction holder and a saliva ejector were also tested. Photographic analysis was used to examine the fluorescein samples, followed by image processing in Python and assessment of the diameter and count number. For device comparison, statistics were used with an independent t-test. Result: When using the dental mouth prop with a suction holder, the scaler produced aerosol particles that were maintained on the upper board paper (mean ± SD: 1080 ± 662 µm) compared to on the bottom board paper (1230 ± 1020 µm). When the saliva ejector was used, it was found that the diameter of the aerosol on the upper board paper was 900 ± 580 µm, and the diameter on the bottom board paper was 1000 ± 756 µm. Conclusion: There was a significant difference in the aerosol and splatter particle diameter and count number between the dental mouth prop with a suction holder and saliva ejector (p < 0.05). Furthermore, the results revealed that there was a statistically significant difference between the two groups on the upper and bottom board papers.

Aerosol reduction of two dental extraoral scavenger devices in vitro

Objective

Since the outbreak of SARS-CoV-2, aerosol control in the operatory has become a key safety issue in dentistry. The utilisation of extraoral scavenger devices (EOSs) is one of the various approaches to in-treatment aerosol reduction in dentistry. The use and efficacy of EOSs in dental settings, however, are still a matter of debate in the literature and there are still open questions about their proper use. Thus, research into this area is essential to inform dental practice. The objective of this study was to examine the aerosol reduction efficacy of two different EOS in vitro.

Methods

Two commercially available EOSs were tested during modeled dental treatment in a setup that previously proved to generate high aerosol load. Measurements were done in two particle size ranges: 5.6–560 nm (the full range of the spectrometer) and 60.4–392.4 nm (a range that is especially relevant to the spread of SARS-CoV-2 with aerosol).

Results

Both devices managed to reduce the aerosol load to a statistically significant extent as compared to the scenario when only a high-volume evacuator and a saliva ejector (and no EOS) were used.

Conclusions

Within the limitations of the study, the results support the assumption that EOSs for aerosol reduction increase in-treatment safety in the dental operatory.