Managing Aerosols

Current recommendations on aerosols generated by handpieces and ultrasonic scaling

Although there is currently little evidence* for a transmission of SARS-CoV-2 (the virus that causes COVID-19) via aerosols, public health agencies and dental associations globally recommend minimal use of aerosol-producing dental procedures at this time.^1,2

_{*Inhalation of airborne particles (aerosols) possible but has to be confirmed

1. Peng X. et al. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 2020; 12:9

2. Van Doremalen et al.: Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1: N Engl J Med. 2020 Mar 17}

Use professional judgment to employ the lowest aerosol-generating armamentarium when delivering any type of restorative or hygiene care. As an example, use hand scaling rather than ultrasonic scaling when appropriate. High-velocity evacuation (8mm large bore devices with 100 cubic ft/min capacity) should be employed whenever possible.

– American Dental Association

Possible transmission routes of COVID-19 in a dental office

Principles of blocking possible transmission routes in a dental office

Patient screening

Screening form

Symptoms like fever, breathing difficulties, cough, gastrointestinal upset, headache, fatigue, loss of smell within the past 14-21 days?
Exposure to risk groups or patients with confirmed COVID-19 infection within the past 14-21 days?

If one of the questions is answered with yes, more in-depth discussion and consideration of postponing treatment.

Personal protective equipment

The Occupational Safety and Health Administration’s (OSHA) Guidance on Preparing Workplaces for COVID-19 places DHCP in the very high exposure risk category
ADA: Considering that patients who are asymptomatic may still be COVID-19 infectious, it should be assumed that all patients can transmit disease.

Disinfection, re-processing, engineering controls, single-use consumables

Disinfection and re-processing

Non-dedicated and non-disposable equipment should be disinfected according to the manufacturer’s instructions. Handpieces should be cleaned to remove debris, followed by heat-sterilization after each patient.
Routine cleaning and disinfection procedures with an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.
Surfaces such as door handles, chairs, desks, elevators, and bathrooms should be cleaned and disinfected frequently.

Engineering controls, single-use consumables

Anti-retraction functions of handpieces may provide additional protection against cross-contamination.

Managing aerosols

Protect yourself

Country-specific PPE and disinfection
- Masks (N95 during COVID 19)
- Gowns
- Face-shields
- Rubber dam
- Surface Disinfection
- Barrier sleeves

Reduce aerosol

High volume evacuation
- 4 handed dentistry
- Proper HVE tips

Sanitize aerosol

Pre-procedural mouth rinsing
- Peroxide-diluted (1.5%)
- Povidone (0.2%)

Conclusion

Aerosol generating procedures are a major component of modern dentistry. Most restorative and prophylaxis procedures cannot be performed without using rotating handpieces that create the potentially infectious spatter and droplets.

Currently, there is little evidence for a transmission of SARS-CoV-2 via aerosols. However, minimizing the risk for dental health care professionals and patients is essential. Thus, reducing the amount of and managing generated aerosols is a key focus of dental teams and Dentsply Sirona.

The risks presented by aerosols can be managed by proper personal protective equipment, sanitization measures as well as compliance with the infection prevention measures according to state, local, and country-specific guidelines.

The amount of generated aerosols can further be reduced by using high-volume evacuation (HVE) instead of saliva ejectors for procedures. HVE, like Dentsply Sirona’s Purevac® High Volume Evacuation Mirror Tip, can enables evacuating fluid and debris with 90% less aerosols during ultrasonic scaling compared to low-volume saliva ejectors.

Purevac High Volume Evacuation System

Visibility and suction all in one hand

The Purevac High Volume Evacuation Mirror Tip enables a one-handed approach to evacuating fluid and debris while facilitating retraction, visibility, and illumination during dental procedures.

The Purevac HVE Mirror Tip System provides many ergonomic benefits and converts a standard 11mm HVE valve to a 16mm valve to securely fit the mirror tip.

Learn more about Purevac HVE >

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Managing Dental Aerosols with Regards to COVID-19

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The information provided on this page does not, and is not intended to, constitute legal advice; instead, all information, content, and materials cited in this paper are for general informational purposes only. Because of the dynamic status of COVID-19, the regulatory environment, and federal, state, and local laws and directives changing daily - information in this presentation may not constitute the most up-to-date advisory, legal or other information. This presentation contains citations to third-party publications. Such references are only for the convenience of the reader. Readers should consult their own legal and other advisors for specific information impacting their practices.