Dental Infection Control Through Aerosol Containment

Our office continues to introduce and use new technology to protect our patients and staff. To reduce dental aerosols caused by using a high speed handpiece or an ultrasonic device, we have added another new device which quickly removes dental aerosols. The device is called a Portable Floor Sentry HVE and uses an ULPA filter for an additional layer of protection.

Aerosols & COVID-19

What is Dental Aerosol?

Dental aerosol is created from the use of compressed air and water in dental tools forming a suspension of solid and liquid particles in a gas. Dental instruments that can create dental aerosol include low-speed and high-speed handpieces, lasers, electrosurgery units, ultrasonic scalers, and air polishers. Ultrasonic scalers and high-speed handpieces generate much higher levels of dental aerosol than other tools. Dental aerosol can be composed of water, saliva, plaque, microorganisms (such as bacteria, fungus, viruses, and protozoa), and metabolites (such as endotoxins and toxins). Over 700 microbial species can be found within the human mouth with the type and severity dependent on the patient’s age, tooth eruption, tooth loss, disease status, and/or drug use.

Dental aerosol can be classified as 3 different sizes:

  1. Splatter – Splatter is dental aerosol larger than 50 microns that easily falls and contaminates countertops, floors, and other surfaces in a dental office.
  2. Droplets – Droplets are dental aerosol smaller than 50 microns that can be airborne and evaporate to form droplet nuclei.
  3. Droplet Nuclei – Droplet nuclei are smaller than 10 microns, can reach up to3 feet away from the procedure, stay airborne for 30 minutes, and penetrate deep within the lungs. 90% of dental aerosol is smaller than 5 microns.

Health Risks of Dental Aerosol

Inhalation or direct contact of dental aerosol can lead to the development of respiratory infections and diseases. The exact makeup and risk of exposure to dental aerosol cannot be measured due to the vast differences from patient to patient. Dental aerosol has been shown to cause airborne bacteria levels to increase by up to four times.

Exposure of dental aerosol can cause nasal congestion, headaches, asthmatic episodes, and respiratory infections and illnesses. Possible respiratory infections and illnesses include the cold, influenza, sinusitis, pharyngitis, pneumonia, tuberculosis, legionaries disease, severe acute respiratory syndrome (SARS), and various strains of coronavirus.

Methods to Minimize Dental Aerosol

Dental professionals must assume that all patients can be infectious or carriers of disease and take as many safety precautions as possible to protect the safety of dental staff and other patients. The best way to minimize dental aerosol is utilizing a layered prevention approach with multiple protections. The CDC recommends specific procedures to minimize airborne dental aerosol in the Guidelines for Infection Control in Dental Healthcare Settings.

  1. Professional Protection Equipment (PPE) – PPE provides the first layer of protection for dental professionals including gloves, surgical masks, eyewear, and gowns.
  2. Antimicrobial Mouth Rinse – The second layer of protection is having the patient use an antimicrobial mouth rinse before the procedure.
  3. High Velocity Air Evacuation (HVE)– The third layer of protection, the HVE, reduces airborne dental aerosol by up to 90%.
  4. Air Filtration System – The fourth layer of protection is air filtration systems using a HEPA filter, carbon filter, electrostatic filtration, or ultraviolet germicidal system.
  5. Air and Waterline Disinfection – The CDC also recommends following equipment guidelines for air and water discharge for a minimum of 20 to 30 seconds on each piece of equipment between each patient.

Combining all these prevention methods will help prevent the spread of bacteria and viruses.

HEPA-ULPA-Coronavirus-N95-Particle-Size-Chart

Benefits of Dental Aerosol Extractors

Dental Aerosol Extractors utilize a self-supportive arm to position near the source with a powerful fan to draw in dental aerosol particles into the filtration system. The system releases the filtered air back into the surrounding room therefore improving the indoor air quality of the dental office. High quality filter options include HEPA Filters (up to 99.97% efficiency on particles 0.3 microns and larger), ULPA Filters (up to 99.9995% efficiency on particles 0.12 microns and larger), and activated carbon filters for chemical fumes. Dental Aerosol Extractors offer numerous benefits over other filtration systems including:

  • Source Extraction – Self-supportive extraction arm allows the capture hood to be moved closer to the source. Source extraction helps to prevent contamination of surfaces, removes most of airborne particulate, and protects the breathing zone of technicians.
  • Ductless Design – The system’s ductless design creates a recirculating airflow pattern providing easy installation with no ductwork or required makeup air.
  • Added Layer of Protection – HEPA or ULPA filtered systems provide an additional layer of protection against airborne bacteria, fungi, and pathogens.
  • Multiple Filter Configuration – Multiple filters allow for the removal of particulate and fumes (such as mercury and formaldehyde).